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THE

HOMGEOPATHIO

THEORY AND PRACTICE

E. E. MAROY, ..MD, AND F. W. HUNT, M.I).

VOLUME I.

KEW-YOKK:

WILLIAM EADDE, 550 PEAEL-STEEET.

PhilacM])McB : F. E. Boebicke, 635 Arcli-st. — Boston : Otis Qi.Kvv.—8t. Louis
H. C. G. LuYTiES. — GTiicago : 0. S. Halsby. — Gincdiinati : Smith & Wokth-
mGTOi^.— Cleveland: John B. Hall, M.D. — Detroit: E, A. Lodge, M.I).~-
Pittsburg, Pa. : J. G. Backofen & 8oiii.~-Manchestm\ Eng. : H. Tuiinee & Co., '
41 Piccadilly and 15 Mwi\Qi-^l.—Loiulon, Eng, : R TuRNEii & Co., 77 Fleet-
street.

1 8 6 6„

Entered according to Act of Congress, in the year 1864, by

WILLIAM RABDE,

In the Clerk's Office of the District Court of the United States for the Southern District of

New- York.

HENKY LUBWIG,

Printer and Stereotyp«p,
39 Centre-street. ,

PREFACE.

The authors present this work to the profession with a
hope that it may afford some aid to the medical man in
the midst of his arduous and, sometimes, perplexing prac-
tical duties, as well as to the neophite who has just en-
tered the portals of the temple of medicine.

While we have endeavored to present the results of
our personal experience respecting the causes, nature, and
treatment of diseases, we have not failed to collate, con
dense, and illustrate the discoveries and opinions of other
physicians touching medicine and the collateral science.^.
We have freely quoted from the writings of other reput-
able physicians, with a view of presenting to the pro-
fession all the varieties and shades of opinion in the
homoeopathic school. These views have been arranged and
introduced in proper order under the various topics dis-
cussed; and it is proper in this place to remark that
many of these opinions do not accord with our own. But
as we are advocates of the largest liberty in all that
pertains to medical thought and medical progress, we
have deemed it expedient to furnish as complete a tab-
leaux of the field of homoeopathic literature as possible.

Vi PREFACE.

Our object througlioiit lias been to present to the
medical profession and tlie friends of homoeopathy a com-
prehensive and intelligible view of the principles and
practice of onr school, as it is now represented by onr
best writers and practitioners; to embody, as far as our
wide range of subjects permitted, the latest opinions and
theories of investigators of every school on pathology and
collateral sciences connected with medicine; and to give
to all mquirers after advanced scientific truth the oppor-
tunity to investigate our principles, and to see them tested
by facts, as illustrated in the clinical experience of a large
number of reliable observers. From all accnmnlated ma-
terials we have aimed to sift the true from the false, and
to condense within as small a compass as possible, all
reliable facts bearing upon the subjects discussed.

Medical science is yet in its infancy. Our knowledge
of the functions of the intricate organs of the human
body, of the causes and nature of diseases, and of the
effects of medicines, in health and disease, is still limited,
although progressive. If we have added a mite to the
general advancement, and have contributed something to
the general sum of medicul knowledge, we are content.

CONTENTS OF YOLUME I.

Page

HISTORY OF MEDICINE, ... 33

Egyptians, 37

Greeks, Si

^sculapius, 37

Temples, 37

Hippocrates, 39

Plato, , 40

Aristotle, 40

Successors of Hippocrates, . . 43

Alexandrian School, „ 41

Study of Anatomy, 42

Empirical School, 42

Medicine at Rome, % . 42

Asclepiades, » . . . 42

Celsns, o . . . . 43

Druids, 43

Roman Improvement, Her-

culanseum and Pompeii, . 44

Aretseus, 44

Galen, 45

Arabians, 47

Libraries, 47

Rhazes, 47

Turks, . 47

Avicenna, . 47

Fags

Paracelsus, 47

Servetus, 48

Harvey— Circulation of the

Blood, 48

Regular Medicine 200 years

ago, 49

Ambrose Pare, 49

Sydenham, , 50

Boerhaave, 51

Hoffmann, 51

Cullen, 62

Hahnemann, 52

Discovery of the Principle of

Homoeopathy, 54

The Great Law of Cure, ... 55

Insanity, 56

Hahnemann's Works, ..... 57
His Treatment of Cholera, . : 58
Hahn em Einn's Death and Char-
acter, 59, 60

His Theory of Medicine, ... 60
Medical Revolutions of the

Present Century, 62

Pinel, Broussais, 63

Louis, 64

GENERAL PRIKCIPLES OF MEDICAL SCIENCE.

Present Position of Allopathic
Medicine, 65

Medical Scepticism, 66

Nervous Fluid. Dynamic Influence, 67
Mental Impressions affecting the

Body, 71

Material and Natural Stimuli ... 73 '

vii

Health, perversions of Health,

Nature of. Disease, 75

Hygiene, '. 75

Therapeutics, 75

Specific Effects of Poisons and

Remedies, 79

Irritability, . , , 82

Vlll

CONTENTS.

Paob

Medicinal Action, ..,,.. 82

Poisons, 83

Allopathy, 86

Inconsistent Reasonings, 88

Objections to Allopathic Practice, 91

Mercury, 95

Opium, 96

Tartar-emetic, 98

Cinchona, 99

Homoeopathy, 105

Brief Exposition of the Homoeo-
pathic System, 106

Modus Operandi of Remedies, . . 110
Tabular View of the Actions of

Remedies, 110

Classification of Medicines, .... Ill
Primary and Secondary Action of

Drugs, 112

Susceptibilities of the Organs in-
creased by Disease, . , 116

Apparent Exceptions, . 121

Natural Irritability, 117, 13^7

Allopathic Admissions, ... , 118, 321
Small Doses act on a Diseased

Organism, 120

Reasons for using Attenuated Me-
dicines, 121

Hahnemann's Experience, 122

His Preparation of Attenuations,. 122
Small Doses have Remedial

Power, 123

Imponderables admitted by all to

be Potent Agents, 123

Minuteness of Miasms, 125

New Powers Developed, 127

Some Remedies Absorbed, 130

Weight and Dimensions of some
powerful Agents Inappreciable, 132,

134
A perfect Theory of Cure not yet

attainable, 134

Summary of Points of Diflference
between the Old and New

Schools, 135

Objection to Small Doses answered, 137
Direct Action instead of Counter-

FAoa
Irritation applied to Healthy
Organs, 136

Divisibility of Matter, 139

The Chemical Theory answered,. 140
Homoeopathic Mode of Restoring
Deficiencies in the Constituents

of the Blood, 140

Attenuations of Drugs, 142

Considerations which Influence
the Choice of Attenuations,. . . 142

Example, 146

Size of the Dose, 137, 147

Medicinal Interference, 149

Impurities of Substances Em-
ployed in Preparing Medicines, 150

Adjuvantia, 151

Selection of the Proper Re-
medy, \ 152,419

" What is the Like that Cures ?" . 152
Advantages of Minute Division, . . 154

Repetition of Doses, 154

Medicinal Aggravation, 155

Selectipn of the Second Remedy,. 156

Alternation of Remedies, 156

Medicines Operating on Different

Spheres, 158, 418

Cures by a Single Remedy,. 157, 161

Changing the Remedy, 159

Antidotes, 149, 159

Hahnemann on Antidotes,. . 160, 161
Mode of Administering Remedies, 162

Hahnemann's Practice, 162

Homoeopathic Notation, 163

Mode of Preparing Medicines,. . . 163
Proving of Drugs. Improvement

of the Materia Medica, 164

Semeiology — Symptoms of Disease, 165

General Diagnosis, 166

Figure and Attitude, 168

Fashionable Dress, 169

Physical Education, 170

Symptoms of the Tongue, 171

Nervous System, 172

Alimentary Canal, 172

External Signs, 173

Importance of Correct Diagnosis, 175

COISTTENTS.

Temperature of the body, 175

Pathology, Ill

Alteration of Solids, Ill

Of Fluids, 180

Congestion, " 180

Hypertrophy, 111

Atrophy, 1T7

Induration, 178

Transformation of Tissue, , 179

Observations on the Causes of

Diseases, 182

Determining Causes, 182

Predisposing, 182

Exciting Causes 182

Heat and Cold,. 183

High Degrees of Heat, ... 183

Effects of Cold, 184

Vicissitudes, 184

Power of Resisting Cold,. 185
Influence of the Seasons, . 185

Impurity of Air, 185

Contagion, 186, 539, 542, 558
Hereditary Tendency,... 186

Respiration, 187

Fatigue, 187

Debility a Cause of In-
flammation, 188

A cause of Fever, . . 188

Animal Heat, 188

Eff'ect of Stimulating Food, 189
Efl'ects of Cold Climates,. 190
Intense Cold,.. .: . . 190
Increase of Animal Food

Required, 191

Condition of the Capillaries

in Inflammation,. 191, 195
Functions first Deranged
by the Causes of Dis-
ease, 192

Power of Resisting Disease, . . 193
Primary Cause of Inflam-
mation, 194

Inflammation Perverted Ku-

trition, 196

Hypersemia induced by Ar-
tificial Means 196

Inflammation from Morbid

Matters, 196

Artificial Excitement of In-
flammation, 196

DifPerent Efl'ects of Cold on
difierent Persons, ....... 196

Influence of Dress, 197

Radiating Power of Flan-
nel, ... 197

Fitness of Clothing for

Washing, 198

Influence of Color, 198

Limit of the Human Con-
stitution to Resist Dis-
ease, 199

Influence of Diff'erent Periods

of Life, 199

Infancy, 199

Infantile Diseases,. . . . 200

Teething, 201

Weaning, 201

Childhood, 202

Youth, 203

Adolescence, 203

Old Age,. 217, 702

Periodicity in the Actions of
the Animal Economy, ... 204
Different Periods of the

Day, 204

Influence of Night, 205, 207

Morning, 20f)

Evening, 200

Comparative Mortality of
the Present with Former

Times,.:.. 208

Muscular Strength, 208

Digestibility of Food, ... 209
Influence of Cookery,. 209
Physiological and Chemical
Classification of Nutritive
Substances, 210

ARRANGEMENT AND CLAS-
SIFICATION OF DISEASES, 211

Acute, 211

Chronic. 211

CONTENTS.

Page

Sporadic, *.. 211

Epidemics, 211

Kumber of Diseases, 211

Object of Naming and Clas-
sifying Diseases, 212

Ch^and JDMsiom or Classes of Dis-
eases, 212

CLASS I.— DISEASES OF THE

DIGESTIVE FUNCTION, 213
Outline of tlie Process of Di-
gestion, . , 213

Taking of Food, 213

Mastication, 213

The Saliva, 214

The Sense of Taste, 214

** Quintessences," 215

Deglutition, 215

Cliymification^ 215

Process of Digestion, . . . . i . 215
Case of St. Martin— Beau-
mont's Experiments,.. 215
The Gastric Fluid, .... 216, 281
Its Mode of Operation,. . 217
Phenomena of the Process of

Chymification, 218

Changes Effected by Diges-
tion, 219

Living Bodies not Digestible, 219

Pancreatic Juice, 220

Bile, &c., 220

Absorption of Nutritious Mat-
ters for the Supply of the

Body, 221

The Lacteals, 221

The Blood — Physiological

Properties, 222

Sanguification,. .' 222

Lymph, 222

Composition of the

Blood, 223

Nutrition, 224

Disintegration, 224

Nitrogen in Pood, 225

Quantity of Pood Ne-
cessary, 225

Ordek 1. —Diseases Affecting
THE Alimentary Canal, ... 226

Ge7ius I. — Affecting the Teeth and

Gums

9,9,n

Dentition. Teething, . . .

226

Process of Dentition, . .

227

Symptoms, .

227

Treatment,

228

Cham., Merc, Puis,,

Ipec, Aeon., Bell,

Calcar.-carb., Coffea,

Hyoscyamus,

228

Canabis-Ind., Igna., . . .

229

Wisdom Teeth,

229

Lancing the Gums, . . .

230

Toothache.— Odontia Do-

loroso, .

230

Gangrene, Causes.— Caries,

Inflammation,

230

Hot Drinks, 231

232

Prevention of Caries, ....

232

Treatment,

232

Derangements of Digestion

233

Injuries, Mercury, 233

234

Bell,

234

Cham., Staphys, SuL,

Puis., Hyos,, Aeon., .

235

Local Remedies, Kreo-

sote. Arsenic, Argent-

nitr.,

236

Minor Operations on

Teeth, ...»

237

Heemorrhage,

237

Local Ana3sthetics, ....

238

Cbloroform, .

238

Galvanism,

238

Tooth-edge.— Odontia Stu-

poris,

239

Treatment, ........

239

Tartar.— Odontia Incrus-

tans,

239

Treatment, . .

240

Affections of the Gams. —

Gum-Boils, «.

240

Treatment,

241

CONTEIv^TS

Page
Genus 11.— Diseasea of the Mcml-
lary Bones^ 241

1. Abscess of the Antrum Max-

illare, 241

Symptoms, 241

Purulent Secretion of

the Antrum, . . , 242

Treatment, 243

2. Ftjngous Tumor of the

Antrum, .,,.,. 243

Treatment. Extirpation, 244

3. A-ffections of tlie Lower Jaw, 244

Anatomy, 245

4 [nflammation, ..,.,„ 246

li Luxations, 246

G, Fractures, 246

7. Caries,. «,....-. 24T

G^nr,s IIL—Ptyalum^ 248

1. ^cute, 248

2. From Mercmy, 248

3. Chronic Ptyalism, 248

Mercur,-Corrosivus, 248

Tartar-Emet., 249

KiMc-Acid, Iodide of Po-
tassium, ]^itro-Mur.-Acid, 249

4. Morbid Saliva. — Alumina,,. 249

5. Foefcld Odor of the Mouth,. 249

6. Salivary Fistula, 250

7. Salivary Concretions, 250

General Remedies for Af-
fections of the Mouth,. . . 250

Mercurius, 250

Laches., 251

Aeon., Nux-Vom., Sul., 251
Kemedies for Affections of

the Fauces, . . 252

Genus lY. — Dysphagia.— i){^cw?if
Deglutition^ ^ ........ . 252

1. From Mechanical Injury, . . 252

Foreign Bodies in the
Throat,. 252

2. Prom Nervous Irritation, . . 253

3. Dysphagia from Spasmodic

Constriction of the Pha-
rynx, 264

General Remedies for Dys-

pbagia, 254

Morbid Thirst, .......... 255

1. Excessive Thirst, .... 255

2. Loss of Thirst, .... . . 25 G

Genus Y. — Derangements of Bi-
geetion—Jjimosis^

1. Anorexia.— Want of Appe-

tite,

2. Bulimia. — Fames Canina —

Morbid Appetite,

Causes,

Pathology,

Treatment,

Cases,

3. Abstinence. — .

I. As a Remedy in Disease,

II Effects of Protracted Ab-
stinence. Examples, 259,

Symptoms,

Treatment,

III. Inanition as a cause of Dis-
ease,

lY. Appetite, Yitiated or De-
praved,

Cases,

Y. Cardialgia. — Heart-Burn, .

YL Flatulency, 266,

Catarrh of the Stomach,

Treatment,

Ipec, Puis., .

China, Cham., Carb.-Yeg.,

Coloc, Carmina lives, . .

YII. Pyrosis, "Water Brash, . . .

Treatment,

YIII. Gastrodynia. — See Index.
IX. Nausea and Yomiting.
Sickuess at the Stomach,
Emesis. Pathology. Phe-
nomena of Yomiting, . . .

Treatment,

Pnls., Cham., Coccul.,

Secale, Antim-Crud.,

Arsen., Camphor, Ipec,

Cases,

256

268

256
.258
25^7
258
268
258
258

261
260
262

263

264
265
266
299
865
26^7
267

267
267
268

268

268
270

270
270

Xll

CONTENTS.

X. Vomiting of Blood. Hse-

matemesis 413

XL Dyspepda, 271

1. JBh'om Deficient Secfetion
of the Gastric Juice^
with Inordinate Sensi-
MUty of the Nerves of

the Stomachy 271

Diagnosis, 272

Combination of Gastric

and Hepatic Disorder, 272
Appetite, 272 Liver, 273
Tongue, 273. Skin, 274

Loss of Strength, 274

Pulse, 274

Effects of Slow Digestion, 275
On the Mind, 275, 278, 282
Imperfect Nutrition, 276
Distinction between Func-
tional Dyspepsia and
Malignant Structural

Disease, 276

Kerves employed in Di-
gestion, 278

Causes of Deficient Gastric

Secretion, 279

" Wear and Tear,"

Malady, • 279

Exciting Causes,... 280
Effects of Eating too

much, 281

Effects of Mental

Emotions, 282

2. Fermentation of the
Contents of the Sto-
mach from Deficient
Secretion of Gastric

Juice, 282

Causes, Treatment. Diet, 284

Quantity of Food, 284

Hunger, 285

Irritation from Taking
Food in a State of

Fever, 285

Purity of Food Indis-
pensable to Invalids, 286

PA<3H

Poisonous Properties of
Fermented or otherwise
Deteriorated Food, 286, 312
Cryptogamic Fungi Devel-
oped in Fermentation, . 286
Butter when Strong con-
tains Infusorial Animal-

culse, 286

Cheese, Flour, Tainted

Food, 287

Exercise, 288

Medical Treatment, 289

Nux-vom., . 289

Sulphur, 291

Pulsatilla, 291

Bryonia, . 292

Lycopodium, ........ 292

Graphites, 292

Lobelia-inflata, 293

Calcarea-carb.,. 294

Hepar-sulph., 294

Ignatia, 294

Cedron, Case, 295

Aperients, Use and A-

buse of, 295

Treatment of Fermentation
of the Contents of the

Stomach, 296

Bad Teeth, 296

Water, Eemedial Pow-
ers of, 297

Effect of Drinking too

little, 298

Effect of Drinking large

Quantities, 298

Medical Treatment, ..... 299
Sanguinaria-canadensis, 299

Phosphorus, 299

See also Page 399

20. Acute Inflammation of the

Liver, 924

1. Adhesive Inflammation of

the Liver.— Hepatitis, .... 924
Diagnosis, 924. Pathology,. 925
Prognosis, 026. Causes,... 926
Suppurative Hepatitis, .... 926

Abscess — Causes, 926

Diagnosis, 927

Abscesses of Large Size, . . 928
Prognosis, 929

21. Inflammation of the Gall-

bladder and its Ducts, ... 929
Diagnosis, 929. Pathology, 929
Ulceration of the Gall-blad-
der, 930. Pathology,. . . 930
Treatment of Inflammatory

Diseases of the Liver, ... 930
Aeon., 410, 930. Bry.,. . . 930

Cham., 931. China, 931

Lachesis, Bell, Merc, Nux.-v., 931

Puis., 931. Sulph., 931

Podophyllum, 931

Leptandra-virginica, 932

Nitro-muriatic-acid, 932

22. Chronic Hepatitis, 933

Diagnosis, 933. Causes,.. 933

Treatment, 933

Hypertrophy of the Liver,. 934

Aurum. — Case, 934

Fatty Degeneration of the

Liver, 934. Causes, 935

23. Cancer of the Liver, ...... 936

Diagnosis, 936. Causes,. . 936
Pathology, 937. Treatment, 937

24. Splenitis— Inflammation of

the Spleen, 512, 516, 937

25. Pancreatitis, 941

26. Leucothyaemia Splenica, . . 942

27. Leucosis, 943

THE

HOMCEOPATHIC

THEORY AND PRACTICE

MEDICINE^

HISTOEY OF MEDICINE;

The Science of Medicine bas not hitherto been ranked among the
exact sciences. Its most zealous votaries are still compelled to ac-
knowledge that all efforts to reduce its principles to the precision of
mathematical rules have failed ; and, though we purpose to show that
Theoretic and Practical Medicine is the grandest of all the Sciences
and the noblest of all the Arts^ we do not pretend to have discovered
any royal road through which indolent or careless inquirers may as-
cend its subiimest heights. Persons who desire to be successful in
treating even simple diseases must be willing to devote some time to
the study of the human body, the nature of disease, and the effects of
remedies.

The reading of primary Hand-books w^hich may contain a mere sum-
mary of many subjects can never qualify for the full understanding and
correct treatment even of the most common diseases. So exten-
sive is the field of Medical Sc,ience, so intricate are the problems in-
volved in the theory of all complicated forms of ill health, that a
book which can be considered a safe guide for cmy-body in severe cases,
must be something more extensive than a cheap domestic Manual, though
works of that character have performed an immense public service
mqxtalifying the feojple to discriminate between good and bad practice,
— between substantial merit and pompous pretension in practitioners.

The object of the student of Medicine is the attainment of Truth as
revealed in the human body in its relations to the created Universe;
and all his aims are consistent with the best interests of our race.
Those who study Medicine most extensively, will become most familiar
with man's nature in all its aspects ; they will become conversant with
the sources of physical and moral evil ; and, in penetrating the mystery.

Vol. I.-3. 33

B4: HISTOKY OF MEDICmE,

of afflictioiij they will learn to comprehend the la^vs by which nature is
governed in her efiforts to resist the powers of disease, as well as to aid
those efforts in accomplishing their beneficent purposeSo

The origin of Medical Science is lost among the obscure traditions
and fables of the earliest ages. The mythological history of the ancients
derived the art of curing diseases from the direct inspiration of their gods
and even among the moderns many authors of the highest reputation
have attributed to Medicine a Divine origin. But, in reviewing the
progressive steps by which the most sublime of all sciences has advan-
ced from a position in which it was a mere appendage to the priestly
office to that of a proud and noble profession, we may safely begin with
the assumption that individual observations must have been made by
the earliest inhabitants of our earth ; that these observations embraced
the diseases to which they found themselves subject, as well as the
injuries received in war or by accidents. As in modern times the
lowest savages discovered by explorers have possessed some degree of
medical and surgical knowledge ; it may be presumed that medicine
in its rudest form is almost coeval with the duration of human existence.
The sight of suffering in the earliest times must have led to the desire
to relieve it. And when men's small experience failed, super-natural
means, such as charms and incantations must next be tried.

At what period it began to be practiced as a distinct profession is
not known. The most ancient physicians we read of were those who
embalmed the body of the patriarch Jacob, by order of his son Joseph ;
and these physicians were the servants of Joseph, not priests, as the
earliest physicians are supposed to have been. At that time Religion
and Medicine had been already separated into distinct callings and
they so continued ever afterwards.

The Egyptians themselves attributed the invention of Medicine to
Thoth, the Hermes, or Mercury of the Greeks. He is said to have
written many nhings in hieroglyphic characters upon certain pillars, in
order to perpetuate his knowledge. These were transcribed by
Agathodemon, or the second Mercury, whose son Tout is said to have
composed books of them which were kept in the most sacred places in
the Egyptian temples. The books however attributed to these ancient
personages have long been considered as forgeries ; and they were more
probably written many ages after the time of Hermes.

The art of curing disease was blended in the religion of Egypt with
superstitious traditions and observances ; and it is certain that their first
physicians were priests. They were treated by the people with the
highest respect ; and on certain public occasions they moved in solemn
procession through the splendid temples and palaces of Thebes and
Memphis, dressed in stately robes, and bearing the symbolic, represen-
tative bed of the goddess of Love and Beauty, As the Egyptians, and

HISTORY OF MEDICINE. tS5

afterwards tlie Greeks, considered diseases as a direct manifestation
of the displeasure of the gods, they looked to the ministers of these
deities, the officiating priests of the temples, as the divinely favored
agents through whose influence the pestilence might be averted^ They
believed there w^ere thirty-six spirits or demons of the air, who divided
the human body among them ; they had names for them all ; and by
invoking them according to the part aflfected, the patient was cured.
This system has prevailed in all Pagan countries. The American
Indian priests, says Monardes, when consulted by the Caciques, took
large quantities of tobacco smoke, fell to the ground, and after lying
a while in a stupor, they arose and delivered the answers they had re-
ceived from the world of spirits.

It is not known that Mercury, the father of Medicine in Egypt, em-
ployed many natural remedies. The only prescriptions made by him
that have been transmitted to us by the poets, consisted of the herb
Mercury, of w4iich he discovered the use, and the herb Moly, which he
gave to Ulysses to secure him from the supernatural powers of Circe
the enchantress. His successors learned the process of venesection
from the Hippopotamus, which is said to perform the operation on itself
by striking the leg against a pointed reed, taking care to direct the
stroke against a vein. Cathartics, emetics, clysters and abstinence
constituted the principal remedial measures of the early successors of
Mercury in Egypt. Galen saj^s that 630 years B. C. the Egyptian
king Nechepsus wrote, that a green Jasper stone, cut in the form of a
dragon, surrounded with rags, and applied to the epigastrium externally
would strengthen the stomach and promote digestion.

At a later period Medicine was divided into numerous branches or
specialties in that country. Herodotus says: "Each physician applies
nimself to one disease only, and not more. All places abound in phy-
sicians : some are for the eyes, others for the head, others for the
teeth ; some devote themselves to parts about the abdomen ; and others
entirely to internal disorders." — {Herodotus^ Eiderpe, cap, 84.)

The art of embalming, which still astonishes modern nations was per-
formed rather as a religious rite than as an appropriate appendage to
the medical art. In the process, says Herodotus, the brains were
drawn through the nostrils with an iron hook ; and the intestines were
taken out through an opening in the side with a sharp stone. It is
not probable that those engaged in the art of embalming ever acquired
much knowledge of the structure of the human body. The decaying
bodies of the dead were viewed only as objects of disgust or supersti-
tious reverence ; andsamong the Hebrews, who had passed a captivity
of near four hundred years in Egypt, he who even touched a dead body
had certain ceremonies of purification enjoined upon him; and if these
were neglected, it was declared that his presence defiled the sacred

60 HISTOEY OF MEDICIKE.

Tabernacle, and lie was separated from the congregation of Israel, On
going out from Egypt to Canaan, the Israelites carried with them the
bon^s of the patriarch Jacob, and his ear-rings were buried as amulets
under the oak of Sichem. The Jewish priests continued to be the only
physicians. The Law of Moses, combining enlightened principles of
Hygiene with typical and emblematic religious observances, prescribed
the separation of persons infected with the leprosy, and pointed out
the diagnostic symptoms by which the priests should pronounce upon
the character of any cutaneous disease which should present any of
of its features. The Law directed that any "rising, scab, or bright
spot" on the skin, which should " resemble the plague of leprosy,"
should be exhibited to a priest ; " and when the hair in the plague is
turned white, and the plague in sight be deeper than the skin of the
flesh, it is a plague of leprosy, and the priest shall look upon him and
pronounce him unclean," on whose skin it occurs. The further medical
duties required of the priests are detailed in the twelfth and fifteenth
chapters of Leviticus. They have long been regarded as embodying
the most profound principles of medical police ; and the latest writers
have expressed " admiration for the wisdom and foresight which made
such salutary regulations a religious duty." — [BeQioticircV s History of
MedicinSj p. 33.) In the course of successive centuries after the ar-
rival of the Jews in Palestine, medicine became a separate vocation.
Sometimes men were consulted who professed to be in direct communi-
cation with the spirits or deemons of the invisible world ; as the king
of Judah sent messengers to inquire, through the priests of Baalzebub,
the god of Ekron, whether he should recover from his disease or not.
The author of the Apocryphal book Ecclesiasticus mentions the office
of physician as distinct from that of a priest about 200 years before
the Christian era ; and claims that high " honor is due him for the
uses ye may have of him ;" " For of the Most High cometh healing,"
and the physician "shall receive honor of the king." Josephus says
{Lib, 8. G, 2, 5.) that Solomon the king discovered a plant which cured
epilepsy with the aid of a charm or spell. The root was concealed in a
ring and applied to the nostrils of the demoniac ; and the historian
says he saw it practiced with complete success .in the presence of
Vespasian, his sons and the Tribunes of the Roman army. From thia
tradition come the stories of the Seal of Solomon:

^^ Some amulet of gems anneaVd

In upper fires, some tabret seaVd

AVitli the Great Name of Solomon.^

Which spelFd by her illumined eyes

May teach her, where beneath the moon

In earth or ocean, lies the boon.

The charm that can restore so soon

An erring spirit to the skies. [Paradise and the Peri,)

HISTOEY OF MEDICINE. 37

The Greeks attributed tlie invention of medicine to several persons
of whom PrometheuSj Apollo, and JUsculapius were the most dis-
tinguished. Being a warlike people, the art of curing disease was .
little cultivated for centuries, while the sxiTgical department of Medicine
was so highly esteemed that their best poet declared, that

*^ A wise physician skilled our wounds to heal
Is more than armies to the public weal.^^

They trusted much to amulets as late as the days of Pericles, who was
pronounced insane by Theophrastus, because he wore an amulet on
his neck. •

The most celebrated Greek physician during the fabulous ages was
iEsculapius. His skill in curing diseases was so great that he was
highly revered by the people during life ; and, after his death it was
believed that he had been removed from earth at the request of Pluto,. w^ho
complained that the physician performed so many cures that he was
rapidly diminishing the number of the dead, ^sculapius was after-
wards ranked among the gods ; and temples were erected in which his
pupils, Chiron, Machaon, Podalirius solicited the aid of their great
master. Among the pupils of Chiron the Centaur were : Hercules,
who discovered the virtues of many plants ; Aristeeus king of Arcadia,
who first used the drug called Silphium, supposed by many to be
asafoetida ; Theseus, Jason, Telemon, Peleus, and Achilles. The last
named of these is said to have discovered the use of Verdigris in
cleansing foul ulcers ; and Palamedes prevented the plague, which had
ravaged most of the cities of the Hellespont, including Troy, from en-
tering the Grecian Camp. His method was to confine the soldiers to
spare diet and oblige then to use much exercise. Helen mixed opium
with wine and gave it to the guests of Menelaus under the expressive
name Qi Nepenthe^ to drive away their ca.res. Opium was obtained from
Thebes in Egypt, from w^hich Tincture of Opium was called Thebaic-
tincUire, { Odyssey "F".)

The first great schools of medical knowledge among the Greeks were
the Temples of ^sculapius. The priests who directed their erection
knew how to select healthy locations ; the reverence which the priests
inspired in the minds of the invalids ; the invigorating effects of hope,
change of scenery, diversion of mind ; and the exercise of long journeys
by which the temples of the god were reached ; all contributed to in-
crease the fame, as vrell as the successes of the priests of iEsculapius.
Their powers were greatly enlarged by strict hygienic rules, which
men will observe when prescribed as parts of a religious ceremony, but
scorn and neglect when dictated by true science and coininon sense.
These priests (or Asclepiades) also employed many agents of real
power. Darwin thouo:ht the Cumsean sibyl took a few drops of the juice

38 HISTOKY OF MEDICINE.

of the cherry laurel before ascending the prophetic tripod. Others
suppose they used stramonium or opium. (Paris, Yol. 4, 24.) In
some cases they prescribed bloodletting, purgation, emetics, friction,
sea-bathing, and A'arious mineral waters. Beyond all this, and exercis-
ing a powerful influence on the sick and their friends, was the mental
influence of the doctor-priests. Admission to the temples was only
permitted after certain processes of purification had been undergone.
The interrogation and the answers of the oracle were often delayed for
a day, and one or two nights while the patient remained lying in the
temples. Abstinence, prayers, fastings, sacrifices followed. In some
of the temples a ram or a fowl, at Cyrene a goat, and in other places
various animals were sacrificed to ^sculapius before the will of the
oracle was asked for. Socrates, requested in his last interview with
his friends, that they would sacrifice for him a cock to iEsculapius.
The answers were sometimes delayed, and sometimes mystical and dif-
ficult of interpretation. Sometimes the divinity was made to appear
in the form of a serpent, devouring the cakes upon his altar ; other
manifestations were made through dreams which were interpreted by
the priests. The temples of the god of Medicine thus became the
first hospitals in which the sick were regularly treated. To them those
who could reach them brought the afflicted ; and those who could not,
in various countries, exposed the sick by the side of the highways, that
they might receive the advice of every one who passed. {Good^ Car
hanis^ Henouard^ &c.) In these early ages the knowledge that was ac-
cumulated by such means as these was chiefly transmitted to posterity
by tradition. {Strabo)

The chief temples of ^sculapius were those of Epidaurus in the
Peloponessus, Pergamus in Asia Minor, Ehodes in the isle of Cos,
Cnidos, etnd Gyrene in Lybia. Besides these nearly one hundred have
been enumerated in the different countries afterwards included in the
Roman Empire. (Schulze Hist Med) In these temples the first re-
corded experience of men in the treatment of diseases were transmitted
to posterity in the form of inscriptions on plates of metal, wood or
stone. The priests reported to new patients the history of cases which
had been previously treated with success. The descriptions of cases
and the methods of cure were briefly and imperfectly given ; but they
were of immense value to men in succeeding generations. They formed
the first rudiments of that art which was in future to grow into a
sublime and noble science, through that very method of observation
and experiment which was there first inaugurated in the world. These
temples of the god of Medicine maintained their rank in the estimation
of men long after the genius and industry of Hippocrates had reformed
the theories and practice of ancient medicine. Democedes,who had been
the slave of a tyrant of Sardis, became court physician to Darius, Emperor

HISTORY OF MEDICINE. 39

of Persia.j by his success in curing the "king of kings" of a sprained
ankle. The intellectual labors of Pythagoras, Heraclitus, and Demo critu.^,
had already divested it of many of its useless superstitions, when " that
divine old man'' Hippocrates undertook to create* a new science out oi
the old materials ; and then to supersede all the old by new obser-
vations on diseases of every form. At that time anatomy and physiology
%vere almost entirely unknown. The Materia Medica of the Greeks
was limited to a small number of articles, and the powers of these were
imperfectly understood. But the reformer brought to his work the
most extensive and varied qualifications. In the ability to observe,
collect, arrange, and methodize, he surpassed all who had preceded him*
Inheriting the wisdom recorded in the votive tablets of the Temples as
the "seventeenth lineal descendant of ^sculapius," he commenced the
labor of making a clinical report of the daily changes that occurred in
individual cases of disease. In recording the symptoms from day to
day, and narrowly watching the good and bad effects of his remedies,
Hippocrates originated Clinical Medicine y through the " bedside ex-
perience" of the wisest and best physicians of all ages, Medicine, as a
science and an art, has since grown to what it now is.

Hippocrates (born 460 B. C.) lived four centuries before Christ, and
he is the most ancient medical author whose works have descended to
our times. Regarding his science " as a principle of humanity, and not
merely as a means for attaining profit and glory," he abandoned the
course his ancestors had pursued; and, instead of instructing the mem-
bers of his family alone, he endeavored to communicate his knowledge
to strangers ; and thus to extend the usefulness of medicine in the
world. The "^sclepiadean oath," by which the mysteries of the
science were confined to the limits of a single family, was now super-
seded by the " Hippocratic oath" or declaration still respected in Modern
Schools. Several of his pupils became his most distinguished successors.
Many of the works attributed to him are known to be forgeries. Brevity,
gravity, and the absence of visionary theorizings are the characteristics
of his writings."

The Theories by which Hippocrates endeavored to explain the causes
of disease were necessarily imperfect, though generally based upon
patient observation. His knowledge of Anatomy was limited to the
results of the dissection of animals ; and but once in his life did he
enjoy the privilege of seeing a human skeleton. He refers much to
the humors of the body, particularly to the blood and the bile, sup-
posing that there were but two fluids in the body; he employs the
same word to express his idea of a nerve^ a ligament^ or d^ tendon] he
gives much attention to the good and bad effects of sleep, watchings,
exercise, and rest. With him the same word is used for an artery, a
vein, or an excretory duct; and the word a^m<:^ signifies any fluid. On,

40 HISTOEY OF MEDICINE.

the subject of diet he wrote several books, and was particularly careful
in selecting the food of invalids ; in observing the courses and changing
of the winds ; the irregularity of the seasons, the rising and setting of
the stars or of certain constellations ; also, the times of the solstices,
and of the equinoxes. To all of these meteorological and astronomical
changes he attributed effects which he has not attempted to explain.
He thought the above causes, with many others, when operating on
different regions of the body, produced diseases of greater or less
malignity ; some of these he accounted mortal, others dangerous, and
the rest easily curable, according to the cause from which they originate
or the parts of the body on which they fall. He also distinguished
diseases into acute and chronic, into endemic^ when confined to certain
localities, and epidemic^ when they seized great numbers at a time,
passing from one place to another ; of this kind the most terrible known
to him was the plague. He also remarked that single cases of diseases
usually epidemic sometimes appeared alone: these cases he called
sporadic. He distinguished between those diseases which are heredi-
tary, or born with us, and those which are contracted during life; and
also between those that are of a milder character and those of a ma-
lignant nature, and are less frequently overcome by medicine. The
chief articles in his Materia Medica were : Hellebore, Colocynth, Elate-
rium, oxydes and scales of Copper, Onions, Garlic, Parsley, Wine, Honey,
Cantharides. The peculiar merit of Hippocrates is found in- that great
power of observing facts which he so eminently possessed, and so con-
scientiously employed; in that high analytical intellect which could
trace symptoms to their origin, and classify 'and arrange the vast
number of observations made by himself and others ; in that exalted
morality which always commands respect ; and in that intuitive insight
into human character, and physical as well as moral peculiarities, by
which minds can be controlled, and pathological conditions analyzed.
Though but an indifferent practitioner in our view, he was the greatest
of medical observers. Whatever may have been the merit of his suc-
cessors, the improvements made by their master appear to have been
so satisfactory to them, that no real advances were made for ages after
his death, which occurred at Larissa, when he had reached the age of
90 years. He had practised his profession at Abdera, in Thessaly,
but chiefly at Cos ; which he had rendered famous by making it the
only great School of Medicine in the world. At the same time that
Hippocrates was constructing the Science of Medicine, " the illumined
Plato'' was employed in revolutionizing philosophy. Without entering
into the study and practice of medicine, as a profession, Plato became
familiar with what was then known of the theory, of the science and
the economy of the human body. He was followed by Aristotle, whoso
wonderful genius left its impress on all the intellectual pursuits of men

HISTOEY OF MEDICINE. 41

for more than a thousand years. The character of his mind was
different from that of any philosopher who had preceded him, in that
strange power of "grasping, as if by intidtion^ all the stores of
knowledge ;" while it " leaves dull learning toiling far behind." His
strength consisted, not in collecting with patient labor the minute facts
of which a theory might be constructed; but in boldly penetrating the
realms of the mysterious and unknown, and generalizing, as if by the
aid of inspiration, the truths already known, and those which remained
to be discovered. As a primary doctrine he regarded the soul as "the
efficient, the final, and the formal cause of the body." That his pro-
found speculations should be found invariably true, could certainly
never have been hoped for by himself, but tha.t his genius, such as it
was, should have sufficient inspiration in it to sway the minds of men
for a long series of ages, continues still to be a subject for the admiration
of philosophers. Medicine in succeeding centuries permitted the
Aristotelian Philosophy to mould her theories, when her disciples
should have been employed in making new observations for themselves.

Among the most distinguished successors of Hippocrates were
Polybius, Draco, Prodicus, and Praxagoras, who ventured to deviate
from the opinions and practice of Hippocrates. He is said to have
cured ileus by cutting open the abdomen and intestines and sewing
them up again. Erasistratus adhered more strictly to the doctrines ot
the great master. He gave to the world the first regular indications
of the pulse, and came near discovering the circulation of the blood ;
but he could not perceive the use of the two sets of cavities in the
heart, and was afraid to bleed, lest the blood should find its way from
the heart to the arteries which he thought ^contained nothing but
spirit.

The death of Alexander the Great, 824 B. C, was followed by the
dismemberment of the vast empire he had erected on the ruins of
conquered kingdoms ; and his successful general and half-brother,
Ptolemy Soter, became king of Egypt, in the year 821 B. C. Alex-
andria, founded only seven years before, became his capital, and the
centre of the science and learning of the Greeks. The first Ptolemy
founded the library and museum of Alexandria, which vfcre enlarged
by the munificence of his successors until the literature of all nations
were collected in the royal library of the successors of Alexander.
After the purchase of the library of Aristotle, the largest then in the
world, the Alexandrian collection, according to Eusebius, contained
one hundred thousand volumina or rolls, the whole of which were
placed "at the disposal of studious men, who were desirous to use them
for their improvement and the advancement of science." (Heno'uard,
p. 166.) The extensive commerce in which the Greeks were engaged,
enabled the Ptolemies to gather together the rare plants and animals

42 HISTORY OF MEDICIiSrE.

of distant climafces, stimulating the curiosity of naturalists and physi-
cians! Medicine was now divided into three branches, the dietetic, the
pharmaceutic, and the chirurgic ; these branches became entirely .
distinct and were cultivated by different individuals.

Anatomy and Physiology now received a new impetus in the efforts
of Herophilus a^d Erasistratus, who commenced the dissection of the
human body and the vivisection of animals at Alexandria. About 287
B. C. Serapion of Alexandria formed a new sect called the eonjpirical.
He retained the practice of Hippocrates ; but despising his. mode of
reasoning, depended on personal experience alone. His followers used
Castor, Opium, Cicuta and Henbane. Those who maintained the value oi
theories were afterwards known as dogmatists ; they insisted on the
necessity of knowing the latent as well as the evident causes of disease:
and taught that physicians should understand the natural actions and
functions of the body. At this period there were medical schools of
some importance at Smyrna, Pergamus, and Epidaurus, all of which
attracted students, and were visited by distinguished pupils from
Alexandria.

At Rome the study and practice of Medicine remained entirely un-
known for more than six hundred years after the founding of the city.
{Pliny ^ Liber 39. Chap. 1.) Though the usual efforts of ignorant men
to mitigate pain must have been made, there was no class of men who
devoted themselves to the treatment of diseases alone. The people
had faith in the priests and oracles, and the mystical responses of the
Cumsean Sibyl were particularly reverenced. jEneid,^ Lib. VI. 78.)

According to Livy, the Roman historian, the medical and religious
sciences of the Greeks were introduced at Rome 234 years B. C.
Fifteen years afterwards Archagatus, son of Lysanias of the Pelopones-
sus, settled in the Eternal City as a physician and surgeon. The
practice of surgery was considered incompatible with kindness and
humanity, and the Romans were deeply prejudiced against everything
from Greece; hence ail the Greek colonists in Italy w^ere regarded with
envy or hatred by the people; and Marcus Porcius Cato, the Censor,
particularly distinguished himself in his hatred of physicians, (Got-
neliits Agfi-ppa^ Arts and Sciences^ p. 297) and he even meditated the
expulsion of every man from Rome who should attempt to practice
there. For a century more no distinguished physician appears in that
city, till Asclepiades of Bythinia (born 91, B. C), who, having failed as
a teacher of rhetoric at Rome, took up the practice of Medicine, at
a comparatively late period of life. He at once openly opposed
Hippocrates' theory of natural power and sympathy or attraction, and
engrafted upon his science the physical principles of the Epicurean
philosophy. By the general condemnation of the practice of his co-
temporaries, and the disparaging manner in which he spoke of all the

HISTORY OF MEDICINE. 43

doctrines of his predecessors, he attracted a large share of public
attention. "His arts/' says Pliny, were such as every fashionable
physician employs : soothing the patient and avoiding every thing that
can give pain till nature cures him, or he sinks under the disease."
By these arts Asclepiades became the most fashionable practitioner oi,
his time. He declared that he deserved no credit if he should ever
become sick himself; and by good fortune he always escaped disease
till extreme old age, and was then killed by a fall down stairs. He
employed the lancet in acute diseases of the chest accompanied with
pain ; incised the tonsils ; and was the first to perform the important
operations of laryngotomy and tracheotomy. He originated the doctrine
of "the self-limitation of diseases, asserting that the principal cure for
a fever was the disease itself.'' ( Watson^ p. 101.)

On the conquest of Gaul and Britain the Komans became acquainted
with the Druids, who were both priests and physicians. They gathered
the Mistletoe or Yiscum Album, cutting it with a golden knife when the
moon was only six days old. This parasitic plant, when consecrated
by certain ceremonies w^as considered the most certain remedy against
poisons and sterility. The letter R used at the beginning of a medical
prescription is now usually understood to be an abbreviation for the
word Recipe^ but was originally employed as the astrological symbol
of Jupiter, as it was under this planet the plant prescribed was to be
gathered.

Vervain was to be gathered after drinking of honey, at the rising ot
the dog-star, at a time when no sun or moon was shining, and collected
only with the left hand. It then had power to cure fevers and the
bites of serpents ; and was employed to conciliate friends.

Immediately after Asclepiades arose Themison, the founder of the
Methodic Sect ; whose doctrines evinced equal hostility to the dog-
matists and the empirics; he divided diseases into the two classes
of hypertoniG and atonicj a division which with some modifications
has descended to the present day ; Thessalus, who was contemporary
with Nero, was a man of merit but of inordinate vanity.

Aurelius Cornelius Celsus, the first native Roman who wrote on
Medicine, was born in the year 4, A. D. After receiving the best
education the times aiforded, he engaged in writing on various scientific
subjects; and it is said that he served as Secretary to the Emperor
Tiberius on his expedition to the East. Devoting himself to medicine,
he left behind him a large work which is equally valuable for the
elegance of its language, and the complete knowledge it gives of the
state of medicine at the time he wrote. The Treatise "De re Medica,
libri octo" is the only work of Celsus that has been preserved, and it
is not entirely complete. In many parts of it the author agrees with
Hippocrates, and quotes largely from him, Asclepiades is his next

44 HISTORY OF MEDICINE.

highest authority ; and after these Themison his contemporary, and
Herophilus and Erasistratus of the Alexandrian school. Though
agreeing in general with HippocrateSj Celsus rejected the doctrine
of Gritical days^ which has been often revived and exploded, and still
holds a place in modern works on febrile diseases. {Brit. <& For, Rev, ^
July, 1857, p. 61.)

In the time of Celsus Surgery had made more progress at Rome
than it had ever done among the Greeks or Asiatics. Many of the
largest operations are minutely described by Celsus ; and the instru-
ments and apparatus employed by the ancient surgeon's have been dis-
played to modern eyes among the relics of the disentombed cities of
Italy. In the year 79 A. D., while Celsus was still living at Rome,
and was probably engaged in writing his great work " De re Medica,''
the Cities of Herculaneum and Pompeii were overwhelmed by a tempest
of ashes, cinders, and lava, poured upon them by an eruption of Mount
Vesuvius. The people with all their wealth were in a moment en-
tombed in their own dwellings ; and all their works of art, all the para-
phrenalia of domestic life, and all the apparatus employed in all the
branches of science, stood still in their places, and remained unchanged
and uninfluenced by the revolutions of seventeen centuries. Modern en-
terpinse has now disrobed the silent cities of the dead, and brought to
light the long-buried remnants of ancient arts and sciences. Among
them tlid offices of the physician and apothecary, and the various
implements employed by the surgeon may be seen in the Royal Museum
of Naples, (See Prof, Vulpes^ '^Illustrazione Sti'umenti GMtut,^^
cfec."— Dublin Quar. Jour. Med., Aug. 1852.) The Romans still trusted
much in the powers of charms and amulets, till the Emperor Caracalla
passed an edict that no more amulets should be worn. [Paris Phar-
7RaGologia IntroditG.) For 250 years, extending from the time of
Asclepiades to Galen, Celsus was the only distinguished medical writer
at Rome. The state of the sciences generally can be best seen in the
works of Pliny the younger. The Romans made few discoveries, but
they were ever ready to adapt to public uses the improvements made
by the Greeks. Among their sanatory improvements may be noticed
" their immense doacm for the drainage of the city,— their public
baths,— their care in the selection of sites for new towns, villas, and
private residences, — -their improvements in architecture, and domestic
arrangements of dwellings," — all of which show that the lectures of
their Greek masters on the rules of health had been properly appre-
ciated. Watson^ PisGOurse^ — N. Y. Acad, of Med., 1856, p. 142.)

Of distinguished men in the distant provinces of the Empire, at this
period, the most conspicious was Aretasus of Cappadocia. Though little
is known of his life, it is supposed that he passed part of his life in
Egypt, and probably made his way to Rome, the great capital of the

HISTOBY OF MEDICINE. 45

empire, (Ada7ns^ BiogT, Worlds of Aretmus^j He was the ablest of
the defenders of the new doctrines of the sect called the Pneumatics;
who taught that the body was constituted of solids, fluids, and pneuma
or spirits, and upon the due correspondence and relationship of these
.three constituent elements depended health. The "pneuma" or spirits
was regarded as a subtle fluid, passing from the lungs to the heart, and
thence by the arteries distributed to all parts of the system. The heart
was believed to be the focus or central point of the vital force or souL
"A dense pneuma" was supposed to cause organic obstructions. The
description of Hypochondriasis by Aretgeus is elegantly written and
proves him to have been an accurate observer. The two Andromachi
became conspicious at Rome, by the elder one, (the father), becoming
physician to the Emperor Nero ; and Dioscorides, born in Cilicia in the
latter part of the first century, wrote the only complete treatise on the
Materia Medica now extent among the labors of antiquity.

In the year 131 A. D,, during the reign of the Emperor Hadrian,
was born Claudius Galen at Pergamos in Asia Minor. Pursuing the
study of medicine in his native city, in Smyrna, Corinthj and Alexandria,
he, after travelling through Cilicia, Phoenicia, and the isles of Scyros
and Crete, returned to Pergamus at the age of 28 years. It was not
long till the successes of many Greek physicians attracted him west-
ward to Rome. Here he commenced lecturing, writing and practicing
his profession, and soon drew upon himself the envy of inferior men,
who stigmatized him as a theorist and a dealer in magic. In less than
five years he was obliged to leave Rome, under pretence of avoiding a
plague then raging there, which had originated at Antioch, 166 A. D.,
but he was soon recalled from his native city to attend the two Em-
perors Aurelius and Verus, of whom the latter died. The physician
made the long journey on foot, and Aurelius formed so high an opinion
of Galen, that he entrusted him with the care of his two sons ; and
Galen having predicted the recovery of one of the princes from fever
in opposition to the opinion of other physicians, rose at once to the
highest rank in the profession. He lived to the age of 70 years and
died during the reign of Severus. To him is commonly attributed the
famous maxim: ^^contraria Gontrariis Giivaofituv^'' and the invention of
cold and hot, dry and moist diseases.

Galen wrote about 750 Essays on various medical subjects, constitu-
tions and medicines. His first object was to illustrate Hippocrates
who was then imperfectly understood by the commentators.

Galen was evidently superior to all his contemporaries. And so
successfully did he expose the " deficiency of their information," and
the "futility of their reasoning," that he triumphed over all his rivals^
and " attained a rank in the medical world, and swayed the opinions of
physicians and the public on all points connected with medicine in a

4:6 HISTORY OF MEDICINE.

manner before and since unknown." He lived at a time when the Roman
Empire combined all nations into one ; and when extended intercourse
between men of different countries had developed the human mind to a
degree that had not been reached at any former age. Of the many works
attributed to him, eighty-three are believed to be genuine. The bes
edition of his works is that of Kuhn, in twenty volumes, 8vo. 1821-1833 '

Galen attached himself to no one of the different sects into which
he found the profession divided, and despised those who gave them-
selves up to obey any particular master. He followed Hippocrates in
denominating the vital principel Natiire ; like him he admitted the
existence of four distinct humors, from the predominance, or de-
ficiency, or disproportion of which originate the different tempera-
ments of the animal frame, and the varieties in the different diseases
to which it is subject ; these humors are the blood, phlegm, yellow,
and black bile. He likewise established three distinct kinds ot
auras, gases or spirits, a natural, a vital, and an animal, which he
regarded as so many instruments to distinct faculties ; referring the
seat and action of the first chiefly to the liver, of the second to the
heart, of the third to the brain.

Though Galen nowhere refers to the dissection of the human body,
he frequently examined monkeys and other animals, and made some
important experiments in Physiology. It had been taught by Era-
sistratus and the disciples of the Alexandrian school that the arteries
contained only air. Galen contrived a series of experiments by
which he demonstrated the fact that these vessels contained blood
and blood alone. This was the most important discovery in Physi-
ology that had ever been made ; and the account he gives of the
respiration shows also that his mind h.ad caught hold of some cor-
rect ideas, which aided in the making of future discoveries. In
pathology his views were less correct. Like Hippocrates, he sup-
posed that the primary cause of disease existed in the fluids ; and
he adopted the doctrine of the four elements as the basis of all his
reasonings. He distinguished between the remote or predisposing
causes of disease, and those now called exoiUng or causes near at
hand ; and regarded the superabundance, the degeneration, or the
putridity of the humors as the primary cause of all diseases. Upon
this pathology his practice was based, and it was often successful,
even when suggested by erroneous theories. In his general rules
of regimen, diet, and the prescribing of medicines he followed Hippo-
crates ; at Pergamos he acted both as physician and surgeon, ac-
cording to the usage in provincial cities. In the great metropolis
of the world he restricted himself to medicine exclusively. [Brit. &
For, Med. Chir, Bev.—U\j 1857, p. m)

After the death of Galen no medical author of high abilities appear-

HISTORY OF MEDICINE. 47

ed for centuries ; and the reign of the " Prince of the Latin Physicians"
continued unshaken. Ordinary men could originate nothing new ; and
they dared not express an opinion in opposition to the authority of
Galen. After the overthrow of the Roman Empire of the West, the seat
of learning and the arts was transferred to Constantinople ; but no im-
portant discovery in medicine was made till the commencement of the
sixteenth century. The Arabians adopted the chemical ideas which
the learning of antiquity afforded ; but they neglected the study of
Anatomy, and the solid sciences on which alone a true system of me-
dicine could be erected. There could be no general diffusion of medi-
cal knowledge so long as an individual could not obtain the written
works of his predecessors. The few manuscripts that existed could
only be s'een in a few libraries, and the greatest collections the ancients
had ever made were burned by ignorant or fanatical invaders or rulers
who knew ^nothing of their value. The Alexandrine Library was
destroyed by Caesar's soldiers, and when the Arabs conquered Egypt
a few centuries after, all that remained of classic literature in the city
of the Ptolemies was burned by order of the sultan Amrou. (A. D.
640.) The Library founded by Constantino at Constantinople, contain-
ing at least 300,000 volumes, including the works of Homer written in
letters of gold on the entrails of serpents, was burned by order of Leo
Isaurus the bigoted Emperor. The Vatican library of Rome was destroy-
ed by Charles, Constable of Bourbon. In France the first Library was
founded by King Charles V., who died in 1380. The 20 volumes be-
queathed to him by his father were augmented by him to 700, and
placed in the Louvre. Before printing was invented a manuscript
was a precious treasure. A Latin breviary was. kept in a few churches,
enclosed in an iron cage.

But little advance had been made in practical medicine since the
time of Galen. Rhazes of the Arab Empire of Persia had described
the small-pox and used some chemical remedies. He died A. D. 923,
Avicenna followed him and died near 50 years later in the same city,
(Bagdad). Averrhoes, of the Arabic capitol in Spain left a treatise on
medicine at his death in 1206. His preceptor Avenzoar had made im-
portant observations, and is said to have lived to the extreme age
of 135.

From this time no progress was made in science till the Turkish
sultan Amurath IL took posession of Thessalonica in 1430. Theodore
Gaza escaped from the captured city, carrying with him some valuable
manuscripts, and reached Florence, where he was kindly received by the
Medici family. From these manuscripts thus preserved, the stores of
Grecian literature were gradually disseminated in Italy. But no new
theories in medicine were promulgated till the time of Paracelsus.
This man was born in Switzerland in 1493. Havino; made himself ac-

4:8 HISTORY OF MEDICINE.

quainted "witli the old medical theories and chemical remedies, he
travelled extensively, gathering up from all sources a knowledge of all
the claims of empirics and quacks. Adopting the wildest theories of the
alchemists, he boldly began the use of active remedies. With Mer-
cury, Antimony, and Opium he appears to have effected some remark-
able cures. These successful cases were displayed in the most pompous
terms to all who consulted him. In 1527 he began lecturing in the
university of Basel as the first professor of Chemistry in Europe. He
now pretended to cure diseases by chemical remedies, burnt the works
of the ancient authors Galen and Avicenna in solemn state, and profess-
ed to have discovered a universal remedy which would cure all manner
of diseases, and give to his followers immortal life and health. But his
death, in 1541, at the age of 47, exposed his vanity and blasted all
their hopes.

Paracelsus was the first to give Mercury internally, thaugh the sa-
livation it causes when externally applied, had been known to Friar
Theodoric in the 12th century. Though Paracelsus displayed human
insolence^ conceit, and insincerity, vanity as well as immorality in the
most extravagant degree, he rendered important services to our race.
He broke down the despotism of the schools and sects of his time, and in-
troduced some valuable and powerful remedies. His example and teach-
ings excited the envy of some, the emulation of others, and the industry
of all. (PariSj Pharmao. Vol. 1, j?. 27.) At the same time that he
wandered from place to place, generally intoxicated, seldom changing
his clothes, or even going to bed, he was teaching fragments of truth
which the world could not receive till the discoveries of four centuries
should teach men how to use them.

The great discovery of the Circulation of the Blood was the next
step in the progress of discovery. Michael Servetus, (born in Arragon
in 1509) was proceeding rapidly with the researches on this subject,
when he w\as charged with heresy and arrested and imprisoned through
the influence of John Calvin, the Eeformer. When Servetus had com-
pletely established the fact of the passage of the blood through the
lungs, he happened to pass through Geneva ; there Calvin procured his
arrest, brought against him a charge of blasphemy and heresy ; and
Servetus was found guilty and burned at the stake (in 1558) with his
books around him, to kindle the flames. The tract on the circulation
w^as saved by one of the judges ; and was finally traced out by Dr. Sig-
mond through Dr. Mead and the Landgrave of Hesse Cassel. ^

The discovery rested for nearly three-fourths of a century. Twenty-
five years after the death of Servetus, William Harvey was born in
Kent, England. His education was prosecuted abroad and in England,
and his researches occupied his time for many years before any publi-
cation of this theory of the circulation was made. In 1615 he was ap-

HISTORY OF MEDICINE. 49

pointed lecturer on Anatomy and Surgery in London. In this position
his new views which were soon to revolutionize all medical philosophy,
became known (about 1619); but he fortified himself by every possible
proof that the subject could admit of, before he published his first work
on The Circulation in 1628. The publication of his theory brought upon
him the most bitter opposition ; some of his contemporaries condemned
his doctrines as presenting an unjustifi^^ble innovation, others declaring
that it was no new discovery, but had been well known before. Though
he lost popularity at the time of the publication of his discoveries, and
his practice was diminished by it, he lived to see his opinions establish-
ed in the scientific world ; he served as physician to James L, and after-
wards to Charles I. He became President of the College of Physicians,
and saw his bust placed in its hall before he died in 1658. The best edi-
tion of his works is that of the College of Physicians published in 1666.

At this period the powerful remedies introduced by Paracel-
sus were still in the hands of quacks only : and Yan Helmont who con-
tracted the common itch in 1640, could not be cured by regular medi-
cine, and had to resort to the quack remedy sulphur.

In this century the French Parliament interdicted the use o^ Anti-
mony as a medicine, and the Faculty of Paris not only forbade the
employment of all chemiGal remedies^ but would not even allow them
to be mentioned in theses, and examinations. In the same century,
also, the discovery of the valves of the veins by Amatus Lusitanus was
denied and ridiculed by the chief anatomists of the day.

In 1615 Solomon de Cans, the discoverer of steam-power, was im-
prisoned by Cardinal Richelieu in the Bicetre, and there he became a
lunatic. Lord Worcester who visited him there, thus spoke to his
keepers: "Misfortune and captivity have deprived him of reason ; you
have made him mad, and when you threw him into that cell you shut
up the greatest genius of the age."

At this period the universities, which possessed the sole power of
authorizing physicians to practice medicine, were mere ecclesiastical
establishments. They taught very little, but persecuted all who at-
tempted to learn anything not found in the writings of Galen. When
a few men attempted to learn something of Surgery by observation
and experience, they were persecuted by the regular Galenist priests ;
who, having been prohibited by the Pope from the practice of surgery,
themselves gave secret lessons in this branch to their barber servants ;
and these last became the Barber Surgeons. At this time hot irons,
hot oil, and hot pitch were applied to wounds to stop bleeding ; and
Guy de Chauliac, asserting that it was better to let a limb drop off
by sphacelation than to amputate it, compressed the limb with pitch
plasters to compel it to mortify. Ambrose Pare saw the bad results
of such practice, and invented the mode of arresting the bleeding by

Vol. I- 4.

50 HISTORY OF MEDIOIITE.

tying tlie arteries, and curing tlie wound by mild dressings. But this
discovery, thougli worth more to humanity than all the improvements
made by the routine followers of Galen in a thousand years, was not
permitted to be published ; and Pare was so cruelly persecuted for
pretending to innovate upon Regular Medicine that he was compelled,
for his own safety, to adduce garbled and incorrect extracts from the
old authors to prove that his discoveries were made by tliem^ and not
by himself.

The establishment of the important fact of the circulation of the
blood did not, for a long period after its truth was admitted, produce all
the advantages that might have been expected from it. . For the phy-
siologists of that day, in reasoning upon the powers by which this
phenomenon, as well as others of the animal frame was accomplished,
unfortunately took hold of the mechanical philosophy as their guide ;
and the explanation of every function was immediately attempted ac-
cording to the law of projectiles ; the system was speedily pushed so
far that it destroyed itself by the absurdity to which it was carried.

The first English physician who introduced important improvements
in medical practice was Thomas Sydenham, born in 1624. After
graduating at Cambridge he commenced practice in Westminster. De-
voting his attention to the study of febrile diseases, and finding ample
opportunities in an extensive practice, after six years experience he
published in 1666 his great work '^Methodus Ourandi FebresP To
this work he afterwards added the experience of nine subsequent years ;
and the whole of it displays the most careful observation of nature and
the effects of remedies. In the treatment of small-pox he first introdu-
ced the method of checking the eruptive fever by means of cool air and
other antiphlogistic means, by which he found that the eruption and
subsequent danger were diminished ; and the same practice has been
since applied to other eruptive and febrile diseases. In the accurate
histories he has left behind him of small-pox, measles, gout, hysteria,
and some other diseases ; in his close discrimination between the dif-
ferent varieties of the febrile maladies as they disclosed, in different
seasons, and different years, peculiar epidemic constitutions of the
atmosphere ; Sydenham surpassed all his predecessors, from Hippo-
orates to his own time : and he has still maintained his rank as the first
practitioner of his own country. He died in 1689. His work displays
all the elements of a master mind, and will be referred to in all future
time by the student who is ambitious to measure all the depths of the
human intellect. — [Goooh, Diseas. Fern, &c, 1832.)

Regular Medicine lays claim to all the accidental discoveries made
"by men who do not pretend to be making their voyages of discovery
under her authority. The discoveries of Peruvian-bark, Vaccination, Io-
dine, and Lemon-juice against scurvy, were made by accident. Peruvian-

HISTOET OF MEDIOmE.

bark was discovered by tbe Indians of Soutli America, and was first
brouglit to Spain in 1632, It remained in Spain seven years before it
was tried by Alcala an ecclesiastic in 1639.

The medical profession was roused to fury by the introduction of
this substance into popular practice. This remedy was not brought
into the profession through the portals of the college ; and the new
discovery, says Bouillaud, had to be "baptized in tribulation." The
physicians of Oliver Cromwell allowed him to die of ague rather than ad-
minister the hated specific. In the same century the president of the
College of Physicians committed Dr. Groenvelt to Newgate, for daring
to prescribe Cantharides internally.

Sydenham was followed by tlie great medical philosopher Boerhaave,
who led the way to many important reforms both in theory and practice.
He was born in Holland in 1668. After thoroughly studying the
works of Hippocrates and Sydenham, he commenced making a selec-
tion from all the ancient and modern authors ; a,nd from these materials
he constructed a new theory of Medicine, which was so well adapted
to the existing state of science, and so ably explained and defended by
its author, that it was generally adopted throughout Europe, and
rendered its author a commanding authority for more than half a
century. After several years devoted to teaching other branches he
was appointed to the professorship of the practice of Medicine at
Leyden in 1715. His lectures on this subject, on Chemistry and
Botany rapidly extended his fame. Students flocked to him from all
countries, until the little city of Leyden, which had so suddenly become
the Medical Metropolis of the world, could scarcely furnish accom-
modations for the votaries of science drawn together by the genius of
Boerhaave. He died in 1737, and his fellow-citizens erected an ele-
gant monument to his memory. His theory of the origin of diseases
from acrimony, lentor, or other morbid changes in the fluids of the
body, has long since been so far modified by later discoveries that it can
scarcely be recognized in the form in which it appears in the medical
writings of the present day.

Hoffmann of Saxony was contemporary with Boerhaave. Appoint-
ed by the first King of Prussia Professor of Medicine at Berlin, he in-
troduced to the public through his lectures and his " System of Ra-
tional Medicine," (a work which cost him the labor of twenty years,)
an important modification of the humoral pathology. He has the merit
of first directing the attention of physicians to the morbid affections
of the nervous system, instead of framing mere mechanical or chemical
theories ; he laid the foundation of the spasmodic hypothesis, by resolv-
ing the origin of all diseases into a universal atony, or a universal
spasm in the primary moving powers of the system. This theory still
holds its place in modifying modern theories and practice. It was

52 HISTOET OF MEDICINE.

this doctrine, combined with that of Stahl, from which Cullen selected
the materials of that theory which can not yet be said to be entirely
superseded by any more recent system. The popularity of Monro hav-
ing made Edinburgh the chief centre of attraction for medical students,
Cullen was appointed to a professorship there in 1756, and became at
once a leading spirit in the profession. The humoral pathology had
governed medical practice ; though vague notions had been disseminat-
ed by Stahl, of the controlling power over the noxious disease-
causing agencies, that w^as ever exerted by the internal rational soul,
which resided within the animal economy and directed all its operations.
The genius of Cullen seized upon the two prominent ideas of Hoffmann
and Stahl and blended them into one harmonious system. His most
important work: "The First Lines of the Practice of Physic," in four
volumes octavo, pu'blished in 1784 revolutionized the theories and prac-
tice of the profession. Though, controverted by Brown and Darwin, in his
own time, the theories of Cullen have never been entirely exploded.
Medicine had thus reached a proud position among the sciences at the
close of the eighteenth century. It was already established in the
public mind as the most sublime, the most comprehensive, and the most
useful of all the departments of human knowledge, and was cultivated
with enthusiasm by a vast number of men of the highest order of mind
in both hemispheres. In the medical schools of Europe and America
new doctrines and new discoveries were being successively announcedj
such as never entered into the imagination of the wisest of ancient sages.
Just at this time a new theory, which seemed to set at nought all
the accumulated wisdom of ages, was proclaimed to the world by a phy-
sician of Germany.

In 1790 Samuel Hahnemann, then residing at Leipzig, was employed
in translating Cullen's Materia Medica ; and was dissatisfied with the
explanation given by that author of the anti-febrile powers of the
Peruvian-bark. He determined to discover by experiment on him-
self, what were the real properties of the bark. He took it in consider^
able quantities, while in perfect health, and found that it produced an
ague, similar to the intermittent marsh fever. This remarkable fact
was treasured up in the memory of Hahnemann, until its great value
and significance cOuld be rendered appreciable in the light elicited by
further observations and discoveries.

Hahnemann was a native of the little town of Meissen, on the Elbe,
near Dresden, in Saxony, born April 10th, 1755. His father, who
was a painter on porcelain, enjoined the son to avoid all the liberal pro-
fessions. But the youth managed to evade his father's injunctions, by
secretly contriving for himself a midnight lamp; and by its aid he was
able to gratify his intellectual longing for knowledge, while the members
of the household were asleep. His assiduity excited the admiration of

HISTORY OF MEDICINE. 53

tlie school-master, and the aspiring hoy was advised to pursue a more
intellectual vocation than his father had designed for him. The father
was displeased, and placed him in a position where mental improvement
was more difficult. But he was at length moved by the solicitation of
the teacher, to permit the latter to direct his son's studies, which he
did till young Samuel reached the age of 20 years. {Dudgeon^s In^
iroduGtory Lecture.) He now began his medical studies at Leipzig,
where he supported himself by translating French and German works
into English. From Leipzig he went to Vienna, where he studied
under the direction of Dr. Von Quarin, who treatedhim with the great-
est kindness. He graduated at the university of Erlangen in 1779, on
which occasion he defended a dissertation, " Conspectus Affectuum
SpasmodicoTUiinr He had already served Baron von Briickenthal,
governor of Transylvania, for some years in the capacity of physician
and librarian. He now commenced practice at Mansfeld, but soon re-
moved to Dessau, and afterwards to Magdeburg. After some years in
practice, he published his first medical work, giving an account of his
practice in Transylvania. In this work he honestly confesses, that me-
dical experience was unsatisfactory; and admits that most of his
patients would have fared better if left without any treatment at all.

He had now practiced his profession eight years ; and he says he had
bestowed the most "conscientious attention" on his patients. And he
had only "learned the delusive nature of the ordinary methods of
treatment." He determined to relinquish the office of physician ; as
he said " it was painful" to him to " grope in the dark, guided only by
books in the sick-room, to prescribe according to this or that (fanciful)
view of the nature of the disease, substajices that owe to mere opinion
their place in the " Materia Medica." " I had," says he, " conscientious
scruples about treating unknown morbid states in my suffering fellow
creatures with these unknown medicines ; which, being powerful sub-
stances, may, if they be not exactly suitable, change life into death, oi"
produce new affections, or chronic ailments, which are often much more
difficult to remove than the original disease;" " and how is the physician
to know whether they are suitable or not, seeing that their peculiar
special modes of action are not yet elucidated ?" " To become in this
way the murderer or the aggravator of the sufferings of my brethren of
mankind, was to me a fearful thought— so fearful and distressing was
it, that shortly after my marriage, I abandoned the practice and scarce-
ly treated any one for fear of doing him harm," and "occupied myself
chiefly with chemistry and literary labors." — (Hahnemann's Letters
on the necessity of a regeneration of Medicine, 1808.)

In chemistry his talents found a wide field for successful exercise,
and in the course of a few years prior to 1790 he published some
valuable tests for ascertaining the purity of wine, and a treatise on

54: HISTOKY OF MEDICINE.

Arsenic, which is still referred to bj the ablest writers, as a work of
great originality and scientific accuracy ; and Dr. Christison quotes the
account of poisoning by Arsenic. Berzelius admitted the claims of
Hahnemann to distinction as a chemist.

In 1789 he was settled in Leipzig and published a medical report
of some forms of disease which he had treated with success ; and here
he described his method of preparing "soluble Mercury." The next
year he made the first step towards the discovery which was in future
to infuse a regenerating influence into the whole science of Medicine.

His first conception of the Homoeopathic law of cure, says Dr. Hen-
derson, was not reached by the inductive method, nor has any other
great discovery ever been made in that manner. " Lord Bacon's method
was never tried by anybod}^ but himself." Bacon himself once attempt-
ed to form a new theory of heat by gathering up all the facts he could
find that had any bearing on the subject. He then tried to arrange
them into a theory by placing them in tables ; and, grouping them ac«
cording to various methods, "he cross-questioned them in every possible
way, and could educe no general law from them, for nature thus inter-
rogated was silent ; a " memorable instance of the absurdity of attempt-
ing to fetter discovery by any artificial rules." [Brewster^ s Life of
Newton,)' — Hahnemann's mode of proceeding w^as very different. Hav
ing ahandoned the practice, he still reflected on the possibility of find
ing some more successful mode of treating disease.

Is it, said he, " the nature of the art that it should not be possible
to bring it to any greater certainty ? " Shameful, blasphemous thought
Shall it be said that the wisdom of the Eternal Spirit could not produce
remedies to allay the sufferings from the diseases he allows to arise ?"
He thought there must yet be some "easy, sure, trust-worthy method,"
by which we might learn the effects of medicines, "as to what they are
really, surely, and positively serviceable for." " The alterations which
medicines cause on the healthy body do not occur in vain: they must
signify something^ else why should they occur ? What if these altera-
tions have an important, an extremely important signification ? What
if this be the only utterance whereby these substances can impart in-
formation to the observer, respecting the end of their being ?" " How do
medicines effect what they do in disease except by their power to
alter the healthy body ? Certainly in this way alone the effects can
occur."

"It follows, then, that the medicine among whose symptoms these
characteristics of the given case of disease occur in the most complete
manner, must most certainly have the power of curing that disease ; in
like manner that a morbid state which a certain medicinal agent is
capable of curing, must correspond to the symptoms these medicinal
substances are capable of producing in the healthy body. In a word^

HISTORY 01^ MEDICINE. 00

medicines must only have the power of curing diseases similar to those
they produce in the healthy body, and only manifest such morbid
actions as they are capable of curing in disease!^'

Such were the reasonings of Hahnemann in the day when, through
the inspiration of a highly illuminated intellect, he had grasped the
outline form of that great Law of Oiire which was in future to recon-
struct the healing art ; but which the world could not receive until it
should be demonstrated by an amount of evidence that had never before
been demanded for the establishment of any doctrine in physical
science. Like Newton, meditating the tremendous problem of At-
traction^ he knew that his clairvoyant mind had seized upon one of
the commonest facts, with which all men were familiar, and had " borne
him away to conclusions that common minds never would have reach-
ed." But Hahnemann felt from the first a deep conviction that his first
conjecture embodied an ever-living truth, and that his self-evident
reasonings must be true also. " If all this be not true," said he, " how
was it that those violent tertian and quotidian fevers which I completely
cured, four or six weeks ago, (without knowing how the cure was
effected,) by means of a few drops of tincture of bark, should present
almost exactly the same array of symptoms that I observed in myself
yesterday and to-day, after gradually taking, while in perfect health,
four drachms of good Cinchona-bark by way of experiment."

Other men had developed intermittent fever by giving bark as a
remedy for some other condition which they did not understand.
Hahnemann alone possessed penetration enough to perceive that the
disease caused by Cinchona was the very same disease that it was
capable of curing : and that the remedy, both in causing and curing
disease must be governed by some higher law than was yet known to
men of science. He felt assured that the Being who created the
universe must be the wisest and most benevolent -of all beings ; and
that "there must somewhere exist a principle" through which the powers
of the remedies he had created could be rendered available for the
promotion of the happiness of "His best loved creatures." (See
Henderson^ p. 11 9.^'

Through successive steps the one idea of curing disease upon the
simple principle of ^^liTte hy liJce^^^ took possession of his mind ; but
extensive and varied experience could alone demonstrate to the outer
senses of men in an age of materialism, the truth of Homceopathy ;
though that truth was clearly embodied in his own mind in the
aphorism "Similia Similibus Curantur." To attain that precise know
ledge which experiment can only give, he tested the powers of useful
remedies, deadly poisons, and articles hitherto believed to be inert;
he tried them on himself, his patients, and then on his friends ; and he
foimd that they ail possessed powers new and hitherto unsuspected

56 HISTOBY OF MEDICINE.

His experiments often resulted in astonisliing cures ; but difficulties,
such as the advocates of revolutionizing truths always meet, and such
as no reformer ever before met, obstructed his path, and persecution,
poverty, and the dark clouds of adversity gathered around him. To
carry out his own principles it became necessary that he should pre-*
pare his own medicines ; and in doing this he was compelled to set at
defiance that ancient law of Germany that restricted the preparation
of medicines to the apothecaries ; public sentiment and tradition erected
tremendous barriers in the way of any man who dared to set at nought
the wisdom of the wise, and threatened to scatter to the winds the
counsels of the learned.

In 1792 Hahnemann was requested by the reigning duke of Saxe
Gotha to take charge of an asylum for the insane in Georgenthal, in
the Thuringian forest. Among the patients treated by him at that time
was the Hanoverian minister Klockenburg, who had been rendered
insane by a satirical epigram of Kotzebue ; the successful treatment of
this case by Hahnemann created some sensation ; and from his report
of it, published in 1796, it appears that he, in that first case^ instituted
the system of treating the insane by mildness instead of coercion. He
says: "I never allow any insane person to be punished by blows or
painful corporeal inflictions, since there can be no punishment wdiere
there is no sense of responsibility; and, since such patient can not be
improved, but must be rendered worse by such rough treatment," It is
believed that this is the first announcement of the modern doctrine
which directs the moral treatment of the insane; though it was in that
same year (1792), that the illustrious Pinel made his first experiment
by unchaining the most furious maniac in the Bicetre at Paris ; and, by
treating him as a man and a friend, succeeded in restoring him to
reason.

- But is was not by discovering new modes of curing any one disease,
but by the initiation of a radical doctrine that was to revolutionize the
treatment of all diseases that Hahnemann had aroused the attention^
as well as the hostility of medical men. To maintain the ground he
claimed, and establish his doctrines on the basis of accumulated
experience and facts, was the work of many painful years. In 1795 ho
established himself in Konigslutter where he remained till 1799. During
this time he published his "Friend to Health, a popular miscellany; his
Pharmaceutic Lexicon; his Essay on anew principle for ascertaining the
remedial powers of medicinal substances." (Hufeland's Journal 1796),
and other works on the absurdity of complex prescriptions and regimen
in the treatment of febrile and periodical diseases. In 1800 the scarlet
fever prevailed extensively in Germany, and it was at this time that
Hahnemann discovered the prophylactic power of Belladonna in averting
this disease. For a long series of years he was depressed by poverty

HISTORY OF MEDICmE. 0/

and driven from one town of Germany to another by tlie persecutions
of physicians and apothecaries. In 1803 he was without a fixed resi-
dence ; and, though he had reached the age of forty-eight years, and
had been styled by Hufeland " one of the most distinguished physicians
of Germany," he felt himself a stranger in every corner of his native
land. At one time engaged in writing a new book; at another experi-
menting on himself with a new remedy. Then, gathering up his familyj
his books and his medicines, he flies again before his enemies ; and was
at one time detained six weeks on the road by the turning over of his
wagon, by which "^ limb of one of his children was fractured.

In 1803 he published a work on the injurious effects of coffee, as it
was then used. After practicing for brief periods at different places in
the north of Germany, in 1805 he published "Esculapius in the
Balance," and " The Medicine of Experience." In the same yearj
Napoleon the First applied to the French academy to know if concen-
trated steam, according to Fulton's process^ could propel a vessel? The
question was answered by a burst of laughter, and the emperor was
extremely mortified for having shown his ignorance. "The same body
of philosophers rejected the proposition to light buildings by gas, as an
impossibility: and a few years ago Mr. Arago was received with bursts
of contemptuous laughter, when he wanted to speak of an electric tele-
graph,— his learned confreres declaring the idea to be ^erfeetly
Utopian^

In 1808, Hahnemann wrote to Hufeland his celebrated "Letter on
the urgent necessity for a reform^in medicine," in which he said: "I
cannot resist the desire I feel to unveil to the public the convictions that
now possess me. For eighteen years, I have wandered from the beaten
track of medicine. It was a punishment to me to grope always in
obscurity when called to wrestle with disease, and to prescribe medi-
cinal agents which had at least an arbitrary place in the materia
medica."

In 1810, while residing at Torgau, he wrote his " Organon der
rationellen Heilkunde^^ which was published at Dresden the same
year. At the same time he established himself in Leipzig: and, in
order to obtain the privileges of a physician in that city, he defended
his thesis, De Hellehorismo Yeterurri'^ in 1812.

From this time till 1821 Hahnemann was actively engaged in
defending his new system of medicine, in teaching it, and in enlarging
its domains by new researches. In 1819 he published an improved
f;dition of his Organon^ which was further improved in a third edition,
translated into French, English, and Italian, 1824. • Homoeopathy was
introduced into Italy by the surgeons of the Austrian army, when they
entered Naples in 1821. But all the rising prospects of the reformer
only strengthened the hostility of his enemies. The law which prohi*

58 HISTORY OF MEDICINE.

bited physicians from preparing their own medicines still existed; and
Hahnemann, who could neither find his medicines already- prepared,
nor find apothecaries, who would obey his instructions, was compelled
to violate it. A formidable combination of interested persons demanded
of the government the enforcement of its own absurd statute, and
Hahnemann the founder, the first apostle and, martyr of homoeo-
pathy, could no longer remain in the city which was in future to erect
a monument to ask posterity to excuse the wrong she had inflicted on
her noblest benefactor. Driven from Leipzig, Hahnemann found an
asylum at Anhalt-Cothen, where Prince Frederick "offered him pro-
tection. Here he was permitted to practise his profession without fear
of apothecaries, though his enemies circulated false statements, to
prejudice the people against him. In 1828 he completed his great
work on " Chronic Diseases," in five volumes ; and its publication was
followed by other smaller works, since collected in two volumes, under
the title of " Minor Writings," 1829 to 1834. In the work on " Chronic
Diseases," he announced and explained his theory of the origin of a
great number of the most inveterate forms of disease. He says, that
the majority of the cases known as palsies, asthmas, dyspepsias, con-
sumptions, headaches, epilepsies, vertigoes, &c., are caused by the
presence of a morbid matter or miasm existing in the body. When it
comes to the skin, it produces, some of the obstinate cutaneous
affections, known as, leprosies, milk-crusts, scald heads, ring-worms,
itch, herpes, pustules, &c. The term Psora^ he employed as a general
designation, not of iteh^ but of all the constitutional hereditary
afiections described by other authors under the head of psorio or dys-
crasio diseases.

In 1831, at the age of 76, Avhem epidemic cholera had excited the
alarm of all the nations of Europe, Hahnemann examined the symptoms
of the disease, as reported by those who had seen it, and predicted the
remedies that would be found most successful in its treatment. His
directions wert printed and circulated; and their value and accuracy
are attested by the general success of his disciples in the treatment of
cholera asiatica.

The first public hospital and school for the advancement of homoeo-
pathy was established at Leipzig, and there the theory and practice of
the new system of medicine continues to be taught.

When Hahnemann saw old age advancing upon him, he had the gra-
tification of knowing, that he had not lived and labored in vain; but that
his doctrines had been accepted by some of the progressive minds in
all the countries of Europe, and by many in other parts of the world.
Approaching the age of seventy years, he said: "I have paid no regard
to either ingratitude or persecutions in the course of mj^ life, which,

HISTOIIY OF MEDICINE.

although toilsome^ has not been without satisfaction, on account of the
grandeur of the.end I had in view."

" The grandeur of the end he had in view," was rapidly unfolding
itself, when these words were spoken; and it has continued to expand
with increasing splendor as successive years have passed away. His
wife, who had witnessed and shared his trials and sufferings, without
understanding him or sympathizing with him in the greatest of them,
lived to see his fame safely established; and then died in 1830. At
this time his writings had made his discoveries and successful practice
known far from the city in which he had been almost imprisoned by
the narrow prejudices of the people. In 1835 Mile. Melanie d'Her-
viily, of an ancient noble family of France, visited Hahnemann at
Cothen; and so thoroughly did she comprehend the greatness of the
man and his discoveries, that she became one of his most distinguished
pupils. At a later period she was united to him by marriage ; and, ob-
taining from M. Guizot, then at the head of the cabinet of Louis Phi-
lippe of France, the privilege for her husband of practicing his pro-
fession in Paris, she induced him to remove to that city. The royal
ordinance granting this permission, was dated August 31, 1835, and from
that time till his death, Hahnemann was engaged in practice at Parip.

In 1843 he had reached the age of eighty-nine, but his intellect wa^^
still clear; his habits of constant and patient observation made it v»
pleasure to note the symptoms of disease; and his ever-glowing bene-
volence inspired him with an ever-burning zeal in the cause of science
and humanity. " He was," says Hering, " a true man without falsity,
candid and open as a child. When the last fatal hour had struck for
the sublime old man, who had preserved his vigor almost to his last
moments ; then it was the heart of his consort, who had made his last
years the brightest of his life, was at the point of breaking. "Why
shouldst thou," she said, "who hast alleviated so much suffering, suffer
in thy last hour ? Providence should have allotted thee a painless
death?" Then he raised his voice, as he had often done when he exhorted
his disciples to hold fast to the great principles of homoeopathy: "Why
should I have been thus distinguished? Each of us should here attend
to the duties which God has imposed upon him. Although man may
honor, more or less, yet no one has any merit. 'God owes nothing to
me. I to Him owe all," With these words he took leave of the world,
his friends, and his foes."

A^ devoted admirers of the genius of Hahnemaiin we are still de-
sirous to do no injustice to any other benefactor of our race. It will not
be claimed, that the last victory of science had been won when the
founder of homoeopathy closed his eyes near the gardens of the Luxem-
bourg. But, while we admit that important discoveries have been made
by others which prepared the way for a higher unfolding of the prin-

60 HISTORY OF MEDICINE.

ciples on which disease originates and may be removedj we must still
claim the precise discovery made by Hahnemann, as that which of
all others, the world most needed in the nineteenth century. Already
the lightning had been drawn from the clouds, and all the properties
of all the elements of the atmosphere had been examined with great
accuracy. All the sciences, that sought to subdue the various king-
doms of the physical world had announced a succession of splendid
victories ; and strong impulses were moving in minds of a high order to
stir them up to search for the laws that ruled, and the causes and. prin-
ciples which operated in some higher sphere, above the mere physical.
There were men enough employed in constructing the winding path-
way by which the hill-tops might reached; the world needed a
commanding genius, who, "seeing the towering, distant tops of
thoughts, that men of common stature never saw," could at once ascend
to the point where the labors of other men were ' designed to end ; and
from that point take his " flight sublime " towards the brighter region
that encircled the mountain top. It may not be necessary here to at-
tempt to provej that Hahnemann alone was capable of meeting the want
of his age.

In his mind, says Dr. Henderson, a conspicuous feature was one
common to the German mind, which "is impatient of ignorance where
knowledge is impossible, most eager and enterprising, where the dark-
ness is the thickest," and must trust to the wings of conjecture more
than the solid footing of observation for reaching the goal at which it
aims. ¥/^ithout it the HoTYKBOjpathiG Lctw would have floated through
the world a Viewless spirit,' and the extreme powers of attenuated me-
dicines would have never been discovered. The literary labors of
Hahnemann extended' over a wide field of labor, embracing more than
seventy different works on chemistry and medicine; some of which
were large volumes. He also translated about twenty-four works from the
English, French, Italian, and Latin, on chemistry, medicine, agriculture,
and general literature. His philosophical principles are thus given in
Dt, CI. Miiller^s F'estival Speech^ %th Aprils at the Celebration of
the \^^th Anniversary of Hahnemann'^s hirth^ Leipzig: — Plomoeo-
pathy itself is " especially based on the peculiar observation of
the dynamic element in the phenomena of life. Thus, far, from con-
sidering the organic life in its various aspects of health, disease, even
the medical art, and the effect of medicines on the organism as chemico-
mechanical processes, instead of these, homoeopathy recognized therein
the exclusive dominion of a peculiar power which is subject neither to
the mechanical nor chemical laws, viz., the vital power ; and the laws
by which this operates are also her own., Thus not the mass — not the
material as such, but only so far as it is vividly penetrated by this
power, and thereby brought under the dominion of the laws of vitality

HISTORY OF MEDICINE. 61

is it the object of her investigation and. the scope of her efforts. Hahne-
mann in his Organon (5th Edit. §, 9, &c.) expressly recognizes an in-
dependent vital power (autocracy) which in the healthy state of man
as spiritual, rules to an unlimited extent over the living power of the
material body, and keeps all its parts in a w^onderfully harmonious
tenor of sensation and activity, so that our indwelling rational spirit
can employ itself for the higher objects of our existence, independent
of this living instrument."

The material organism, considered apart from vital power, is capable
of no perception, no activity, no self-support : it is only the immaterial
that imparts to the former all its perception, and executes its vital
action, whether in the healthy or diseased condition of the quickening
principle. In disease, it is originally only the vital power that is mor-
bidly out of tune, and expresses its suffering (the internal change) by
abnormal states of the sensations and activities of the organism. The
suffering of this diseased vital power, and the morbid powder, and the
morbid symptoms thereby originated, are an inseparable totality — one
and the same thing. It is only through the psychical influence of the
morbific evils that our psychical vital power can become diseased ; and
thus also it is only by the psychical " dynamic" operation of medicines
that it can be restored to health. This recognition of a purely dynamic
efficacy in the medicines, led Hahnemann to his theory of " potencies,"
inasmuch as it brought him to the conclusion, that, by a systematic
attenuation (which at first he adopted merely to avoid undesirable
primary and secondary action) combined with succussion, the dynamic
curative powers would be exalted, and so in a manner the effect would
be more powerful and free from interference."

Hahnemann as a philosopher was an opponent, aye, the very antipode
of the modern system of materialism.

This system of philosophy, which is the dominant one of modern
times, is " founded on the consideration of force and matter alone ; and,
by virtue of and in conformity to these, of the existing and working
aggregate of the external world. It is based conclusively on the re-
cognition that force and matter presented inseparably one with the
other, keep at work incessantly according to stringent laws ; and that
the immense universe, with the immense riches of its incessantly
changing forms, and with the full machinery of its mighty restless
movement, is only a possible and positive fact, on the supposition of and
n conformity to the operation of force and matter. Its leading
principle is to take as a starting-point for the discovery of results
nothing whatever but w^hat —

1. Each one either knows assuredly by nature, or learns by observation.

2. Relatively, what the collective body of savans receives as posi-
tively attested and established by observation ; and

62 HISTOET OF MEDICINE.

8. Under all circumstances, what the rational, impartial, unprejudiced
mind must consider as true." (See Peee Buffiee " Sur les premieres
Yerites."— See Fletcher's Physiology of Pathology.)

The whole theory of Hahnemann may be termed nothing hut the
corrollary of that of John Brown. For while the Brunonian doctrine
of the cure of indirect debility by stimulants is unimpeachable in the
main, yet it fails in particular instances from disregard of the special
character of the stimulus in both causing and curing the particular
disease. Here Hahnemann steps in and supplies the missing link, and
it now becomes clear not only how a stimulus can cure an inflammation
that it could cause, but also why it is not any stimulus, but only one
of a special Gharacter that will do so. We ^ee that this character
must be very similar to that of the stimulus which in other circum-
stances would produce inflammation. [Ifuller.)

The leading minds of the medical profession, who preceded Hahne-
mann, employed their highest powers in constructing general theories
which should render close observation unnecessary. The grand object
of pursuit has been a comprehensive theory of disease and of practice
wdiich shall "bind together the scattered facts of medical, knowledge,
and converge into one point of view the laws of organic life." It has
been believed that such a theory " would on many accounts contribute
to the interest of society, that it would capacitate men of moderate
abilities to practice the art of healing with real advantage to the public ;
it would enable every one of literary acquirements to distinguish the
genuine disciples of medicine from those of boastful efirontery and art-
ful address ; and would teach mankind in some of the most important
situations, the knowledge of themselves."^ This great desideratum of
the medical philosophers was never realized, and the eighteenth century
closed with the dawning light of. the discoveries of Hahnemann, the im-
portance of which was not yet appreciated by himself. Other medical
discoveries of that period are still spoken of now with admiration, though
not then so received by the profession. Jenner who had not really
discovered the preservative power of the vaccine disease against the
the small-pox, but who appropriated a discovery which he had heard
of in Gloucestershire thirty years before, was lampooned, and ridiculed,
and contemptuously excluded from the honors and privileges of the
college of physicians, merely for advocating before the public the
truth of a principle which had been known for ages before. Of other
discoveries of the eighteenth and nineteenth centuries we shall not now
undertake to give the history.

The principal improvements in the science of medicine made during
the nineteenth century have grown out of the researches of anatomists

* Darwin's Zoonomia.

HISTORY OF MEDICmE. 63

and pathologists. Bicliat, of wliom Corvisart said "no one had clone,
so mucli in so short a time, and done it so well," announced his dis-
coveries and died at the beginning of the century. The old theories
of humoralism and solidism have since been often exploded and again
revived. As modified by Hamilton, the former was introduced into
England by Abernethy. The two united formed the basis of the sys-
tems of Pinel, Broussais, and later names which have receded before
the improvements in microscopic pathology and chemistry.

Pinel occupied the highest places of medicine ; a chair ojt the faculty
clinique, at the hospital, a seat at the institute, at the academy, titles,
decorations, &c. &c. All drew their inspiration from him; books,
pamphlets, journals, official and' other courses were but reflections of
the nosography, so styled, jpTiilosopKiGol. In the sight of these
philosophers the medical problem was stated in the terms: Given a ma-
lady ; to determine its place in a nosogTaj)hiG category, [I? Art Med.)

" And with the calm security of a conscience at peace with itself,
they ticketed, they described diseases as objects of natural history;
after which, these were neatly pinned each in its case, like a butterfly
or a beetle upon its cork, and the savans slept soundly. If some patient,
obtuse towards the perfections of nosology insisted on being cured,
they silenced the impertinent, and snored on louder than before.

" Things Avent on thus during fifteen years, when suddenly appeared
upon the horizon " L'Examen" of Broussais, a book w^hich made a pro-
digious stir, and created a stamj)ede in the Pinelist Camp.

" Broussais, henceforth master of the battle-field, over-ran, ploughed
and harrowed it for the reception of his new doctrines. He held
forth that —

" There is no specificity in diseases ^m.i]iQb: causes ^ nor in onedicines.

" Every disease is the cry of a suffering organ ; which one, we must
ascertain.

" There are but two diseases, inflammation and sub-inflammation ;
and of these two, the second only serves pro Quemoriam^ and as a di-
'Derticidum,

The clinical problem is reduced to this :

" Where must we place the leeches, and how many leeches must we
place ? ''—{LMontpellier Medical, 1860.)

Matters were thus beautifully simplified, and indeed the practice w^as
simpler than this : for as gastritis constituted the immense majority of
maladies, if you did but prescribe an application of leeches to the epi-
gastrium, you had but one chance in a thousand against you. It was
magnificent.

" All the acute diseases, — fevers, exanthems : all the chronic diseases
—dermatoses, gout, gravel, neuroses, &c., — all these were gastrites oi
gastro-enterites, and all were treated by leeches and diet. Ah ! the

64 HISTOEY OF MEDICINE.

diet, sir, was an admirable thing. What disease couM have resisted a
diet, more or less absolute in its severity, prolonged during weeks, dur-
ing whole months ?

"It is related that a patient once sought Broussais, complaining,
" Doctor, your regimen fatigues me to the last degree ; the diet is kill-
ing me ; I am literally dying of hunger." Broussais reflected a moment^
then said, "Well, you carnivorous animal! I will content you." And
he allowed him a teaspoonful of broth in a glass of water."

The medical system ,of Broussais was only fitted to amuse the pro-
fession for a few short years, when there came from St. Petersburg
another giant in the person of M. Louis ; a man of immense genius, if,
as Buffon has affirmed, genius were only patience ; M. Louis, armed
with several thousand brute facts, which he calls observations, bravely
flings them at the head of the colossus of Val the Grace, and at one
blow fells it to the ground. Broussais, after making a few imperfect
experiments in homoeopathy on others, tried it on himself with partial
benefit ; but his friends objected, and he went back to his leeches
and died, <•

The system constructed upon the bloody ruins of the temple of
Broussais consists in the employment of the senses rather than of the in-
tellect To observe is simply to take account of all that strikes the
external senses ; to observe and count " how many times in a hundred
or a thousand cases a certain symptom has occurred ; and deduce the
average. As to therapeutics, the study of signs, of indications, the
determination of medical constitutions— all that is suppressed; we may
employ, ad libituvi^ the first remedy at hand," no matter what may be
the nature of the disease ; and then it only remains to count on your
fingers how many die, and how many get well under the influence of
such or such a remedy. Indeed the game of goose is algebra beside
such therapeutics ! " Your school," said d' Amador, " has devised a new
method. You count facts and pretend to appreciate their value by
their number; you add, divide, subtract ; and with candid simplicity
believe that you are perfecting the methods of art."

Thus the operation of the senses and statistics comprize the whole
of medicine for M. Louis. Accordingly M. Bouilland bleeds his pa-
tients, while M. Delarocque evacuates them excessively upwards and
downwards, M. Piedagnel inundates them with warm water. M. Stein-
brenner swells them out with cold water, M. Magendie gorges them
with punch, M. Serre with mercury, M. Petit with bark, M. Broca with
quinine, Mr. A. Barthez with alum, others with asses' milk, others again
with alcohol ; while some, like M. Andral, do nothing at all ; — and each
boasts of his successes, invoking statistics^ that lady of good help, who
sets every body in the right. — [F Mont^ellier Medical.)

The more rigid observers of nature now cultivating the wide fields

GENERAL PRINCIPLES OF MEDICAL SCIENCE. 65

of pathology have abandoned the .eftort to construct a true theory by
counting and averaging partially observed facts. In nature, says M.
Bernard, " there never was, nor will be,* such an anomaly as an average.
Every thing is the absolute and certain result of fixed and definite
causes. Alter these in any way, even to the least degree, and the re-
sults vary acGordingly^ and in a fixed and certain proportion, Sh€
knows no meditim^ she knows nothing but a unit ; and this unit is a
combination.of fsicts^ varying in each, and the originating results vary-
ing correspondingly — experimentation, therefore, and the accumulation of
facts, can alone furnish us with the key to her enigmas— and each fact
is valuable, just in proportion as (^Z^ its conditions are aceurately 'ds-
certained, and in that proportion only ; and in collecting these facts
we should be careful not to allow " preconceived ideas" to become " fixed
ideas." The former are necessary, indispensable : we can do nothing
without them ; we should only know how to abandon them when they
are no longer right. The preconceived idea is always interrogative ;
it addresses the question to nature, and calmly awaits the answer;
ceasing to question when this is received, and adopting the fact with
the same readiness, whether opposed to, or in accordance with itself."

GENERAL PRINCIPLES OF MEDICAL SCIENCE.

, The present position of allopathic medicine must be ascertained by
asking the opinions of its standard authors. A few of these may be
permitted to speak for the profession: Prof. Christison of the University
of Edinburgh, addressing a class of graduates thus speaks of thera-
peutics : " It is of all the medical sciences the most unsettled and un-
satisfactory in its present state, and the least advanced in its progress."
{Edin, Monthly Journ. Med, SoienGes, Sept. 1851.) In an address
delivered before the British Medical Association at Edinburgh in 1858, he
said : " Therapeutics considered as a branch, whether of medical science
or medical art, and compared with the other branches of medicine,,
fundamentally and practically is in a backward and unsatisfactory con-
dition. It is not enough to admit that for a good many years past we
can neither point to a single great authority, nor to a single plausible
or generally admitted theory as to the action of remedies, but even our
therapeutical facts must be allowed to be too often scanty, vague,, or
insecurely founded." — {Lancet^ Aug. 7, 1858.)

Dr. Headland of London, author of the essay on the action of me-
dicines, when reviewing the relative operations of the va,rious branches
of medical science, says : "Eor the proper perfection of medicine as a
rational science, two things are in the main needed: the first is, a right
understanding of the causes and symptoms of disease ; — the second, a

Vol. I.— 5.

66 GENEEAL PEINCIPLES OF MEDICAL SCIENCE.

correct knowledge of the action of remedies. Should our acquaintance
with these two subjects be complete, we should then be able to do all that
man could by any possibility effect in the alleviation of human suffer-
ing. This sublime problem is already being unravelled at one end.
Diagnosis and nosology are making rapid strides : and perhaps we shall
soon know what we have to cure. But at the otlier end^ our medical
system is in a less satisfactory condition ; and though some impatient
men have essayed to cut the gordian knot, and have declared boldly
on subjects of which they were entirely ignorant ; yet it must be con-
fessed, that in the understanding of the action of medicines and of their
agency in the cure of diseases we do not so much excel our ancestors.
While other sciences are moving and other inquiries are rapidly advan-
cing, thi^ subject, so momentous in its applications, has in spite of the
earnest labors of a few talented investigators, made after all, but small
progress." The late Dr. Adams of Banchory, who was said to be the
most learned man in the profession during the last half century, said :
" Now-a-days we have abandoned all general rules of practice, and pro-
fess to be guided solely by experience. But variable and uncertain
have been its results ! I myself — though but verging towards the de-
cline of life— -can well remember the time when a physician would have
run the risk of being indicted for culpable homicide if he had ventured
to bleed a patient in common fever ; about twenty-five years ago, vene-
section in fever and in almost every disease was the established order
of the day; and now, what shall I state is general practice that has
been sanctioned by the experience of the present generation ? I can
scarcely say ; — so variable has the practice in fever and in many other
diseases become of late years."

There is a widely-spreading skepticism in all the old systems of
medicine. Such questions as the following are continually rising:
"Is there such a thing as therapeutic science? Is the world considered
as one complex individual, advancing more and more towards maturity
in medical knowledge?" Some really believe that the controversies
and sects are incapable of settlement: and that whilst "old divisions
continue for ages, new ones arise to increase the distraction of the
human mind." To many, no doubt, the claims of homoeopathy will still
continue to be classed as one of the multitude. Dr. Oesterlen (Medical
Logic, Sydenham Edition, p. 238) says: "If we bring to the bedside of
the same patient, a disciple of Brown or of Broussais, an empiric of
the old, or one of the modern stamp, an adherent of the so-called
Vienna. anatomical or of the Giessen chemical school, a nerve-patholo-
gist, or a blood-pathologist, each will recognize a different state of
things. The opinion, which each forms of fever, and similar aggregates
of symptoms, of their origin, connection and dependence upon various
local or general changes and conditions, and of those in their relations

DOCTEIIsES EESPECXma A VITAL PEINCIPLE. 67

to each other, will be different from that of the others. Each of them,
if he reflects upon it at all, mil form a different notion of all that he
has been able to observe. He will arrange and combine the various
phenomena in the patient after his own manner — that is in accordance
with his own point of view. If the same remedy be administered in d^,
given case, the assertions and opinions of each concerning its effects
will equally differ; for each has expected from it different services, and
modes of operation in accordance to his previously formed theory ; he
will, therefore, interpret what he has observed in the manner which
best corresponds to his own views; and in the remedy employed will
acknowledge only such effects as it has been his aiiii to produce."

Such views as those from the work now quoted are common among the
leading men of the regular profession; and one of the sharpest contro-
versies they have engaged in during the present century is .now going
on, to determine which is best for the patient, "Medication or Non-
Medication."

Medical skepticism is openly taught from our chairs of clinical me-
dicinCj and from the seat whence Dr. Henderson was deposed for his
revolutionary tendencies. Dr. Bennett now utters such sentiments as
these: "At this time, medicine is undergoing a great revolution, and to
you, gentlemen, to the rising generation, do w^e look as to the agents
who will accomplish it. Amidst the wreck of ancient systems, and the
approaching downfall of empirical practice, you will, I trust, adhere to
that plan of medical education which is based on anatomy and phy-
siology. Everything promises that before long a law of tru6 harmony
will be formed out of the discordant materials which surround us ; and
if we your predecessors have failed, to you, I trust will belong the honor
of building up a system of medicine, which from its consistency, sim-
plicity, and truth, may at the same time attract the confidence of the
public and command the respect of the scientific world."

DOCTRINES RESPECTING A VITAL PRINCIPLE.— NERVOUS FLUID.
DYNAMIC INFLUENCE.

The universe is governed by the same divine Power that created it;
and he exercises upon all animate and inanimate things a controlling
influence which is perpetually in operation; but he operates in all con-
ditions in accordance with certain fixed and invariable principles,
usually spoken of as the Laws of Nature, All created objects are
divided into two great classes, called living and dead ; and they are all
in some degree subject to the physical laws of nature. But living
bodies are also endowed with a set of properties entirely different, called
vital properties^ which living matter continues to manifest so long as
it is alive, and no longer. The study of life, its manifestations, is the

bb GENERAL PKINOIPLES OF MEDICAL SCIENCE.

object of the science of physiology ; in the state of health this vital in-
fluence, perpetually emanating from the Creator, exercises an absolute
sway over every portion of the body, and maintains all its functions in
order and harmony, both of sensation and action; and when these con-
ditions of order and harmony exist, "our indwelling rational spirit may
freely employ these living healthy organs for the superior purposes of
our existence."

Of this '^ vital principle^y bII aiithoYS on physiology and medicine
have written something.

" There is not," says professor Paine, "in the whole range of medical
literature, one author, however devoted to the physical and chemical
views of life, who does not evince the necessity of admitting a governing
vital principle^ as a distinct entity, distinct from all other things in
nature. I say, there cannot be produced one author of any considera-
tion, who does -not summon to the aid of his discussion a vital prin-
ciple whenever he touches upon the abstract phenomena of life."
Thus Hippocrates speaks of the "Phusis," Paracelsus and Van Hel-
mont of "Archseus," Stahl of "Anima;" medical men of the present
day of the "vital principle." " Visvitce, vis insitwP

But the reasonings of physiologists on this subject contain little of
scientific accuracy.

" To speak of the vital forces, to give them a definition, to interpre
phenomena by their aid, and yet to be ignorant of the laws which
govern them, is doing nothing, or rather is doing worse than nothing
It is to attempt an impossibility, it is to content the mind to no pur
pose, to stop the search after truth. To state that the liver separates
the elements of the bile from the blood by means of the vital force^
is merely to assert that the bile is formed in the liver. By thus varying
the expression, a dangerous illusion is established." *

In regard to the nature of the intelligence, or soul, and how it acts
upon the material parts, to aid in producing the phenomena of life,
we do not now propose to inquire. We are able to see its results, and
appreciate its wonderful influences, but the mode of its operation we
will not now attempt to explain. ' It pervades every part of the body,
and operates in a different manner on difierent organs. It gives rise to
sensation in the organs of sense, motion in the organs of motion, di-
gestion, absorption, assimilation, respiration, circulation, &c., in the
organs provided for these functions.

All modifications or derangements of structure, alter the peculiar
effects of this spiritual power ; for it acts only through the medium of
the organs as they actually exist. All deviations therefore from the
normal organization of parts, induces corresponding alterations in the
manifestations of the intelligence.

* Matteucci on Living Beings.

DOOTBINES EESPECTINa A VITAL PEINCIPLE. 69

The living intelligence has no particular location, but pervades every
portion of the nervous system, exercising a constant, and direct in-
fluence over every organ and tissue. This is clearly apparent from the
experiments of Philip, Stilling, Hall, and others, which prove, "that
the power of the heart and vessels of circulation, is independent of the
brain and spinal narrow," and ^' that the power of the muscles of
voluntary motion, vessels of secretion, and peristaltic motion of the
Stomach and intestines, are independent of the nervous system, and
that their relation to this system is of the same nature with that of the
heart and vessels of circulation, the nervous power influencing them in
no other way than as other stimuli and sedatives do."

From these and other experiments, Dr. Philip supposed, that the
vessels possess *^a principle of motion independent of their elasticity,"
and identical with galvanism. The experiments of Magendie and later
physiologists have shown that the hemispheres of the brain and cere-
bellum may be removed in a mammiferous animal, and it will continue
to experience sensation, perceiving odors, sounds, an4 rapid impres-
sions. Vision, however, is abolished,"

Dr. Dowler of New-Orleans, has instituted a series of experiments
on the alligator, which exhibit in the clearest manner the peculiar
operation of the living intelligence upon the organism. In one experi-
ment Dr. D. divided the muscles of the neck, the cervical vertebrae, and
the spinal cord, also the spinal cord between the shoulders and hips,
destroyed the sympathetic nerve, and removed the intestinal viscera,
"yet, for a period of more than two hours, the alligator exhibited com-
plete intelligence^ volitiQn^ and voluntmy motion in each and all
divisions of the hody. Itfelt^ saw^ defended itself ; showed anger^
fear^ and even friendly attentions to its heejper^ a Mach hoy P^ In
another experiment, " the upper portion of the skull, including a hori-
zontal stratum of the brain, was removed! The animal performed a
series of voluntary motions, intelligibly directed, to ward off injuries.
The entire hrain and the medulla oblongata were now removed^
without diminishing its power to direct its limbs to any part thai
was pained by the slightest touch of a pin orhnife, A metallic rod
was passed many times within the spinal cord, completely destroying
the spinal marrow beyond the hips. It was still found that both volun-
tary motion and sensation remained, though their manifestations were
greatly impaired."

Dr. D. concludes from these and numerous other experiments of a
similar nature, " that voluntary motion is neither directly communicated
from, nor regulated by the brain, or the cerubellum; that the muscles
in connection with the spinal marrow, perform voluntary motions for
hours after having been severed from the brain ; that these motions are
not only entirely independent of the brain, but may take place, though

70 GENEEAL PEmCIPLES OF MEDICAL SCIENCE.

imperfectly, after the destruction of the cord itself ; that the trunk^ as
well as the hrain, thinks^ feels, and wills, or displays psychological
phenomena / that the sensorium is not restricted to a single point,
hut is diffiised, though unequally, or in a diminished degree, in the
periphery of the iody y and that actions which take place after de-
capitation, as described above, are in absolute contrast to reflex
ACTIONS, being sensational, consentaneous, voluntary, and in other
respects dissimilar P Is it any more wonderful that the soul conduces
to the phenomena of digestion, assimilation and appropriation, when the
natural stimuli of these organs are presented to them, that sight
is appreciated when the natural stimuli of the eye, the rays of light,
are applied to this organ ? Is it any more singular that this spiritual
stimulus should endow each structure with power to exclude all noxious
substances, and select each its natural excitant, than that the sense of
hearing should only appreciate one voice in the midst of a hundred
other voices and instruments, whenever the will so directs ?

In order to acquire a correct idea of the functions of life, it is neces-
sary, in the first instance, to contemplate the body as a perfect machine
— adapted in every part by a definite and special organization, to re-
ceive different impressions according to the nature of the substances
or excitants presented, and the offices which they are destined to per-
form. "Without doubt, chemical and ^mechanical forces exercise an
important influence in the operations of this machine. The combustion
of oxygen with the carbon at the lungs, and in other parts of the system,
must develop heat, expansion and motive power, and mechanical causes
may operate somewhat in adding to this force, yet all of these influences
are wholly inadequate to accomplish and perpetuate the more com-
plicated phenomena of life. It is then essential that another important
agency should be ever3rwhere present, in order to enable the organs "to
respond properly to their specific stimuli. Consequently we have " super-
added to the body" an intelligence, which affords a specific stimulus to
every part ; acting solely through each particular structure as it exists,
and modified in its operation according to the modifications or altera-
tions in the organs themselves. If the structure of the eye is injured^
an imperfect image will be formed upon the retina, the intelligence will
manifest itself through this injured structure, and this sense will be
altogether impaired. If the structure of other organs be altered, so
that their natural stimuli cannot be brought to bear as usual, the opera-
tion of the spiritual stimulus will be modified in proportion, and dis-
ordered function result.

This mental or spiritual stimulus acts at each particular part speci-
fically, and in a measure independently of other parts, causing irrita-
bility of different grades in the muscular fibres, and exercising those
peculiar properties every where. The influence likewise which it

NEEVOUS FLUID. 71

exercises upon the body as a cause of disease has never yet been' pro-
perly appreciated.

In the ordinary waking ^state, the operations of the soul are mani-
fested directly through the media of all the physicalstructures, and
these manifestations are limited in extent and variety, and subject to
certain fixed laws, having reference to the sti^uctures and sthnuli act-
ing upon them. Thus, the power and extent of vision is determined
by the physical condition of the eyes and brain, (which furnishes them
with blood vessels and nerves,) and the number and intensity of the
rays of light which strilce the retina. Ligld^ in this instance, is the
rnaterial stir/iulus or rather the undulatory nerve-force, which passes
through the structure of the eye in the same manner as it passes
through an optical instrument, producing the reflection of images upon
the retina in a manner analogous to images formed in the oaTnera of
the photographer. The soul takes immediate cognizance of these
images upon the retina, in precisely the same manner that it recognizes
the images in the cmnera obscura. It is worthy of note, that these
images may be formed upon the retina, and yet the soul be entirely
unconscious of them; so may an absent-minded man look into the cOr
mera obscura^ filled with reflected figures, and derive no impressions
from them. Without this invisible, incomprehensible, and eternal soul,
the eye would be but a mere optical instrument, perhaps taking the
first rank among such instruments, but entirely on a par with them, and
subject to similar laws. No imponderable agent, like electricity,
magnetism, or galvanism, or what has been termed animal nervous fluid,
could ever enable it to appreciate impressions, or perform a single a-ct
of intelligence.

Every structure of the organism, whether situated within the cranium,
chest, abdomen, or in any other part, is in a similar condition in rela-
tion to the soul, and without its presence and influence, is subject only
to the ordinary laws of matter.

It is the office of the soul to preside over the necessities of the phy-
sical man — to guard against and ward off injurious influences, and
to respond to all impressions made upon the textures. So long as the
normal physical condition exists, and no undue influence is exerted
upon the mind, a spiritual or vital equilibrium is maintained through-
out the system ; but if a part be attacked by an enemy in the form of
inflammation, or if an undue impression is made upon the mind, this
equilibrium is disturbed, — the spiritual force is unequally distributed^
and disordered action follows.

We append a few examples to illustrate the influence of mental im-
pressions in modifying the action of the tissues : an individual in per-
fect health, and undisturbed by any external influence, finds himself in
a gallery of paintings. At one point a devoted daughter is seen brav-

12 GEKEEAL PEIKCIPLES OF MEDICAL SCIEKGE.

ing the horrors of a foul dungeon, to offer from her own breast suste-
nance to an aged and starving father, and while we look, the lachrymal
glands are excited, and unbidden tears flow freely. At an other point,
an inhuman monster has seized an innocent child, and is in the act of
dashing out its brains against the wall, and while we gaze, the blood
mounts to the brain,'the cheeks glow with indignation, and the heart
throbs violently at the bare contemplation of the outrage. Another
tableau meets the view, and we see the executioners in the act of cast-
ing a struggling criminal into a den of poisonous serpents, and, as we
behold the reptiles coiled up for a deadly spring, with fiery eyes, and
forked tongues, the blood forsakes the surface, the stomach sickens,
the heart sinks, and a cold shudder steals over the whole system. An-
other scene presents itself; we behold a table loaded with the most
tempting viands and fruits, and an immediate change occurs in the sa-
livary glands, the mouth fills with saliva, the stomach indicates its
want, and a general perturbation of the digestive system ensues. The
. mere sight of an epileptic often induces a corresponding complaint. in
others ; the indulgence of bad habits in one member of a family like
snuffling, distortion of the mouth, eyes, &c., frequently bring about the
same habits in other members of the family. Violent emotions from
sudden intelligence, whether good or bad, often induce diarrhmaSy
syncope, catalepsy^ apoplexy ^ mania^ &c. ; fear and apprehension are
most powerful predisposing Qd^usQ^ of disease, and when excessive^
often act as exciting csLUses, particularly during the prevalence of epi-
demic or contagious affections, as cholera asphyxia, smallpox, yellow
and typhus fevers^ &c. Protracted grief is a common cause of chronic
diseases, like dyspepsia, jaundice, neuralgia, hypochondria, phthisis
pulmonalis, k^a. Intense and exclusive application to any subject,
eventually causes disease of the brain and nervous system, and mental
derangement. The hypochondriac, who suffers under the effects of
morbid fa,ncy, continues to feed his malady by pondering over his ima-
ginary ailments ; the monomaniac, as he dwells upon his delusion, fans
the flame that is consuming him. If an individual in the most perfect
health be told by several different persons that he looks pale, haggard,
and sick, it is more than probable that the impression will exercise so
powerful an influence, that he will actually feel sick, and take to his
bed ; we have witnessed more than one example of this kind.

The case of the criminal is often quoted, who died of fright by the
;simple flowing of tepid water over his limb, while the attendants made
suitable remarks on the effects of the loss of blood, till fatal syncope
was produced. Professor Bennett says, a butcher was brought into
jthe ofiice of a druggist, suffering from a terrible accident. " The man
on trying to hook up a heavy piece of meat over his head, slipped, and
the sharp book penetrated his arm so, that he was himself suspended.

DYNAMIC INFLUEiSrCE. i6

On being examined, lie was pale, almost pulseless, and expressed him-
self as suffering acute agony. The arm could not be moved without
causing excessive pain, and in cutting off the sleeve, he frequently cried
out; yet when the arm was exposed, it was found quite uninjured, the
hook having only traversed the sleeve." In disease also, the manner,
bearing, and expression of the physician, often exert the most surpriz-
ing effects upon the patient, either in ameliorating or aggravating his
malady. Most diseases are attended with an exalted state of the
nervous system, and with a highly sensitive and irritable condition of
the mental faculties. In this condition, a doleful expression of counte-
nance, or words of doubt, discouragement and sadness, are often capable
of plunging the patient into the most profound state of mental and
physical depression, and thus aggravating, to a serious extent, his ma-
lady ; while on the other hand, a cheerful face, a lively and agreeable
manner, and words of hope and encouragement usually exercise an
influence of the most favorable character, and conduce very materially
in bringing about a curative action of the organism. It should never
be forgotten, that courage, hope, confidence, and a cheerful state of
mind, are powerful tonics, and often enable the healthy system to resist
the influence of contagious, epidemic, and other noxious impressions,
and the sick organism to combat successfully the destructive effects of
disease ; while fear, apprehension, grief, despair of recovery, sadness,
and depression of spirits, by impairing the resisting powers of the eco-
nomy, become both predisposing, and exciting causes of disease. Show
me a physician w^ho has attained a high reputation in the treatment of
difficult, and dangerous cases of disease, and I will have confidence,
that he is one who carries a cheerful face; who delights in dwelling
upon the bright and pleasant things of life, rather than upon those
which are gloomy and dismal ; and who does not fail to infuse into his
patients, and all around him, confidence, hope, and comfort. The ex-
pression and bearing of such a man always act as a beacon of hope,
to arouse the sinking energies of the patient, and to encourage him to
strive against the depressing influence of his malady. In these and
other analogous instances, it is the intelligence alone which is operated
on and Avhich diffuses its influence, not over any vital properties of the
organism, but upon the respiratory, circulatory, digestive, and nervous
systems.

We have, then, constantly operating upon the machine first, what may
be termed the material or natural stimuli, and second, the immaterial
or spiritual stimuli, both of which are absolutely essential to the
continued performance of the functions. In some parts of the organ-
ism, these material excitants, must be constantly present; in order that
the system may be kept in operation. The heart and blood vessels,
and the respiratory organs must be incessantly acted upon I y the

74 GENEEAL PBINCIPLES OF MEDICAL SCIE]SrGE.

blood and atmosplieric air, in order to ensure life. Other parts, like
the stomach, lacteals, capillaries, &c., may be deprived of their natural
stimuli for a length of time without causing death, but not without
inducing derangement of function, or causing disease. These "iuateria
stmiuli^ not only exercise a highly important influence in the phenc-
mena of life, but it is upon them that morbific and other noxious im-
pressions are often made in causing disease. According to Liebig,
" the slightest action of a chemical agent upon the blood, exercises an
injurious influence." Any material deviation, then, from the natural
properties of the inspired air, or the other stimulants of the organism,
must constitute a source of disease.

The other agency exerts a not less important influence over all parts
of the body, and gives rise to its manifestations in accordance with the
peculiar organization and modification of each structure.

The operation of this intelligence upon the organs produces that
peculiar state which enables them, when supplied with their material
stimuli^ to accomplish their functions. It manifests its power in the
capillary system in enabling these vessels to exclude the red globules ;
over the lacteals. In enabling them to exclude all but the nutritious
portions of food, over the organs of involuntary motion, in enabling
them to respond with unformity and regularity to their material exci-
tants; over the nerves of sensation and motion, in enabling them to take
cognizance of injurious foreign impressions, and to exercise voluntary
motions ; over the organs of the special senses, in enabling them to
appreciate sight, hearing, smell, taste, and touch. This spiritual in-
fluence operates only through the medium of these organs and tissues,
developing specific and harmonious manifestations, according to the
peculiar use and structure of each part. Under its guidance the mole-
cules are appropriated and become a part of the organism. Through
the same influence the system is enabled to resist, to a certain extent,
morbific and other injurious impressions. It is this stimulus which
endows each tissue with its specific irritability, causing eacK part to
recognize and respond to its own natural material excitant, and offer
resistance to the application of all disturbing agencies.

The soul does not leave the body, until the structures are so much
injured, that the functions all cease operation. Many organs may be
destroyed or rendered incapable of transmitting mental or spiritual
impressions, yet the intelligence, entire and unaltered of itself, will
still pervade the remaining portions of the organism. It will still mani-
fest itself just so far as it finds normal organs and tissues to operate
through, or manifest an influence upon. The material parts alone may
be impaired or obliterated, but so long as there is life, the immaterial
part must pervade the body unaltered, although its manifestations may
be entirely changed.

PERYERSIONS OF HEALTH. — NATTJEE OF DISEASE. 75

PERVERSIONS OF HEALTH.— NATURE OF DISEASE.

The boundary between health and disease, though in some degree
familiar to all, is not easily defined. Health in perfection is perhaps
never seen in such a world as ours. It is usually described as a con-
dition of the organism, in which there is "freedom from pain and un-
easy sensations, and freedom from all those changes in the structure oi
the body that endanger life, or impede the easy and effective exercise
of the vital functions." Departures from this happy state of life present
themselves to us both in form and degree in infinite variety.

Disease consists in some deviation from a state of health. It may
extend no farther than to some simple derangement of function, in which
no alteration of structure is discovered or suspected; or maybe at-
tended with appreciable change of texture, and may run a longer or
shorter course, with or without modification from medical treatment.
The former of these grades of disease may often be properly assigned
to the care of the hygienist, who, by dietetic regulations, by correct
employment, food, drinks, temperature, and pure air, may restore the
invalid to a state of health. The physician must also be a practical
hygienist, and able to employ auxiliary agencies with scientific pro-
priety, as well as to select with certainty the necessary specific remedy
On the "nature of the relations of the sciences of Therapeutics and
Hygiene," Dr. Dunham remarks :

" That the province of Hygiene is, to discover whatever causes may
have contributed to induce or perpetuate the diseased condition, and if
possible to remove them.

" That Hygiene alone is sufficient to restore many sick persons to
health, and that it is in most cases an indispensable aid to Therapeutics.

"That Therapeutics Q6n(tQYn^ herself only with the discovery and
selection of an individually-specific remedy for each individual case of
disease ; which is done in accordance with a therapeutic law. This
law may be the homoeopathic formula, or it may be some broader
generalization, — but there can be but one law of this kind.

" That in so far as Hygiene is concerned, homoeopathists and allo-
paths occupy common ground, — the philosophy of the science being
the same for both, however modified and shaded in practical application
by the diff'erent therapeutics of the two schools.

" That in Therapeutics alone, that is, in the discovery and selection
of the individually-specific remedy for each individual case of disease,
do we differ radically from the old school of medicine,— the allopaths
having in fact no science of Therapeutics whatever, their philosophy
of cure leing an application of the principles of Hygiene to all dis-
eased conditions.'^

* Homoeopathy, the science of Therapeutics.

76 GENERAL PEINOIPLES OF MEDICAL SCIENCE.

THERAPEUTICS*

There are but three modes of treating disease. They are distin-
guished as follows :

1. The SommopathiG^ which only is salutary and efficacious. It
"alone leads in a direct way to a mild, sure and durable cure, without
either injuring the patient, or diminishing his strength."

2. The Allopathic or Seteropathic. Without regarding what is
really diseased in the body, it attacks those parts which are sound, in
order to draw oft* the malady from another quarter, and direct it to-
wards the latter.

3. The Antipathic or Enantiopathic^ which is merely palliative.
This consists in paying attention to only a single symptom or feature

of the disease,— -that of which the patient complains most loudly, and
prescribes a remedy which may palliate that. For pains of every de-
scription, Opium, which may benumb the senses and allay the pain.
For diarrhoea, the same remedy to stop the peristaltic action, or an
astringent to suppress the secretions. For insomnolence, the same
remedy. For long-continued constipation, purgatives. For habitual
debility, Wine.

Of these different modes of treating disease, the first alone is truly
efficient and salutary. The reason that this is true, and that all the
others are pernicious, says Hahnemann, "is founded upon the dif-
ference which exists between the p^7Vy'mary o^ction of every medicine,
and the reaction, Q>r secondary effects, produced by the living organism
(the vital power;." ^

At the presejit time there exists no uniform or general system of
therapeutics, because there is no theory of disease in which universal
confidence is reposed. The medical world being divided into several
distinct schools, each inculcating a different doctrine concerning patho-
logy and the methods of cure, and all endeavoring to sustain their
favorite systems, without much regard to accura,cy respecting facts, or
to logic in their inductions, it is not surprising, that the science of
medicine is so often looked upon by the public with distrust and dis-
respect. We behold the vitalist denouncing the doctrines of the
chemist and mechanician, as inconsistent and highly dangerous in
practical operation, while all agree in ridiculing that system which is
alone founded on accurate observation of facts, homoeopathy.

It is doubtless true, that many new and valuable ideas may be de-
rived from each of these conflicting schools by the medical philosopher,
whose sole object is truth. Indeed, the coincidence of opinion between
the father of homoeopathy and many of the most prominent advocates
of the vital theory, like Paine, Bichat, Philip, &c., in regard to physio-

* Halmemann, Organon, § 63.

THERAPEUTICS.

logy and pathology, is remarkable. These eminent authors not only
agree, respecting the "properties and laws of healthy beings," but they
concur as to the changes and modifications which take place in dis-
eased states of the organism. Although they entertain totally different
views concerning the practical arppllcation of remedies, it will be ob-
served, that the allopath often adopts the precept ''simiUa similibuSj^l
in effecting his cures.

Nor are there men wanting, — -men, who stand high in the ranks of
allopathy,r— who unhesitatingly place the pathological and therapeutical
doctrines of homoeopathy, far above those of either the chemical or
physical schools.

Thus Paine in his ^'Institutes of Medicine^^ observes : "It is due to
truth {fiat justitia mat coduon)^ that the physiologist concedes to the
homoeopath, that his hypothetical views may be directed by an enlight-
ened understanding of the properties and laws of healthy beings.
Upon this ground, indeed, his hopes can alone repose; and even his
doctrines in pathology and therapeutics are a thousandfold better, more
rational, more consistent, more conducive to health and to life, than
any or all of the tenets of the chemical or physical schools."

We shall not be surprised at this concession, when the opinions of
Hahnemann are contrasted with those of many allopathic authors who
have written since his days. ,

The vitalists hold, " that all disease consists in modification of the
vital properties and a consequent change of function, and is, therefore,
only a variation of the natural states, that the artificial cure consists
in a restoration of these properties and functions, by making upon the
former certain impressions, which enable them to obey their natural
tendency to a state of health; that remedial agents of positive virtues
operate like the truly morbific, but less profoundly in their therapeutical
doses, and that the philosophy of their cure consists in establishing, in
a direct manner, certain morbid alterations in the already diseased pro-
perties and actions of life, which are more conducive to the natural
tendency that exists in the vital properties to return from a morbid to
their natural state." [Paine)

Hahnemann, in his " Orgam^on^'^ says : "It is solely the morbidly af.
fected vital principle which brings forth diseases : that in disease this
spontaneous and immaterial vital principle, pervading the physical or-
ganism, is primarily deranged by the dynamic influence of a morbific
agent, which is inimical to life. Only this principle, thus disturbed,
can give to the organism its abnormal sensations and incline it to the
irregular actions which we call disease."

So also of the operation of remedies, Hahnemann has it, "that the
brief operation of the artificial morbific powers which are denominated
medicinal, although they are stronger than natural diseases, renders it

78 GENERAL PRIISrOIPLES OF MEDICAL SCIENCE,

possible that they may, nevertheless, be more easily overcome by the
vital energies, than the latter^ which are weaker. Natural diseases,
simply because of their more tedious burdensome operation, can not be
overcome by. the unaided vital energies, until they are more strongly
aroused by the physician, through the medium of a very similcbv^ yet
more powerful morbific agent, (a homoeopathic medicine). Such an
agent, upon its administration, urges, as it were, the instinctive vital
energies, and is substituted for the natural morbid affection hitherto
existing. The vital energies now become affected by the medicine
alone, yet transiently ; because the medicinal disease is of short
duration."

The vitalists of both schools also suppose that natural, morbific and
remedial agents, possess certain peculiar and distinct properties, which
enable them to exercise an influence only on particular parts of the
system through the means of particular nerves ; ^^ passing over^ in the
fulfilment of this laio^ various intermediate nerves of more direct
anatomical connection.'''^'— [Paine)

Although we are not advocates of the vital theory thus stated, yet it
must be conceded that this principle of elective affinity is so universal,
as applied to the operation of the morbific and remedial agents, that
the influence which any substance of either class exerts upon the or-
ganism, may with propriety be denominated its sfecific effect. The
miasms of plague, of intermittent, yellow, and certain other fevers ; the
infection of contagious diseases ; the virus of hydrophobia, syphilis,
gonorrhoea, &c., all produce peculiar and specific effects upon the sys-
tem. Each of these substances possesses the property of selecting
that tissue for which it has an affinity, and of expending its entire pri-
mary action upon the particular part selected.

It is owing to this specific law, that medical men have been able to
classify diseases ; to predict with certainty, that the exposure to the
influence of morbific agents, under certain circumstances, will give rise
to abnormal action in certain parts, attended with a definite and uni-
form train of symptoms.

It is also in virtue of this specific law, that medicines may be admi-
nistered which operate with certainty upon particular tissues and or-
gans and effect those primary and sympathetic modifications in dis-
eases of the organism, which enable nature to bring about safe and
speedy cures.

One of the chief objections urged against the therapeutical doctrines
of homoeopathy is the supposed " fallacy of reasoning from the effects
of remedial agents upon healthy to morbid conditions." [Paints In-
stitutes of Medicine) The reason adduced for this opinion, is the
fact that diseased parts become modified in their, action, and far more
susceptible to the operation of remedies than when healthy. This last

THERAPEUTICS. 79

statement is doubtless true, and it stands, as we shall endeavor to show,
at the foundation of the homoeopathic method of administering me-
dicines.

Although the axiom, " contraria contrariis opponenda^ is almost
universally acknowledged as a principle of faith among the diiFerent
schools of allopathia, so far as theory is concerned, yet mpractice^ the
principle " similia similihics curantur,''^ is as we have before observed,
not unfrequently adopted.

In order that a clear understanding may be acquired of the manner
in which medicines operate, as exhibited by the old and new schools,
we shall attempt to demonstrate : —

1. That most morbific and remedial agents operate specifically and
with much uniformity, both in health and in disease, as causative and
curative agents.

2. That all drugs produce upon the Ymm^-n. ho({j prhnary ^iiidi se-
condary effects, the first of which appear speedily, and when the dose
has not been excessive, are of short duration, and are then succeeded
by the second, which are of opposite character and permanent.

3. That in disease^ the susceptibility of the affected parts to the action
of remedies is vastly greater than of the same parts when in health.

4. That medicines, when administered in crude form, and in large
doses, according to the doctrines and ordinary practice of the old
school, whether applied directly to the diseased organ or tissue, or to
a healthy structure, remote from the diseased part, are not only incom-
petent to eradicate disease in a safe and speedy manner, but generally
serve to aggravate the already existing symptoms, and by superindu-
cing additional medicinal disease, complicate, to a serious extent, the
original natural affection.

5. That when a curable natural disease has been excited in the or-
ganism, attended with a definite train of morbid symptoms, a medicine
capable of causing (in large doses,) a similar series of symptoms, in
health, will become speedily curative of such natural disease, if admi-
nistered in the attenuated doses of homoeopathy.

SPECIFIC EFFECTS OF MORBIFIC AND REMEDIAL AGENTS.

All are aware that the natural poisons of certain animals, the virus
of hydrophobia, syphilis, gonorrhoea, and sycosis ; the miasms of plague,
and of yellow, typhus, and intermittent fevers; the infection of con-
tagious diseases, &c., when introduced into the circulation, produce
specific effects upon the human system, and give rise to definite and
easily recognized symptoms.

There are other morbific agents, like intense and protracted heat and
cold, atmospheric vicissitudes, excessive physical and mental exertion,

80 GENEKAL PRINCIPLES OF MEDICAL SCIENCE,

violent emotions, &c., that operate in a more general, but not less spe-
cific manner. Their operation, when carried so far as to become mor-
bific, induces debility of the nervous system ; loss of irritability in the
capillary vessels, which makes them incapable of excluding the red
globules, and as a consequence, developing augmented heat, swelling,
redness, and pain.

The influence of almost every agent, whether morbific or medicinal,
appears to possess a kind of elective afiinity for some particular organ
or structure of the organization." This fact is so apparent in regard
to mc>r5'^o agents, that it scarcely requires notice; but there are many
authors who still entertain doubts respecting the specific action of me-
dioines. An attentive examination of the following facts, must, how-
ever, settle that question satisfactorily in the minds of aU impartial
inquirers.

Remedial agents operate in the same specific manner, both in health
and in disease ; but with the difference that in the latter condition, only
a very minute quantity of the specific agents is requisite to produce a
salutary impres sion, on account of the augmented suspectibility to
remedial impressions which diseased parts acquire.

1. "A medicine administered in certain doses, and during a certain
period of time, can produce pathological lesions analogous to those
that characterize certain diseases,"

2. "This same medicine, given to a healthy individual, on the same
principles, produces the characteristic symptoms of the diseases
whose pathological lesions it gives rise to."

8. " This medicine is a specific in these same diseases."
4. " Specificity is not therefore an isolated fact, but the law which
should guide medical treatment." [Des specifiques enmedeGine^
Paris; jpar L. J, J, Molin),

The experiments of Magendie, Blake, Pereira, Eau, Liebig, Miiller,
Orfila, Griesselich, Molin, Matteucci, and Philip, prove conclusively,
that most morbific and remedial agents, when given in massive doses,
produce their effects after having been absorbed into the blood. It
has also been proved with equal certainty, that foreign substances,
when absorbed into the circulation, are conveyed to those structures
for which they have a special affinity, and there make a specific im-
pression, which modifies the function of the part, according to the na-
ture of the agent, and predisposition of the individual. The blood
serves as conducting medium merely, and if the absorbed substances do
not possess the power of exercising an influence upon any tissue, they
may continue to circulate through the lungs until inspired air gradually
neutralizes them, or they may remain for an indefinite length of time,
(as sometimes happens in cases of hydrophobic virus, and fever
miasms, without affecting the system), and yet retain their activity

SPECIFIC EFFECTS OF MOEBIFIC AKD REMEDIAL AGENTS. 81

The reason of this may be, that the tissues upon which they act, are
in so perfect a state of vigor as to be able to resist the power of the
noxious agent, until some cause shall enfeeble the part to be aifected,
and thus predispose it to receive the injurious impression.

It will not be denied, that both in healthy and diseased states of the
organism, Cantharides, Copaibse, Cubebs, the Turpentines, Juniper,
Squills, Colchicum, Digitalis, Apis-mel. Cajeputi, and most other
diuretics, produce their effects by acting directly or speoifiGally w^on
the kidneys, as topical irritants; that the preparations of Mercury,
Nitric-acid, Iodine, &c., exercise a direct and specific action upon the
glands, mucous membranes, and skin; that Senega, Phosphorus, Ipeca-
cuanha, tartarized Antimony, (whether taken into the stomach, or in-
jected into the veins), and many of the resins exercise a specific action
upon the lungs ; that Aloes, Gamboge, Colocynth act specifically upon
the stomach and rectum, while Senna, Rhubarb, Scammony, Jalap,
and certain other cathartics, spend their effects upon all portions of
the intestinal canal; that Ergot, Savin, Pulsatilla, Madder, Tansy, &c.,
operate speciJiGaUy upon the uterus ; that Belladonna, Opium, Stra-
monium, Strychnine, Hyoscyamus, Conia, and Coffee impress specifi-
cally some portion of the nervous system; and in a word, that almost
every drug impresses certain tissues in preference to others, and that
a knowledge of the manifestations to w^iich these different impressions
dve rise, can alone enable us to combat diseases. That the above
enumerated substances are actually absorbed, and exert a topical effect,
IS apparent from the fact, that they have often been detected in the
blood, secretions, excretions, and even the solids of the body.

It is asserted by Flourens, "that Opium acts sjjeGifically on the
cerebral lobes ; that Belladonna in a limited dose, aflects the tubercula
quadrigemina, and in a larger dose the cerebral lobes also; that Alco-
hol, in a limited dose, acts exclusively on the cerebellum, but in a larger
quantity, it affects also neighboring parts ; and lastly, that Nux-vomica
more particularly affects the medulla-oblongata." He also states,
" that in birds, it is possible to observe, through the cranium, changes
of color, (some alterations in the vascular condition of the parts) which
these agents affect in the brain." Pereira, in his Materia Medica, also
declares, that "the ammoniacal, empyreumatic and phosphoric stimu-
lants, containing Ammonia and its salts, the empyreumatic oils. Phos-
phorus, Musk, and Castoreum, all agree in producing a primary and
specifiG effect on the nervous system, the energy and activity of whose
functions they exalt. On account of their specific influence over the
nervous system, they are administered in various spasmodic or con-
vulsive diseases, especially in hysteria, and also in epilepsy and chorea.
The beneficial influence of some of the vegetable tonics, (as Cinchona),
in intermittent diseases, should probably be referred to the specific

Vol. I.— 6-

82 GENERAL PEINCIPLES OF MEDICAL SCIENCE,

effects of j:liese agents on tlie nervous system. The preparations of
Arsenic, Silver, Copper, Bismuth, Zinc, &c., are usually, but I think most
improperly, denominated tonics. They are agents, which in small and
repeated doses, as well as in large and poisonous doses, speGifically
affect the nervous system."

We are also assured by Liebig, in his work on animal chemistry
that ^^we can by remedial agents exercise an influence on every part
of an organ, by substances possessing a well-defined chemical action."
It will be observed, that we have adopted, in part, the views of Miiller,
in regard to the operation of morbific and remedial ' agents. This
distinguished physiologist supposes, that the blood is only the "vehicle
of introduction," and that as it passes through the tissues of different
organs, the medical particles with which it is impregnated " act on one
or more parts, which are endowed with a peculiar susceptibility to
their influence." He also supposes, "that a change is effected in the
composition of the organic mat.ter of the parts acted on."

That medicinal substances induce modifications in the functions of
the organs by topical action, is proved, as we have before observed,
from the fact, that medicinal particles are often found in the ex-
cretions of the affected part. The inference must follow, from a careful
consideration of all the facts bearing upon the subject, that the functions
of the organism are generally morbidly altered by the direct action of
noxious substances. (For further proofs respecting the doctrine of
absorption and topical action of drugs, see the experiments of Miiller,
Tiedemann, Gmelin, Magendie, Matteucci, Liebig, Rau, Flourens, I)u-
trochet, Blake, Hering, Mayer, Christison, Orfila, and Dumas).

In regard to the mode in which these substances operate, we suppose
that their primary impression is made upon the sentient extremities of
the nerves, impairing their integrity, and rendering them incapable of
conducting the spiritual stimulus (which is an essential condition to
imiahility^) to the extreme vessels.

It must be borne in mind, that in all inflammations, the capillaries
are the "instruments of disease," that the primary impressions of all
deleterious agents are made upon these delicate structures, and that
all of our remedies must be directed with reference to the state of
these vessels in curing disease, "upon these vessels, all remedial agents
exert their curative effects, whether by their direct action, or through
the instrumentality of the nervous power." {Paine),

The extreme terminations of the nerves are so highly impressible,-
that the very minutest quantity of a specific agent is- capable of pro-
ducing prompt and decided effects, while the same agent would prove
powerless if applied to the larger nerves. Thus it is that imponderable
substances and mental emotions are so often the causes of diseaseo
Here we have one reason, also, why medicines, when administered ho-

SPEGIFIO EFFECTS OF MORBIFIC AND EEMEDIAL AGEKTS. 83

moeopatliicallj, produce those happy modifications in the affected parts
which dispose them so speedily to recovery. In connection with this,
if we take into consideration the extreme sensibility which diseased
parts acquire to the operation of medicinal agents, we shall be unable
to doubt the propriety of administering medicines according ^to the
homoeopathic method.

Miiller supposes, that when impressions are made by specific sub-
stances, "changes are effected in the composition of the organic matter
of the parts acted on." Of this, however, there is no satisfactory evi-
dence. On the contrary, we know positively, that very many cases of
: disease occur without giving rise to any change whatever in the organic
construction of the parts affected.

One of the first indications generally observable in an abnormal state
of an organ or tissue, is a loss of tone, or irritability and perverted
function of the capillary vessels. In the experiments performed on
the blood by Philip, Alston and Gallois, it was observed, that the
smaller vessels were the first to succumb to foreign influences, and
then, if the potency of the agent were increased, the larger vessels
would become affected.

Now, when we reflect, that irritdbility is dependent, 1., upon a nor-
mal organization of parts ; 2., a regular and uniform supply of natural
material stiinuli, the arterial blood, &c., and, 8., a healthy action of
the mind, in order that the spiritual stimulus shall make its due im-
pression, we can readily conceive, how slight a cause, moral or physical?
morbific or remedial, may disturb or impair this irritability, and thus
induce disease. " Every part of the organism depends for the per-
formance of its proper functions on the receipt of arterial blood and of
nervous influence ; so alterations in the supply of either of these essen-
tials may modify or even suspend the functions of a part." ( PereiraJs
Materia Medica)

The nerves are simply the conduGtors of the intelligence, and so
long as their integrity, tone or conducting power remains unimpaired,
this essential condition of irritability will remain. If, however, any
cause acts upon them in such a manner, as to injure or destroy
this important property, the stimulus of the superintending spirit is
not transmitted, and, as a consequence, disease must result from the
absence of one of the important requisites of irritability or con-
tractility.

Injurious impressions may be made upon the extreme nerves either
by deleterious matters absorbed into the blood, and brought into
direct contact with them, or by certain external applications, like
electricity, magnetism, heat, cold, exercise. Inflammation may be
excited by the operation of either of these causes, by a primary
effect upon the sentient extremities of the nerves, which induces.

84: GENERAL PEINOirLES OF MEDICAL SCIENCE.

loss of tone and conducting power, and, as a consequence, loss of
irritability and resisting power in the capillaries. This impression
is not made, as some theorists would have it, upon an iTmnaterial
jprinciple^ but upon something material, tangible and demonstrable,
viz., nerves themselves.

Poisons and other noxious substances, when taken into the blood,
are rapidly conveyed to all parts of the body; and when they ar-
rive at the structures, upon which they have a specific action, nature
makes an effort to expel them through these particular parts. If
the substance be active in its effects, the impression which is made
upon the minute nerves of the part, will be in a corresponding
manner severe. The length of time required for foreign substances
to produce their effects is extremely variable. Some articles, like
several of the salts of Potash, Juniper, the Turpentines, Asparagus,
Indigo, Madder, &c., are expelled through the urinary organs in a
few moments, while other substances may remain in the blood for
an indefinite period of time, or until some predisposing cause shall
act upon the system in such a manner as to augment its suscepti-
bility and place it in a condition to be affected by the morbific
agent. In some instances, the morbific agent remains harmless in
the circulation for months, and even years, when suddenly some
tissue becoming enfeebled and incapable of resisting the action of
the specific agent, the disease in all its violence bursts forth. In
cases like these, it is quite evident, that the injurious impressions
can not be made upon the mtal properties of parts, for the effects
must be sooner propagated and rendered apparent. Neither can we
suppose with the advocates of the chemical hypothesis, that the
constituents of the blood become altered and contaminated with the
peculiar miasms or virus, for such blood introduced into the circu-
lation of a healthy individual gives rise to nothing like the original
disorder. We again repeat, that the blood is simply the vehicle
which conveys the poison, and that no effects are produced until
the structure for which the poison has the greatest affinity, has
become ready from predisposing cause, to receive the impression of
the deleterious agent, and thus is specifically affected.

Why it is, that morbific and remedial agents select particular
organs and tissues to exert their action upon, we do not know ;
but that such is the fact, all medical observers will bear witness.
Nor is it more surprising, than that some of the natural fluids, like
the urine, gastric juice, bile, &c., remain with impunity in some parts
of the body, while if they gain admission to other parts, as the
cellular substance or peritoneum, they occasion inflammation, sloughing
and death.

Those substances in nature, which in certain modes of application to

SPECIFIC EliTECTS OF MORBIFIC AND REMEDIAL AGENTS. 85

tlie living organism produce immediate deatli, and in other degrees of
their power only derange the healthful operations and produce disease,
^re usually known under the name of -poisons.

Poisonous substances produce disease by three different modes : ^

1. By local destruction or irritation of the living surface to which

they are applied.

2. By producing changes in the composition of the blood.

3. By direct changes in the nervous system.

I. The first class of poisons embraces all substances that produco
their effects in accordance with the laws of organic chemistry: such as
concentrated acids, alkalis, some salts and metallic oxides, also some
kinds of acrid vegetable matter. The effects of these articles vary
widely according to the quantity in which they are employed, and
they become deadly poisons or beneficent remedies according to
the conditions under which they are used. A small quantity of
Arsenic taken into the stomach excites a severe inflammation, with
vomiting and diarrhoea, by which the irritated organ endeavors
to expel the offending substance. If we take the one-thousandth
part of a grain, a series of phenomena of a different character will be
elicited. The minute particles of the poison having been tolerated in
the stomach, pass out of it with its other contents; and may be ab-
sorbed with the chyle from the inner surface of the intestines and con-
veyed into the general circulation without producing violent symptoms.
Thus the effect of a corrosive poison is entirely changed by merely re-
ducing the dose. We will hereafter see, that when the dose is reduced
to a quantity sufficiently small and finely attenuated, the agent would
produce no perceptible effect on a person in health ; but that the
same dose, charged with the dynamic force, which is developed by
the process of attenuation, is capable of exerting a curative influence
in a patient affected by a disease which is similar to that which Arsenic
is capable of causing.

Of this dynamic force, which is developed by trituration, and succus-
sion in the preparation of homoeopathic attenuations, Hahnemann says :
The discovery by which this development of the medicinal powers of
drugs is effected " is of inexpressible value^ and so undeniable, that
those who, from a w^ant of knowledge of the resources of nature, con-
sider homoeopathic attenuations as 'tnere meGhanical divisions of the
original drug, must be struck dumb when they consult experience."

II. There are other substances whose particles in their ordinary state
adhere so firmly together that in their unchanged condition they mani-
fest no action upon the human organism except in their chemical rela-
tions. Metallic gold, silver, tin, vegetable coal, silicea, &c., are en-
tirely inert, even if taken in large quantities. But these apparently

* Dr. H. Gouilon.

86 aENERAL PRINCIPLES OF MEDICAL SCIEINXE.

powerless substances are, nevertheless, charged with a latent force, anc|
by trituration with an inert substance, as sugar of milk, become changed
into active medicinal agents. And the more perfectly their surface is
atomized by trituration, i, e,, their atoms are liberated, " the more their
latent peculiar electricity is developed, and at the same time transmitted
to another vehicle, as is done by every electric-machine." They have
then become potentized^ dynamized^ having " their latent force ren-
dered active through the solution of cohesion." In order that this con-
cealed or latent power might be eifectually developed, Hahnemann
directed that in preparing the first triturations, two- whole hours should
be consumed.

III. SubstanceSj cMefiy Yegetalle^ which are actwe in their na-
tural state, — Of these the number is very large, and it is remarkable
that the chemical composition of such as are feeble in their actioA7, is
almost the same as that of others which are virulent poisons. I'bey
are all active in their natural state ; but, as remedies, they require to
be used in small quantities, and they become highly useful in remov-
ing diseases and symptoms, such as they are capable of producing.

ALLOPATHY.

It would be very difficult to give a correct definition of the above
term. The axiom, which is adopted by a portion of the disciples of
the allopathic school, and upon which their hypothetical doctrines ar
founded, is ''contraria contrariis oj)ponendaP Although distinctions
are recognized between the antipathic ov palliative^ i\iQ allopathic or
heteropathic^ and the Ghemical methods of practice, yet in point of
fact, they may all with propriety be resolved into one and the Si*me
school. All employ venesection, emi^cs, purgatives, diaphoretics, and
alteratives, to reduce inflammations ; opium to allay pain and suppress
unnatural discharges ; bark, iron, and brandy, &c., as tonics ; blisters,
setons, moxas, issues and escharotics to produce counter irritation ; re-
vulsives, derivatives, and indeed all of those means, which are termed
allopathic.

Allopathists do not, however, uniformly adhere to any of the above
doctrines, but often unconsciously encroach upon homoeopathic ground,
and, by practicing according to the law of " similia similibus^^^ effect
their speediest and safest cures.

Thus Rhubarb and Calomel, when administered in large doses during
health, cause irritation or inflammation of the membranous tissue of the
bowels, as is indicated by the griping pains, and discharges of watery
or mucous fluids ; yet these are favorite allopathic remedies for diar-
rhoea and dysentery ; Copaiba, Cubebs, Turpentine, and Cantharides,
when given in large doses in health, induce inflammation of the mucous
membranes of the urino-genital apparatus ; yet these specific medicines

ALLOPATHY. 87

are almost invariably prescribed in tlie acute and clironic affections of
these parts ; Ipecacuanha, in doses of twenty to thirty grains, is the most
common emetic of the old school ; yet this same school are constantly
in the habit of administering this drug in doses of one-twelfth or one-
sixteenth of a grain, in cases of obstinate nausea and vomiting, with the
most happy results ; inhalations also of the particles in Ipecacuanha
cause asthma, cough, dyspnoea., &c. ; yet it is a common remedy in
small quantities for the cure of these complaints ; excessive use of alco-
holic liquors or opiates, often induces <:Z(?^im<^m^7^^m6^i5/ yet Opium
and Brandy, which exercise the same specific effect upon the brain, are
the principal allopathic resources in curing this dangerous malady ; the
preparations of Mercury, when given in considerable quantities, cause
ulceration and sometimes gangrene and sloughing of the mouth and
throat, pains in the muscles and bones, eruptions upon the skin, and
inflammation of the bowels, attended with tenesmus, and mucous and
bloody stools ; yet for syphilitic and other ulcerations of the throat,
pains in the limbs, eruptions, and bowel affections, the use of small
closes of this mineral, in some form is deemed indispensable by the al-
lopath. Sir Astley Cooper, in his Lectures observes : " Children often
contract syphilis in utero^ and within twenty-four hours after their en-
trance into the world, have the palms of their hands, the soles of their
feet, and the nates covered with copper-colored eruptions ; and the nails
begin to peel off, and if care be not taken, the little patient will sink
under the effects of disease. In these cases you give the mother a
quantity of Mercury, the influence of which is communicated to the
child, through the medium of the milk, and it becomes cured of the sy-
philitic disease." — Ooojper^s Manual of Sitrgery ly Gastle) ,

This is excellent homoeopathic treatment; the Mercury in this in-
stance is attenuated in the mother's milk to a very great extentr— pro-
bably to such a degree that no analysis can detect it, or any scales
weigh it, and yet Sir Astley Cooper assures us, that the infinitesimal
quantity of Mercury, which finds its way to the milk of the mother, is
^ sufficient to effect a speedy cure upon the child. In this instance
nature, instead of art, attenuates the drug. Tartarized Antimony exer-
cises a specific effect upon the lungs, stomach, and secretory organs,
causing, according to Magendie, an inflammation or engorgement of the
two first named organs, whether taken into the stomach or injected into
the veins ; yet this is the sheet-anchor of allopathy in pneumonia,
pleurisy, and in the first stages of gastric or bilious fevers. Arsenic,
when taken in large doses, in health, has a specific influence upon the
nervous system, heart, skin, and alimentary canal ; and this is an im-
portant old-school remedy in neuralgia, epilepsy, chorea, angina-pec-
toris, cutaneous affections, and intermittent fevers. When nitrate of silver
is absorbed in health, it makes a specific impression upon the nervous

bb GETSTERAL PRmCIPLES OF MEDICAL SCIE:N^CE.

system the brain, &c. ; allopathists employ it in epilepsy, chorea, and
morbid sensibility of the gastric and intestinal nerves. Large and re-
peated doses of Nux-vomica or Strychnia, taken in health, produce "ri-
gidity and convulsive contractions " of the muscles ; yet in cases of trau-
matic tetanus, Strychnia has effected cures in the hands of allopathic
physicians, in doses of one-fourteenth to one-twentieth of a grain. —
{See Report of a case hy Dr, Fell^ — N.-Yor'k Med, and Surg, Be-
forteTyNo, 8.)

The specific action of Nux-vomica under all circumstances is upon
the cerebro-spinal system, and thence its efficacy when properly exhibited
in tetanus, epilepsy, chorea, and hysteria. Belladonna, taken in health,
gives rise to inflammation of the throat and a scarlet eruption upon the
skin ; and yet this remedy is highly extolled and extensively used as a
prophylactic against scarlatina by many leading men opposed to homoeo-
pathy. An eruption resembling psora is often produced by an exces-
sive use of Sulphur and Iodine ; still these are the grand remedies in cu-
taneous affections of this kind. Pereira prescribed Prussic-acid to a
lady who had been suffering for months from gastrodynia; in a few.
hours, to the astonishment of every one, she was quite well. "It can
hardly be imagined," says Pereira, *^ that irritation of the stomach can
be rapidly removed by a substance which is itself an irritant, ^^ The
direct application of blisters to surfaces affected with rheumatic, erysi-
pelatous, and other natural cutaneous inflammations, is constantly recom-
mended at the present time by the followers of Hippocrates. " Ery-
sipelas and other cutaneous inflammations may be removed by the
direct action of Cantharides upon the part inflamed. The remedial
agent in these cases varies the mode of inflammation, and thus intro-
duces a modification in which the properties of life are brought into
recuperative action ;" [Paine's Institutes of Medicine)] yet they affect
a superlative contempt for the law of '^similia similibus curanturl"

It is from experience alone, that the old-school physicians have
learned, that Ipecac, in doses of one-twelfth to one-sixteenth of a
grain, arrests, nausea and vomiting, and imparts tone and vigor to the
stomach ; that Calomel, in doses of one-twentieth of a grain, is invalua-
ble for the cure of inflammation of the mucous membranes of the
bowels : " in cases of inflammation of the mucous tissue of the intestines,
attended with frequent watery discharges, there is nothing comparable
with Calomel, in doses varying from the twentieth to the eighth of a
grain once in four to twelve hours," (Paine'' s Institutes of Medicine,)
That Quinia, in doses of one-sixteenth or one-twentieth of a grain is
more efficient in removing remittent and intermittent fevers, and as
a general tonic in diseased states of the system, than when exhibited
in quantities of from one to ten grains at a dose, is admitted by the best
v^uthors, "Quinia, in the dose of five to ten grains," says Dr. Payncj

ALLOPATHY.

"may speedily arrest an intermittent fever by \i^ febrifuge VvciuQ] but
tbis is bad practice, since, by its associate tonic virtue, it is likely to
increase or to induce local congestions; thus leaving the patient im-
perfectly cured, and subject to relapses: I have seen, in my own family,
the most formidable grade of remittent fever, of long duration, and at-
tended with the foregoing complications, ardent heat, thread-like pulse,
loss of mind, &c., and where hope of recovery had been abandoned,
yield to less than a grain of Quinine^ divided into sixteen doses.^^
{Institutes of Medicine), By experience also they have learned, that
Strychnia in very minute quantities, will cure tetanus ; and that the
class of remedies denominated alteratives, are capable of producing
powerful effects upon the organism, and that too in a manner altogether
unknown and imperceptible.

But how do these physicians know that the virtues of these medi-
cines cease at these points? Have they ever made honest trials of them
in a pure form, and in doses of one-fiftieth, one-hundredth, or a still
smaller proportion of a grain, and learned from actual observation,
that they have then lost their power of impressing diseased structures?
We venture to affirm, never, or they would long since have deserted the
standard of allopathy.

This leaning towards the modern theory is not altogether confined
to the few practical cases, which we have cited, but some of their most
eminent writers have approached so near to the views of Hahnemann,
that we are at a loss whether to rank their theoretical doctrines as ho-
moeopathic or allopathic.

Pereira in his Materia Medica, writes as follows: "Unguents and
lotions are used in cutaneous diseases, ulcers, &c.; gargles in affections
of the mouth and throat; Collyria in ophthalmic diseases, and injec-
tions into the vagina and uterus in affections of the urino-genital or-
gans. In all such eases, we can eayplain the therapeutical effect in
no other way, than by assuming, that the ^nedicine sets ujp a
new hind of action in the part affected, and that the new action
subsides when the use of the medicine is suspended or desisted
from.'^^

This explanation is the true one. The medicines in these cases, as
well as in all other instances where appropriate specific remedies are
ased, do ''set up a new hind of action in the part affected, creating
u r)%edicinal disease, which supersedes the natural oneP

The only fault we have to urge against the allopathists in the treat-
ment of these and analogous cases, is, that they give much too large
doses, and thus create a far more violent medicinal disease, than is
necessary to bring about their cures. Notwithstanding, however, their
errors in exhibiting medicines in a crude and impure form, and in un-
necessarily large doses, we must give them the credit, {fiat justicia

90 GENERAL PEINCIPLES OF MEDICAL SCIENCE.

T%mt emlum)^ of occasionally curing disease (although unwittingly) in
a "rational and consistent manner."

"When the intestinal mucous tissue" says Dr. Paine, "is affected
with that condition of disease which results in a preternatural watery
secretion and consequent evacuations, which is called diarrhoea, and
Rhubarb is administered in a certain dose, this substance first impresses
the membrane in such a way as to determine an increase of the
peristaltic movement, Si^z^ it simultaneously alters the morbid state of
the intestinal mucous tissue in such a way, that the nattcral secre-
tion is arrested. Whether, therefore, the Rhubarb purge, or prove
astringent or tonic, a common principle and common laws are concerned
throughout; and all the sensible results depend upon certain altera-
tions, which the agent effects in the vital properties and actions of
the vessels or tissues which are the seat of the morbid conditions, or
in which the various phenomena may tcike placed {Institutes of
Medicine.)

The same principle directs the practitioners of the old school
in the treatment of many other diseases, and yet they sneer at homoeo-
pathy, and hold up their own inconsistent and uncertain doctrines as
philosophical and correct! They thus constantly administer medicines
after the manner of the homoeopathist, abandoning their own theories,
they practice upon the principles of our modern heresy. , Gentlemen
of the old school, where is your pride, where your consistency? You
have the boast of antiquity; you have received your "bundle of ideas"
from Hippocrates and Galen, to whom you pay reverence and alle-
giance ; you disdain innovations, and despise discoveries and improve-
ments ; you have withstood the changes of more than two-thousand
years, and by your powerful dicta have continually discouraged all
original induction, and endeavored to crush in the bud every advance-
ment in medical knowledge. Where is now your former pride, that you
so often practically abandon your time-sacred axiom, '^contraria con-
trariis^^ and adopt the new heresy, ^''similia shnilibus?\VeYhdips the
light of modern science and discovery breaks, against your will,
through the crevices of your unjointed and heterogeneous theories, or
you are startled from y£>ur propriety by the overwhelming accumula-
tions of fact which Hahnemann and his disciples have displayed before
the world; or, possibly, the disrespect and abuse of some of the most
eminent and able of your caste, has impaired all confidence in, and
respect for, your own dogmas and their applications, and you are at
sea in search of a system. Are we wrong! If so, we have excuse in
the following from the late distinguished editor of the '' British and
Foreign Med, Chirur, Review ^"^ Dr. Forbes, who asserts:

"1. That in a large proportion of the cases treated by allopathic
physicians, the disease is cured by nature, and not by them."

ALLOPATHY. 91

**2. That in a less, but still not in a small proportion, tlie disease is
cured by nature in spite of them; in other words, tbeir interference
opposing instead of assisting the cure."

"3. That, consequently, in a considerable proportion of diseases, it
would fare as well or better with patients, in the actual condition of
the medical art, as more generally practiced, if all remedies, at least
all active remedies, especially drugs, were abandoned. We repeat our
readiness to admit these inferences as just, and to abide the conse^
quences of their adoption "

We have thus far made allusion to that part only of the allopathic
practice, which hesiTS some approximation to the correct method. In
most of the instances enumerated, specific onedicines are employed, —
medicines that produce a similar state when given in health, to that
which they are to cure. Although large quantities of crude and im-
pure drugs are used in these instances, and the medicinal diseases are
thus rendered violent and complicated, still it must be admitted that
occasional cures are accomplished.

But we come now to a more interesting and momentous part of our
subject. It becomes our duty to lay before our readers the doctrines
and practice of allopathy, as they actually exist ; to note their many in-
consistencies, and to point out some of the innumerable evils which they
entail upon mankind.

We have seen that in the treatment of disease, the old-school phy-
sicians make an indiscriminate use of the jpalUative, heteropathic, and,
in a few instances, to the homoeopathic methods of practice.

A general idea prevails that all diseases consist in "local determi-
nations of blood," and that no two aifections of any consequence can
exist in different parts of the same organism, at once. On this account
it is that new diseases are created in healthy parts for the purpose of
removing the primary natural one.

Physicians have been led to adopt this mode of reasoning from ob-
serving that the spontaneous appearance of cutaneous eruptions, dis-
charges of blood, profuse perspirations, &c., occasionally afford relief
to morbidly affected internal organs. Without reflecting that these re-
sults are "inerely synhjptoTns of the internal disorders, and that the
causes upon which these signs depend are located in the blood, they at-
tempt to annihilate diseases by imitating artificially these symptoms.

In regard to the first position, we affirm that their premises are un-
true. There are no facts, which warrant the statement, that " no two
excessive determinations of blood can exist in the same individual at
the same time." Neither is it true, that the appearance of cutaneous
eruptions, spontaneous,, sweats, diarrhoea, and discharges of blood are
invariably, or even generally, indications that the affected organ is in
process of restoration, or that the system at large is recovering its lost

92 GENEEAL PRINCIPLES OF MEDICAL SCIEISTOE.

energy and vigor ; since it often occurs that the symptoms of the com-
plaint are all aggravated upon the supervention of either of the above
occurrences.

Dr. Wilson observes, that "there is often a remarkable tendency to
the worst species of haemorrhages from the bowels, towards the termina-
tion of fatal cases of phrenitis." Dr. Eberle says, " on the day pre-
ceding the fatal termination of a case of phrenitis, which came under
my own observation, an exceedingly copious discharge of dissolved blood
took place from the bowels, and on the following morning the haemor-
rhage occurred also from the mouth and gums."- — [PraGtice of Physic)

Let us suppose a case of phrenitis. We have here an inflamma-
tion, or a congested state of the capillaries of the brain. To relieve
this inflammation and withdraw a portion of the fluid which is con-
cerned in the congestion, bloodletting, both general and local, is resorted
to as a primary and indispensable means of cure. By this means the
general strength is reduced, the pulse increased or diminished in fre-
quency, and the temperature of the skin is altered, but the congestion
still continues, and the morbid and debilitated state of the extreme
vessels (in which the disorder alone resides) remains the same as before.

A resort is- then made to revulsives and counter-irritants, in order
that new inflammations may be created in healthy structures, which
shall supersede that already existing in the brain. To eflect this object
purgatives of the drastic kind are exhibited, and blisters applied to the
head, neck, and lower extremities, in order that the intestinal canal
and portions of the skin, shall be placed in a state of artificial inflam-
mation.

Let us understand the case clearly. We have a disease consisting
solely in a loss of tone ajid irritability of the serous vessels of the
brain, which prevents them from excluding the red blood, and of per-
forming properly their functions. To obviate this condition, a quan-
tity of blood is abstracted, and artificial or medicinal inflammations are
caused in the intestinal canal, and upon different parts of the surface of
the body.

We now inquire in what manner these violent means can, by a.ny
possibility, reach the seat of the malady, and impart tone and vigor to
the weakened capillaries, so as to enable them to exclude from their
structure the red globules, and resume their healthy function ?

All will concede that inflammation consists in loss of tone and irrita-
bility in these vessels, and that no cure can take place, until this im-
paired irritability is restored. In inflammation, according to Philip,
Hastings, Eberle, Wilson, and Allan, the capillaries of the part are in
a state of debility and passive relaxation. The immediate exciting
cause of the inflammation may be either stimulant or sedative. In
both instances the impression is made upon the nervous filaments of the

ALLOPATHY. 93

capillaries, and if the cause acts as a stimulant^ tlie reaction which
must follow this augmented action will leave these delicate nerves
in a state of debility proportionate to the amount of the previous
Excitement.

If the primary cause is directly sedative^ no reaction will occur
but a similar state of relaxation will obtain as in the former^ ins tance.
How then, we repeat, can venesection, catharsis, and blisters effect
the necessary object? They do not certainly prevent the red blood
from still entering the relaxed capillary tubes, for the whole remaining
mass must continue to circulate through the brain, as well as other
parts of the organism, every few minutes.

By lessening the quantity of blood, we also abstract a portion of that
natural stimulus of the organism, which is one of the essential condi-'
tions of irritability. " Every part of the organism depends for the per-
formance of its proper functions, on the receipt of a/rterial Vlood
and of nervous inflxience ; no alterations in the sujpjply of either of
these essentials may modify or even suspend the functions of a panftP
{Pereira^ — Materia Medioa)

How absurd and pernicious then, in inflammations, the very essence
of which is debility and loss of tone, to detract from one of those con-
ditions upon which this very tone and vigor depends ! As well might
you remedy the breach through which the waters of a raging torrent
are madly rushing, by turning off from its course some small tributary
rivulet. As well attempt to suppress the leak of a storm-tossed vessel,
by diverting from its proper channel a portion of the stream on which
it floats.

It is not the blood which is at fault ; but a portion of the organism ;
correct therefore the cause of the disturbp-nce by direct and appro-
priate specifics, and you may then, and not till then, effect cures, safely
and philosophically. Seek not to deprive the system of that fluid,
which is so essential to the organism, and on whose integrity its func-
tions depend ; for by so doing, the cause of the malady will remain
untouched.

It is very true, that whea a large quantity of blood is abstracted,
during inflammation, there will seem to be in some instances an appa-
rent amelioration of all the symptoms, but this effect is only temporary ;
for as soon as the reaction comes on, the enfeebled capillaries again
admit the destructive "carriers of oxygen" as before ; the state of con-
gestion and inflammation remains, while the system at large has lost
a portion of that stimulus, which conduces so materially, not only to
Bustain the normal integrity of the functions in health, but to aid in the
restoration of enfeebled and diseased parts.

The remedies, which stand next in importance in the old-school
method of treating inflammation of the brain, are revulsives and cow iter-

94 GENERAL PEINCIPLES OF MEDICAL SCIENCE.

irritants. It is supposed, that by exciting the intestinal exhalents, in-
flaming ihe membrane of the bowels, and portions of the skin, the cir-
culation is diverted from the brain and directed especially to these
parts.

But by this means is the brain in reality relieved ? Is the whole
mass of blood thus prevented from circulating as usual through this
organ once in three or four minutes, or the character of its red globules
changed ? By exhausting the energies and resisting force of distant
healthy structures, and creating sympathetic symptoms throughout the
body — thus complicating the already existing disease, and impairing
the entire nervous and muscular energies- — are the inflamed capillaries
of the brain placed in a more favorable condition to recover their im-
paired tone and irritability? Everyman who has a correct idea of
the laws which govern the organism in health and disease, and who is
willing to banish prejudice and be guided by common-sense and true
philosophy, must answer in the negative.

We object to these remedies, however, not only because they are in-
Competent to produce salutary impressions upon inflamed parts, but
because of the evils of a positive character to which they give rise.

The chief remedies of the old school are the preparations of Mer-
cury, Opium, Antimony, and Bark, In a vast majority of all the cases
treated by the practitioners of this school, one or more of these articles
is made use of. Indeed scarcely a single malady of any moment can
be named, in which one of these medicines is not considered in-
dispensable.

Let us then examine some of their effects, in allopathic doses, upon
the healthy and diseased organism.

1. Mekcuey. — This mjneral is more uncertain in its action in all
states of the system, than any other article in use. It possesses the
power in different constitutions and under certain circumstances of af-
fecting nearly every organ and tissue of the body; and it is not in the
power of the most judicious physician to say beforehand, where, or in
what manner^ it will exert its force.

Some of the more common deleterious effects of Mercury are: ex-
"^essive salivation and sloughing of the giims^ mouth and throaty
g astro-enteritis^ mereurial erethism^ dysentery, eutaneoiis erwptions,
inflainraation of the periosteum and bones, nodes, excessive de-
rangement of the nervous system, jparcdysis, tremors, necroses of
the maxillary and other hones, rheumatism and ophthalmia.

When Mercury is administered, even in a moderate quantity, no
human being can be at all certain that one or another of these evil
consequences will not result. Indeed it is the direct object, oftentimes,
to produce some of them to operate as cotmter-irritants,

?Vhether it is employed in large or small quantities, solid, or in the

ALLOPATHY. 95

form of vapor, it is of little importance, so far as its power of affecting
the system is concerned. The following, from the editor of the Med, and
Surg. Journ,^ illustrates the baneful influence of the vapor when inhaled:
"In 1810 the Triumph, man-of-war, and Phipps, schooner, received on
board several tons of quicksilver, saved from the wreck of a vessel
near Cadiz. In consequence of the rotting of the bags, the Mercury
escaped, <^7^<^ the whole of the crew hecame more or less affected.
In the space of three weeks 200 men were salivated, two died, and all
the animals, cats, dogs, sheep, fowls, a canary-bird, — nay, even the rats^
mice, and cockroaches were destroyed."

The following cases, resulting from the employment of Calomel, have
come under our own observation, viz., three cases of necrosis of the in-
ferior maxillary bones, requiring the removal of portions of the jaw ;
several cases of gangrene and sloughing of the mouth and throat, which
have terminated fatally; a number of cases of mercurial palsy;
numerous instances of ulceration of the nose, throat, &c., skin diseases,
affections of the bones, nodes, rheumatic affections, &c., &c.

Professor Chapman of Philadelphia, after descanting upon the woful
effects, which have been so often produced by Calomel, and referring to
many disgusting cases of mercurial disease, which had come under his
own observation, thus concludes : " Who is i% that can stop the career
of Mercury at Avill, after it has taken the reins in its own destructive
and ungovernable hands! He, who, for an ordinary cause, resigns the
fate of his patient to Mercury, is a vile enemy to the sick ; and if he
is tolerably popular, will in one successful season have paved the way
for the business of life ; for he has enough to do ever afterwards to
stop the mercurial breach of the constitutions of his dilapidated patients.
He has thrown himself in fearful proximity to death, and has now to
fight him at arm's length as long as the patient maintains a miserable
existence."

And this dreadful poison is the most common, — ^yes, the daily remedy
of allopathy, for almost every disorder, whether mild or severe, acute or
chronic. This is the agent with which artificial diseases are created in
healthy parts, to cure primary or natural ones! This is the substance
with which unfortunate mortals are drugged, from the time they come
into the world until' their wretched and too ofen premature departure,
with its well-known and generally-admitted evils and dangers, — -from
the contemplation of which the well-instructed and experienced allopath
shrinks with instinctive dread,— -and from its questionable value in most
instances of its prescription, it may justly detain our attention. Calomel
and Opium are the common remedies in traditional practice for a large
number of diseases. We will see to what extent they may be used in
a practice that is philosophical.

By glancing at the standard works on the practice of medicine, it

96 GENERAL PEINCIPLES OF MEDICAL SCIENCE.

will be observed, that there is scarcely a single malady, either acute or
chronic, in which one or both of these articles is not recommended as
an important, if not indispensible means of cure.

The allopath is taught to believe, that Mercury excites the functions
of all the organs, — acts specifically upon the liver, salivary glands,
heart, lungs and nervous system, — and therefore that it may be ad-
ministered almost universally. Regardless of the secondary sym-
pathetic affections to which it usually gives rise, he attributes all of
these symptoms to the natural disorder, and if the patient succumbs
before the combined attacks of the primary disease and the medicinal
one, he consoles himself with the reflection that he has followed his
authorities and prescribed as his predecessors have done for centuries
before him.

Ask him, what are his views concerning inflammation, and he
answers, that it consists in a debilitated and congested state of the
capillaries of the part affected. Ask him, what is the methodus TYie-
dendi of Mercury in cure of inflammation, — ^how any of its effects can
reach the seat of the malady, the congested capillaries, and restore to
them their impaired tone and healthy functions, — and he either avows
his ignorance, or offers an unsatisfactory explanation.

2. Opium. — ^If we except Calomel, this drug, and its preparations
are more frequently used by the medical men of the old school, than
any o'ther article in the materia medica. Possessing the power, as ife
does in an eminent degree, when exhibited in large doses, of covering
(not curing) symptoms, and of shutting the mouths of clamorous and
inquiring patients, it is used constantly and indiscriminately in nearly
all protracted maladies.

Let us then briefly examine the effects of opium in health and dis-
ease, and see if it possesses the wonderful property of reaching every
structure, and of counteracting so many diverse and contradictory
symptoms.

Its effects upon the human system, in medium doses, are in the first
instance stimulating, but in a short time this is followed by a condi-
tion of diminished sensibility and desire to sleep. This state " continues
from eight to twelve hours, and is followed by nausea^ headache^
tremors, and other symptoms of diminished and irregular nervous
energy. All of the secretions, with the exception of that from the
skin, are' either suspended or diminished." ( Wood and Bache, U. S.
Dispensatory) These effects, with a very few exceptions, are uniform
under all circumstances, so far as we can judge.

How, then, is this substance applicable to the treatment of so ma.ny
diseases?

We have remarked, that in a large proportion of all known mala-
dies, there exists an inflammation of an acute or sub-acute character in

ALLOPATHY. 97

some part of the organism, and it is the presence of this inflammation
which maintains and perpetuates the disease. We have also observed
that all inflammations consist in a congested state of the capillaries of
the part aflected, caused and kept up by a loss of tone, resisting power,
or irritability, which disables them from resisting the intromission of
red blood.

It is apparent, then, that in order to prove efiicient, such remedies
should be exhibited as are capable of acting upon the seat of the com-
plaint, and of restoring the delicate capillary nerves to their normal
state of integrity. Opium cannot accomplish this, for its operation
tends to impair the nervous energy, instead of adding vigor, to dry up
most of the secretions, instead of aiding nature to give vent to the
poisonous, and pent-up fluid; it induces nausea^ headaohej iyreifnoTs^
and many other medicinal symptoms of sufficient severity to make a
healthy man sick, or to complicate to a serious extent any existing na-
tural affection.

If we have urged, that opiates have the power of allaying pain,
while other more efficient measures are pursued to effect the cures, we
reply, that by covering up the pain, the Teal state of the case is con-
cealed; other new symptoms set in, which will be unnoticed by the
benumbed patient, while secondary sympathetic affections will be pro-
pagated to every part of the body, aggravating and complicating the
original disorder.

Opium is highly extolled in low forms of fever and other complaints,
where the powers of the system are in an exhausted condition. But
let it be remembered, that the stimulating effect of this drug is of
short duration, and that the corresponding reaction or dejpression will
bear an exact ratio to the previous exaltation. This law is fundamen-
tal ; for the system possesses but a definite and limited amount of vital
power, and is capable of resisting only a limited degree of unnatural
action or disease, so that we can readily perceive how opiates and
stimulants must ultimately prove deleterious.

It IS true, that perspiration is promoted by the use of this narcotic,
but this does not cure. Sweating is merely a symptom, and it may be
favorable or otherwise. When excited artificially by medicine it is
not productive of benefit, because this adds nothing towards invigorat-
ing the weakened capillaries.

"Perspiration," says Dr. Paine, "induced by medicine is of little mo-
ment, unless the remedy simultaneously impresses, direcfy or indi-
rectly, the parts diseased j and then the salutary result, so far as the
surface is concerned, depends upon special vital influences exerted by
the remedy upon the skin and reacting sympathies. This is exempli-
fied by the profound effects of tartarized Antimony, and Ipecacuanha,

the uselessness of hot water, (Q^^<:Z the f-equent pernicioiis resiclts of
Vol, l— 7.

98 GENEKAL PKINCIPLES OF MEDICAL SCIENCE.

tlie corn-pound powder of IpeoacuanKa^ when free perspiration may
follow the administration of either. The efiect, therefore, depends but
very little upon the evacuation from the skin, as produced by what are
called sudorifics." {Instiimtes of Medicine.)

It is proper to observe, that Opium may, and sometimes does effect
cures in the hands of allopathists, when given as a specific. Its cura-
tive virtues in deliriurri tremens and intoxication, even in large doses,
are well known. In these instances, the remedy impresses directly
the part diseased^ and q>vc£^% homoeojpatliically , It is quite true, that
an infinitesimal quantity of the drug, properly prepared, will always
prove more efficient, speedy and safe in accomplishing the object,
and will not give rise to the unpleasant medicinal symptoms which ne-
cessarily attend the employment of large doses ; yet the fact must be
conceded, that clumsy and unscientific cures are occasionally effected
by the course alluded to.

An interesting case is related by Pereira, illustrative of this:
" Opium," says he, "is sometimes employed by drunkards to relieve in-
toxication. I knew a Uiedical man, addicted to drinking, and who for
many years was accustomed to take a large dose of laudanum,
whenever he was intoxicated and was called to see a patient." The
^pecifixi ^(?<?i^ of the alcoholic stimulants and opium given during
health, are exerted as remarked elsewhere, upon the same organ; and
we should therefore expect thg^t a malady caused by the excessive use
of the one, might be cured by the specific action of the other.

Taetarized Antimony.^ — -This salt has been several times formally
banished from the materia medica on account of its dangerous qualities^
and as often restored after some accidental benefits were observed
from its use. *

Tlie faculty of medicine, at Paris, in 1566, and 1615, passed solemn
decrees against it, as a virulent poison, anji these decrees were even
sanctioned by parliament, though afterwards formally reversed. ( Yale)

Since this period, some have loudly extolled its virtues in the treat-
ment of a great variety of diseases, while others have as earnestly con-
demned its use, as deleterious in all cases.

The distinguished professor Nathan Smith, in his essay on typhus
fever, remarks: "I have seen many cases, in which persons in the
early stages of this disease were moping about, not very sick, but far
from being well, and who upon taking a dose of tartrate of Antimony,
with the intention of breaking up the disease, ka.ve heen immediately
confined to their hedsP He arrives at the conclusion after much
experience, that " Tartar-emetic should not be used in this affection,
even at its commencement, and in the latter stages of the disease, that
it is sometimes followed by fatal consequences."

In emetic doses, tartarized Antimony irritates the stomach, causes

ALLOPATHY. 99

congestion, and sometimes inflammation of the lungs, attended with
more or less constitutional disturbance.

When it fails to produce emesis speedily, it often acts violently upon
the bowels, giving rise to severe griping pains and watery evacuations.
The tenderness of the stomach and intestines, and the constitutional
disturbance which succeeds its emetic and cathartic operation, indicates
the injury which these delicate structures have sustained.

The primary impression of Antimony is not the only objection against
its employment; for, like Calomel and Opium, it gives rise to numerous
secondary symptoms in remote parts, which tend to aggravate in a
serious manner any natural affection which may be present; one of the
most important of these secondary evils is dilatation of the ventricles
of the heart. Having witnessed this result in several instances, one of
which occurred in my own family, my attention has been particularly
directed to the subject, and I am fully of opinion that cases of this
description, from the use of Antimony, are by no means unfrequent.

CiNOHOisrA.— In intermittent fevers, general debility, and in certain
stages of most other affections, Peruvian-bark and its preparations are
usually employed by the old school. jFor the cure of the former, es-
pecially. Quinine is the remedy upon which universal reliance is placed ;
possessing the property, when used in large and repeated doses, of
speedily arresting the chills and fever, it is constantly prescribed for
this malady, without the slightest knowledge of its specific powers, and
without any regard to the dangerous medicinal disorders, which it
superinduces.

All allopathists who have had much experience in the treatment of
fever and ague, are aware that the mere suppression of the paroxysms
by no means restores the patient to health ; for in a great majority of
instances, he lingers for months or even years in a diseased and mise-
rable condition. In these cases it is probable that a medicinal affec-
tion is induced by the remedy, so serious in its character, as to super-
sede teiyiporarily the primary one. This is evident, from the fact that
after the effects of the medicine have somewhat subsided, the original
disorder again generally makes its appearance. In some instances,
however, the medicinal affection is so severe as to constitute a perma-
nent disease, and thus entirely usurp the place of the fever.

'^ Experience,'' says Dr. Paine, "shows that, though bark and its al-
kaloids, in large doses, will often arrest intermittent fever suddenly,
such doses are liable either to induce some congestion, especially of the
liver or of the mucous tissue of the stomach, or will aggravate and es-
tablish some co-existing congestion ; and thus while the patient is for
the present relieved of the fever, he is disinissed with an insidious
local complaint that not only renders him a permanent invalid, (re-
sulting often from indm-ated enlargements,) iiit which local malady

100 GEInERAL Plill^TGIPLES OF MEDICAL SCIENCE.

may^ and often does heGOine^ injprooess of time ^ the exciting cause of
another attach of fever. In respect to relapses, it is not unfrequent
thatj when intermittents are suddenly stopped by a large dose of Qui-
nine, the paroxysms return as soon as the patient begins to exercise
much, or to take his ordinary food.'' — [Institutes of Medicine.)

We should naturally suppose that these untoward results would deter
practitioners from using so frequently these dangerous remedies ; or
at all events, as rarely and in as small quantities as possible.

On the contrary it seems to be peculiar to allopathy, that her ad-
vocates take credit to themselves, when they succeed in administering
this, as well as other medicines, in larger doses than any of their 0071-
temporaries^ without dest/i'^oying their patients. Indeed, so far has
this destructive system been carried, of experimenting upon disease,
that the enormous quantity of a scruple, and even half a drachm of Qui-
nine has been exhibited at a dose, and repeated several times a day.
These monstrous quantities create (say TFc>6>cZ and Bache) ^^ g^^ix^d-
enteritic irritation, nausea, griping, purging, head-ache, giddiness, fever,
somnolency, in some cases delirium, in others stupor, &c." Paine as-
serts that he has witnessed many of these effects " from five grains
only ; " yet, as patients sometimes li'})e in spite of this treatment, many
persist in adhering to these desperate innovations.

There are many other medicines employed by allopathy in the treat-
ment of disease, besides those to which we have alluded, but in general
they serve only as auxiliaries. In this list may be ranked diaphore-
tics, diuretics, expectorants, refrigerants, emmenagogues, emollients,
errhines, &c., but the articles belonging to each of these classes, in a
crude state and in large doses are liable to important objections.

The fault of those medicines which operate specifically, like diruetics,
emmenagogues, &c., in the hands of allopathists, is the aggravation which
they must necessarily cause, if the part acted upon be irritated or in-
flamed. This objection will be clearly appreciated, when it is remem-
bered how extremely sensitive to specific remedial impressions orgaiis
and tissues become during inflammation.

The evils resulting from the use of those medicines which are not
specifics, are, first, their inability to reach the seat of the disease, and
secondly, the sympathetic derangement to which they give rise in
various parts of the body, the direct tendency of which is to retard and
counteract the recuperative efforts of nature.

As an example of the first class, let us take the diuretic Copaibt^ as
a remedy for gonorrhoea. In this example, the remedy doubtless im-
presses directly the inflamed membrane of the urethra, but the impression
is so violent, that either a decided increase of the inflammation ensues,
or the discharge is suddenly suppressed, and some other organ, as the
bladder, kidneys, testicles, or lungs, takes on diseased aciiori. Indeed,

ALLOPATHY. 101

we are decidedly of opinion, tliat not one genuine case of virulent go-
norrhoea can be adduced, where a safe and permanent cure has been
effected by large doses of this balsam.

A not unfrequent effect of Copaiba in moderate quantities, is to ex-
cite serious disorder of the lungs. This consequence I have often
witnessed, and I have a patient at this time, who assures me, that he is
unable to take a single dose of it, without being afflicted with a pain in
his chest and cough.

Gastric and intestinal disturbance, also usually result from, its use.
In some instances, a troublesome eruption makes its appearance, ren-
dering it necessary to discontinue its employment for a time. And yet,
with all of these artificial consequences, the disease is very rarely, if
ever, cured by this nauseous substance.

Diaphoretics were introduced into practice by the advocates of the
humoral pathology, under the supposition that their sweating qualities
would aid nature in throwing off *frhe morbid humors. When the hypo-
thesis universally obtained, that fevers were caused by an excess of one
of the four humors, blood, phlegm, and black and yellow bile, and that
this superabundance must be expelled through the pores of the skin,
kidneys, &c., it wa,s a rational deduction that the employment of dia-
phoretics and diuretics should conduce essentially to aid nature in .
the cure.

But when more correct ideas in regard to the nature and seat of
diseases were introduced, and medical men had learned that spontaneous
sweating diuresis, discharges of blood, diarrhoea, &c., in the latter stages
of diseases occurred in consequence of a natural amendment or a sud-
den J9r6>^^r^^5^6>^ in the powers of the affected parts, and not as an effect
of the medicines, it is a matter of surprize that these uncertain reme-
dies should have been retained.

The late Prof. N. Smith- sd^js: "As there is more or less sweating
in the decline of most febrile diseases, and, as a general perspiration
is often accompanied with other symptoms of amendment, it has been
looked upon as the natural cure of the disease. Under this impression,
it has been a pretty universal practice to encourage sweating; but with
respect to the grounds upon which this practice is founded, it is a ques-
tion whether the effect has not, in this case, been mistaken for the
cause; that is, whether the sweating is not the effect of the amend-
ment, rather than the cause of it ; and, if so, it is still more question-
able whether sweating, produced by art in the beginning of the disease,
would be attended with good effects. In all cases^ %olieTe I have seen
this sweating regimen adojpted^ the jpractice has been obviously in-
juriousP

Many other eminent professors, as may be readily proved, entertain
similar views in regard to this subject.

102 GENEEAL PEIISrCIPLES OF MEDICAL SCIENCE.

Physiology teaches us, that no unusual disturbance, no inflammation,
and no functional derangement can accrue to any part of the body,
whether by a moral, physical, morbific or medicinal agentj without be-
ing followed by secondary sympathetic symptoms in remote parts, more
or less severe according to the violence of the exciting cause. The
stomach and bowels more especially, being the grand centre of junction
of the ganglionic system of nerves, are so intimately connected with all
parts of the economy, that disturbances at either of these points are
reflected through the sympathetic nerves upon remote healthy struc-
tures, thus complicating to a serious and often fatal extent, any dis-
order which may already be present.

There is scarcely any part of the machine, which is not called into
morbid sympathetic action by derangements of the stomach and in-
testines. Even the presence of bile or acid, in unusual quantities,
causes pains in the head and limbs, nausea, and other affections of a
distressing nature, until the offending substances are removed.

All of the organs and tissues are so closely connected by the nervous
system, that it may be laid down as a general rule, that no disorder
can happen to one part without implicating more or less other part8,
whether diseased or healthy. {MuUer^s Physiology.) "A particular
state of one organ, such as inflammation, or a secreting action in it,
often causes the production of a similar state in other parts. The
principle of the balance of sympathy teaches us, how we rmist avoid
aggravating the m^oriid condition of one organ hy the means we
ajpjply to another P

How reasonable, then, to expect that artificial medicinal inflammation?
of the sensitive structures of the economy should give rise to secondary
affections of a grave and permanent character.

In conclusion, the theoretical and practical doctrines of allopathy
may be briefly summed up as follows :

1. In the rude ages of the world, when the arts and sciences were in
their infancy, — when vague, indefinite and absurd notions were enter-
tained respecting diseases, — when anatomy, chemistry, physiology,
pathology, botany, and even correct methods of induction were entirely
unknown, — when the imaginatians of men, instead of ascertained facts,
w^ere appealed to in establishing theories, — and when systems of prac-
tice were founded upon merely fanciful conjectures,^ — then it was that
blood-letting, cathartics, diaphoretics, diuretics, refrigerants, revulsives,
derivatives, counter-irritants, and most of the other remedies of allopathy
made their first appearance. As the pathological, doctrines of this
period were all entirely erroneous, it is but fair to conclude, that their
therajpeuticcd inferences must have been equally incorrect.

2. Whatever may have been the changes in respect to the theory of
disease, from age to age, long established customs, the force of habit,

ALLOPATHY. 103

education, prejudice, &c., ha-ve served to retain until our own period,
most of the violent, unnatural and pernicious methods oi tT6atnfhen% in-
vented and adopted by the founders of medicine.

3. At the present time, every thing pertaining to the theory ancj
practice of the old school is indefinite, obscure and uncertain. Scarcely
two different allopathists entertain the same views in regard to patho
logy, and no one can determine beforehand wdth any kind of certainty
precisely what effects his medicine will produce ; yet in the treatment
of nearly all cases. Venesection^ Calomel^ Opimn^ and Anthnony
are empirically, and we might almost say, universally employed, in
quantities too great to be beneficial or safe.

In those cases, where refrigerants, diuretics, expectorants, &c., are
used, they can only be looked upon as auxiliaries, and are usually ad-
ministered without any accurate knowledge as to whether they promote
or retard the designs of nature.

4. Owing to the absence of any generally received or consistent
theory of disease, allopathists are obliged to prescribe at random. They
strike at the name^ and not at the seat of the maladies, where alone re-
medies can prove efficient. Thus it is, that patients are so often reduced
to the lowest point by medicines, while the disease continues its pro-
gress unchecked.

5. Lastly, there is every reason to believe, that the production of
violent artificial diseases in healthy structures, for the suppression of
natural maladies, is, upon the whole, far more productive of deleterious
than of beneficial consequences.

The effort, to discover specific remedies for individual diseases, is
not yet abandoned; but it is restricted to the making of experiments
upon the sich^ and results only in infrequent cures, which are never
satisfactory and which can not be repeated or imitated in subsequent
cases.

Hahnemann, in his essay, entitled: E^ar)iination of the Sources
of the Common Materia Medica^^ {Lesser Writings, p. 748), with
a masterly and irresistible logic, that has never been surpassed, shows
that such experimentation is nothing but crude empiricism, a^nd that,
though it has been in vogue for some thousands of years, it has never
yet given us a single reliable specific.

A great part of the medicine, given with the pretence of oicring dis-
ease, is not expected to cure, but to palliate, to cover up the loud
complaints that the organism is everywhere uttering for help. Dr
Parrish, Lecturer on Pharmacy, (Philadelphia) said recently : " The
prevailing doctrines among medical men at this time, direct, that a large
per-centage of all the prescriptions now made contain Opium, Morphia,
or Hyoscyamus." Five years ago, he ascertained, that his own prescrip-
tions averaged thus ; Opiates 24 per cent ; Mercurials 23 per cent ;

104 GENERAL PEIlSrOIPLES OF MEDICAL SCIEiSTOE,

Iodine and Iodide of Potassium 6 per cent ; Cinchona and its aL
kaloids 9 per cent.

These were the proportions in the written prescriptions. Of the
unwritten prescriptions the proportion of Opium was larger, as Opium
in some form was in every house. Second in importance is HyoscjamuSj
Then, Conium, Belladonna, Stramonium, Cannabis-indica.

Allopathy is a mere collective title of all the various modes of treat-
ment not homoeopathic, and has no pretensions to a place among the
definite curative modes by specifics. {Ifilller,)

The more recent theory of speoijiG or substitutive action teaches,
that diseases even widely dissimilar may supersede each other, or that
one may supersede another : we have examples of such supersessions^
and of a new and not similar disease complicating an old one, but not
of removing it. "In fact, w^hen the latter event takes place at all, it is only
when the new disease approaches to the required degree of homoeopathic
city. In fine, the real fact of the matter we apprehend is simply this, that
the degree of homc^opathicity that suffices for cure is not accurately fixed;
and, as we recede from complete homoeopathieityj a certain margin is left
within which specifics given in more massive doses may still have curative
effects.'' Within this margin may room enough be found for the spe«
cificers, Rademacherians and Trousseauist substitutivists. But beyond
that we protest against allowing any such method as an allopathic
alterative one any positive existence at all. The great discovery of
Hahnemann, viz., the positive homoeopathic, law of specifics must not
he let down and diluted and refined away, by giving it only a place
as one of a sliding scale of specific actions, all on pretty much the same
footing. No ! if we are compelled to admit as matter of fact that
there are other actions of medicine, which we must on exceptional oc-
casions make use of, such as the antipathic or revulsive, let us say so
plainly, and not attempt to shade them ofi'into the homoeopathic. (Jfi^M^r.)

In view, therefore, of the present condition of the medical art, we
most earnestly request the allopath to pause or reflect deeply and
seriously, before he rejects finally the most important discoveries in
the art of curing disease, that have been made in ancient or modern
times.

Let him remember that a high responsibility attaches to his po-
sition,— that the welfare, happiness and lives of his patients hang upon
his judgment and decision, — and that an improper exhibition of re-
medies may so complicate and aggravate the natural disease, as to con-
sign his patient to a premature grave. Let him look about, candidly
and impartially, and see if there are really no improvements in the
healing art since the times of Hippocrates and Galen. Let him submit
■new discoveries and new doctrines' to a rigid jot actioctl test^ and decide
•from the resultSj— from the cures effected, — what system is most correct

HOMCEOPATHY. 105

and best calculated to promote the welfare of the human race. Let
him no longer reverence ancient doctrines and ancient names, simply
on account of their antiquity^ but seek after truth alone^ whether of
ancient or modern discovery, and found his practice only upon this
certain basis.

HOMCEOPATHY.

The Discovery of the Homoeopathic Mode of treating disease is thus
announced by Hahnemann: ^

" By observation, reflection, and experiment, I discovered, that, in
opposition to the old allopathic method, the true maxim; To effect a
onild^ To/pid^ certain^ and permanent cure^ choose in every case of
disease^ a medicViie which can itself produce an affection similar
(ofiotov rrdSog) to that sought to he cured.

" Hitberto no one has ever ta%ight tbis bomoeopathic mode of cure,
no one has practiced it. But if the truth is only to be found in this
method, as I can prove it to be, we might expect that, even though it
remained unperceived for thousands of years, distinct traces of it
would yet be discovered in every age?

"And such is the fact. In all ages, the patients who haveteenreally^
rapidly^ permanently^ and evidently cured iy medicines, and who did
not merely recover by some fortuitous circumstance, or by the acute
disease having run its allotted course, or by the powers of the system
having in the course of time gradually attained the preponderance,
under allopathic and antagonistic treatment, for being cured in a direct
manner differs vastly from recovering in an indirect manner. — Such
patients have been cured solely, (although without the knowledge of
the physician), by means of a (homoeopathic) medicine, which possessed
the power of producing a similar morbid state."

When Hahnemann first promulgated to the world his pathological
and therapeutical views, their novelty, their entire variance from all
preconceived opinions, and their alleged superiority over all other
systems, when applied to the practice of the healing art, induced
physicians to suppose the man mad, and his ideas the offspring of a
disordered imagination. '^

It was difficult to conceive that acute maladies could be cured
without venesection, emetics, cathartics, sudorifics, refrigerants, altera-
tives, and counter-irritants and on this account the great discoveries
of the father of homoeopathy were for many years coldly received, and
his arguments answered only by impudent sneers or senseless ridicule

Like the illustrious Fulton, who — when he announced to his country-
men the powers of steam, and first applied this agent to the propulsion

* Organon. — Introduction.

106 GENERAL PEINCIPLES OF MEDICAL SCIENCE.

of a vessel — was declared, even hj his nearest friends insane, and his
projects visionary : like Harvey, the discoverer of the circulation of
the blood, who was bitterly assailed " by the bigotted abettors of old-
esta-blished systems, with whispers, innuendoes, and controversial writ-
ings, and himself pronounced a reckless innovator, and unworthy of
public confidence as a practitioner; like Galileo, who, after demonstrat
ing the truth of the Copernican system was persecuted by his rivalr,
and twice compelled by the inquisition to abjure a system which he
knew to be correct; like Columbus, Newton, Locke, Jenner, and many
other benefactors of the human race, Hahnemann has been aspersed,
and his doctrines, like theirs, have been ridiculed, misrepresented, and
contemned : but time has cast all the columniators of Columbus, of
Galileo, of Newton, of Locke, of Hajve}^, of Jenner, of Eulton, into a
deserved oblivion, while the names of these eminent persons stand high
on the roll of fame, and their discoveries remain to benefit the world.

Brief Ex])osition of the HommojpatliiG Method of Treating Dis-
ease.— The following truths are established by reason and experience :

1. There is nothing for the physician to cure in disease but the suffer-
ings of the patient. The changes in his state which are perceptible to
the senses comprise what is known by "the totality of the symptoms by
w^hich the disease points out the remedy it stands in need of." These
changes are internal as well as external, and the physician takes into
his enumeration of symptoms, not only all that appear upon the sur-
face, but all the pathological changes which he knows to be going on
internally.

2. Disease can not be converted into health but by the aid of medi-
cines and agencies which are capable of producing similar disease-
symptoms. The powers of a given remedy to produce similar symptoms
are best learned through experiments on healthy individuals, so far as
experimenting may safely go in such researches: where these neces-
sarily terminate, we may learn their further powers from the accidental
uses and abuses of the same agents in allopathic practice and cases
of poisoning.

3. "According to every known fact," says Hahnemann, "it is impos-
sible to cure a natural disease by the aid of medicines which have the
faculty of producing a dissimilar artificial state or symptom in healthy
persons. Therefore the allopathic method can never effect a real cure.
Even nature never performs a cure or annihilates one disease by adding
to it another that is dissimilar^ be the intensity of the latter ever so
great."

4. "Every fact serves to prove that a medicine capable of exciting
in healthy persons a morbid symptom opposite to the disease to be
cured, never affects any other than momentary relief in disease of long
standing, without curing it, and suffers it to reappear after a certain

I-IOMGEOPATHY.

107

interval more aggravated than ever. Tlie antipatliic and purely pallia-
tive method is, therefore, vf holly opposed to the object that is to be
attained, where the disease is an important one, and of long standing."

5. The homoeopathiG method which employs against the totality of the
symptoms of a natural disease a medicine that is capable of exciting ii?
healthy persons symptoms that closely resemble those of the disease
itself, is the only salutary method. It always annihiliates disease, or
the purely dynamic aberrations of the vital powers, in an easy, prompt,
and perfect manner. In this respect nature herself furnishes the
example, when by adding to an existing disease a new one, that resem-
bles it, she cures it promptly and effectually.

"A new and more intense disease suspends a prior and dissimilar
one already existing in the body, only so long as the former continues,
but it never cures it. If the new disease, which is dissimilar to
the old be more jpoioerfxil than the latter, it will then cause its
suspension until the new disease has either performed its own course
or is cured ; but then the old disease reappears. We are informed by
Tulpius (Obs. Lib. 1. Obs. 8.) that two children having contracted tinea,
ceased to experience any further attacks of epilepsy to which they had
till then been subject: but as soon as the eruption of the head was
removed, they were again attacked as before. Schopf saw the itch
disappear when scurvy manifested itself, and return again after the
cure of the latter disease. {Hufel. Journ, XV. 2.) A violent typhus
has suspended the progress of ulcerous phthisis, which resumed its
march immediately after the cessation of the typhoid disease {Chevalier),
When madness manifests itself during the pulmonary disease, it effaces
the phthisis with all its symptoms; but then the pulmonary disease
again rears its head and kills the patient. {Reil. Memorahilia), When
measles and small-pox exist together, and have both attacked the same
child, it is usual for the measles which have already declared them-
selves, to be arrested by the small-pox which bursts forth, and not to
resume their course until after the cure of the latter; on the other hand,
Manget has also seen the small-pox, which had fully devel(?ped itself
after inoculation, suspended during four days by the measles which
intervened, and, after the desquamation of which, it revived again to
run its course. The eruption of measles on the sixth day after inocula-
tion has been known to arrest the inflammatory operation of the latter,
and the small-pox di^ not break out until the other exanthemata had
accomplished its seven days "course." [J, Hunter on the Venereal
Disease.) In like manner vaccine disease and scarlatina have been
seen to suspend each other, the stronger of the two expelling for the
time the other.

" It is the same in all diseases that are dissimilar : the stronger
one suspends the weaker (except in cases where they blend together,

108 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

which rarely occurs in acute diseases :) tut they never cure each othef
reciprocally y

" In the same manner, violent treatment with allopathic remedies
never cures a chronic disease, but merely suspends it during the
continuance of the powerful action of a medicine incapable of exciting-
symptoms similar to those of the disease : ' but afterwards the latter re-
appears, even more intense than before."

"Or the new disease, after having acted for a considerable time on
the system, joins itself finally to the old one, which is dissimilar,
and thence results a complication of two different maladies, either of
which is incapable of annihilating or curing the other." In this case
each occupies the particular region of the economy, installing itself in
those organs with which it sympathizes, and abandoning the others to
the diseases that are dissimilar. Thus venereal and psoric diseases,
being dissimilar, *' are incapable of annihilating or curing each other.
The condition of the patient is worse under the two diseases than he
would have been under either of them alone." [Organon § 40, p. 112.)

When a medicinal disease is excited which is similar to the existing
one, and is stronger than it, the new disease supersedes the old one.

Two diseases, says Hahnemann, " that differ greatly in their species,
but which bear a strong resemblance in their development and effects,
— that is to say, in the symptoms which they produce, always mutually
destroy each other when they meet together in the system. The
stronger annihilates the weaker. Two dissimilar diseases may co-exist
in the body, because their dissimilitude would allow of their occupying
two distinct regions." But when the diseases are similar, the stronger
disease exercises an influence upon the same parts as the old one, and
even throws itself, in preference, upon those which have till now been
attacked by the latter ; so that the old disease, finding no other organ
to act upon is necessarily extinguished. Or, to express it in other
terms, as soon as the vital powers which have till then been deranged
by a morbific cause, are attacked with greater energy by a new power,
very analogous to the former, but more intense, they no longer re-
ceive any impression but from the latter, while the preceding one, re-
duced to a state of mere dynamic power without matter, must cease to
exist."— (§ 45.)

" Of any two diseases which occur in the ordinary course of nature,
it is only that one whose symptoms are similar to the other which can
cure or destroy it. This faculty never belongs to a dissimilar disease.
Hence the physician may learn what are the remedies with which he
can effect a certain cure, that is to say, w4th none but such as are
honKBopathicJ^

A remedy that is perfectly homoeopathic cures the disease with-
out any accompanying ill effects ; and a disease that is of no very

HOMCEOPATHY. 109

long standing ordinarily yields, without any great degree of suffering,
to a first dose of a well-selected remedy. When a perfectly homoeo-
pathic remedy acts upon the body we see nothing more than symptoms
analoo'ous to those of the disease laborino; to surmount and annihilate
these latter symptoms by usurping their place. The remaining symp-
toms, caused by the medicinal substance, which are often numerous,
and correspond in no respect with the existing malady, scarcely ever
show themselves, and the patient improves from hour to hour. The
remedy having expended its force in those portions of the organism
that were already a prey to existing disease, and in these parts exerted
that specific action by which it extinguished the original disease.

But there are a few exceptions to this general truth. "There is no
homoeopathic remedy, however suitably chosen, that does not (espe-
cially in a dose not small enough,) produce at least during its action,
some slight inconveniences or fresh symptonis in very sensitive and ir-
ritable patients. In fact it is scarcely possible for the symptoms of
the medicine to cover those of the malady ivith as much precision as
two triangles with equal sides and angles. But these differences, which
are of little importance in a case that terminates in a short time, are
easily effaced by the energy of the vital principle, and the patient does
not perceive it himself, unless he is excessively delicate. The re-
establishment of health goes forward, notwithstanding, unless impeded
by the influence of heterogenous medicinal agents upon the patient,
errors of regimen, or excitem.ent of the passions. — [Ilahoieinann^ § 156.)

When a true homoeopathic remedy in small dose has been given, it
quietly annihilates the acute disease which is analogous to it, without
exciting new and non-homoeopathic symptoms ; but it often happens
that it produces at the end of one or two hours (according to the dose),
a state something less favorable, which resembles the original disease
so closely, that the patient supposes the primitive affection aggravated.
But in reality it is nothing more than a medicinal disease, extremely
similiar to the primitive one, and rather more intense in its nature.

This trifiing hoinceopathio aggravation of the malady during the
first few hours may be accepted as a happy omen that the disease will
soon be cured, perhaps even with the first dose. The medicinal disease
is similar to the other, but more intense than the one it is intended to
cure. The smaller the dose of the homoeopathic remedy, the slighter
the apparent aggravation of the disease will be, and proportionably of
shorter duration.

In a discussion in the Societe Med. Homoeop. de France, Feb. 20,
1860, M. Cretin thus stated what he called the double principle enun^.
ciated by Hahnemann.

1. The curative effect is so much the more uncertain and rare in

110

GElsERAL PKINCIPLES OF MEDICAL SCIENCE.

proportion as the dose induces more marked and more numerous patl^o*
genetic symptoms. (Superior limit.)

2. The curative effect is so much the more sure and constant in pro-
portion 8bS the dose approaches that which would excite the slightest
aggravation of existing symptoms. (Inferior limit.)

The real nature of homoeopathic cures is thus explained by Fletcher
,.on the Brunonian theory : The primary action of stimuli, and therefore
of all specifics, as well as of all other positive agents, is in reality two-
fold ; and in all organic diseases, such as inflammation and its conge-
ners, fevers, increased secretion, &c., — consists in, first, a stage of ex-
citement, with constriction of the capillary vessels, followed by indirect
debility with dilatation of the capillaries, and increased secretion ac-
cording to its kind. When the homoeopathic cure takes place, the
disease is in the stage of indirect debility, and the medicine exerts upon
it its action, viz., that of a stimulus, and thus the cure takes place by
anti^athio action. But this must not be confounded at all with that
action in the sense of the allopathists, for it does not refer with them to
this view of the ultimate nature of the action of medicine, but to its
broad meaning as primary and secondary on the healthy body.

^ ^«-r,™/,^Tr^ . -r S DEPENDING Oil the ciiEMicAL aflSiiity wMch exists between the drug and
I. CHEMICAIi, -j ^jjg TISSUES of the "body.

II MECHANICAIL15 j Consisting chiefly in violent eiforts on the part of the organism to eject

^1 " '" '■

or Revolutionaky,

from its cavity the offending substance.

III. DYNAMIC,

A. GENEEIC —
Common to all
the members of ^
a certain class

of DRUGS.

B. SPECIFIC—
Resulting from
the DYNAMIC ac-
tion of the DRUG.
These are spe-
cific, and PECtr-
LIAR to it.

y PRODUCE

ARSENIC.
CUPRUM.

TARTAR-EM.
YERATRUM.

I ARSENIC.
Poisoning, as
the speedy re- H
suit of LARGE
DOSES.

[Primary. Secondary.']

COLD SWEATS.
CRAMPS of the EX-
TREMITIES.
DIARRH(EA.

Constipation.

ARSENIC. MERCURY.

COLD SWEATS, f

CRAMPS of
the EXTREM-
ITIES.
DIARRIICEA.

VOMITING.

2. PERIPHERAL.

The EFFECTS appear -j
more slowly ; they are
generally the result
of SMALL DOSES re-
peatedly taken, or al-
lowed to act for some
time without inter-
ruption.

GRADUAL poisoning, as

by EXHALATIONS.

ARSENIC cachexia, or

DYSORASIA.

Affection of the glands
and BONES.

MARASMUS.

ERUPTIONS on the skin.

INCRKASEJJ

action of the

LIVER.

BONES, dis-
eases of.

GLANDS, ey-
citement or
inflamma-
tion of.

MERCURIAL
CACHEXIA.
PTYALISM.

Skin aflec
tions.

HOMCEOPATHY

111

CLASSIFICATION OF MEDICINES,

According to their Primary Effects in Massive Dosea^

ALTERANTS.

a. Anti-inflammatory.

h. Anti-cachectic —
or Invigorating.

1. Blood-letting.

2. Emetics.

3. Cathartics.

4. Diuretics.

5. Antilithics.

6. Emmenagogues.

7. Expectorants.

8. Anthelmintics.

9. Diaphoretics.
10. Nauseants.

1. Stimulants.

2. Narcotics.

3. Antispasmodics.

4. Tonics.

5. Astringents.

1. Baths, at Yarions Temperatures.

2. Frictions.

3. Uubefacients.

4. Epispastics.

j 5. Suppuratives.

V 6. Cauterizing Counter-irritants.

II.
EVACUANTS.

III.
INCITANTS,

EXCITANTS.

ly.

DERIVATIVES;

REVULSIVES ;

COUNTER-IRRITANTS-

The curative powers of drugs, says Hahnemann, are in no wise dis-
coverable in themselves ; and the pure experiments which have been
made, even by the most skillful observers, exhibit nothing to our view
which could be capable of rendering them medicines or curative re-
medies, except the faculty they possess of producing manifest changes
in the general state of the human economy, particularly with persons
in health, in whom they excite morbid symptoms of a very decided
character. We ought to conclude from this, that when medicines act
as remedies they can not exercise their curative virtue by the faculty
which they possess of modifying the general state of the economy and
giving birth to peculiar symptoms. Consequently we ought to rely
solely upon the morbid appearances which medicines excite in healthy
persons, — the only possible manifestations of the eicrative virtues
tohioh they possess^ in order to learn what malady each of them pro-
duces individually, and at the same time what diseases they are capable
of curing." {Org anon, p. 21.)

"Medicinal substances manifest the nature of their pathogenetic
power, and their absolute, true action on the healthy human body, in

112 GENEKAL PEIISTOIPLES OF MEDICAL SOIEKOE.

tlie purest manner, when each is given singly and uncombined to healthy
individuals. And thus we obtain the pure result of the form of disease
that each of these medicinal substances is capable of producing ab-
soliitelyj and in itself on the huma,n body." [Hahnemann's Lesser
Writings^ Maroy^s Edition,, p. 452.)

"It is impossible that the alterations in man's health, which medicines
are capable of producing, can be known and observed more purely, cer-
tainly and completely by any other method in the world than by the
action of medicines upon healthy individuals ; indeed there is no other
way conceivable, in which it were possible to obtain experience that
shall be at all of an accurate character. Even when given in human
diseases, in order to ascertain their effects, the peculiar symptoms
which were solely due to a medicine can never be distinctly recognized,
never accurately distinguished amid the tumult of morbid symptoms
already present, so as to admit of our ascertaining vfhich of the changes
effected were owing to the medicines, and which to the disease." ^^

PRIMARY AND SEOONDxiRY ACTION OF DRUGS.

Homoeopathy teaches that the impressions which drugs produce upon
the organism, in health and in disease, are analogous in their character.
But there is this important difference between healthy and diseased
structures, that large quantities of the drug are required to produce
appreciable impressions upon the former, while the susceptibility of the
latter is so morbidly augmented that the most minute atoms of the
medicine are instantly effective. Not only so, but even the natural
material stimuli of the structures can not be tolerated, but become im-
mediate and additional causes of disease, and, if persisted in, of fatal
disorganization. If then, we desire to know the precise effects of^drugs
in disease, it is necessary to prove them by taking when in health doses
sufficiently large or so often repeated as to affect the structures sen-
sibly and decidedly. Even if contraria eontrariis oj>j)onenda be
adopted as the law of practice, this is an important discovery, for we
may then administer the remedies with a full knowledge of the parts
they impress and of the exact symptoms they induce, and thus remove
allopathy a single step from empiricism. Some eminent writers of the
old school have distinctly shown the importance of this subject. Thus,
Dr. Paris, in his Materia Medica, remarks, "that observation and ex-
periment upon the effects of medicine are liable to a thousand fallacies,
unless they are carefully repeated under the various circumstances of
health and disease^ in different climates, and on different constitutions."

Professor Dunglison [On New Remedies^ page 7) says: "to treat
disease methodically and effectively, the nature of the actions of the

* Hahnemann's Lesser Writings, 721-722 pp.

PRIMARY AND SECONDABY ACTION OF DEXJGS. 113

living tissues, in both the healthy and morbid conditions must be cor-
rectly appreciated; the effects which the articles of the Materia Me-
dica are capable of exerting under both those conditions must be known
from accurate observation, and not until then can the practitioner pre-
scribe with any well-founded prospect of success."

Pereira assures us, "that in order to ascertain the action of remedial
agents on the living body, it is necessary that we examine their influence
both in healthy and diseased conditions. For by the first we learn the
positive or actual power of a medicine over the body ; while, by the
second we see how ths^t power is modified by the presence of disease."
{Materia Medica and Theraj),^ VoL L, p. 126.)

Other equally distinguished allopathic writers now entertain the
same views upon this point, but without taking into consideration some
very important circumstances connected with the provings. We have
reference to the great fact inculcated by Hahnemann, that all drugs ex-
ercise upon the organism two effects^ a jprhnary and a secondary^
and that these secondary effects are always the reverse of the primary.
A knowledge of this truth will enable us to classify both the primary
and the curative results of medicines, and thus more clearly to ap-
preciate the phenomena which should guide us in their application.
The primary symptoms make their appearance soon after the medicine
has been taken into the stomach, and continue for a longer or shorter
periodj according to the magnitude of the dose and the condition of the
general health ; after which they disappear, and the secondary or op
posite series of phenomena manifest themselves and remain until the
organism recovers its equilibrium. But in a few instanoes the power
of drugs is displayed in such a manner that these primary or secondary
effects appear in alternation for a considerable time, when the primary
symptoms yield to the secondary, or serious organic derangements
ensue. The mode of operation in these instances is probably analogous
to that of the miasm of intermittent fever, in producing alternate chills
and heat. Medicines of this description are tQvm^ poly or ests,

No one who has candidly tested the operation of drugs, with reference^
to this law, can for an instant deny its truth and importance ; and the
law applies not only to large doses of drugs, but to every other cause
which unduly impresses the structures : that is in such a ma,nner as to
disturb that healthy balance in the operations of the organs which con-
stitutes health. Let us examine the ordinary effects of cathartios^ in
health; First, the mucous membrane of the intestinal canal is irritated
or inflamed, and the natural consequence of inflammation follows in the
form of increased mucous and serous secretion, increased peristaltic
action, and a painful and loose state of the bowels : this is the primary
effect. After several thin discharges from the bowels, a debility a,nd.
a depression of the parts occur, the degree of which is proportioned tc

Vol. 1.-^8.

114 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

that of primary irritation; tlie peristaltic action becomes impaired or
suspended, and constijpation results as the secondary effect of the drug,

There is no exception to this rule, unless the cathartic operates so
violently as to produce a permanent inflammation and disorganization
of the mucous membrane, in which case the primary symptoms may be
continuous and constitute a permanent affection. Even in cases of this
kind, however, partial reactions sometimes occur during the course of
the malady, and secondary symptoms are manifested, in the form of
constipation alternating with diarrhoea. These violent primary symp-
toms rarely continue beyond a few days without resulting in serious
structural lesion, or a healthy and permanent reaction.

The primary effects of Opium, in large doses, are to induce sleep,
lessen nervous and muscular sensibility, cause agreeable dreams, and
diminish or suspend all of the secretions, with the exception of per-
spiration, which is augmented. If the quantity taken has been mode-
rately large, a pleasurable excitement for a short time precedes the
soporific influence as a primary symptom. These first results continue
from twelve to forty-eight hours, according to the magnitude of the
dose, when the organism reacts: the exhilaration is succeeded by de-
pression, the sopor by constant and prolonged wakefulness, morbid irri-
tation of the whole system, a return in preternatural quantities of all
the secretions, which had been suspended, and a suppression of the
cutaneous secretion, which had been morbidly augmented ; and the
mcondary effects of the drug are thus manifested.

So long as diuretics continue to irritate the kidneys, they are for-
cibly stimulated to pour out an unusual quantity of urine ; but as soon
as the specific is omitted, the organism reacts against the temporary
irritation set up by the medicine, and a corresponding diminution of
the urinary secretion follows, until the organ recruits from the pre-
vious overaction, and the disturbed equilibrium is restored.

The primary operation of stimtdants gives rise to an exaltation of
the mental and physical powers, while a corresponding depres-sion and
abasement invariably result as secondary consequences.

The primary operation of Digitalis in large doses, is to retard the
action of the heart and arteries. The reaction of the system against the
drug, or the secondary effect, is an augmentation of this action.

^he primary symptoms' caused by Aconite are intenser action of
the circulatory vessels : the secondary consequence consists of a re-
duction of the pulsations, in some instances as low as thirty-five in the
minute.

The primary effect of intense cold is to stimulate and invigorate the
whole system; and the secondary le^vlts are loss of muscular and
mental energy, stupor and death.

All drugs, whatever may be the special nature of their action, give

PEIMARY AND SECONDAKY ACTION OF DRUaS.

115

rise in every part of tlie organism where this action manifests itself, to
two orders of symptoms, which are generally, if not always, opposed to
each other. Hahnemann attributed no other symptoms to the drugs
directly, except those which he had seen develop themselves under
their influence, and which he therefore called ^'jprimary sym^toonsP
Whereas he considered as simple reactions of the organism all those
symptoms that succeeded the former, and which he therefore designated
as ^^seGondaryP Teste considers it not yet perfectly settled that the
secondary symptom is always the contrary of the primary, (Materia
Mecl.^ p. 48.) Hahnemann says: Every agent produces, more or less,
"some notable change in the existing state of the vital powers, or creates
a certain modification in the health, of longer or shorter' duration : this
change is called the primitive effect. But our vital powers tend always
to oppose their energy to this influence or impression. The effect that
results from this, and which belongs to our conservative vital powers
and their automatic force, bears the name of secondary effect or re-
action,''^

Examples.

The Primary Effect of dipping
the hand in cold water is to make
it hotter than in the common state.

Violent exercise causes ex-
treme heat.

Wine stimulates and heats the
body.

An arm held for some time in
freezing v/ater becomes cold and
pale.

Strong coffee stimulates the phy-
sical and mental powers.

Opium excites somnolence or
deep stupor.

Opium causes first constipation.

Purgatives increase the action
of the bowels.

Secondary Effect,

After drying it becomes colder
than before.

Shivering and cold follow over-
heat.

Next day the slightest current
of air produces chill.

Being withdrawn and dried it
becomes hotter than the other.

It leaves behind it heaviness
and drowsiness which lasts long.

More difficult to fall asleep when
its action is entirely expended.

Diarrhoea follows the constipa-
tion.

Constipation follows the purg-
ing;.

This law of primary and secondary action applies not only to me^
dicinal^ but to a large proportion of morMfic agents. On this suppo-
sition we may readily account for the remissions and exacerbations
which are observed in most fevers. It is only when the morbific in-
fluence has been very active and the resulting inflammation violent,
that no reactions or remissions occur. It may nevertheless be set down
as general law, that no structure of the human body can be called into

116 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

preternatural action, or stimulated heyond a gwen ^oint^ "without a
speedy tendency to reaction on the part of the organism. In severe
forms of disease, this reaction may not be apparent for -vyeeks, and per-
haps until organic lesion occurs ; yet, sooner or later, some reaction,
with secondary symptoms, manifests itself. There is a healthy point
in the functional actions of the organs^ — an equilibrium, if we may be
allowed the expression, of the respiratory, circulatory, digestive, absor-
bent, assimilative, secretory and excretory functions— which can not
be disturbed with iilipunity. Stimulate one of these beyond its natural
point, and a corresponding depression must necessarily ensue before
the normal balance is restored. Each tissue possesses only a definite
amount of resisting power, and therefore every undue expenditure of
this power entails future debility. Nature is constantly striving to
maintain the functions in their natural condition, and this she accom-
plishes by inducing in the different parts a reaction the renjerse of the
disturbing caicse^ and bearing an inverse ratio to this cause. The
amount of strength and resisting force which is acquired from the food,
&C.J is fixed and definite ; and this force is expended in limited and definite
quantities throughout the econom}^, and thus secures the healthy per-
formance of the functions^

The practical deductions which legitimately arise from these views
of this subject, are of the most interesting character, as regards the
application of remedies ; for if the ideas which ha,ve here been adduced
are correct, it is plain that the antipathic docti'ine of cure is erroneous,
while the truth of the homoeopathic becomes equally apparent.

SUSCEPTIBILITIES OF ORGANS AND TISSUES TO THE INFLUENCE
OF REMEDIAL AGENTS, VASTLY GREATER IN DISEASE THAN
IN HEALTH.

One of the principal arguments which has been adduced against
Hahnemann's system of Therapeutics is the supposed fallacy of judg-
ing of the effects of medicines in disease, from their operation in
health. It is considered that the modifications which occur in what
are termed the " vital properties" of parts, in a state of disease, also
alter the action of remedical agents in a. corresponding manner.

The fact is incontrovertible, that tissues in a state of inflammationj
do acquire properties very different from what they possess in the nor-
mal state, but respecting the nature of these acquired properties,
numerous facts go to prove, firstly, that the parts actually inflamed, be-
come extremely sensitive to the impressions of specific remedies ; and,
secondly, that the facility of absorption is promoted throughout the
whole system. The recent experiments of Miiller and Matteuccihave de-
monstrated the fact, that in proportion as the tone of the nervous and

INFLUENCE OF KEMEDIAI. AGENTS ON ORGANS AND TISSUES. 117

muscular systems becomes impaired, or inflammation obtains, up to a
certain point, just in the same ratio will absorption be promoted, and
foreign agents exercise their influence.

We have seen that inflammation consists m a " congestion of the
capillaries'' induced by debility and the want of resisting power in
these structures to exclude the arterial blood, and that the effects of
inflammation of a particular organ upon the general system, are las-^
situde, pains, and other symptoms which indicate diminished nervous
and muscular energy. That condition, therefore, which is termed
erethism^ is not, as is sometimes supposed, indicative of increased
nervous energy, but results directly from loss of strength.

In health the capillary vessels possess the power of excluding all of
those constituents of the blood except the colorless fluid which is their
natural stimulant. Although the capacity of these minute tubes is
sufficiently large to admit the red globules with ease, yet they are en-
dowed with a peculiar property which enables them to resist their
entrance.

Any cause, therefore, capable of impairing this natural iffitabiUty^
becomes a source of debility and inflammation.

It has been proved that, in health, most medicinal snbstanccs may
become absorbed into the blood ; but unless they possess some pecu-
liarly noxious qualities, they will act upon those parts for which they
have a specific afiinity, and be thrown off in the form of excretions,
causing in their passage through the structure on which they act, only
a slight and perhaps unappreciable irritation.

When taken in disease, these same substances are absorbed with
far greater facility, and exercise the same specific affinity for parti-
cular parts as jn health ; but with the difference, that they make im-
pressions upon the inflamed tissues, far more energetic and strongly pro-
nounced, than when taken in a healthy sta.te of the organism. Nor is
is this augmented susceptibility to the influence of remedies, confined
to the tissues primarily affected, but the whole system becomes far
more impressible than during health. It is a well established law, that
no one structure can be inflamed without giving rise secondarily to
sympathetic symptoms in other parts of the economy. It matters not
whether the part jjTirnarily affected, be the lungs, stomach, skin, or
any other structure, the whole system may be ultimately disordered,
through remote oontiguous or continuous sympathy. The connection
between the different parts of the human body, through the media of
the sympathetic nerves, is so close and direct, that no organ can be
acted on by a morbific agent, without developing secondarily sympa-
thetic symptoms more or less violent, according to the nature of the
agent, the severity of the primary impression, and the constitution of
the individual.

118 GENERAL PBINCIPLES OF MEDICAL SCIENCE.

All of the organs are so designed and constructed by the Supreme
Architect, that, in health, a certain harmony of action prevails through-
out every part of the machine, causing every function to be executed
with uniformity, so that no disturbance can accrue to any single part
without impairing this healthy equilibrium.

Dr. Paine, in speaking of this subject, presents the following views
which v/ill be found to coincide very nearly with the doctrines of
Hahnemann ; we only wonder that the practical deductions of these
two distinguished authors should differ so materially :

*^It appears, therefore, to be a most important law, th^st mo7'Md states
call into operation that function of sympathy among organs, which in
their natural state manifest but feeble, and perhaps no direct relations
whatever ; and that in consequence of morbid changes, remedial agents
Yf ill operate sympathetically through the stomach, &c., upon remote
parts, when they would have no such effect in the healthy state of the
organs. New vital relations being developed by disease, our remedies
continue to operate through those acquired relations so long as they
exist."

Again, '* In proportion, therefore, as the susceptibility of the system
at large is increased by morbid changes, or predisposed by morbific in-
fluences, so, in a general sense, will the alterative action of remedial
agents be felt in a corresponding manner."

Again, " It is one of the most important laws in medicine, that the
8u.sceptibility of tissues and organs to the action of remedial agents, is
more or less affected by disease. Many agents which operate powerfully
in certain m6>r5^(^ states^ and in certain doses, both locally and sympathe-
tically, may be perfectly inert in the natiiral states of the same organs."

Finally, "It is worthy of repetition, that such is the analogy between
morbific and remedial impressions, that the organs which sustain the
former are rendered susceptible of the latter, when they might other-
wise be insensible to the same remedial agents, in their appropriate
doses. Take many of the most powerful agents. Arsenic^ tartarized
Antimony, Iodine^ &c., and when administered in certain small and
repeated alterative doses, they bring about the cure of the most obsti-
nate and formidable conditions of disease ; while the same doses may
not manifest any action upon the system, or on any part of it, under
circumstancss of health. This manifestly depends upon an increased
susceptibility of the organic properties in their diseased conditions, to
the action of foreign agents, and upon an increased disposition to under-
go changes. This law, which unfolds a principle latent in health, and
by which morbid organic properties acquire susceptibilities to salutary
influences from agents which in health would either produce no effects,
or lead to untoward results, and its ally, the great recuperative prin-

INFLUENCE OF REMEDIAL AGENTS ON OEGANS AND TISSUES. 119

ciple, impose the highest obligation upon physicians .to become medical
philosophers."~(Pa^W5 Institutes of Medicine.)

Most of the positions laid down by Dr. Paine in the above quotations
are doubtless correct; but, in all his inductions, he is laboring undei
an important error in supposing that morbific and remedial agents
exercise their infiuence only upon certain immaterial jprinGijples oi
vital properties.

Can it be supposed, that when Tartarized Antimony or IpeGacn-
anha are taken into the stomach, in emetic or diaphoretic doses, they
act upon an immaterial property of this viscus, in causing emesis or
diaphoresis! Can it be believed, that the diuretics, Copaiiw^ Cubebs,
Turpentine, &c., operate upon the vital properties of the urinary
apparatus in producing diuresis, or that J^elladonnay Strmnonitcm^
Strychnia^ Gonia^ Alcohol^ and the vapors of Ether, or Chloroform,
expend their force upon the spiritual properties of the brain and nerv-
ous system; or that the preparations Oii Mercury^ Iodine, &c., exercise
their powerful influence upon the organism, by impressing immaterial,
imponderable or vital properties?

We think it is more consistent with known facts and sound logic, to
suppose that all such agents exert their influence primarily upon the
sentient extremities of the nerves, modifying the functions of those
parts which they supply, increasing their susceptibility to the influence
of foreign agents, and thus establishing inflammation or a new action.

It has been remarked by Dr. Paine, as w^ell as by other authors, that
Arsenic^ Antimony^ Iodine^ Mercury^ &c., given in certain small
and repeated doses. in disease, are productive of decisive effects, while
the same doses in health, would exert no appreciable influence. For
this reason, they assert and would have us believe, that the conditions
and properties of diseased parts are so modified and altered in all
respects, as to be incapable of responding to the action of those medi-
cines which operate specifically in health.

It is quite certain that most medicinal substances may be taken in
very small doses during health, without any apparent effect, on account
of the power which the system then possesses of resisting the aggres-
sions of slight foreign agents: but if the same substances be taken in
large doses^ most decided, powerful, and specific results will follow in
all states of the system. If taken in still smaller quantities, the
effects are yet perceptible, but less strongly marked. These results
will be unequal in point of intensity in normal and abnormal states of
the organism, according to the amount of disease present; but in all
instances, their sjoecifio operations w^ill be uniform,

Tartojrized Antimony and Tpecacuanha^ in large doses, both in;
health and disease, exercise a specific influence upon the stomach,
lungs, and skin, as is indicated by vomiting and augmented secretiona

120 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

from the respiratory organs and skin. In doses of one-sixth or one-
eighth of a grain, no eftect is produced upon the respiratory muscles or
stomach, but the influence is yet visible upon the skin. If the quantity
be diminished still farther, even to an attenuation according to the rules
given by Hahnemann, the impression may not be jpeTGeptihle^ either
upon the stomach, lungs, or skin, yet we find them capable of influencing
the extreme nerves in a decided manner. It does not folio>Y, because
a patient does not vomit, purge, or sweat, that a medicine has no eifect.
On the contrary, we know that morbific agents give rise to the most
virulent diseases without creating the slightest sensation in the system
at the period when the noxious impression is made. The direct and
sympathetic eflects of such agents are, however, severe and dangerous*

Experience on the most extensive scale has proved in the most
conclusive manner, that minute quantities of medicinal agents may pro-
duce salutary influences in the same manner; and the law obtains with
regard to specific medicines. The efiects in these instances may not
indeed be sufiicient to induce emesis, catharsis, or other violent eifects'
in any part of the body; yet from the great sensibility of the minute
nervous ramifications, they must receive impressions and be modified
in their action, when the trunks or larger branches of nerves, would
remain unaffected. "Who shall decide when the quantity has become
too small to produce an effect upon the most sensitive parts of the
body? Shall the allopath, because he does not witness vomiting, purg-
ing, or sweating ; or the homoeopath, who from accurate observation in
numerous instances, notes from infinitesimal doses, prompt and decisive
curative effects?

To illustrate our meaning more fully, we will suppose a certain medi-
cine possessing the power, when given in large doses, during health, of
affecting a particular tissue. The same substance, administered in
very small doses under the same circumstances, has no apparent
influence. If now, the tissue for which it has a specific afiinity,
ieeomes inflamed^ its susceptibility is so acute, that an extremely
minute quantity of the specific agent is capable of making potent and
salutary impressions, '

The other parts of the organism which become disordered through
the media of the sympathetic nerves, also acquire an exalted sensibility
which renders them highly impressible, and capable of being acted
upon by infinitesimal quantities of specific medicinal agents. Homoeo-
pathic remedies, as Paine has well observed of medicines generally,
act only through these '^acquired relations," and their power ceases as
soon as these acquired relations have been removed and health re-
established.

We shall appreciate, then, the importance of selecting a remedy
which shall, cover, not only the symptoms resulting directly from the

INFLUENCE OE REMEDIAL AGENTS ON ORGANS. AND TISSUES. 121

tissue primarily affected, but which shall embrace all of the remote
sympathetic effects. In other words, we must prescribe for the 'totality
of the symptoms."

"It will now be apparent from what has been said in the preceding
section, how it is that remedial agents will call into salutary reaction
sympathies in various parts of the body not affected by disease, but
whose susceptibilities are increased by morbific sympathies reflected
from the seat of absolute disease, and upon which parts the remedial
agents might otherwise be inoperative. Whatever, too, may be the
complexities of disease, the right remedy will be at least compatible
with the whole condition." (Paints Institutes of Medicine^

"A particular state of one organ, such as inflammation, or a secreting
action in it, often causes the production of a similar state of other
parts." And "the principle of the balance of sympathy teaches us
how we must avoid aggravating the morbid condition of one organ by
the means which we apply to another." (MuUer's Physiology,)

An adherence in all cases to Hahnemann's axiom : ^^similia simili'
ius^^ in our remedial measures, is the only means by which this last
objection can be obviated with any certainty of success.

It is proper here to remark that there are a few apparent, though
not real exceptions to the principles which we have advanced. A most
remarkable one is observed in the case of tetamcs, wlieYQ enormous
quantities of Opimn, both in a crude form and in tincture, may be
administered by the stomach or rectum, without producing any marked
effect. This fact, however, by no means proves that the susceptibility
of the parts for which Opiu?n is a specific, is diminished ; but it proves
only that absorption is prevented. If Opium is injected into the
veins, under these circumstances, it has been found by Magendie,
Orfila, and Miiller, that it exerts its influence in the same manner and
degree as when taken during health.

We suppose, therefore, that in tetanus the lacteals and other absorb-
ents, are in a state of spasm^ and thus mechanically exclude the
entrance of all substances from their structure. In this manner,
opiates and other drugs are shut out of the circulation, and conse-
quently, cannot be brought mi(y oontaot ^Ri\h. those parts of the nervous
system upon which they exert their specific force, and where alone
they possess the power of producing their legitimate effects.

All cases of this description, are simply apparent exceptions to the
general rule, and do not in the slightest degree invalidate the general
principles which we have advanced.

The public of Europe and America are fast rendering the same
justice to Hahnemann and his doctrines, and the time will ere long
arrive, when the united w^orld will rank him by the side of those great
men to whom we have just alluded. It is even now conceded by many

122 OENEE^L PRIIsrCIPLES OF MEDICAL SCIENCE.

eminent allopathic writers, that the hypothetical doctrines of homoeo-
pathy are correct.

But when we come to the therapeutical inferences deduced from
these opinions, we find a wide and essential difference. The allopath,
in summing up his method of treatment, has retained all of the violent
and barbarous remedies of antiquity, with very little knowledge of their
mode of operation upon the human system, and with as little certainty
as to whether they w^ill ameliorate or aggravate the disease.

The homoeopathist has pursued a different course. In consideration
of the facts that the action of no two medicines upon the econC)my is
the same, that almost every agent exercises a peculiar and specific in-
fluence upon certain structures only, and that this specific effect obtains
both in health and disease, he institutes a series of accurate experiments
during health, in order to arrive at the pure effects of different medi-
cinal substances. The illustrious founder of homoeopathy not only
tested the operation of medicines upon his own person, but he induced
others — -men of science and undoubted integrity in different parts of
Europe — to make trials of the same substances, without informing
them of the results of his own experiments ; and when their observations
were completed, he instituted comparisons, and found that the effects
of the medicines upon the different individuals, were almost uniformly
the same. Having by extensive experiment ascertained with certainty
the pure effects of a number of articles during health, he commenced
exhibiting them for the cure of diseases, in accordance with the prin-
ciple which he had previously conceived to be philosophical and true ;
and we need not repeat that the results of these experiments were in
the highest degree satisfactory.

In the early part of his career, Hahnemann made use of the pure
toother-tinctures in ordinary doses, but he observed that the primary
effects were too active, — there usually occurring a temporary augmen-
tation of symptoms. This induced him to reduce his doses until he
came to make use of attenuations and dilutions : and he found that,
when the medicines were properly prepared, they still had their speci-
fication, and that disease was more speedily removed than when cruder
preparations were employed.

In the preparation of Dilutions and Attenuations^ Hahnemann
mixed one drop of some powerful extract with 99 drops of Alcohol by
vigorous shaking. This vfas i]iQ first dilution.

One drop of this was again mixed Avith 99 drops of Alcohol. This
was the second^ and so of. other successive dilutions.

In prepai'ing the triturations, he triturated one grain of a metal or
mineral with 99 grains .of Sugar of Milk, of which one grain was tri^
turated with 99 of Sugar of Milk for the second trituration.

INFLUEKCE OF REMEDIAL AGENTS ON OEG-ANS, AND TISSUES. 12S

The third trituration was dissolved and then treated as a fiuid sub-
stance. He carried this process to the 30th degree.

But the principal objection ever raised against the system of homoeo-
pathy is the supposed inefficiency of infinitesimal quantities of medicines
when administered as curative agents. Nor is this at all surprising,
for it has been customary for three thousand years, when disturbance
prevails in the human citadel, to storm it with agents of destruction.
Blood is made to flow, the delicate membranes of the stomach and in-
testines are raked with broadsides of emetics and drastics, the nervous
system is shattered by narcotics and stimulants, and the functions of
every organ deranged by showers of destructive allopathic missiles
with which the enfeebled body is constantly assailed. By these sum-
mary means the disturbance is smothered, but the citadel is in decay
its resources exhausted, its foundations impaired, and its strength for-
ever diminished.

Homoeopathy resorts to a different mode of procedure. In her re-
medial measure;! ahe uses no unnatural violence, nor seriously disturbs
the function of any organ : but her remedies are exhibited with a de-
finite object; the affected organ or tissue is acted upon with almost
mathematical certainty, and that too without creating disease in healthy
parts, or 'in any way complicating the natural affection. But she
usually administers her medicaments in infinitesimal^ or at least at-
temiated doses^ and we now come to the question, whether such minute
quantities of matter are capable of producing salutary impressions
upon the organism when laboring under disease.

ISFo one will deny, that the human body during health is constantly
being acted upon and disturbed by influences or agents so subtle that
neither the chemist nor physiologist can analyze or even detect them.
The simple application of substances to the surface of the body is suf-
ficient to produce decided and permanent effects. Turnbull says, that
" so small a portion as the one-Tiundreth jpart of a grain of Aconite
made into an ointment and rubbed upon the skin, has produced a sen-
sation of heat, pricking and numbness, that has continued a whole day."

A leaf of tobacco applied to the wrist or sole of the foot, will excite
the action of the respiratory muscles, blood-vessels, glands and skin,
causing nausea, vomiting, &c.

If the leaves of Hyoscyamus or Belladonna be applied to the eye,
an effect ivill he produced^ which will remain for several weeks. It
is asserted by Pereira and Sigmond, that a "dilatation of the pupils
may be produced by only apjgroximating the leaves of Hyosyamus or
Belladonna to the eyes."

It is also well-known, says Paine, that " violent erysipelatous inflam-
mation over the whole surface of the body is often induced from aj^
proaching within a few yards of several sjpecies of RhusP

124 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

The wild buffalo scents tlie hunter for a distance of more than a
mile, and hastens from the vicinity of danger.

The carniverous bird recognizes the odoriferous particles arising from
a dead carcass miles distant in the air, and with hasty wing pounces
upon the prey.

The medicinal quality of cod-liver oil [01. Jec, Aselli) consists of
Iodine distributed in infinitesimal quantities throughout the oil. Ac-
cording to an analysis made by Falker, the Iodine forms only the one-
forty-thousandth part of the oil, being about equal to a third or fourth
homoeopathic attenuation of Iodine. The value of this naturally at-
tenuated medicine in the treatment of scrofula and consumption is at
the present time generally conceded. The analysis of Stein, De Jongh
and Balard fully confirm that of Falker.

The very minutest quantity of the natural poison of certain animals,
the virus of hydrophobia, small-pox, kine-pox, syphilis, and gonorrhoea,
is sufficient, when placed in contact with an abraded or delicate sur-
face, or otherwise introduced into the system, to give rise to all of their
corresponding maladies. Other diseases, like scabies, leprosy, &c.,
may be con^municated by the mere touchy or from inhaling the breath -
of an infected person.

Miasmata, animal exhalations, electricity, magnetism, heat, light, and
even mental emotions, are all, under certain circumstances, capable of
disturbing the organism and causing dangerous maladies, and yet, as
Liebig, in his Animal Chemistry, truly observes, "with all our discoveries,
we shall never know what light, electricity, and magnetism are in their
essence. We can ascertain, however, the laws which regulate their motion
and rest, because these are manifested in phenomena. In like manner the
laws of vitality, and of all that disturbs, promotes, or alters it, may cer- .
tainly be discovered, although we shall never learn what life is.''

Let it be ever borne in mind, that most substances^ loth in the or-*
ganio and inorganic hingdoms^ possess certain active principles
which are latent and unappreciable in the natural state^ and are
only called forth and developed hy some agent or process, which
effects a transformation or metamorphosis of the crude material.

Heat, electricity, and magnetism, become apparent when certain phy-
sical substances operate upon each other in such a manner as to dis-
turb or change the original state of cohesion of particles.

Caloric is a property common to all material substances. In the
natural state of these substances, this active principle is latent, and
can not be appreciated by the senses; but if yWcz^^'o^^ be used, this
agent is set free, and its power becomes manifest.

Electricity also pervades all material bodies, and only becomes sen-
sible when the natural state of these bodies is disturbed hj friction.

It is probable, likewise, that iron and other substances contain mag

INFLUEISrOE OF REMEDIAL AGENTS OK OKGANS AND TISSUES. 125

netism in a latent state, and only require tlie operation of certain in-
fluences, to develop in them the phenomena of magnetism. This is
evident from the fact, that " the same magnet may successively mag-
netize any number of steel-bars, without losing any portion of its origi-
nal virtue ; from which it follows, that the magnet communicates nothing
to the bars, but only develops, by its influence, some A'Z^6?6?67i principle."
{Bec¥s Chemistry.) These forces are all now known to be only modes
of motion.

Large quantities of vegetable, animal, or mineral substances, may be
taken into the stomach in a crude state, with impunity ; but if their
elementary particles become separated by decomposition, or otherwise,
and then introduced into the system, they give rise to the most baneful
results. It is a matter of little consequence, whether this minute sub-
division of particles is eflected by the action of solar heat and mois-
ture, by trituration, or succussion ; the ultimate effects are the same.
The elements of the substance are separated, the essence or medicinal
part is set free from the crude, material, and non-medicinal portions, >
and reduced to such a state of attenuation as to becopie readily ab-
sorbed, and yet retain all the specific qualities pertaining to the ori-
o;inal assent.

Indeed, so minute and subtle ar,e the miasms from vegetable and
animal decomposition, the exhalations arising from contagious disorders,
&c., that no one has yet been able to appreciate their physical or che-
mical properties, by the most accurate tests of chemistry or optics.
Who, however, for this reason will presume to deny or doubt their tre-
mendous, although mysterious power upon the human system ?

When Ether or Chloroform evaporates, the cohesion between the par-
ticles of the liquid is destroyed; its elements float in the air, and are
capable of impressing the organism in a much more powerful, and in
a totally different manner from any impression which could be pro-
duced by these constituents in a less attenuated state ; as, for example,
that of the original liquid. If a large quantity of Ether be swalloAved,
but slight effects will result ; but if an imponderable quantity be intro-
duced into the blood through the lungs, in the form of vapor, it is im-
mediately brought into contact with the brain and nervous system, and
the most astonishing effects speedily ensue.

" If the TTsT-oth part of a grain of tartrate of Mercury be diffused
through the substance of a mere hard sweet-pea, the beautiful germ of a
graceful flowering herb which lies folded up in its horny pericarp, shall
never come out and be expanded, though you imbed it' in the softest
mould, and solicit it by every art." — [Leiichs)

Professor Doppler of the Royal Institute of Prague, in speaking of
the modus operandi of infinitesimal particles, writes thus: '^From the
moment in which the substance of the atoms succumbs to the influence of

126 GENERAL PEINOIPLES OF MEDICAL SCIENCE.

tlieir surfaces, and apparently independent of tlie law of gravitation, they
move with, the greatest facility in every direction, and, as it were, become
alive ; from that moment only, in my opinion, drugs acquire the capa-
city of penetrating the organism, and of exciting there a curative effect
For if drugs, prepared in this manner, be brought in contact with the
invisible extremities of nerves, their hyper-microscopical atoms will
enter the organism at the same time with their supeoficial electriGity^
and will, if the nerves be in a perfectly natural state, be thrown out of
the system without impediment, after having penetrated it in every
direction. But, if a body in state of health be accompanied by an ac-
tivity of the nervous system perfectly unimpeded and equally free in
every direction, we cannot^ on the other side, but presume, that in a
state of imperfect health the power of conduction proper to the ner-
vous substance will be materially diminished, partially and in indivi-
dual organs, either in consequence of a chemical change, or for some
other reasons. But to use rather a material, but nevertheless by no
means unfit comparison, as streams deposit the sand and pebbles they
carry along, on those spots only where their currents meet with an im-
pediment, and their rapidity seems broken by obstructions, so in a
similiar manner, in the diseased organism, may the electric currents,
however feeble, leave the atoms at the diseased spots, where they, ac-
cording to their individual properties, exert a curative or detrimental
influence."

If, then, imponderable substances possess powers so unequivocal and
potent upon the healthy subject, when the organs are in high state of
vigor, and consequently in a good condition to resist the influence of
foreign impressions, why may we not infer, with perfect propriety, that
medicinal substances, equally imponderahle^ are capable of impressing
the organism during disease, when the affected structures are unusually
susceptible to extraneous influences ?

Ilomoeopathists suppose that the mode in which their attenuations
operate is analogous to that of infection by miasms ; that the inert
matter ofthe substance is destroyed, and the active principle set free ; and
that the smallest quantity of this active principle, triturated with sugar of
mill:, or diffused in water or alcohol, is capable of communicating to the
vehicles its properties, and thus to the organism its peculiar action.

The essential principles of all vegetable substances constitute but a
very small proportion of the original crude article, and the more per-
fectly we separate these active from the inactive portions, the more
pure and powerful will the remedy become. Like caloric, electricity
xnd magnetism, the strength remains latent in their crude state of
the substance, and can only be developed by the important agency of
heat, friction, or trituration.

Peach-blossoms, the bark of mountain-ash, the kernels of peaches,

INFLUENCE OF REMEDIAL AGENTS ON OEGANS AND TISSUES. 127

cliemes and plums, bitter almonds, &c., contain, in a latent condition
the active poison known as Prussic-acid, which may readily be obtained
from either of these articles by a chemical process.

Ipecacuanha is indebted for its virtues to a principle called emetine,
Pelletier found, upon analysis, that the brown Ipecacuanha-bark con-
tains only sixteen per cent of impure emetine ; and the red bark four-
teen per cent.

According to Eerzelius, the impure emetine possesses only one-third
the strength of the pure. We therefore find, that of one-hundred parts
of crude Ipecacuanha, only five parts possess the medicinal virtues of
the drug. Nor is it all improbable, that farther researches will enable
the chemist to free this principle from other impurities, and thus deve-
lop a still more potent medicine.

Opium contains but a very small per centage of its narcotic principle,
Morphia. The crude substance contains in addition to Morphia, at least
fourteen other ingredients, all of which are destitute of any particular
virtues. Only about eight or nine per cent of Morphia is obtained from
Turkey Opium, and this is quite impure and unfit for use, containing
Narcotin, &c. Cinchonia is composed of ten or twelve ingredients, of
which, all but Quinia and Cinchona, are inert. Even these last, as
usually obtained, are highly adulterated, and do not by any means re-
present the active principle of Bark in its purity.

The same rule obtains in relation to most other substances. The
essential properties are distributed but sparingly throughout ligneous,
resinous, and other matters, and it is only by the utmost care and
nicety, that we can separate and develop these properties.

Indeed, there are many instances where the skill of the chemist is
unable, not only to develop artificially certain principles of vegetable
and animal substances, but even to analyze them when they become
spontaneously disclosed by the action of heat and moisture. Miasmata
and other noxious exhalations are examples of this kind.

It is a fundamental law of therapeutics, that the .active properties
of all medicinal substances can only be manifested from their surfaces ;
and it follows as a consequence, if we would develop the full powers of
drugs, that they must be made to occupy as great a surface as
possiile.

If a compact piece of wood be ignited, but a small blaze can be pro-
duced; while, if the same wood be cut into small portions, so as to
expose a large surface^ and then ignited, a large and powerful flame
will appear.

Only a limited amount of electricity can be drawn from a given sur-
face of glass; but if the same glass be made to occupy double the space,
an additional amount of the fluid may be set free.

If a hole be rapidly made through an ordinary piece of iron, the surface

128 GENERAL FEINCIPLES OF MEDICAL SCIENCE.

of eacli chip so detached will bo found to possess magnetic properties
and a singular circumstance connected with this, is the fact, that when
the boring is accomplished in ^ j^erj^endiGular direction, the chips are
more highly magnetized than when it is effected horizontally. Here,
again, is an instance where friction has developed properties entirely
unappreciable in the natural state.

A single grain of matter may be made by trituration to pervade every
part of one hundred grains of sugar of milk, and each molecule thus
separated, may be still farther subdivided into corpuscles, which in their
turn may be diffused intimately through additional quantities of the
medium. In this manner only, can we call forth all the latent pro-
perties of drugs, and reduce them to that state of attenuation which is
compatible with absorption, and which enables them to exert those
salutary specific influences which the homoeopathic practitioner so uni-
formly observes.

Each atom thus minutely separated, retains the powder of exercising
its specifio influence upon the organism. Quantity is of but little
consequence, provided, that the substance is properly prepared ; for an
imponderable quantity in its highest state of development is quite as
capable of producing its peculiar effects in certain conditions of the
body, as a much larger amount.

It is undoubtedly true, that an atom, either morbific or medicinal,
which possesses an affinity for a particular structure, is capable of com-
municating to such structure its peculiar action, the influence being
propagated from one molecule to another, and each acquiring the
properties of the original atom, until the influence is expended. Ex-
amples of this kind of action are constantly presented to the physician
in the form of continuous sympathy.

One inhalation of a noxious miasm, under favorable circumstances,
is as capable of causing its specific contagion, as a thousand, or more.
One thousandth part of a grain of a natural or morbid virus, is as
capable of imparting the peculiar action of the poison to all pa^rts of
the organism susceptible to its influence, as a larger quantity.

So also, when an atom of a medicine is absorbed into the system and
comes in contact with an organ or tissue already diseased, upon which
it exercises a specific infiuence, it communicates to the surrounding
atoms its peculiar action until the whole tissue is involved, and thus, if
the remedy be homoeopathic to the malady, it will supersede the primary
affection.

La Place and Berthollet have advanced the opinion, that " a mole-
cule, being put in motion, can communicate its motion to others, if in
contact with them."

This law is applicable to both animate and inanimate matter, under
certain circumstances. Thus, the smallest point of decayed vegetable

mFLUENOE OF REMEDIAL AGENTS ON OSaANS AND TISSUES, 129

or animal matter, if placed in contact with liealtliy vegetable or animal
substances for which it has an affinity, will communicate to the latter
its own morbid condition.

The smallest point of decay in a tooth, continually propagates its
peculiar action to the surrounding parts, until the whole tooth is
destroyed, or the diseased portion is removed.

The slightest spark of fire, put in contact with a combustible
material, communicates its action to all parts susceptible of combustion,

A minute nucleus being once formed in the mineral kingdom,
possesses the power of attracting to itself in a regular and uniform
arrangement, all of these particles near it, for which it has an affinity,
and the different varieties of minerals communicate to these particles
their own peculiar action and arrangement.

It is asserted by the supporters of the chemical hypothesis, " that
substances in a state of putrefaction, by entering the blood, impart
their peculiar action to the constituents of that fluid, and all the sub-
stances of the body are induced to undergo a modified putrefaction."
{Paris' Phanrmacologia.)

Liebig affirms that ^' a body, the atoms of which are in a state of
transformation, may impart its peculiar condition to compounds with
which it may happen to communicate."

These assertions, however, are not sustained by facts. There is no
proof that the blood becomes contaminated by the atoms which enter
it in a state of transformation ; nor is there any proof that such atoms
are capable of "imparting their peculiar conditions," indifferently to
other "compounds with which they may happen to communicate."

Every substance in nature, whether morbific or medicinal, possesses
its own characteristic and distinct mode of action, and is only able to
exercise or communicate this action, m a specific manner to particular
structures. Thus, the contagion of scarlatina imparts its peculiar
action to the throat and skin. . The contagion of scabies acts exclusively
upon the skin. The miasms which occasion many kinds of fever,
appear to expend their effects upon the nervous system. The virus of
gonorrhoea is specific and uniform in its results upon the mucous mem-
brane of the urethra. The virus of syphilis, although more general in
its operation, affects only a certain class of structures. All of these
poisonous matters are incapable of imparting their peculiar influence,
unless they are brought into contact with those tissues for which they
possess a '^Mnd of elective affinity r There is no reason to suppose,
that in any instance we have named, the blood itself is contaminated,
but it serves merely as the vehicle which conveys the morbid particles
to the different parts of the body.

What we have advanced in regard • to the modus operandi of
morbific, is equally true of medicinal agents. We have before shown^

Vol. I.— 9.

130 GENERAL PEINCIPLES OF MEDICAL SCIENCE.

that most drugs possess well-defined specific actions, which can only
be manifested after having been conveyed by the blood to their destined
structures.

It will be perceived that the views here advanced, in regard to the
mode of operation of morbific and medicinal agents, differ essentially
not only from those of the chemical school, but also from those of most
writers who have hitherto appeared as advocates of homoeopathy. From
quotations made at page 106, it will be observed, that Hahnemann him-
self is a firm advocate of the "vital theory." In common with many
distinguished writers of the old school, he supposes all diseases to con-
sist of certain alterations of the "vital properties" of parts, and that
medicines cure these diseases by acting upon these (supposed) im-
material properties in such a manner as to restore them to a normal
state. In advocating these doctrines, Hahnemann has virtually rejected
the theory of absorption, the truth of which has been so ably maintained
by Miiller, Pereira, Elaine, and others, and thus has raised opposition to
a portion, of his beautiful system.

It may seem impossible, at a first view, that attenuated drugs can
be alsofbed into the system, and exert their influence tojoically on the
different structures ; but in support of this opinion we beg leave to
submit the following ideas : —

Medicines, as we have already remarked, are often detected in those
structures on which they have exerted their effects. Mercury, lodinCp
Sulphur, Nitrate of Silver, the Salts of Lead, Iron, Bismuth, Copper, &C.5
have all been found in different tissues of the economy; and even Liebig
himself advises us, that many of these substances often form "per-
manent compounds with the different tissues." The same author also
remarks, "if by the introduction of a substance certain abnormal con-
ditions are rendered normal, it will be impossible to reject the opinion,
that this phenomenon depends on a change in the composition of the
constituents of the diseased organism, a change in which the elements
of the remedy tahe a shareP

The elements of the remedy do most certainly take a share in this
change, but only so far as the disordered organ or tissue is concerned.
It matters not, whether the specific agent be imponderable in quantity,
administered through the lungs, stomach, or skin, or injected into the
veins; it seeks that part for which it has an affinity,' and there mani-
fests its force.

I have known persons to become salivated by the use of less than
one half of a grain of the first trituration of Corrosive Sublimate given
in divided doses. This can be explained in no other way than by sup-
posing that the remedy is rendered innoxious to the absorbed vessels
by the peculiar mode of preparation ; for so small a quantity of the
orude article has never, to our knowledge, been known to produce this

INFLUENCE OF REMEDIAL AGENTS OK OEGANS AND TISSUES. 131

result. By trituration, the crude particles of the mineral are so minutely
separated and diffused through the vehicle, that the delicate absorbents
admit them into the circulation with facility, while in an unprepared
state the remedy would be recognized as an irritant^ and consequently
excluded.

When salivation is produced by large doses of Calomel or Blue-mass,
it is highly probable, that evaporation occurs from the heat of the
stomach and intestines, and that this vapor, im.pregnating the chyle, is
absorbed. It has been said by the opponents of absorption, that the
preparations of Mercury cannot be absorbed on account of their in-
soluble nature^ and therefore that salivation is caused "by an im-
pressicn which is made upon the " vital properties" of the stomach, and
that this impression is reflected to the salivary glands through the sym-
pathetic nerves. But, if the advocates of this doctrine will reflect, that
Mercury evaporates at a comrnon temperaUvre^ and that this vapor,
when inhaled, exerts all the specific effects of the mineral, they must
admit, that when submitted to the higher temperature of the stomach
and bowels, this evaporation and absorption will be augmented. "I be-
lieve,'' says Pereira, ^^with Buchan, Ori&la, and others, that metallic
Mercury in the finely divided state in which it must exist as vapor, is
itself poisonous P

An argument which we deem conclusive upon this point is from the
fact, that traces of Meroury itself have often been detected in the se-
cretions, excretions, and solids of the body : and if any " vital properties"
have reflected the influence, they must have conveyed the solid sub-
stance along bodily to the affected glands. &c.

In considering the subject of absorption and the topical' action of
attenuated drugs, it must be remembered, that the absorbing structures
are very delicate and sensitive, so that they are enabled to exclude all
crude and irritating substances ; and also that the extreme terminations
of the nerves in all parts of the body are exquisitely susceptible to the
influence of specific foreign agents : and a cause, capable of affecting
powerfully these minute filaments, would be entirely without energy
andunappreciated, if brought to bear upon the trunk or larger branches
of the same nerve.

Another fact, illustrative of the truth of absorption and tojDical action,
is, that substances always exercise their specific effects more promptly
and potently when introduced directly into the mass of the blood, than
when taken by the stomach. "Medicinal or poisonous agents injected
into the blood-vessels exert the same kind of specific influence over the
functions of certain organs, as when they are administered in the usual
way, but their influence is more potent." [Pereira) Liebig also assures
us, that "we can by remedial agents exercise an influence on every part
of an organ by substances possessing a well-defined chemical action."

132 GENERAL PEINCIPLES OF MEDICAL SCIENCE,

There is a distinct recognition of tlie principle of the topical or sjpe*
eific action of remedial agents, although the character of this action is
supposed to be chemical. Without enteriri'^ into any discussion upon
this point, or attempting to explain, how morbific or remedial agents
produce their peculiar effects, we shall remain satisfied with the po-
sitions we have before laid down, and simply refer our readers to the
numerous instances within their own knowledge, of the topical action
of substances, both ponderable and imponderable, with the addition of
a few examples of the latter, which can be understood and appreciated
by all.

1. Odors, When odoriferous particles are brought into contact with
a certain nasal structure, (the schneiderian membrane,) the minute and
sensitive nerves of the part, take cognizance of the stimulus, a decided
impression is made upon the- whole membrane, and an odor, agreeable
or otherwise, according to the nature of the exciting cause, is the result.
In this hi^tMicQ J physical^ but iinponderahle particles operate upon
the nasal tissue hy absolute contact^ and impart that peculiar action
which enables us to appreciate odors.

2. Light, According to Sir Isaac Newton, light is ^ physical^ but
imponderable^ Q,^Wi^^mA^ and can only manifest its power when its
atoms are in contact with the organ of sight. These particles of light
are the natural stimulus of the eye, — material ^imponderable^ specific.
When this compound is separated into different primary rays, each
particular ray, when brought into contact with the eye, exercises a
special and distinct influence, giving rise to the perfect appreciation or
the different colors of the prism. Here again we are presented vrith an
example of the specific influences of imponderable atoms upon a certain
part of the system. On the dynamic theory the illustration is more forcible.

3. Heat, Newton also maintained, that caloric is ^^ a distinct
material substance^ the particles of which .repel one another, and are
attracted by all their substances."

When caloric is given off by a heated body, its atoms impart to dl
other atoms with which it comes in contact^ its own peculiar action, and
the sensation of heat, with its attendant phenomena, expansion, &c., is
the consequence. Here we are furnished with a still more striking in-
stance of the power of an imponderable substance in altering and modi-
fying the character and properties of all substances upon which it
exercises its action. This active principle, present in all bodies, hidden
and unappreciable, except when set free hj frictionj percussion^ mix-
t%ire^ electricity^ or comb%tstio7i^ possesses properties when thus libe«
rated, surpassing in power and influence every other substance in nature ;
yet it is more subtle and imponderable than the most attenuated medi-
cines of homoeopathy.

4. Electricity, galvanism, magnetism, and the various gases, are

INFLUENCE OF REMEDIAL AGENTS OK ORGANS AND TISSUES. 18S

all matericd substances and manifest their influence physioally by
contact with the body.

It must not be supposed, that light, heat, electricity, magnetism, &c.,'
are merely imaginary properties of matter,-— because they can not
be weighed, handled and made subservient to all of those con-
ditions which govern more crude substances. Nor must it be sup-
posed of drugs, that they possess no qualities except those which are
apparent in the crude state, and can be fully appreciated by their
nausoousness of taste, offensiveness of smell, or power of raking the
stomach and intestines.

Modern science has demonstrated, that \i^ fnci/ion^ percussion^ rnvx-
ture^ &c,5 some of the most powerful principles known may be liberated
from substances which in a crude state are entirely harmless. It has
shown, that the more perfectly we can disencumber these principles
from their inactive envelops, the more potent they become. It has been
shown that the mass of ligneous, resinous, starchy, fatty extractive,
and coloring matters, which surround and enclose the active portions
of vegetable substances, instead of possessing medicinal properties,
serve only to nauseate and oppress the stomach and bowels, and thus
complicate any existing malady.

Pereira, and other authors opposed to our system, have endeavored
to cover it with ridicule by entering into a computation respecting the
weight and strength of the different attenuations. They have displayed
before us tabular views showing the strength of each attenuation, and
then assured us, without the trouble of testing the question practically,
that such exceedingly small doses of medicines can produce no effect
upon the system, but ^Hhat the supposed homoeopathic cures are refer-
able to a natural and spontaneous cure, aided, in many cases, by a
strict attention to diet and regimen."— -il/a^^^r. Med, & Therapeictics.)
This is the principal argument urged against the therapeutical doc-
trines of Hahnemann.

We beg leave, however, to request those gentlemen who judge of
the potency of substances by their weight and dimensions^ to enter
into a still further calculation, and inform us which possesses the great-
est weighty the medicinal particles pertaining to a drop of a thirtieth
attenuation of a homoeopathic remedy, or the charge of electricity,
which lays prostrate and senseless the strongest man, — or the quantity
of sulphuretted hydrogen, or carbonic acid-gas, requisite to cause im-
mediate death when inhaled ? Which can be most readily detected
and appreciated by analysis, the atoms of a high attenuation of Hahne-
mann, or the deleterious mia.sms which arise from vegetable or animal
decomposition?

Which present the greatest difficulties in examination and descrip-
tion, ike physical structure of the particles of a homoeopathic medica-

13i GENERAL PEIISTCIPLES OF MELICAL SCIEK-CE.

ment, or that of small-pox virus ? Will the respectable HippocratiG
who can not recognize power in any material substance, unless it can
be weighed or handled^ enter into a computation, and inform us
how imcch a poisonous dose of the vapor of Hydrocyanic-acid, Mercury
or Lead, weighs"}

Let it be remembered, that not one atom of matter in the whole uni
verse can be annihilated ^ transformations may be effected— the cohesion
of particles may be changed — atoms in their ultimate state of chemical
combination may he physically divided into molecules, and again sub-
divided into lesser atoms to such an extent as to baffle detection from
the most perfect tests of chemistry or optics — new powers may be deve-
loped in these atoms, the exact operation of which we may not at pre-
sent be able to understand, but in no instance can we destroy one single
particle of matter. We may effect an entire metamorphosis of almost
any solid substance, and diffuse its elements in such a manner as to
occupy and effect a very large amount of space. The elements of a
few grains of gun-powder may be made with the aid of the imponder-
able influence of caloric, to change their form, and impregnate every por-
tion of the atmosphere of a large room. In like manner, a single grain
of a vegetable or mineral substance may be transformed, and its atoms
diffused throughout large quantities of inert materials, in such a manner
as to impregnate them in every part with medicinal properties, but in
no instance can a single atom be annihilated.

Until we arrive at more accurate knowledge in relation to the laws
which govern the chemical and physical action of the minute atoms of
substances than we at present possess, let us not deny that they may
be endowed with properties and powers (although their modus medendi
is a mystery to us), capable of exercising an important influence upon
the human organism.

But it may not be possible in the present state of human science to
follow the operations of nature through each particular step. It may
be that we are not yet in possession all the materials necessary for
the erection of a perfect theory of cure ; and that none of the hypo-
theses yet advanced are entirely true. On this point we may accept
the conclusion reached by a faithful laborer in the field of medical reforms.
Dr. Joslin says :

" Many physiological and pathological problems are of such a cha-
racter as to present to those who may now attempt their solution,
elements of uncertainty similar to those encountered by previous medi-
cal theorists ; so that considered in relation to some of those collateral
or auxiliary topics, Reformed Medicine is not destined to be exempt
from slow development. Here lie the same rocks on which have been
wrecked so many navigators of other times, compelled by their position
simultaneously to encounter invisible undercurrents, and unforeseen

INFLUENCE OF EEMEDIAL AGENTS ON OEGANS AND TISSUES. 135

shifting winds. The investigator is compelled to grapple with a
problem of numerous and uncertain elements." But in our efforts to
master the complex problems that rise to meet us as we progress, " our
position is different from that of the physiological schools. With them,
theories of the functions of the human organism are the foundation of
therapeutics. They are working at one unfinished monument ; we a
another. Their alterations are in a considerable degree, fundamental
and cause dilapidations in the superstructure, and necessitate its fre-
quent demolition and reconstruction. We build on an immovable
foundation, and every extensive alteration involves progression,

" In proportion to our faith in this, will cmteris pa/ribus^ be our
happiness and activity ; for one of the most agreeable and effectual
incitements to labor, is the certainty of success."

In regard to the preparation of medicines, there are several points
of difference worthy of particular notice, between the old and new
schools.

1. Allopathy employs her drugs in a crude and consequently in-
active form ; while homoeopathy makes use only of their pure essential
principles, unencumbered by foreign matters.

2. Allopathy employs so great an amount of artificial heat in her
pharmaceutical operations, that a large proportion of the active pro-,
perties of her drugs is expended in -evaporation ; while homoeopathy
makes use only of expression, trituration, and succussion, and thus not
only retains ail of their virtues inherent in the drug, but actually
develops powers which would have remained latent under other cir-
cumstances,

3. On account of the peculiar mode of preparation, the remedies of
allopathy are offensive to the taste, they nauseate the stomach ; and,
by in their indigestible and irritating qualities, serve directly to induce
gastric and intestinal derangement, and other serious medicinal symp-
toms. The medicines of homoeopathy are liable to none of these
objections.

4. For the reasons above enumerated, many of the remedies of the
old school are excluded by the sensitive absorbents, on account of their
irritating qualities, and are thrown off with the faecal matters as foreign
substances ; having failed in their passage through the intestinal canal
of producing any other effect than an irritation of the gastro-intestinal
membrane. The attenuated remedies of homoeopathy being innocuous
to the lacteals and absorbents, are readily admitted into the circulationj
and conveyed to those parts upon which they exert a specific action,
thus impressing directly the organs or tissues actually diseased. " No
substances," says Martyn Paine, "but such as exist in a fluid or very
attenuated state, are taken up by the lacteals and absorbents."

So, also, in the therapeutical application of remedies, we claim^ a

136 GENEEAL PRLN"OIPLES OF MEDIGAi SCIENCE.

far as accurate scientific principles and sound pliilosop-liy are concerned^
that homoeopathy is vastly superior to allopathy. We shall briefly re-
iterate some of the more prominent points of difference in the practice
of the two schools.

The system of homoeopathy is founded upon rational and scientific
principles, inasmuch as its remedies are exhibited with a definite object,
and the results can in most ■ cases be predicted with mathematical
certainty.

The practice of allopathy must always be indirect, uncertain, and
empirical. The violence of the remedies employed, necessarily induces
medicinal and sympathetic affections, which, mingling with the symp-
toms of the natural disease, render it impossible to distinguish between
the two classes of symptoms, or to judge whether the malady, or the
medicine, or both combined, are killing the patient The fact that so
few allopathic practitioners coincide precisely in regard to the treat-
ment of very many diseases, proves conclusively that their system is
one of giiessing^ rather than one founded on scientific knowledge and
ascertained facts.

Homoeopathic remedies being s^eciJiG and certain in their effects.,
operate only upon those parts, which are actually diseased. Without
inflaming healthy structures, debilitating the system, or disturbing the
function of any organ, they induce, when judiciously exhibitedj anew or
alterative action in the part affected, of just sufficient severity to banish
the natural malady, while the new or medicinal action subsides speedily
and spontaneously.

According to the doctrines of homoeopathy, no two diseases or kinds
of inflammation can exist in the same structure at the same time j for
whenever two exciting causes act upon the same part, the one possess-
ing the most powerful action, must necessarily banish and supersede
the weaker. Therefore, in accordance with the rules of our system,
remedial impressions are always made directly upon the organ or
tissue affectedj. and a new kind of action set up, which abolishes the
disease and usurps temporarily its place.

According to the strict tenets of the old school, remedies should be
exhibited in such a manner as to impress structures which are healthy
and remote from the organ or tissue diseased^ in order that revulsive^
derivative^ or counter-irritating effects may be produced, and thus
serve to attract the fluids from the natural affection to the artificial
one. This plan of treatment originated as we have seen, from the sup-
position that no two maladies of consequence could exist m different
parts of the same organism at the same time. As this idea is at present
universally conceded to be erroneous, we assert that a mode of practice
deduced from such false data, must of necessity be unscientific and
empiric ah

INFLUEisrCE OF EEMEDIAL AGENTS ON OEGANS AND TISSUES. 187

By operating on healthy st/nictures^ the allopath, accomplishes little
or nothing towards restoring the impaired capillaries of the affected
part to their original condition of strength and resistance, and conse-
quently his system must he entirely inadequate to effect cures. We
are, for this reason, forced to the conclusion that the "Modern Celsus,"
Dr. Forbes, is correct when he asserts that " in a large proportion of
the cases treated by allopathic physicians, the disease is cured by
nature, and not by them."

It is a fundamental law of medicine, that no inflammation can be
created in any part of the body, without giving rise to secondary sym-
pathetic affections in other and distant parts. It is evident, thereforCy
that the greater the number of structures affected with inflammationj
whether natural or artificial, the greater will be the number of sym-
pathetic symptoms, and consequently the more serious and complicated
the malady. Thus we perceive the force of Dr. Forbes' remark, " that
in not a small proportion of the cases treated by the physicians of the
old school, the disease is cured by nature, in spite of them : in other
words, their interference opposing instead of assisting the cure."

We have before sho^vn that organs and tissues become morbidly
susceptible to the impressions of specific remedial agents during in-
flammation; therefore it is, that extremely minute quantities of specific
medicaments are capable of exercising powerful influences during
disease^ which, under circumstances of health, would be productive of
no effects whatever. This is a truth of vast importance in the admi-
nistration of medicines, and should be thoroughly appreciated by the
practitioner who regards the welfare of his patients. Let him remember
that these acquired susceptibilities are so great, that even the natural
stimuli, food, gastric juice, bile, light, &c., can not be tolerated; and
from this fact, take warning lest he inflicts injury and counteracts the
efforts of nature by too active medicines.

But as we have so frequently observed, it is not so much our prin-
ciple of Gure^ at which the shafts of the old school are directed, as to
the doctrine of stroII doses. It is not because the adherents of allo-
pathy cannot make themselves acquainted with the powers of attenu-
ated drugs, but it is because their inveterate prejudices will not allow
them to investigate the facts which are involved. They prefer to die
of vomiting, purging, and sweating, as their predecessors have done for
two-thousand years, rather than to be cured quietly under a new
system. These individuals are not satisfied unless they feel and see
the poor body writhe and suffer for the sin of being sick. What care
they for any interior, or invisible action of a medicine, when they can
be cut, racked, and tortured, by the lancet, emetics, cathartics, blisters
and m^xas, and that too, secundum artem! To be sure, they were not
aware of any msible effects %ohen the morhid agent operated upon

138 OEKERAL PEIIiTCIPLES OF MEDICAL SCIENCE.

their systems to proditoe the disease, but the curative part is in their
own hands, and they are determined to exercise their privilege of a full
and continual appreciation of the whole modus operandi of the remedial
process. This '^d.Yi^ nature has no power to cheat them of, but Hippo
crates now reigns, and they are resolved to exercise their anoien
reserved rights, and bleed, vomit, purge, sweat, and blister, ad Uhitu7)%

But why have our opponents dwelt so much upon our doses! Does not
every homoeopathist aim and intend to give a sufficient quantity of the
medicine at a time to effect a speedy cure ; and is not this quantity
determined by experience of simple facts ? We have different strengths
or attenuations of each medicine, from the strongest tincture up to the
most minute attenuation, and every homoeopathist selects that strength
or attenuation of the drug which most sjpeedily and safely cures his
fatient The great point with him is, to select such a medicine as
shall be homoeopathic to the symptoms of the disease, and then to ad-
minister just enough of it to effect his object in the most safe and
speedy maimer. He finds by experience — by a mass of facts, — that the
tinctures and alkaloids, although often capable of subduing diseasej
are less prompt, less efficient and less safe than finer preparations of
the drug. This easily demonstrated truth, was not the result of
theory or hypothesis, but originated with Hahnemann, as we have
already seen, through necessity, on discovering that the tinctures which
were first employed by him, in accordance with his principle, often
produced too violent impressions upon the affected structures. What
cared Hahnemann — what care his disciples — -whether they use one or
twenty drops of a tincture, or one grain of a twentieth attenuation?
Were twenty drops of a tincture, or twenty grains of a crude substance
more efficient in curing sickness than one drop or one grain of an
attenuation, is there any man who supposes that Hahnemann or his
followers would not have administered them in this form, in preference
to any other? The chief glory of the founder of homoeopathy does not
consist in the discovery of the efficacy of small doses, but in the
demonstration aud practical introduction of the great doctrine of curing
maladies by impressing diseased tissues with medicines which operate
specifically upon these tissues themselves, rather than on distant parts.

It matters not therefore, in regard to the homoeopathic law of cure,
whether we use this or that strength, provided the remedy is homoeo-
pathic to the disease, and exactly the requisite impression is produced
upon the affected parts. The man who cures a Belladonna headache
with ten drops of the tincture (if he be successful) adheres to similia
similiius as much as he who cures with the thirtieth attenuation of
the medicine. The only question to be decided is, which strength
cures most safely and quickly ; and if facts prove, as all homoeopaths
believe, that a preparation (apparently) weaker than the tincture is by

INFLUENCE OF REMEDIAL AQENTS ON ORQANS AND TISSUES. 1S9

far tlie most safe and efficient, then it is our duty to give these pre-
parations the preference. It is found, for example, when repeated doses
of tincture of Belladonna are given in acute inflammation of the brain,
that the primary symptoms from the drug manifest themselves too
violently- — that it causes dangerous and protracted medicinal aggrava-
tion, and a tardy reaction of the organism; while a dilution of the
remedy impresses mildly the diseased structure, causing scarcely per-
ceptible /prmxary symptoms, and is speedily followed by its secondary
or curative ejects.

We shall conclude this section with a few observations by a
distinguished chemist (allopathic) respecting the divisibility of matter,
and some of the phenomena witnessed when a high degree of attenu-
ation has been arrived at. These observations may at least shoAV to
those whose minds are not already permanently made up, that, not
only morbific and medicinal power may exist in infinitesimal atoms of
matter, but even life itself,

"It has been proved, that gold may be divided into particles of at
least T,i-oV<roo of a square inch, and yet possess the color and all other
characteristics of the largest mass. If a grain of copper be dissolved in
Nitric-acid, and then in water of Ammonia, it will give a decided violet
color to 392 cubic inches of water> Even supposing that each portion
of the liquor of the size of a grain of sand, and of which there are a
million in a cubic inch, contains only one particle of copper, the grain
must have divided itself into 892 million parts. A single drop of a
strong solution of indigo, wherein at least 600,000 distinctly visible
portions can be shown, colors 1000 cubic inches of water ; and as this mass
of water contains certainly 500,000 times the bulk of the drop of the
indigo solution, the particles of indigo must be smaller than 2 5-0 ^d^udtoo^j
the twenty-five hundred millionth of a cubic inch. A rather more
distinct experiment is the following: if we dissolve a fragment of silver,
of 0.01 of a cubic line in size, in Nitric-acid, it will render distinctly
milky 500 cubic inches of a clear solution of common salt. Hence the
magnitude of each particle of silver cannot exceed, but must rather
fall short of a billionth of a cubic line. To render the idea of this
degree of division more distinct than the mere mention of so imper-
fectly conceivable a number as a billion could affect, it may be added,
that a man, to reckon with a watch, counting day and night, a single
billion of seconds would require 31,675 years."

According to Doppler, a cubic inch of brimstone, broken into one million
equal pieces, a sand grain each in size, is magnified in sensible surface
from six square inches to more than six square feet. It is calculated
in this way, that, if each trituration of the homoeopathist diminishes
his drug a hundred times, (an exceedingly moderate allowance) the

140 GETSTEEAL PRINCIPLES OF MEDICAL SCIENCE.

sensible surface of a single inch of sulpliur, or any other drug, shall be
two square miles at the third trituration.

"In the organized kingdoms of nature, even this excessive tenuity of
matter is far surpassed. An Irish girl has spun linen yarn, of which a
pound was 1432 English miles in length, and of which, consequently,
17 lb 13 ounces would have girt the globe; a distinctly visible portion
of such thread could not have weighed more than T2-yroVo7o-ou gi*-? cotton
has been spun so fine that a pound of the thread was 203,000 yards in
length, and wool 168,000 yards. And yet these, so far from being ulti-
mate particles of matter, must have contained more than one vegetable
or animal fibre : that fibre being of itself of complex organization and
built up of an indefinitely great number of more simple forms of matter.

The microscope has, however revealed to us still greater wonders
as to the degree of minuteness which even complex bodies are capable
of possessing. Each new improvement in our instruments displays to
us new races of animals^ too minute to be observed before, and of
which it would require the heaping together of millions upon Qnillions
to 1)6 visible to the naked eye. And yet these animals live and feed^
and have their organs for locomotion and prehension, their appetites to
gratify, their dangers to avoid. They possess circulating systems often
highly complex, and blood with globules bearing to them by analogy,
the same proportion in size, that our blood globules do to us : and yet
these globules, themselves organized, possessed of definite structure,
lead us merely to a point where all power of distinct conception ceases ;
where we discover that nothing is great or small but by comparison ;
and that presented by nature on the one hand with magnitudes infinitely
great, and on the other hand with as inconceivable minuteness, it only
remains to bow down before the omnipotence of Nature's Lord, and own
our inability to understand Him. {Kernels Chemistry^ by Draper^ p. 19t)

It is not by supplying deficient chemical materials to the blood that
remedies are to cure disease. It is true, that in various diseases the
blood is deficient in phosphates, carbonates, sulphates, lactates, acetates,
&c., of soda, lime, or other ingredients of normal tissues; these salts
are not, however, furnished to the blood by food, as phosphates and
carbonates, &c.,'but are formed within the organism, and from material
whence the chemist must often despair of extracting them. Whatever
the absorbents receive, undergoes profound and radical transformations,
provided it be not in such excess as to embarrass the functional activity
of the organs which dispose of it. A controlling vital force then forms
the different compounds as they are needed, instead of delegating cer-
tain organs to select them ready made.

Mr. Gundlach, of Cassel, shows experimentally that wax is former]
from honey in the body of the bee, although the honey contained ap
parently no trace of wax. Liebig remarks the absence of fat in th^

INFLrENCE OF REMEDIAL AGENTS ON OKGANS AND TISSUES. 141

flesli of the carnivora, whicL. of all animals eat most fat ; wliile tlie
cow extracts butter from herbs and roots, suet from hay and fodder, &c.
The sugar of the maple is found not in the roots, but in the woody sub-
stance of its trunk, increasing only up to a certain height. Sugar,
starch, gum and humic acid, so nearly allied in their composition to
plants, are not food for them. Sugar can only be absorbed and appro-
priated in the tree like any other foreign matter. All the animal viruses
and venoms, hydrophobine, and the serpent-poisons are rendered inert
by the operation of digestion in the stomach, while the most innocent
articles of food received into the stomach of the viper furnish its body
with all the elements of its structure and secretions, and are trans-
form.ed into the deadly venom in the glands which elaborate that fluid.

Lehmann and others have proved that sugar, found in the blood, is
not assimilated as sugar from those aliments which most abound in
sugar, but from the fibrine and albumen, the proportions of which are
reduced in the blood of the hepatic vein, as compared with that of the
portal vein. The vital force executes disintegration and reconstruction
upon every compound presented to it. Though potash and other salts
of alkaline base, Copaiba, Turpentine and GarliG may be detected after
absorption in the blood, sweat, chyle, gall or splenic veins, they are
speedily excreted with the urine.

The patient under treatment has received in general the same kind
of food that he took in health, but he fails in assimilative power to ex-
tract from the food and appropriate for the uses of the organism the
elements essential to his support. Tuberculosis is not the result of a
deficiency of phosphates in the food, but of loss of the assimilative
power to extract them from it.

The object of the scientific physician^ is not to furnish the system
with some infinitesimal quantity of an ingredient which is deficient in
the blood. If iron be deficient in the blood and that agent be found a
remedy, it becomes such not by furnishing the wanting ingredient, for
the quantity we prescribe is not in any degree sufficient for that, but
by enabling the organism to appropriate that which is presented to it
in the food. The disease does not arise from deficiency of iron in the
aliment, but " the power of digesting, assimilating and forming the
food into blood is defective ; and it is this pow6r which is to be restored
by medicine. The physician who is ignorant of this, and in treating
such a case, regards himself as a mere caterer for supplying materials,
will naturally conclude that he must administer ferruginous medijoine,
and that the medicine must be given at least in quantities appreciable
by chemical tests.

"Neither of these conclusions has the slightest foundation in reason.
The substance which suitably regulates the vital force in this case, will
not necessarily or even generally be iron, but some medicine indicated

142 GENERAL PRINCIPLES OF MEDICAL SOIEiq-CE.

by the generality of the symptoms present. Again, the immediate ob*
ject not being chemical but vital, it is not necessary nor desirable to
employ a dose appreciable to chemical tests, but to the vital test, which
is inconceivably more delicate ; the living body can be strongly and
durably effected by a dilution, which if concentrated a billion fold would
not produce a visible change in any lifeless re-agent. (J9r. Joslin,^)

The question is asked, how is it possible for a perceptible influence to
be exerted by a minute dose of an attenuated medicine "when the same
substance, as salt or iron, already exists in the blood and in sufficient
quantities without it."

This question will only be asked by persons who " deny j;hat special
increase of power called potentization which the homoeopathic medicine
receives by minute divisions in the different stages of its preparation,
and which gives it an efficiency vastly superior to that of the same
quantity in the ordinary' state." To those who admit nothing and deny
everything, it may not be easy to present satisfactory answers to all
questions prompted by mere curiosity ; and it may not be profitable for
us or them to^spend much time in abstract reasonings which weak minds
do not easily comprehend. The only question in this case is one of fact
for an impartial jury to inquire into. A fact well known to many ob-
servers is thus stated by Dr. Joslin: The quantity of Natrum-muriati-
cum, common table-salt, "taken by almost every man, varies by many
grains at his different meals. If he receives a few grains more at one
meal than at the preceding one, he has no Natrum-muriaticum symptoms
as the consequence ; and common-sense would teach a physician that
if he should administer a few grains of the crude substance, he could
produce no effect by it. The intentional increment must be as inoperative
as the accidental. But experience teaches that the potentized form of
this medicine in a quantity inconceivably small makes a decided im-
pression both on the healthy man and the patient. "We are compelled
to conclude that it has a power of affecting the system not perceptible
in what is chemically the same substance in its ordinary state, or in
that state in which it exists in the blood, where it is crude as compared
with the- form in which it is given by homoeopathists. A thousand
physicians daily witness the special power of potencies of other medi-
cines, and are thus able to confirm by analogy the preceding conclusion."

ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES.

In selecting our attenuations for the cure of disease, the following
circumstances are to be taken into consideration: 1. the age, sex,
temperament, constitution, and habits of life ; 2. the condition of the
disordered textures ; 3. the character of the drug to be employed.

* American Horn. Review, Vol. II., p. 38.

ATTENUATIONS OF DEUGS AND REPETITIONS OF DOSES. 143

a. Age. — Infants and cliildren of tender years, whose organisms have
HOt become blunted by exposure to the ordinary stimuli of life, by im-
proper food and drinks, and by abuse of cathartics and opiates, are in
the most eminent degree impressible and require the highest attenu-
ations. It is at this period that the circulation is most active, the
nervous system most delicate, and the tissues most sensitive to the in-
fluence of external agencies.

At the middle period of life, when the body has arrived at maturity
and all of the organs have acquired their full strength and vigor, the
resisting power against both medicinal and morbific agencies is at its
maximum. The action of the circulatory vessels is now moderate and
stable, the nerves are strong, the structures have become accustomed
to all kinds of stimuli, and the mind, which exercises so powerful an
influence over the body, acts calmly and judiciously. At this period
our lower attenuations will often serve us more efficiently than the
higher, especially in acute diseases.

During the decline of life, many circumstances which have a ten-
dency to modify the operation of medicines, are to be considered. In-
dividuals who have passed their lives in intemperance, who have been
afliicted with frequent attacks of disease, and whose systems are loaded
with the cumulative poisons of drugs, usually acquire a remarkable
obtuseness and inactivity of the whole organism,- so that the very low-
est attenuations are requisite to effect suitable impressions. On the
other hand, many old people, upon the verge of the second childhood,
become sensitive, irritable, and so intensely impressible, that the higher
preparations respond promptly and effectively.

b. Sex. — Females are more easily acted upon by medicines than
males, for several reasons. Perhaps the most prominent one consists
in their superior delicacy of organization ; their circulation is more
active, their nervous systems more irritable, and their mental powers
more acute and quick, although less strong, logical and independent
than those of men. J. J. Kousseau asserts that a woman will leap to
a conclusion which would require a man hours of severe thought to ar-
rive at. It is this susceptibility and delicacy of organization which ,
renders the female more impressible than the male sex and which should
always have no inconsiderable weight in the selection of attenuations.

c. Te97ijferament.—TempeYdbment also has an important influence
in the operation of medicines. As most morbific and remedial agents
produce their effects upon the sentient extremities of the nerves, it
follows that a highly susceptible condition of the nervous system is
most favorable to the prompt operation of these causes. We therefore
infer, that the higher attenuations are better adapted to the nervoics
than to either of the other temperaments.

Next to the nervous temperament, in point of susceptibility, may le

144: aENERAL PEINCIPLES OF MEDICAL SCIENCE.

ranked the sanguine. Individuals of tliis temperament are charac-
terized by great activity and energy, and by prominent development
and vigor of the vascular system.

Temperaments which are the least susceptible, to remedial impres-
sions, are the Mlious and the lymjjhatiG, The former is characterized
by large muscular developments, tendency to biliary derangements,
frequent turns of melancholy, and great powers of endurance. The
latter is distinguished by a predominant activity of the glandular sys-
tem, by a flabby and relaxed condition of the muscles, and by a feeble
and rather obtuse state of the nervous system. These temperaments
sometimes require the lowest attenuations, especially in chronic dis-
eases.

Two or more of these temperaments often unite in the same person,
when we have what is termed a m^;3^^<:? temperament. This variety may
be considered, upon the whole, the most favorable to health and longe-
vity, since no quality predominates, and the functions of the organism
are more equalized.

d. Constitution,— MiQiiVid^iioTi^ must also be selected with a due
regard to the constitutional peculiarities of each particular case. We
know of several- persons who cannot take a blue pill, or a pill in which
calomel is a constituent, without being violently salivated. There are
others in whom Opium produces furious and protracted delirium aiid
catharsis as primary effects ; others cannot carry Ipecacuanha about
their persons, or inhale the smallest quantity of it, without attacks of
asthma; others cannot approach the rhus-plant without being poisoned;
others cannot use shell-fish and certain other sorts of food, without
being afflicted with urticaria ; the smell of hay causes asthma in some,
and the delicate fragrance of the rose, syncope in others. On the other
hand, there are some organisms which can scarcely be impressed with
even large and continued doses of medicines. Constitutions which have
been impaired by abuse of stimulants, drugs, tobacco, and licentious-
ness, and in which there is an abasement of the nervous and physical
power, demand low attenuations. In a word, it will be found on rigid
examination, that each individual possesses some peculiar trait which it
will be necessary to take into consideration, when we decide respecting
the strength of a remedy.

e. Habits of Life, — We have read of persons who were ''mAtsio
mad^^ but we have often seen those who were " medicine madr The
world is full of this class of monomaniacs, who " pass away their time in
descanting on their own diseases," and in filling their bodies with all sorts
of injurious and nauseous drugs. After pursuing this course a long time,
the system, by habit, tolerates enormous quantities of the poisons
swallowed, and the structures lose in a measure their susceptibility to
medicinal impressions. It is for this reason that the homoeopathist ex-

ATTENUATIONS OF DEUGS AKD EEPETITIONS OF DOSES. l45

periences so mucli difficulty in the management of cases of dyspepsia,
hypochondria, and constipation, which have been induced by long-con-
tinued abuse of cathartics; also in the affections of confirmed Opium-
eaters, habitual drunkards, and gourmands. Individuals of these
classes, require low attenuations. In the same category may be ranked
those operatives who make a breathe-vapor oiMerouTy^ the salts of Z6<^<^,
strong acids, and other poisonous substances which evaporate at
the ordinary temperature.

Robust persons, who pass much time in active exercise in the open
air, will require stronger doses than those of delicate organization and
of studious, sedentary habits.

2. The condition of the disordered textures, — Those parts of the
system which are most amply supplied with nerves, are, all other things
being equal, most susceptible to the operation of medicines. Thus the
«5ye is more readily impressed than the arm ; the lungs, stomach
and intestines, than the limbs, joints, &c. Much also depends upon
whether the specific employed, is positive and decided in its operation.

But there is another circumstance of vast moment to be taken into
consideration in the choice of our attenuations, and to which we have
elsewhere called particular attention. We refer to the augmented
susceptibility to medicinal impressions which injlamed structures
acquire. We have shown that the condition of inflamed tissues becomes
entirely changed, and that their acquired susceptibilities become so
morbidly increased that even their natural stimuli can not be tolerated,
but when allowed to operate, become additional and powerful sources
of disease. The natural and healthy stimuli of the eye, the ear, the
lungs, the stomach, the bladder, &c., are grateful during the normal
state of these organs ; but let inflammation occur, and the smallest
pencil of light becomes intensely painful to the eye, as noises to the
ear, air to the lungs, food and drinks to the stomach, and urine to the
bladder.

Nor is this augmented susceptibility confined to the operation of the
natural stimuli, but it applies with still greater force to the action of
specific medicines, up to the termination of inflammatory action, when the
sensitive extremities of the nerves succumb from intensity of excitement,,
and a condition bordering on paralysis- or gangrene obtains. It is-
sometimes difficult to decide when this morbid erethism has arrived at
its maximum, and the atonic state commences ; but the gradual sub-
sidence of pain, appearances of effusion or ulceration, and diminished'
sensibility of the affected part, will afford us the best indications upon
this point. This fundamental law of homoeopathy, not only serves to
explain in the clearest possible manner the astonishing effects of infini-
testinal doses, but it teaches an important practical fact, at present:
unappreciated, but incontrovertible, and which stands at the foundation

Voi. I.- 10-

146 GENEEAL PKINCIPLE3 OF MEDICAL SCIENCE.

of our tlierapeutical applications, viz., to ascend in our scale of attenuor^
tions in proj)ortion to the violence of the inflammation, %mtil we
arrive at that point where the nerves of the diseased jpart have at-
tained their maximum of erethism^ after which we must again de-
scend the scale in the same ratio.

This same law applies with equal force to all irritations of the ner-
vous system, even when entirely unattended with the usual phenomena
of inflammation, redness, swelling, heat, and pain. We have often seen
this nervous erethism so strongly pronounced^ — and where there were
no signs of vascular excitement — that a single grain of Ipecacuanha,
or the twentieth part of a grain of tartarized Antimony, would produce
copious vomiting and purging; or a drop of the first dilution of Nux-
vomica, induce involuntary contractions of the muscles, especially of
those parts which are usually irritable ; or a single grain of Jalap,
Rheum, Calomel, or even a mental emotion, immediately cause diar-
rhoea ; or a cup of tea or coffee taken in the evening, prevent sleep for
a whole night ; or the inhalation of a few imponderable particles of
Ipecacuanha, give rise to both its pripaary and secondary specific effects
upon the pulmonary organs.

There may be a few apparent exceptions to this rule^ as in the
example already referred to respecting the inefficiency of large quan-
tities of Opium and Laudanum in tetanus / but these exceptions are
susceptible of ready explanation. In this disease there exists a pecu-
liar preternatural excitement of the nerves which preside over the
voluntary motions, and the contractility of the tissues, which induces a
spasmodic exclusion of those textures of the digestive canal which, in
the normal state, permit the absorption of opiates. This is evident
from the fact, that if Laudanum he injected into the veins during
tetamts^ the usual effects are manifested. In this disease, therefore,
the drug is not aisorhed, and of course can not exercise its specific
effects upon the economy.

It is evident, then, that in the selection of attenuations for chronic
diseases^ the precise condition of the nerves of the affected parts must
always be taken into consideration, since some chronic maladies are
characterized by a highly exalted nervous susceptibility, and call for
the use of high attenuations; while in other cases, this susceptibility
or impressibility remains at a low grade, and consequently will only
respond to low attenuations.

Dr. Lobethal, in alluding to this subject, makes use of the following
anguage: — -"Grod be praised, the times are passed when we adhered
without examination to the prescriptions of Hahnemann, and when we
administered the thirtieth dilution in every case, without any regard
either to the species of the medicine, or the individuality of the patient
The idea of the greatness or littleness is but relative ; we cannot say

ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 147

in a general manner, that some drops of the mother tincture of a certain
medicine will be a strong dose; nor yet perhaps, that the twenty-fourth
or thirtieth dynamization of every medicine shall be regarded as a
feeble dose. The dose of each medicine should %e st/rong enough to
provohe the necessary reaction of the organism, and, provided we are
careful not to administer a too heavy one, but agreeable to take, and
without danger, we should always give a sufficient cne.

'* I am decidedly convinced, that in order to apply the homoeopathic
treatment with success, the physician should take cognizance of the
whole scale at his disposal, from the actual dose of the old school up
to the highest dilutions of which any medicine is susceptible.

"We may establish it as a principle, that the appropriateness of large
or small doses is in inverse proportion to the richness in nerves of the
individual organism, and the species of diseased organ ; that is to say,
the more the sentient sphere of the organism, in a given case, shows
itself predominant, the more attenuated the dose of the indicated specific
medicine should be, and that the more the individual organism, or in a
local affection the diseased organ, is poor in nerves, the more the doses
should be large." [Revue Critique et Retrospective de la Matiere
Medicate S;pecifjg%ie, Vol. III., 1841.)

Dr. G. H. Gross of Germany, also observes, that "homoeopathy, as
now accepted, has determined the point, that the physician rmist
exercise his judgment as to the dose, varying it from the higm-iest

DILUTION down to ONE OR MORE DROPS OF THE UNDILUTED TINCTURE, aS

individual cases may demandP^

Dr. B. F. Ruckert, of Germany, also writes as follows: "I am satis-
fied that the system (homoeopathy) is still progressive, and has by no
means attained perfection. In respect to doses, most generally, I make
use of the first dilutions, and never exceed the twelfth, giving them in
increased volume and repeating them frequently. I have been more
successful in this course of treatment than formerly in the use of the
smaller doses."

Similar views have recently been promulgated upon this subject by
G. Schmid, TrinTcs, Griesselich, Watslce, Madden, Bigel^ Drysdale^
Ritssell, and indeed by a majority of our school, both in Europe and
America.

We have not unfrequently been able to cure diseases with a high
attenuation, after having failed with the fir^t and* second dilutions of
the same remedy: but it has been no very uncommon occurrence
with us to effect cures with the first attenuation after having been un-
successful with the higher preparations. No definite rules, therefore,

* Dr. Gross wrote this in 1840 ; but during several years preceding his death, he
was a most decided advocate of the highest dilutions.

148 GENEKAL PEINOIPLES OF MEDICAL SCIEKCE.

can be given which will apply in all cases, but every circumstance con-
nected with each particular case must be duly investigated, and the
physician then exercise his own best judgment.

The appropriateness of a particular remedy for a given set of symp-
toms constitutes one problem, and the choice of the proper attenuation
another, both of which are to be separately determined, according to the
direction of Hahnemann, ^ by "pure experiments, careful observation,
and correct experience." For practical purposes the rule generally
given is, "the more susceptible the organism, the higher the potency,
and the finer the doses." The theory upon which the action of high
attenuations is to be explained is not yet settled byhomoeopathists. It
has been proposed to apply for this purpose the law of nature mathe-
matically demonstrated by Maupertuis, called the law of the least
quantity of action^ thus expressed by its discoverer: ^' The quantity
of action necessary to effect any change in nature is the least
possiileP

"According to this general principle, says one of our own writers,f
"the decisive moment is always a minimum, an infinitesimal. Apply
this to our therapeutics, and it will be perceived that the least possible
dose is the highest potency, and necessarily sufficient to turn the scale,
that is to effect the cure — always provided the remedy be homoeo-
pathic ally correct.

"This law of the least action appears to be an essential and neces-
Bary complement of the law of homoeo^athicity^ {similia similihus)^
and co-ordinate with it."

Experience teaches that the, strictly homoeopathic remedy, selected
according to the IdbW similia similiius curantur^ will produce aggra-
vations when given in large doses. Dr. Verweg of the Hague opposes
large doses : 1. as unnecessary, as the power of a remedy lies not merely
only inits quantity ; 2. because large doses obstruct the digestion and blood
crasis, offices which ought to remain untouched in a sick state, in order
to carry it to a happy crisis ; 8. large doses produce so many secondary
effects, that the chief effect will appear modified or more or less
obscured. 4. Large doses increase the effect to such a degree that
exhaustion ensues after the too powerful irritation, stopping either the
beginning amelioration or under less favorable circumstances causing
death. 5. Large doses produce as many symptoms as the disease it-
self, yea, the newly- appearing symptoms of the remedy are often more
severe than the symptoms of the disease which we want to cure.
6. Large doses leave after-effects of long duration. 7. Large doses,
according to the laws of polarity, have often a contrary effect.

It is a common opinion that the lower potencies agree with acute

* Organon, p. 278.
' t Br. Fincke Amer. Horn. Eev., Apr, 1840 p. 336

ATTENUATIONS OF DEUGS AND EEPETITIONS OF DOSES. 149

and the higher ones with chronic diseases, the effect of the lower ones
being quicker, but coarser and more evanescent, whereas, the higher
and highest potencies have a slower effect, but more penetrating and
longer enduring. Such general rules are only partially correct.

Diseases which have a chronic character throughout their course, as
cholera, croup, &c., are generally though not ahvays treated by low dilu-
tions. The precursory fever of pneumonia is generally broken by low
dilutions, whilst the higher are employed to remove the exudations
which result from the inflammation. Exanthematous diseases and
typhus are treated with high potencies till they localize themselves;
but we return to the lower when new complications arise.

In chronic diseases, appearing acute in paroxysms, as whooping
cough, migraine, or intermittents, the high dilutions are considered by
Mayer most effectual. High dilutions are considered best in chronic
ca.tarrhs of mucous membranes, leucorrhoea, nervous and mental
diseases, and all blood dyscrasias, new formations, as warts.

The difference between the powers of medium dilutions and those
much higher, is not always perceptible. Many use only a few out of
the great range afforded us, as 1, 2, 8, 6, 12, 24, 80, 60, 200, &c.

Trinks divides remedies into 1. Those working on the organism with
great energy and intensity, yet fleeting in the duration of their action,
even when given in large doses ; as, Aeon., Cham., Ca,mph., Moschus,
Igna., Ipec, Hyoscy., Coffea, Stram., Samb., Opium. 2. Those produ-
cing effects less strong, but more intense, deeply penetrating the organism
and their effects lasting for a long time, such as the mineral remedies ;
Arsen., Cuprum, Merc, Sulph., Graph., Aur., Argen., the mineral acids
and some vegetable remedies.

Medicinal Interference. — It is considered a practical impossibility
to exclude all active medicinal and opposing influences from the pre-
sence of our patients, and it is asked, how can w^e expect infinitesimal
doses to produce their proper effects when they must come in contact
with so many antidoting substances ? " The Camphor in a drawing-
room cabinet,— the fumes of a smoking-room, — the oil of a mineral lamp,
which in spite of washing perfumes the fingers," are supposed to have
power to counteract the remedies. In answer, it can at least be said,
that homoeopathic doses are certainly effectual in curing disease, in
spite of antidotes and external influences. The theory may not be
satisfactory, but the fact is certain. The explanation is attempted by
the Monthly Homoeop. Hemew : " The curative power of a medicinal
substance, homoeopathically selected, is necessarily higher than the
mere antidotal force of an interfering body ; and for the following
reason: The medicine OAves its curative force to the receptivity of the
diseased organism to which it happens to be homoeopathic ; no two drugs
have an equal pathogenesis throughout, and therefore the antidote

150 GEKEKAL PEINCIPLES 3F MEDICAL SCIENCE.

under no circumstances can exercise a power over the disease equal to
the true homoeopathic remedy. The mediGine is aided in its operation
by the vital force of a diseased and highly receptive organism, while
the antidote either acts merely upon the inert medicinal substance to
which it is antidotal, or on oi-gans to whose state it has no relation.

"That the force of a remedy may be influenced to some extent by
its antidotes is no doubt true ; but we believe that a homoeopathically-
chosen medicine will, in all cases, and even in the presence of crude
drugs, exert a certain curative influence upon a diseased, sensitive and
highly receptive organism.

The question still remains : What becomes of the impurities which
unavoidably exist in the attenuating fluid ; and why do not these im-
purities neutralize the effects of the minute quantity of the medicine
employed in the treatment of disease ? This question has been well
answered by Dr. Joslin, in an essay communicated to the American
Institute of Homoeopathy, 1858.^ He shows, that every time a dis-
solved medicine is diluted a hundred-fold, it has its minute parts, called
molecules, made smaller and more active, i. 6, potentized, On the other
hand, " when a dissolved substance, made a little active by a little di-
vision, is brought in contact with the same substance in a still less di-
vided and less active state, it unites with the latter and thus becomes
like it, comparatively crude and inert, — it loses its special power;" that
is, it becomes de-]potentized. "I find that this union by cohesion and
consequently this depotentization always takes place when one portion
of the substance is only a hundreth part more diluted than the other.
Thus, a substance that happens to adulterate the alcohol used for po-
tentizing a medicine, is continually combining with and practically nul-
lifying itself, and the high potency of the medicine remains practically
pure. In this case, the little parts, molecules of the impurity, never
diflJer much in size and never differ so much in the degree and nature
of their activity as to prevent their re-union.

" This statement in regard to the conditions of re-union is not a mere
hypothesis. It is not only a necessary inference from the fact of po-
tentization, but is in accordance with observed facts in crystallization.
I have witnessed the crystallization of Camphor, as exhibited by the
solar microscope, and observed phenomena which have a bearing on
this subject." Though no microscope has power to exhibit to the eye
the smallest crystals first actually formed, it was observed that " those
first visible were in a series of groups, the larger crystals not growing
by the addition of invisible ones, but of those smaller ones already
formed of others still smaller. The first visible molecules unite with
others not too dissimilar in magnitude, frequently after rotating like

* Proceedings of the Fifteenth Annual Meeting.

ATTENUATIONS OF DEUGS AND REPETITIONS OF DOSES. 151

little magnets ; but tliey do not unite in the first instance with those
whose difference of magnitude is very great." *

If then it be asked : Why does not the iron or culinary salt that
exists in the blood, " and which is identical in name with a medicine
administered, unite with the latter, which would thus become depoten-
tized and inert ? '*

To this question we answer, that whether we are able to explain the
philosophy of the phenomenon or not, \h% fact is abundantly established
in the experience of every man who is accustomed to give our remedies
in the medium and higher dilutions, that these remedies are active,
thouo-h administered dissolved in water, which also contains the same
substance in name, though in a form more crude. The fact is thus
explained :

" That the union of the two, and the consequent depotentization of
the medicine does not occur, I attribute to the discrepancy between
their degrees of attenuation. The substance in the natural water and
the blood, which can be detected by chemical tests, must be crude, comr
paired with the same in our medium and higher potencies, which can
not be thus detected. The crystalline affinities of these two kinds of
molecules differ so widely, that they may be regarded as on different
planes of activity: those in the natural fluid comparatively gross and
inert, those in the potency rendered inconceivably minute and active by
regular and consecutive attenuations. This activity, so obvious to the
physician by the use of the vital test, has not yet attracted the atten-
tion of the natural philosopher or chemist, because their tests are not
sufficiently delicate."

Adjuvantia. — They are generally permitted : 1. When the special
nature of the disease calls for other than medical aid, as surgical cases,
the removal of pathological products, toxical cases. 2. When we are
not permitted by the friends to rely upon the simple homoeopathic re-
medies, but know that if we abandon the case, it will go into dangerous
hands. 3. Where the proper remedies are not at hand, and the cir-
cumstances compel us to do something. The occasions that can justify
bloodletting even in the minds of old-school men are not very few.
Leeches are of use in but few cases and we have better means of
managing them. Purgatives are homoeopathic agents in diarrhoea and
dysenteries ; in the removal of irritating substances from the bowels
they can sometimes be employed.

Derivatives, though not often proper or necessary, may in good hands
be directed under the homoeopathic law to perform good service, as we
shall show in treating of the different forms of disease in which they
may be useful. Hahnemann sanctioned their use in proper cases.

* Am. Horn. Review, Vol. II , p. 40. 41.

152 GEI^ERAL PKINCrPLES OF MEDICAL SCIEJSTCE.

(See Ohronie Diseases^ Vol. I., 238.) Poultices may properly be used
to soften abscesses ; and cold and warm water can be applied with good
effects in many cases. Electricity and its allied powers are recom-
mended by Hahnemann. [GhroniG Diseases^ I., 238.) Mild forms of
it are the electric bath, the electric wind, and friction through flannel.
Zoomagnetism was also employed by him, as acting according to the
law of polarity. The water of mineral springs consists only of well-
known medicines in dilution. They would be much more successful
than they are if they contained still smaller quantities of the drugs to
which their virtues are attributed.

Selection" of the Propek Remedy. — The rule given by Hahne-
mann is to choose from the many remedies before us that which presents
the principal symptoms found in the individual case of disease. Though
it is often diificult to find a remedy which has the whole of them, it
should always be fairly sought for. The remedy that will certainly
curey will be one that exhibits "not only the symptoms of the disea.se as
present, but also the symptoms of the patient's constitutional state/'
'^Many symptoms/' says Jahr, "which our school considers as mani-
festations of the general disease, are considered as independent diseases
by beginners, simply because they find particular names for individual
diseases in the books." "The proper selection of a remedy in chronic,
and generally in acute diseases depends upon the following three
points : 1. The remedy must correspond to the pathognomonic symp-
toms of the case; — 2. To the accidental symptoms which do not seem
to be apart of the essential phenomena of the disease ;— 3. To all
other diseases and morbid phenomena which we may be able to dis-
cover in the patient. If the patient be afflicted with pneumonia, we
would not only record the essential symptoms of pneumonia, but also
the symptoms of any other affection which might happen to exist with
the inflammation of the lungs'; and, moreover, the general morbid phe-
nomena of the organism, no matter whether the books speak of them as
symptoms, or as independent diseases."

The formula of Hahnemann, that lilce cures liJce^ has suggested the
question, asked by Hering, " What is the like which ciires ? " and also
his answer, that "it is that which is characteristic,^^ The meaning of
both question and answer has been elucidated with sufficient clearness
by Dr. Wells of Brooklyn : In the treatment of dysentery, * What is the
like which cures,' and how are we to find it ? In other words, what are
the characteristics, i, ^., of the drug and the disease ? It is obvious at
the first glance, that there are two classes of these. One, the generic^
which determines the case you have to treat as belonging to the genus
dysentery, belongs alike to all the members of the genus, and without
which no case is dysentery. The other, the specific, that which

ATTENUATIONS OF DEUGS AND EEPETITIONS OF DOSES. 153

listinguislies individual members of the ocenus from all other mem-
bers.

" It is worthy of remark, that there is in the pathogenesis of all
drugs a class of symptoms, which in their relation to the law of cure
are very analogous to the generic symptoms of disease. The allusion
is to that class of symptoms which rather indicate that the organism
revolts against drug-assault, than point out the particular active agent
in the assault. For the same reason that generic symptoms of disease
can rarely be availed of as guides to the selection of a curative, these
are of comparatively little value to the prescriber. The vomiting pro-
duced by one irritant poison is so like that of every other, that from
this alone it cannot be told what irritant it is. So of the diarrhoea,
nausea, thirst, loss of appetite, headache, &c. These of themselves can
never be guides to a prescription, though the elements associated with
them may be. It is not then to the generic symptoms of either drug
or disease that we are to direct our attention chiefly, in our search for
the "like which cures." •

"Where then are we to look for this ? Evidently in the list of those
symptoms which indimdudlize both the disease and \hQ drug. That
which distinguishes the individual case of the disease to be treated,
from other members of its class, is to find its resemblance among those
effects of the drug which distinguish it from other drugs. This is
what we mean when we talk of '^ charaGteristiGS^'^ as the great reliance
of intelligent practice, and assert that with these the law of cure has
chiefly to do. It is precisely in this relationship that the law exists.
When we say that Hihe.Gures lihe^ this is the like we mean." ^

The student of homoeopathy is always perplexed by finding a dozen
remedies enumerated as proper for a certain disease. He sometimes
learns to discriminate between them, and finds that every diseased state
is capable of being covered by a single remedy and none other. Ho-
moeopathy is the science oi speGifics,, not in the sense that old-school
men call Mercury a specific for syphilis. Iodine for scrofula, but in the
sense that there are no diseases^ but only diseased states j and every
specific remedy, which will alone cover that state and necessarily cure
that state. Every prescription based on nosological genera and species
is wrong ; true therapeutics lies only in the individualism of the Ma-
teria Medica.

3. The Character of the Medicine to he employed.— Gevi^m sub-
stances which are very feeble or even inert in their natural crude state
appear to acquire new and potent qualities on trituration. Whether
these new properties are communicated to the minutely-divided par-
ticles by a chemical combination with the oxygen of the air, for which

* Diarrhoea and Dysentery, P. P. Wells, M.D., New- York, 1862, p. 27;;lbid, p. 29.

154 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

several, like Carbon, Graphites, Sulphur, Lime, &c., possess a very
strong affinity, or whether they arise from the simple subdivision of the
atoms of the drug, we are unable to determine. But these are the me-
dicines which have been found especially serviceable when employed
in high attenuations.

On the other hand, there is a class of medicines so volatile in their
nature, that trituration and exposure to the air and moisture deprive
them of their active principles. Amongst these articles may be ranked
Camphor, Ammonia, Bromine, Argenti-nitr., the Ethers, the Volatile
Salts, &c. Medicines of this kind should always be administered in
the lower attenuations.

We must also be governed somewhat by the positive or negative
character of the specific employed. Some medicines are very marked
and prompt in their specific operation, like tartarized Antimony, Phos-
phorus, Ipecacuanha, Belladonna, Aconite, Hyoscyamus, Stramonium,
Opium, &c., and may ordinarily be used at rather higher attenuations
than those whose primary effects are less prompt and strongly pro-
nounced.

The advantages which we obtain from a minute subdivision of crude
substances are as follows :

1. We develop every part of the active principle pertaining to the
substance by breaking up all natural organization or arrangement be-
tween its molecules, and thus exposing a large amount of active surface
which would otherwise have remained latent.

2. By distributing these molecules intimately throughout an inert
vehicle, (sugar or water,) they are far more readily absorbed by the
delicate lacteals and absorbents, than coarse and irritating particles of
matter.

3. When these minute atoms have been conveyed by the blood to
those parts with which they have an aflinity, they penetrate the smallest
vessels, impress the minutest sentient nerves, and become productive of
results entirely unattainable by drugs in a crude form.

4. During the act of subdivision, it is not improbable that the atoms
of drugs sometimes become oxydized, and thus acquire new and in-
creased powers.

In regard to the repetition of doses, we are to be guided by the
aciite or Ghronio nature of the malady, the urgency and danger of the
symptoms, and the effects produced by the medicine.

In violent and dangerous acute diseases, like cholera, asphyxia,
convulsions, phrenitis, pleuritis, gastritis, &c., the remedies should be
repeated as often as every fifteen, twenty or thirty minutes-— until an
aggravation of the symptoms, (that is, some primary effect of the drug,)
appears, or a perceptible amelioration of the symptoms is apparent
when the medicine should be omitted, in the first ease, until the secon-

ATTENUATIONS OF DSTJGS AND REPETITIONS OF DOSES. 155

dary ov Gurative symptoms have appeared, and, then expended them-
selves ; and in the latter, so long as amendment continues. If the case
demands it, recourse may again be had to the same medicine ; or if new
symptoms- have made their appearance, another appropriate remedy
may be selected.

In less urgent cases of acute disease, it will be sufficient to repeat
the remedy every four, six, or eight hours, until primc(/ry symptoms
(aggravation) occur, or amelioration of the symptoms evinces the secon-
dary or curative effects, when we may rest tranquil until the amend-
ment ceases, and the medicine has expended its curative effect.

In chronic maladies the remedy may be repeated once in twelve or
twenty-four hours, until an impression is perceptible, either in the form
of primary drug-symptoms, or of amelioration of the morbid condition.
When this result obtains, we may with great propriety wait until the
full effects of the medicine have subsided, before we repeat the dose
In these cases it is far better to make use of doses sufficiently strong,
and repeat them sufficiently often to induce decided primary medicinal
symptoms — even if we are obliged now and then to give antidotes — ,
rather than to remain for weeks in doubt as to whether a suitable im-
pression has been produced by a single dose. It is very rare that mo-
derate drug-symptoms are productive of unpleasant consequences in
chronic diseases, while the reaction thus induced in the diseased tissue
usually has the effect to bring about a much more speedy cure. Indeed,
we believe it may be set down as a general rule, that the sooner we can
produce a moderate, but decided medicinal action in a structure suffer-
ing from GhroniG inflammation, the sooner will a ciorative reaGtion fol-
low, and health result.

"It would, therefore, appear that experience has confirmed the
opinion of Hahnemann, that a certain amount of aggravation is essential
to the therapeutic process ; in the vast majority of cases this does not
make itself known in any perceptible degree, but it does occur in a cer-
tain, though small amount of cases, sufficient to confirm its existence as
an essential phenomenon. The cases in which it occurs with infini-
tesimal doses are probably only those of excessive or even idiosyncratic
susceptibility, and even with these it is a phenomenon of no danger,
and only slight inconvenience." Hence we may conclude, that a nor-
mal dose of homoeopathic medicine, sufficiently small to avoid the
liability to aggravation in a certain amount of cases, and yet sufficient
to cure best and quickest in the majority of cases, is a mere chimera,
and ought not to be sought for ; but in seeking for doses the best for the
majority of cases we must lay our account for meeting with a certain
number of aggravations, but practically these latter are of no importance.

Likewise in the case of collateral symptoms, it is affirmed by Hahne-
mann; that " we cannot arrange our doses so as to escape the liability

156 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

to them m a small and practically unimportant degree."-— (Z^?\ Drys-
dale : British Jour, of IIomoeo;p. No. XIII. p. 22.)

In all cases of urgent acute disease, in which we can find no single
remedy Avhich corresponds to the symptoms, it is necessary to select
a second remedy which shall cover the remaining symptoms, and ad-
minister it in alternation with the first. Pneumonia is often accom-
panied by cerebral inflammation ; typhits fever, with serious disorder
of the intestinal canal, the lungs, the brain, and nervous system; inter-
• 77iittent fever, with enlargement of the liver, jaundice, cough, &c., and
other maladies with affections in other parts of the body, which are not
strictly connected with the original complaint. In examples of this
kind, the alternation of remedies is both proper and necessary ; at the
same time it must be remembered, that it is far more desirable that a
single medicine should be chosen which covers all the symptoms of the
disease.

The same rule holds good with respect to giving medicines in sue-
cession. Whenever the first remedy fails in producing the required
impression, or whenever important new symptoms arise to which the
original drug does not correspond, we may resort to another which
corresponds to the totality of the symptoms.

A large proportion of homoeopathic physicians, both of Europe and
America, now advocate a frequent repetition of doses in acute diseases,
and in many instances alternations of the remedies. Some of those
who have expressed themselves decidedly upon this point, are, Drs.
(jross, Schmid, Rau, Fleischmann, Reiss, Ruckert, Lobethal, Hart-
mann, Russell, Hull, Neidhard, Gray, Currie, Trinks, Griesselich,
Madden, Dudgeon, Quin, &c.

The erroneous ideas which were formerly entertained respecting the
alternate employment of remedies, are at present nearly abandoned.
So, long as the opinion prevailed that our medicines could only operate
in a kind of spiritual manner upon certain mysterious appendages of the
organism termed " vital properties'^ it was deemed unsafe to administer
two remedies in alternation, for fear of creating confusion among these
dynamic influences; but since the laws of medicinal action have
become better understood, there is no longer hesitation in alternating
medicines whenever symptoms appear to require it.

Some remedies continue their action for a very short time, others
show a duration of action of thirty-five to forty days. Strong doses
act more energetically on both the healthy and diseased organism,
and their action continues longer than that of weaker and smaller doses.

In acute diseases all remedies act more energetically, but their effect
is more evanescent. They are therefore treated by doses, if not larger,
at least given at shorter intervals. In chronic diseases the process of
disease is less conspicuously visible, making often great remissions and

KEPETITION OF EEMED^ES, 157

intermissions ; remedies act more slowly, with less apparent energy,
but their effects last much longer.

In robust irritable persons, rich in vital power, the curative effect
appears and vanishes quickly, and the time of action is short; in tor-
pid, phlegmatic constitutions, remedies act more slowly, but with more
lasting effect. In childhood the primary effect of remedies is evanes-
cent on account of the rapid process of life, and passes quickly to its
curative effect. In old age there is a longer primary action, and a
relatively short secondary action. The following rules are given by
Koch:

1. The more perfectly similar the curative potency the less neces-
sary is a repetition of it; but repetitions in very small doses may bo
safe, and sometimes necessary to complete the cure. 2. The less per-
fect the similarity of the curative potency, the more necessary is the
repetition. 3. The more intense the diseased action is, the more fre-
quently the dose may be repeated. 4. The more acute the disease the
more frequent the repetition. 5. The more completely similar the
curative potency to the symptoms of the disease, the more injurious the
repetition of large doses.

When a proper remedy has been given and amelioration results, the
rule is not to repeat sq long as amelioration continues. Repetition is
proper : 1. When the amendment has ceased. 2. When the receptivity
to the effect has died out, and larger doses are necessary to have
effect. 3. When the disease is acute the repetitions may be frequent
and thus time is saved, the secondary products of acute inflammation
are prevented. 4. In putrid fevers and other adynamic diseases where
collapse is threatened. 5. When disease manifests itself in paroxysmSj
exacerbations, or spasms. ; In diarrhoea^ colic or vomiting, repeat as
often as the attack recurs.

On the practice of alternating remedies^ Jahr says :

It is very common for physicians to prescribe two medicines in alter-
nation, and this at longer or shorter intervals, according to the nature
or intensity of the disease. This, though in some cases proper is, per-
haps, not generally so. " The custom," says Jahr, " has had its origin
in a one-sided view of the nature of disease. If the symptoms of a
disease were viewed as they ought to be, as the phenomenal manifesta-
tion of an internal state, and if their pathological connection and depen-
dence upon each other were properly known, it would most probably
never be necessary to prescribe two remedies at the same time. It is
only when symptoms are viewed superficially, without reference to their
internal unity, that it seems as though they were disconnected and re„
quired more than one remedy at a time.

Though it is proper always to cure the disease by a single remedy,
it is certain that all prescribers are not capable oi always selecting

158 GEKEEAL PBIISrCIPLES OF MEDICAL SCIENCE.

tlie true remedy ; such must be permitted to cover tlie given case by
alternating the two articles which, in their view, come nearest to it.
If either happen to be the true specific, it will cure in spite of many
adverse influences. Another reason for alternating, given by Jahr is^
that different grouj)S of symptoms are often connected through patho-
logical relations. We take an example from some affection of the
pneumogastric nerve.

This is a nerve of sensation and also of motion, "It is a nerve of
sensation simply because it supplies the lining membrane of the respi-
ratory and digestive passages, and it becomes a nerve of motion when
it supplies the muscles and muscular coats of the same canals. The
pneumogastric nerve supplies branches, on the one hand, to the larynx,
the lungs, and the heart ; and on the other to the pharynx, the oeso-
phagus, the stomach, and the solarplexus. These different parts could
not fulfil their organic functions without the assistance or vitality which
they derive from that nerve. The branches of the nerve are essen-
tially the same ; the functional differences reside in the structural
organization of the parts over which the branches are distributed.

These anatomical facts lead to important practical results in the
treatment of disease. Let us suppose for example, a diseased condi-
tion of the pneumo-gastric nerve, an acute irritation of this nerve, a
neitrosis^ in which the various branches of the pneumo-gastric nerve
are principally involved ; such a pathological state would necessarily
be characterized by the most diversified symptoms, symptoms which
would apparently be disconnected, and yet would constitute one iden-
tical group ; for the irritation would be the same in every branch of the
nerve, but the symptoms characterizing the irritation would differ ac-
cording as -the structural organization of the part affected would differ
from that of another part. We might have dryness, soreness, and heat
in the larynx, with constant tickling, disposition to cough and hawk;
stricture across the "chest ; aching pain or weight in the region of the
heart, or palpitation of the heart; loss of appetite, and coated tongue,
nausea, oppression of the stomach, sensitiveness and fulness or bloated-
ness in the region and pit of the stomach, or a hard aching pain in the
pit of the stomach ; or sensation as of a cold stone in the pit of the
stomach ; soreness of the bowels, looseness or constipation.^' &c.

In this apparently disconnected group of symptoms we perceive that
each one constitutes one of a unitary group connected together by the
various branches of the pneumo-gastric nerve, and if we can find a remedy
capable of acting on the pneumo-gastric nerve specifically so as to
produce only a portion of these symptoms, we shall by employing it be
able to strike at once at the seat of the disease before us. By this
single remedy we shall more effectually subdue it than we could hope
to do by searching the Materia Medica for a remedy that shall preseni

0¥ CHANaiNG THE REMEDY. 159

all the phenomenal symptoms of the case ; and, failing to find them under
a single remedy, employing two or three remedies which may between
them cover the whole list of symptoms.

OF CHANGING THE REMEDY,

It is very common to change the remedies too often. If a medicine
has produced a decided improvement in the symptoms, that is, if the
symptoms remain the same, but are less intense, or if only some of them
have disappeared and others remain with the same degree of intensity,
the original medicine which caused this modification of the primitive
group should be continued by all means, for this reason : that such a
modification of the original disease is not an evolution of a new group
of symptoms, but simply a reduction of the former symptoms to a lesser
degree of intensity.

Suppose a case of inflafrb77iatory rhetcfnatisfn, with a full and bound-
ing pulse, high fever, pains in the joints and bones, swelling and inflam-
mation of certain parts, or any of the other manifold symptoms which
characterize this disease. We prescribe Aconite, After the first
three or four doses the fever is abated, perhaps is entirely subdued ; the
pains in the joints and bones are less, and the inflammation is consider-
ably reduced. This change of the symptoms does not constitute a new
group requiring a difi'erent remedy ; on the contrary, the same remedy
is still, indicated, and if continued, will speedily remove the existing
symptoms.

Sometimes we find that by repeating one remedy often, even in in-
creasing doses, the organism becomes habituated to it, and ceases
to be aifected by it. If then another remedy be substituted as an in-
termediate or intercurrent remedy, in small dose, we may return again
to that originally selected. Griesselich advises : 1. Change when the
remedy has lost its eflect, or has failed to produce that which we had
expected. 2. Alternation, when two remedies are seen to be appro-
priate for difi'erent portions of the organism; then, one is given at one
hour and the other at another. 3. SuGoessory reinedies: When one
remedy is only partially eff'ectual, another may be selected which has
a close relation to the first ; as a case not satisfactory cured by Cal-
carea may be finished by Sulphur. Belladonna is often necessary
after Aconite.

Antidotes.— AxL antidote in the homoeopathic sense, is not a sub-
Btance which is capable of neutralizing the curative action of ^ drug,
or of opposing it, as cerebro-spinal sedatives ; as Cofi"ee antidotes
Opium, or Camphor, Cocculus-indicus; — but which is suited to the re-
moval of symptoms arising from medicinal aggravation by the remedy
previously administered. Thus a well selected-medicine may be con

160 GENERAL PEIN0IPLE8 OE MEDICAL SCIENCE.

tinned too long, and its own symptoms may be added to those of the
natural disease ; or an inappropriate remedy may have been selected,
producing drug-symptoms, in addition to those previously existing;
then the homoeopathic antidote is the medicine which best covers the
totality of the symptoms belonging both to the natural and acquired
disease. Its administration, therefore, interrupts the action of the first
medicine, because it has, itself, become the most homoeopathic of
the two.

In this sense Hahnemann employed homoeopathic antidotes: "If,
however, among the symptoms of the remedy selected, there be none
that accurately resemble the distinctive, (characteristic,) peculiar, un-
common symptoms of the case of the disea.se, and if the remedy cor-
respond to the disease only in general, vaguely described, indefinite
states, (nausea, debility, headache, &c.,) and if there be among the
known medicines none more homoeopathically appropriate, in that case,
the physician cannot promise himself any immediate favorable result
from the employment of this unhomoeopathic medicine. (§ CLXV.)

" Such a case however is very rare^ owing to the increased number
of medicines known, now-a-days, with regard to their pure effects, and
the bad effects resulting from it, when it does occur, are diminished
whenever a subsequent medicine of more accurate resemblance can be
selected. (§ CLXVI.)

" Thus, if there occur, during the use of this imperfectly homoeo-
pathic remedy, first employed, accessory symptoms of some moment,
then, in the case of acute diseases, we do not allow this first dose to
act completely out, nor leave the patient to the full duration of the
effects of the remedy, but we investigate afresh the morbid state, in
its present altered condition, and add the remainder of the original
symptoms to those newly developed, in tracing a new picture of the
disease. {Orffanon of Medicine, ^ CLXYIL)

In his elaborate work on Syphilis, published in 1789, Hahnemann
dwells at length on the necessity of antidoting the effects of Mercury,
when it has been used in excess for the cure of syphilis, and recom-
mends for this purpose the administration of jETepar-sulphuriSy which he
believed was the chemical antidote of Mercury, and of many other me-
tallic poisons. It is curious that in later years he recommends the same
Hepar-sulphuris as one of the dynamic antidotes for the inconveniences
produced by small doses of Mercury unhomoeopathically administered.

In 1798 he wrote em esssij on Antidotes to some powerful vegetable
sitbstanees, in which he attempts a classification of antidotes. He says
the hurtful substance may be antidoted in one of four different ways :

A. Removed, 1. By evacuation, as vomiting purging, or by excising
a poisonous bite ; 2. by enveloping, as giving suet where pieces of glass
have been swallowed.

OF CHANGma THE EEMEDY. 161

B. It may be altered, 1. chemically, as Hepar-sulphuris for Corrosive
Sublimate; 2. dynamically (i, e, their potential influence on the living
fibre removed,) as Coffee for Opium.

Dr. Dudgeon, in his "Lectures on Homoeopathy,^' says, the occasions
for the employment of homoeopathic antidotes are very rare. "The
rationale of the administration of Camphor, Sweet Spirits of Nitre
Wine, &c. in the case of over-action of a drug seems to be that thereby
a stronger but transient and different effect is produced upon the
nerves, whereby the feebler impression of the medicine previously
given is effaced, and the new action, being evanescent, the nervous
system .is speedily restored to its former equilibrium— or a dynamic
neutralization is effected."

Hahnemann advised the employment of one remedy at a time, not
from the fear that one will neutrate the other, but because the result
cannot be predicted with the desirable degree of certainty. Thus, the
vapor of Kreosotic-oil, in a mineral oil lamp, — or Camphor, floating in
the atmosphere, or Musk, may have a homoeopathic relation to the dis-
ease under treatment, and the practitioner may ascribe his results to
the wrong agent. On this subject Hahnemann says: "In no case is it
requisite to administer more than one single and simple medicinal
substance at one time." (§ CCLXXII.) "It is not conceivable, how the
slightest dubiety could exist as to whether it was more consistent with
nature, and more rational, to prescribe a single, well-known medicine
at one time, in a disease, or a mixture of several differently-acting
drugs." (§273.)

"As the true physician finds in simple medicines administered simply
and uncombined, all that he can possibly desire (artificial morbific
agents which are able by homoeopathic power completely to overpower,
extinguish, and permanently cure natural diseases,) he will, mindful of
the wise maxim, that it is wrong to attempt to effect anything with
compound means that maybe effected by simple means, never think of
giving any but a single simple medicinal substance." (§ 274.) f

We know that the effects of every medicine on the animal organism are
either partially or totally annulled by another medicine of which the
positive effects are more or less similar to the first one in its symptoms,
its local and general tendencies and character. " The remedies per-
fectly similar in their positive effects annul one another; whereas, those
whose positive effects cover only solitary organs or tendencies, annihilate
only those symptoms in which the correspondence of similarity holds
out." It is allowable to use antidotes : 1. When aggravations have
been caused by over-doses of a proper remedy, as well as by one not
correctly selected. 2. To relieve symptoms produced on the prover of
a remedy. 3. For the cure of medicinal dyscrasias. 4. Related or
successory remedies act as antidotes to each other; and the greater is

Vol. L— 11.

162 GE^^EEAL PEIKCIPLES OE MEDICAL SOIENOE.

their similarity in tlieir positive symptoms the more decided are their
eiFects in antidoting each other. When a medicine has been abused to
the extent of developing a drug-disease, it may be, after long enough
time, removed by a remedy which has some relations of similarity.
When we are able to detect too few symptoms in a case to come to a
positive choice of a true remedy, we prescribe that which covers such
as are visible ; and then, when other symptoms appear as called out by
the remedy tried, make a new selection, endeavoring to find ane that is
the similimum of the whole disease.

Mode of Administering Remedies,-— ^\i.^ practice of Hahnemann
in later years of his life is given by Dr. Croserio, (N. Archiv.l.2.p.31,)
who says he often witnessed its success.

"Hahnemann always made use of the well-known small globules^
which were generally impregnated with the 30th dilution, both for acute
and chronic diseases. Of these globules he directed one^ or at most
tioo^ to be dissolved in a caraffe, containing from three to fifteen table-
spoonfuls of water, and a half or a whole tablespoonful of French
brandy. One tablespoonful only of this solution was put in a tumbler-
ful of water, and this last the patient took by teaspoonfuls ; on the first
day one teaspoonful, on the second tw^o, on the third three, and so on, a
spoonful more daily until he felt some effect. He then diminished the
dose, or discontinued the medicine entirely. In other cases he caused
a spoonful of the first tumbler to be poured into a second tumbler of
water, in others, from this last into a third, and so on to a sixth tumbler,
and directed a teaspoonful to be taken from the last tumbler only
when he had to do with very irritable subjects. The cases were rare
in which he allowed a table- or a teaspoonful to be taken daily from the
first solution made with from eight to fifteen table spoonfuls of water.
If he gave a pow^der, to be taken at once in a spoonful of water, that
was always only milk-sugar. He never prescribed two different re-
medies to be taken alternately, or one after the other; he would always
first learn the effects of one remedy before he gave another, even in
patients who were treated by him at two-hundred leagues distance.
Neither did he change the medicines. Even in acute diseases it was
rai^ for him to give more than one spoonful once in the twenty-four
hours. But on the other hand, in order to quiet the patient or his friends?
he gave frequent doses of plain milk-sugar. Hahnemann appeared in
the latter years of his practice to employ his whole dexterity in dimin-
ishing the dose more and more. Hence he latterly employed olfaction
very frequently. For this end he put one or two globules in a small
medicine phial containing two drachms of Alcohol, mixed with an equal
quantity of water, which he caused to be inhaled once or twice with
each nostril, never oftener. My own wife was cured by him in this
manner of a violent pleurisy in the course of five hours. In chronic

OF CHAHGINa THE EEMEDY. 163

diseases, happen what might, he never allowed this olfaction to be re-
peated oftener than once a week, and he gave besides for internal usO;
nothing but plain milk-sugar; and in this manner he effected the most
marvellous cures, eyen in cases in which the rest of us had been able
to do nothing."

Hommo^pathiG Notation. — The entire system of potentizing drugs
was invented by Hahnemann. He "created potencies out of crude
matter, refining the drug into subtile doses, developed the medicinal
properties of matter, making them assimilable, and thus specifically
curative." He thus taught, practically, how to cure with the least possible
dose, unconsciously but surely applying the general law of the least
quantity of action, which was discovered and mathematically established
by Maupertuis.

The different degrees of potentization have been designated by men
each according to his own made of notation,* of which we will only
notice those most likely to be generally used.

Our own pharmaceutists have a claim to be understood, and we sup-
pose their systems of notation are generally known. Of these

" Smith numbers his preparations centesimally, but prepares them
according to the decimal scale, i. ^., with 10 grains of the crude sub-
stance he triturates 90 grains of sugar of milk, which he signifies by
the fraction -^^, Ten grains of this preparation is again incorporated
with 90 grains of sugar of milk, Avhich is (iesignated I., making the first
Hahnemannian trituration, centesimal. In this way he makes six tri-
turations of an hour each, in preparing what is called the third tritu-
ration, which is as high as he carries his triturations generally. They
are marked respectively A, 1, 1 J, 2, 2-^, 3. Expressed in fractions they
would be lo, 1 oiTj To 0 0? ~Ti),u"oT3 Tro , 0 0 "o"^ TToTo.fUTT* xlis uiiutions are
all made centesimally from the tinctures, when the medicine is prepared
in that form, or, as with the minerals, from the third trituration. They
are all made by hand and receive 400 succussions each. He has also
prepared the 200th potency with Alcohol, centesimally on the remaining
drop, a.nd with 400 succussions each, by hand. He uses Arabic cyphers
for his notation as above stated. For the tinctura fortis, the common
sign ^ is used. Sometimes however, the strength of the tincture is
expressed by a fraction, e, g.^ Aeon. I-, Cham. -J, Nux-Vom. -^V) Thuja ^.
The fraction J means that an equal quantity of Alcohol is added to the
expressed juice of the plant. The fractions ^, iV, u-V, signify that one
part of the drug. has been mixed with 8, 16, or 20 parts of Alcohol, (or
Alcohol and water as the case may be), which quantity is requisite to
insure solution. The fraction ^ is used to denote the mother-tincture,
where the fresh plant is resinous ; in which case it is first crushed and

* Dr. Fincke, Hoinoeopatliic Notation, Amer, Homoeop. Rev. Aug. 1860, p. 451,

J. 6^ GENEEAL PEmCIPLES OF MEDICAL SCIENCE.

its weight of Alcohol is added and afterwards expressed; this being
the tincture." The system followed by Radde, Hurlbut, and other ho-
moeopathic pharmaceutists is essentially the same.

PROVING OF DRUGS,— METHOD OF IMPROVING THE MATERIA

MEDIOA.

1. In order to obtain an exhaustive proving it seems necessary to
employ both dilutions and massive doses.

2. " The proving should be GommenGed i^\\h dilutions; and high
foteuGies should be employed until satisfactory evidence is obtained

" that the prover is not susceptible to their action. We thus obtain one
of the unknown quantities of our problem, viz., — the measure of the
susceptibility of the prover.

.3. Where a keen susceptibility is found to exist, the greatest care
must be exercised to avoid Hunting or perverting it. With this view,
repeated experiments should be made at long intervals, with high ^po-
tencies- until no new varieties of symptoms are evoked. Then, after a
long period of non-medication, the prover should take lower potencies
and then small doses of the crude substance repeated at intervals, and
finally after another long period of repose, la/rge doses of crude sub-
stance. A thorough proving, after this fashion, may require years for
its completion, — but it will have an advantage over most of our recent
provings, in the fact, that it will be thorough, and that it will be of per-
manent and certain use to the practitioner.

4. In proving with dilutions, as well as with massive doses, a long
period of time should be occupied in testing each preparation, in order
that the full effect may be seen in the production of the dyscrasias, &c.

6. The greatest care should be exercised in verifying symptoms by
repeated experiments, in order that "imaginary" symptoms on the one
hand and cl\emical and mechanical symptoms on the other, may be ex-
cluded. Every sensation felt by the prover during the progress of the
experiment is not entitled to be included amongst the symptoms pro-
duced by the drug." {Dunham. Am, Horn, Rev, I860,)

If the symptoms of a case are minutely noted, their entire removal
under a single remedy tends to verify the pathogenesis, but not in the
same degree as would the recurrence of an equal number of symptoms
in re-proving by new provers. "The morbific effects of drugs are often
observed to be the same on the sick as on the healthy," and they are
probably identical even to the minutest particulars. And the principal
reason for not relying on symptoms observed on the sick is, that we
might be confused by introducing symptoms proper to the disease in-
stead of those caused by the remedy." (Dr, Joslin.)

"A similar danger attends thero/peutiG verifications, and it is in one

SYMPTOMS OF DISEASE, 165

respect greater, viz., in regard to Gritical days Many accurate ob-
servers have noticed certain epochs of decline ct termination of dis-
eases, especially those of a febrile character. The more marked of
these changes occur on the third, seventh, eleventh, fourteenth, or
twenty-first days. Several partial crises are observed in the progress
of the same case, each leaving it changed by the somewhat sudden dis-
appearance or mitigation of some of the symptoms. Now, if under a
correct treatment each of these changes is, on the wholes a favorable
one, and the final result happy, the several improvements and the final
cure are not attributable merely to nature ; and on the other hand, not
merely to the medicines given immediately before the epoclig of the
several changes. If others had been previously administered, they
may have equal claims as the cause of the improvemen', or cure. If the
physician neglects the observation of critical days, he may draw erro-
neous conclusions in regard to the curative influence of a drug. The
quotidian changes are generally appreciated. The before-mentioned
critical days are ^Iso, in regard to some symptoms and in some degree,
days of exacerbation, and their neglect might ntiate the pathogenetic
confirmations, though usually less than the therapeutic.'' * To prove me-
dicines on the healthy is tho great work that devolves on our school.
The mode then of improving our Materia Medica is by the examina-
tion of morbific properties, and not by the direct observation of curative
ones, on which other schools rely. ^Aq advantage oi \hi^ TCLodiQ was
demonstrated by Hahnemann ; but iihe extent to which it admits of
being cultivated has not yet been measured. The first principles of
aomoeopathy are already known to be fixed and eternal ; but the extent
of our resources is only be/^inning to be estimated; and an immense
amount of labor is yet needed to develop the treasures that are waiting
"to be called into use m the cure of human diseases.

8E?iEiOLOGY,— SYMPTOMS OF DISEASE.

The word Symptom has been defined to consist of "everything or
circumstance happening in the body of a sick person, and capable of
being perceived by himself or others, which can be made to assist our
Jtidgment concerning the seat or nature of his disease, its probable
course and termination, or its proper treatment.f From this definition
the purposes for which the symptoms of a case are accurately stu-
iied, are,.

1. To ascertain the nature and seat of the disease ; that is to form a
elear and correct Diagnosis,

2. To enable us to foretell the probable issue of the disease, or to
frame the Prognosis]

* Josiin, Am. Horn. Rev. 1858.— f Watson's Lectures.-Theory and Practice n. 99

166 GENERAL PEmOIPLES OF MEDICAL ecIENCE.

8. To direct the Treatmsnt,

In almost every system of practical medicine the significance and
importance of individual symptoms, and the best modes of combatting
and removing them, have been originally derived from the empirical
effects oi remedies, rather than from observations on the nature of
diseases. Symptoms have been divided into :

Firsts Symptoms or combinations of symptoms which distinguish
the place and nature of a disease, and called signs of the disease.

Secondly^ Those symptoms which point out to us what is to be done
to ensure a return to health, and are called Indications of Treatment

The word Sym^tom^s has been applied to such manifestations of dis-
eased action as are obvious to all persons alike — to the nurse as well as
to the physician. Signs are deduced from symptoms by arranging and
comparing them, and noticing the circumstances under which they
occur; thus signs are generally intelligible to medical eyes only. Some
symptoms are called direct, because they point us to the exact seat of
the diseased action ; others are indirect or "declare themselves through
the medium of the constitution at large." ( Watson) Q^hese sympathetic
symptoms are compared by Darwin to the arrows shot from the bow of
a concealed archer. They prove that there is somewhere an efficient
cause and source of diseased action ; but a careful investigation may
discover it far away from the point which is the seat of the most con-
spicious and tangible symptoms. With respect to the symptoms which
consist of morbid changes, they may all be classed under three heads %
1. Uneasy, unnatural or impaired sensations ; — 2. Disordered, or im-
peded functions; — and 8. Alterations of structure or appearance, chan-
ges of sensible qualities. When these last come within the direct
cognizance of our senses, they are called physical signs.

Of ail the uneasy sensations j?(:^m is the most important. When pain
or uneasiness is complained of in any part or organ, our next business
should be to inquire whether the f%inGtions of that part or organ are
disturbed or suspended. The functions of the brain and nerves, of the
heart and blood-vessels,—- of the respiratory apparatus and of the di-
gestive organs, — are all of the highest importance ; and the symptoms
drawn from the functions belonging to the circulation are of such con-
sequence that the pulse is to the physician what the polar-star is to the
mariner. Its highly significant changes in frequency, regularity, full-
ness and force will be fully explained in the appropriate place,

GENERAL DIAGNOSIS.

It is a matter of the highest importance that the homoeopath should
be perfectly familiar with the most approved methods of diagnosis, in
order that he may take advantage of every possible circumstance which

GENERAL DIAaisTOSIS. 167

may facilitate for his investigations of disease. Although a patient may
be competent in general to indicate the exact seat of his pain, and thus
enable the physician to determine what organ or tissue is affected, this
is by no means true in all eases.

There are many maladies which are entirely unattended with pmn^
or any other looal sign^ by which the physician can detect the suffering
organ. In cases of infants and young children, who are unable to in-
dicate the locality of their sufferings, and in some chronic affections, a
knowledge of the external signs is of vast importance. In all such
cases a proper skill in diagnosis will prepare the medical man to pene-
trate the innermost recesses of the organism, and to understand its
most profound secrets.

It is a singular and highly interesting fact, that the^<zm5of the different
parts of the body impart to the countenance certain characteristic and
easily understood expressions. As these signs are involuntary and
almost uniformly present, all will recognize their importance as diag-
nostic phenomena.

In forming our diagnosis, it is essential in the first instance to notice
accurately every circumstance connected with the patient which is at
all peculiar or unnatural. The general expression of c(iuntenance, the
tone of voice and manner of speaking, the figure, attitude, movements, &c.,
should be attentively marked. At the same time, age, sex, temperament,
hereditary predisposition, occupation, habits of life, whether laboring
under the effects of any previous malady, or of Mercury, and whether
accustomed to the constant use of Opium, should all be duly considered.

The patient should then be permitted to detail his symptoms after
the manner pointed out by Hahnemann in his Organon (§ 206,207,209.)
In cases of inability on the part of the patient to enter into a descrip-
tion of the case, the friends should be called upon to give all the in-
formation in their power in regard to the rise and progress of the dis-
order. An attentive perusal of Hahnemann's advice upon this subject,
is of the utmost importance to the acquisition of a perfect portraiture
of every complaint.

Since, however, there are some instances in which neither the patient
nor friends are able to afford any information respecting the nature or
seat of the affection, it is indispensable to acquire a knowledge of all
external and involuntary signs which can in any way illustrate the
character of the malady.

Allopathic writers have divided diagnostic signs into those exhibited
by the Gountenance^ the attitude^ the nervous system^ the digestive
organs^ the Girculatory system^ the resjfnratory organs^ the sJcin^ the>
lyrrvphatie system^ the secret/ions.

As the countenance is an excellent index of what is occurring in,
distant parts of the organism we should note attentively the expression

168 GENERxlL PIimCIPLES OF MEDICAL SCIENCE.

of the eyes^ nose^ mouth and forehead^ and also wliether sadnesSj
moroseness, peevisliness, despair, fear, grief, or joy is evinced. By
heeding carefully these indications, we shall be greatly assisted towards
accurate opinions in obscure and complicated cases.

The contraction of the features, rapid dilatation and contraction of
the nostrils, dyspnoea, with expression of anxiety, indicate aoitte in-
flammation of the respiratory organs.

Sharp features and expression of anguish, " forehead wrinkled, brows
knit," eyes sunken, countenance pale, hollow cheeks, lips dry and bluishj
indicate pain and severe inflammation of the abdominal viscera.

General expression of countenance flushed and excited, or dull and
stupid ; eyes red and brilliant, or dull and heavy ; pupils contracted or
dilated ; protrusion of the eyes with a wild expression ; mouth drawn
to one side ; twitchings of the eyelids and muscles of the face, indicate
inflammation of the cerebral organs.

Expression anxious ; respiration difficult and rapid during inspiration,
while expiration is comparatively easy ; symptoms worse after assuming
the recumbent posture; face swollen and livid, indicate hydrothorax.

Face flushed and swollen ; lips blue ; eyes prominent and unnatural ;
face cold: sudden startings in sleep ; anxious expression; indicate or-
ganic disease of the heart.

Cheeks pale and blanched ; lips white and pufiy ; a dark circle
around the eyelids ; expression of languor and debility, indicate
chlorosis, -

Paleness and puffiness of the upper lip indicate scrofula and ver-
minous affections.

Eyes and face red ; rapid respiration ; motions of the nostrils rapid,
indicate simple acute fever's,

FiaURE AND ATTITUDE.

In order that the organs may perform their functions in a proper
manner, it is absolutely indispensable that the body should retain its
normal structure and shape, and remain unincumbered by any artificial
appliances which tend to impede the circulation or check the free
action of the muscles. Unfortunately for mankind, it has been custom-
ary both in barbarous and civilized countries, to distort artificially
certain parts of the body, under the absurd notion that they were im-
proving upon nature, and enhancing the beauty of the figure which the
Supreme Architect had formed after his own image.

Among some savage tribes of the Rocky Mountains it has been custom-
ary and fashionable for the natives to flatten the forehead by long-con-
tinued artificial pressure. This constitutes the ideal of savage beautyj
andis their common method of improving upon the works of the Creator,

In other barbarous countries it is customary to slit the ears and nose,

GENERAL DIAGNOSIS. 169

and liang from them large quantities of tin, brass, and other cheap
ornaments.

This with the requisite amount of tattooing and painting, illustrates
their notions of what the human figure should be.

In China, the semi-barbarous inhabitants compress the feet of their
females from birth, in such a manner as to prevent their growth and
development ; and in this abominable distortion consists their idea of
female beauty. This is the Chinese improvement upon nature.

The Turks cram their women with ^'pillany after the manner of
stuffing geese, to cause enlargement of the liver, for ^'^ate defoi gras^^
— that they may become enormously fleshy, and thus present to the
admiring eyes of their lords, figures of uniform dimensions in all direc-
tions. This is the Moslem's style of female beauty.

In the highly civilized countries of Europe and America, it is not
customary to make use of artificial contrivances to flatten the head, pre-
vent the growth and development of the feet, to slit the ears and nose^
or cram their women ; but, through the instrumentality of those " infer-
nal machines," corsets and stays, the sex deem it indispensable, in
order to be genteel^ to compress entirely from its natural shape the
most important and vital part of the organism. These unnatural efibrts
at distortion are usually commenced at an early period, and continued
with perseverance, until the figure has lost its natural symmetry, the
lungs are forced upwards, out of their just position, and the abdominal
viscera made to accommodate themselves in the new situation to which
they have been reduced by art.

Many females of the present day, affect to contemn the symmetrical^
figures which the Creator originally formed, and which the ancient
sculptors delighted to represent in marble, and have chosen to " im-
prove" on these old-fashioned notions, by partially cutting off the con-
nection between the upper and lower parts of the body ; thus reducing
it from the shape of those models of perfection, the Venus di Medici,
and the Venus of Milo, to that of a wasp or an hour-glass. We have
not only the authority of the ancients in all those master-pieces of art
in which they have illustrated their ideas of beauty, but the greatest
of modern sculptors, our illustrious countryman Powers in a MS.-letter
before us, declines the public exhibition of his exquisite statue of Eve,
because he had been compelled by his own sense of harmonious pro-
portion, to present the mother of mankind in the shape which the Creator
approved as the ultimate product and most perfect fruit of Divine in-
telligence and energy. " Eve," says the sculptor, " is a,n old-fashioned
body, and not so well formed and attractive as are her grand-daughters
— at least some of them. She wears her hair in a natural and most
primitive manner, drawn back from the temples, and hanging loose be-
hind, thus exposing those very ugly features in women. Her waist i€

170 GENERAL PEINOIPLES OF MEDICAL SOIEITOE.

quite too large for our modern notions of heauty^ and her feet they
are so broad and large ! And did ever one see such long toes ! They
have never been wedged into form by the nice and very pretty little
shoes worn by her lovely descendants. But Eve is very stiff and un-
yielding in her disposition ; she will not alloio her waist to he reduced
iy handaging^ heoause she is far more comfortahle as she is^ and he-
sides^ she has some regard for her healthy which might fro^n such
restraints ujpon her lungs ^ hearty liver ^ c&c, c&c, (&g. I could never
prevail upon her to wear modern shoes, for she dreads corns, which she
says are neither convenient nor ornamental. But some allowance
ought to be made for these crude notions of hers, founded as they are
in the prejudices and absurdities oi pri'tnitive days. Taking all these
things into consideration I think it best she should not be exhibited, as
it might subject one to censure and severe criticisms, and these too,
without pecuniary reward.'^

Singular perversion of taste ! Wonderful and all-powerful influence
of fashion^ which can induce so many intelligent beings to suffer tor-
ture like savages, for the purpose of distorting their bodies, and bring-
ing them into those artificial shapes which civilized nations denominate
genteel and graceful !

Suppose a fashionable woman should apply corsets and stays to a
favorite monkey, x)r a pet lap-dog, and so compress its body out of shape,
would not the attempt be pronounced heartless, and its author, perhaps
be indicted for cruelty to animals ? but when the same barbarity is per-
petrated upon a human being, it is tolerated, because it is genteel and
fashionable !

Were females the only sufferers from these cruel practices, the sin
would not be so great ; but their posterity participate deeply in the
consequences which result from their criminal perversity. The flat
and narrow chests, the stooping gaits, and the pale or sallow faces
which greet us at every step, demonstrate the extent of our physical
degeneration. Some reform is now visible, but it moves slowly.

But the female sex are not alone censurable. Too great a propor-
tion of the men, — of this country especially, — become round shouldered,
crooked and deformed from a want of free muscular exercise, and too
close an application to business, in constrained, bent, unnatural positions.

Physical education in latter times has beenquite overlooked. Parents
have commenced sending to school in infancy, and their embryo minds
have been tasked with all kinds of mental exercise, while their phy-
sical powers have been suffered to languish in heated and ill-ventilated
rooms. Thus they have grown up with improved minds^ but feeble,
undeveloped, and perhaps crooked, or mis-shaped bodies.

Let it ever be remembered that the mind and body exercise an in-
fluence upon each other, and, if we would secure to the former its high»

GENEEAL DIAGNOSIS. 17J

ast development, we must cultivate and perfect the latter. In this
respect we may with advantage go back to antiquity and copy after
Herodicus, in advancing physical education.

But to return to our subject : as in health the attitude is erect, an
those positions are assumed by the body and limbs which indicate mus
cular strength, so departures from the normal standard induce cor
responding alterations in the position and appearance of the body.

Thus, tremors ; position upon the back, with a constant disposition
to sink down towards the foot of the bed, indicate extreme mttsGular
debility.

Distressing dyspnoea, and sense of suffocation when lying down;
constant desire to assume the erect posture ; general agitation, cough;
and appearance of anxiety indicate hydrothorax.

Common position upon the back ; rigidity and morbid involuntary
contractions of the flexor muscles, usually of the upper extremities, in-
dicate softening of the hrain.

Position upon the back, with the knees drawn up ; head and shcpl-
ders a little elevated; dread of motion, indicate abdominal infiam-
mation ivith acute pain.

Position upon the belly ; pressure of the abdomen affording relief
and great restlessness, indicate spasmodio abdominal pains.

Rigidity and involuntary contraction of the muscles of the neck
back and limbs, indicate inflammation or irritation of the spinal cord.

In the advanced stages of acute diseases, position upon the back?
with the legs drawn up, indicate retention of urine.

THE TONaUE.

The following are a few of the diagnostic signs presented by this
organ :

A clean, smooth and bright red tongue, indicates inflammation of
the gastn^ic or intestinal mucous membrane,

A clean and red tongue, with papillae prominent; or a furred tongue,
with red papillae appearing through the fur, indicates scarlatina.

A reddish and tremulous tongue indicates mania a potu.

A thick and yellow fur covering the tongue, with bitter taste, indicates
biliary derangement.

A white fur upon the tongue indicates slight fever.

Acute symptomatic fevers effect but little change in the appearance
of the tongue.

A relaxed, dilated, and tremulous tongue, indicates congestwe or
nervous fevers,

A pale and flabby tongue, "with large papilla/' indicates gast/rio de^
bility^— met with in chlorosis.

172 GEISTEEAL PRINCIPLES OF MEDICAL SCLEISTCE.

A sliarp and pointed tongue is often observed in irritation cmd in*
flmnmation of the hxcin.

THE NERVOUS SYSTEM.

Tearing, throbbing and aching pains, aggravated by contact, pressure
or movement, mdiG^ite inflammatory action,

Twitcbings of the limbs, jerkings and shocks of the tendons, cramps,
convulsive movements, violent contortion of the body, pains relieved by
pressure, unattended with fever, indicate spasmodic vains.

Sharp and darting pains, unaccompanied by swelling, heat, or red-
ness, indicate neuralgic pains.

Vague and wandering pains about the ankle often indicate inflam-
mation of the hnee.

Pains also in other healthy parts sometimes indicate inflammations
in rem^ote structures.

Wakefulness indicates irritation of the ner'oous system.

Irresistible inclination to sleep, with stertorous breathing, indicates
compression^ or serious disturhanee of the Irain,

Twitching of the muscles during sleep, and frequent waking from
frightful dreams, indicate organic disease of the heart / also charac-
teristic of "(Verminous irritation.

Sudden, ra^pid and jerking movements of the head and limbs indicate
cerehral irritation^ Tuania a potu^ and some forms of insanity.

If there be pain with its hidden cause in any one particular spot, it
can only be by tracing the nerves of and from that spot, that we can
hope to arrive at the real cause of the symptoms. " It is through the
medium of the distribution of the cerebro-spinal nerves of sensation (the
fifth being the true cranial sensitive nerve), that we are enabled to ex-
plain those pains which are called sympathetic, but which result from
the continuity of nerves between the cause and effect, the disease and
the symptom. It is impossible to affix too much practical significance
to this simple statement. External pain may be considered as an ex-
ternal sign or demonstration of some distinct derangement. Seek its
precise position, and see what nerve is the medium of transmitting this
perverted sensation, and we probably reach the original or producing
cause of the pain ; the patient may not judge correctly of the real seat
of his disease." [Hilton^ — Lecture on Pain.')

THE ALIMENTARY CANAL.

The alvine discharges will afford many useful hints to the observing
physician.

Thus, light or clay-colored evacuations denote a lacTc ofhile.
Mucous and bloody stools indicate intestinal inflam^inationj if ac-

GENERAL DIAGNOSIS. 173

companied with tenesmuSj and redness or protrusion of the rectum, we
may conclude that the lower part of the canal is affected.

Watery stools, with slight pain, indicate irritation of the 'bowels.

" Glairy, dark-green evacuations, like chopped spinage, are charac-
teristic of hydrocejjhalusP

Very dry and hard fasces indicate a relaxed arid torjpid state of the
mucous TYiewbhrane of the bowels,

THE RESPIRATORY ORGANS.

Using the abdominal muscles principally in respiration, indicates in-
flammation of the lungs.

Using the intercostal muscles alone, indicates abdominal in-
flammation. ,

Irregular respiration, with stertorous breathing, indicates compression
of the brain.

Inspiration difficult, anxious and rapid, while expiration is com-
paratively easy, is peculiar to hydrothorax.

Wheezing, short, panting and anxious respiration, with contraction of
the larynx, indicate asthma.

Paroxysms of rapid, short, suffocating and spasmodic cough, indicate
pertussis.

White, tenacious sputa mdlcd^tQ chronic bronchitis.

Very thick, yellow, or greenish sputa, which sink in water, are indi-
cative of disorganization of the lungs,

THE SKIN.

A yellow skin indicates a disordered liver,

A sallow skin occurs in chlorosis and a few other chronic ailments,
A pale and waxen skin denotes a deficiency of red globules in the blood,
A blue or livid skin, in infants, indicates a pervious foramen ovale,
A hot and dry skin denotes fever ^ and generally inflammation.
A cold skin, with internal heat, indicates internal congestion,

THE URINE.

Urine red and scanty denotes inflammation.
Urine, clear, limpid and abundant in nervous affections.
Urine depositing a sediment indicates biliary derangement
The above are only a few of the more common and well-known diag-
nostic signs. Our only object is to direct the attention of the physician
to this subject, for there are often many things about the general ap-
pearance of a patient which are slight and indescribable in themselveSj
but which will aid him materially in forming his opinions.

In order then to arrive at a correct diagnosis, it is necessary : —

1, To note all external signs.

2. To ascertain the age, occupation, previous habits, predispositions
and peculiarities of the patient.

174 GENEEAL PEmCIPLES OF MEDICAL SCIENCE.

3. To procure from the patient a spontaneous and minute detail of
his sufferings in his own language.

When the patient is unable or incompetent to afford this information,
get as accurate a description as possible from those best acquainted
with the history of the case.

4. Ask such questions and make such examinations by the touch,
pressure, sight, hearing, percussion, auscultation, &c., as may be neces-
sary to perfect the diagnosis.

All true diagnosis is. based upon inductions gradually drawn from
the facts furnished by observation, pathological investigations and ex-
periments. By careful and repeated observations we have learned to
associate certain phenomena observM during life, with partiqular lesions
found after death ; and sound principles have advanced in the same
proportion as the number of accurate observations have been collected.
"In so far as we are able correctly to interpret symptoms, and to trace
out in connection with them a real change of structure- or function
which affords an adequate explanation of their presence, in so far
we are prepared to form a correct diagnosis." ^ In pursuit of this object
our especial work is to learn to group symptoms together, and to ana-
lyze them separately in such a manner that we may be able to apply
to them a scheme already supplied to our hand, which shall in some
way account for their existence. A comparison is instituted between
the probable results of the supposed malady and those presented by the
particular case under investigation, and their correspondence is ac-
cepted as a verification of the hypothesis. We gather together the
fragmentary evidence furnished by the symptoms, and we apply to the
case the known laws of cause and effect as taught by the generally ac-
cepted theory of disease.

The correctness of the conclusion must greatly depend on our as-
signing the true relative value to each portion of the evidence. Though
one symptom may be more important than another, many errors are com-
mitted by permitting a single symptom to assume undue importance as
a "pathognomonic" sign. It is only correct general knowledge of dis-
ease that can give precision to our judgment ; and the result of the
case will generally verify or disprove its accuracy. In general, the
more numerous the symptoms which are noted in the case the better is
the opportunity for correct diagnosis ; a second examination of a
case brings to light new symptoms, hitherto overlooked, and compels the
physician to throw aside a hypothesis based on insufficient premises ;
thus, when the conclusion has been reached that inflammation is
established in a certain organ, further investigation reveals the cha-
racter of that inflammation.

* Barclay. Manual of Diagnosis. 1862.

G-ENEEAL DIAGNOSIS. 175

Temperature of the Body. — The normal temperature in the arm-
pit of all healthy persons is 98i degrees Fah, In some diseases the
temperature is not at first varied ; but a higher or lower temperature is
always a sign of disease.

The temperature is uninfluenced by hunger, eating, drinking, stimu-
lants, rest, or exercise so long as health is undisturhed ; but when
any of the above influences increase the temperature, this is evidence
that disease is impending. If the temperature rises to 102 from any
of the above influences, there must be active disease beginning, or re-
lapse of a disease supposed to be cured.

Depressing influences, as loss of blood, sound sleep, evacuations, &c.,
may induce a brief sinking of the temperature, such sinking lasts only
a few hours in a healthy state ; if it continue long it shows disease, though
the pulse, which is commonly trusted, should not indicate it.

If in the progress of supposed typhus fever the temperature becomes
normal, or becomes even transiently normal during the second week,
the disease is not typhus. When either pneumonia or hsemoptoic in-
farctus is suspected, the normal temperature decides that the latter is
the disease. When haemorrhage occurs in a tubercular patient, if the
temperature be normal it shows that there is no active pneumonia, and
that tubercular action is not progressing. In a convalescent patient the
normal temperature proves no relapse or new disease progressing. In
intermittent fever, if the temperature does not rise at, or even before the
time for the paroxysm to begin, it will not come. This occurring a second
time shows the return of the paroxysms suspended.

The temperature rises some hours before the feelings of the patient
reveal it ; also in cases where the paroxysms have left, the exacerba-
tions of temperature continue to recur on successive days, as high as
104°. Typhus may be detected by the thermometer several days be-
fore it is seen or felt by any other symptoms. Tuberculosis, if progress-
ing, is known by the thermometer ; also new complications are thus de-
tected before they can be in any other manner.

In general, for one degree of the thermometer the pulse rises 10
beats per minute, but the rise of the temperature 99^ degrees, gives
more evidence of disease than the rising of the pulse from 70 to 80 per
minute. In a slight fever the thermometer stands at lOli'^ ; in a
severe one 104 ; in violent or dangerous fever at 106i ; death is almost
certain at lOBi.^

The importance of a correct diagnosis can scarcely be over-estimated
by the physician, inasmuch as his treatment will always to a great ex-
tent be determined by the opinion' he may form of the nature of the dis-
ease. We have seen remarkable cases of failure as well as of success

* Dr. Oehme, j^ew-Hamp. Horn. Med. Soc. 1863.

176 GENEEAL PKINCtPLES OF MEDICAL SCIEKCE.

wliicli turned upon correctness or error in judging of the patient's real
condition. The following instances of mistakes in diagnosis are given
by Dr. 0. W. Holmes :

" I saw Velpeau tie one of the carotid arteries for a supposed aneu-
rism, which was only a little harmless tumor, and kill his patient. Mr.
Dease, of Dublin, was more fortunate in a case he boldly declared an
abscess, while others thought it an aneurism. He thrust a lancet into
it, and proved himself in the right. Soon after, he made a similar
diagnosis. He thrust in his lancet as before, and out gushed the patient's
blood and his life with it. The next morning, Mr. Dease's patient was
found dead and floating in his blood. He had divided the femora]
artery.

" I have doomed people, and seen others doom them, over and over
again, on the strength of physical signs, and they have lived in the
most contumacious and scientifically unjustifiable manner as long as
they lived, and some are living still. I see two women in the streets
very often who were both as good as dead in the opinion of all who saw
them in their extremity. People will insist on living sometimes, though
manifestly moribund. In Dr. Elder's life of Kane you will find a story
of this sort, told by Kane himself. The captain of a ship was dying
with scurvy, but the crew mutinied, and he gave up dying for the pre-
sent to take care of them.

An old lady in this city, near her end, got a little vexed about a pro-
posed change in her will ; made up her mind not to die just then ; or-
dered a coach ; was driven twenty miles to the house of a relative, and
lived four years longer. Cotton Mather tells some good stories which
he picked up in his experience, or out of his books, showing the un-
stable equilibrium of prognosis. Simon Stone was shot in nine places,
and as he lay for dead the Indians made two hacks with a hatchet to
cut his head off. He got well, however, and was a lusty fellow in Cotton
Mather's time. Jacob Musgrave was shot with a bullet that went into
his ear and came out of his eye on the other side. A couple of bullets
went through his body also. Jacob got well, however, and lived many
years. Per contra^ Col. Rossitor, cracking a plum-stone with his
teeth, broke a tooth, and lost his life. We have seen physicians dying,
like Spigelius, from a scratch; and a man who had a crowbar shot
through his head is alive and well. These extreme cases are warnings.
But you can never be too cautious in your prognosis, in view of the
great uncertainty of the course of any disease not long watched, and
the many unexpected turns it may take."

PATHOLOGY. 177

PATHOLOGY.

A knowledge of general Pathology comprehends, according to Dr.
Watson: — "1, A knowledge of the material changes to which the
several parts of the living body are subject.

2. A knowledge of the processes or actions by which these changes
are wrought.

8. A knowledge of the causes in which these processes originated.

4. A knowledge of the consequences of the same changes, or of the
symptoms they occasion.

The solid parts of the animal frame may be altered in bulk, form,
consistence, in their intimate texture, and in situation. The fluid parts
may be changed in quantity, in quality, and in place." Lectures, p. 41.

I, Alterations of the solid parts in Bulk:

1. They may become larger than xi2,iViVdl,-— Hypertrophy » This is .
best illustrated in the muscular system. By constant exercise the
muscles acquire preternatural volume, weight and power, according
to a law of the animal economy that increase of function leads to in-
crease of bulk ; as when one kidney wastes, the other becomes more
active and increases in size. The supply of blood to an organ is regu-
lated by the demand for it.

When hypertrophy is unattended by change of texture it is only the
result of a more active nutrition, and is not considered as a state of dis-
ease., We have it in the hollow contractible organs, as the heart,
bladder, and intestines. Increased bulk in the muscular tissue of these
organs is not always even a source of disease ; Watson regards it as,
in most cases, a compensatory change, and one conservative of life. In
the voluntary muscles it is generally harmless; but in the involuntary
it is often a cause or a consequence of disease. Hypertrophy is gene-
rally connected, — 1. with certain localities, as in the c as e, of broncho cele ;
—2. with certain congenital or acquired conditions of the body, — as the
hypertrophy of the upper-lip in scrofulous persons, and also the
swelling of the long bones ; — 8. with certain habits of life, as full diet
with inactivity of the body ; and— 4. with the removal of certain parts
of the body, as of the testicles in man and the ovaries in the female.

2. Atrophy, This is a condition in which parts become smaller
than natural without any other alteration of tissue. This depends on'
a diminished nutrition. The alterations effected by atrophy are not
always connected with disease. Some organs of the body are destined
only for a temporary purpose ; and they disappear or diminish in size
when their function is ended : we see this in the thymus gland, the
supra-renal capsules, and some parts connected with the foetal cir-
culatim. The defictencies of hare-lip, fissures of the palate and some
malformations of the heart, are rather instances of arrest of development

Vol. l—12.

178 GE:tTEKAL PRINCIPLES OF MEDICAL SCIENCE.

than of genuine atrophy. But in the muscular system we see atrophy
in its truest form. When a limb remains long in a state of inaction,
whether from palsy or from pain caused by disease of a joint, there is
a deficient supply of arterial blood, and perhaps a change in the in-
nervation of the nerves of the part, which lessens without suspending
the circulation. Atrophy is also directly caused by pressure on the
large arterial trunks, or on the capillaries, thus lessening without en-
tirely checking the flow of blood to the part. Chronic inflammation
sometimes produces wasting of the parts occupied by it. Various
other diseases, by interfering with the digestive functions, diminishing
the quantity of blood, or impairing its quality, produce atrophy in a
greater or less degree.

II. Alterations in Form>.

III. Alterations in Consistence. — -1. Induration^ or ha/i'dening.
This may arise, without any other alteration of tissue, from over-fulness
of the vessels, as in the case of the lungs or liver. Induration of the
hollow organs, or of the cellular parts may arise (without change of
texture) from undue accumulation of fluids within them, as of the bile
in the gall-bladder, urine in its receptacle, of gases in the stomach and
intestines, and, lastly, of serosity in the cellular tissue, constituting
oedema. Induration in an organ may also be caused by hypertrophy,
from the pressing out of its fluid contents, or the pressing together of
its soft parts : thus we see the lung rendered more solid by the com-
pression of its solid parts against the spine in cases of effusion into the
pleura. We also see the lung solidified and hardened in hepatization;
in which case the blood, or fluids separated from it, flow into, fill up,
and obliterate the interstices of the part, making it solid, or resembling
liver in consistence. Other instances of induration may be observed
in cases in which irregular masses of matter are deposited within the
body ; of these, tubercle, cancer, and various malignant growths, are en-
tirely difl'erent from any of the solids or fluids which enter into the
healthy composition of the body.

2. Softening. This is a change of consistence to which almost
every tissue of the body is liable. It may effect the brain and spinal
cord, the cellular tissue, the muscles, the mucous membranes, and
even the bones. (See Mollities Ossium-^ Rachitis^ &g. Index)

The usual causes of softening of the tissues are : Inflammation, dis-
eases of the arteries of the part, causing insufficient substance ; altered
qualities of the blood; every cause which leads to suspended or defec-
tive nutrition. (See Brain., HamollisseTnent of.)

IV. Transformation of Tissues, In the place which should bo
occupied by one natural tissue, we sometimes find another, which last
is thus unnatural in regard to its situation, but natural in all other
respects.

PATHOLOaY. 179

1. The changed or displaced tissue in some cases has had its natural
function for a long time suspended ; and it then gradually approximates
towards cellular tissue, which at length is all that remains of it.

2. In other cases the transformed tissue has been accidentally called
on to fulfil a purpose for which it was not originally destined ; and it
gradually assumes the characters of that other tissue, whose office it
has taken up.

In all these cases we see a compliance with all that is known of the
laws that govern the progressive development of the human body. In
the embryo all the tissues commence by being cellular, and they only
assume other forms and characters, each on the condition of its fulfilling
some special purpose. This explains, why there should be a tendency
in each tissue to revert towards its primitive state, that of cellular
tissue. This same law, or one nearly the same, regulates the hyper-
trophy and atrophy of parts. As the nature of the original function
determines in the first instance the na.ture of the tissue, we can con-
ceive how the natnre of a new accidental function imposed upon a tissue
may determine the kind of transformation it shall suffer : — thus if a
muscle comes to lie around and invest an unreduced joint after a dis-
location, assuming the uses of those tissues which naturally inclose the
joint, it becomes converted into fibrous or ligamentous tissue. But there
is a limit to this transformation: for though nerve, muscle and gland
are convertible into other tissues,— other tissues are not convertible
into them. Cartilage may be transformed into bone, but never becomes
mucous membrane. Mucous membrane may be converted into skin,
and skin into mucous membrane ; but neither can ever be changed into
serous membrane. Besides these transformations of the soft tissues
we have ossifications of the arteries, of the cartilages of the ribs, and of
the larynx. Such changes are said to be the effects of irritation,-—
age also has some connexion with them.

V. Changes of SiUoation, These changes chiefly regard the vis-
cera. Thus in the chest a whole lung may be displaced, and compressed
against the vertebral column by serous or gaseous effusion into the
cavity of the plura. The same causes may dislocate the heart, when
they operate on the left side of the thorax. In the abdomen a^nd pelvis
the various forms of hernia may be adduced as instances of dislocation.
Intussusception is also a displacement of a part of the intestine.

Morbid Changes in the Fhdds of the Body,—T\iQ day is past
when discussions need to be carried on between the advocates of ex-
clusive Iliim'Oralism and those of exclusive Solidism; as it is now
well settled that no important alteration can occur in the solids of the
body which will not soon affect its fluids in. some way ; and it is also
known that every important change in its fluids must lead to or proceed
from a corresponding and proportionate modification of its solids.

180 GEK"ERAL PRmCIPLES OF MEDICAL SCIENCE.

ANIMAL FLUIDS.

1. The Blood. 2. The Fluids that enter the Blood. 3. The Fluids
that proceed from the Blood.

1. The Blood, The blood is subject to variations in quantity, — •
It may be too abundant throughout the body, constituting general
plethora^ or hypercemia. When the growth of the body has been com-
pleted, the blood may continue to be formed in greater abundance than
the wants of the body require. Full living and sedentary life produce
plethora and preternatural distension of the entire vascular system.
The blood is not only greater in quantity, but richer in fibrine and in
red particles than perfect health requires.

Local ^IdTiora properly exists only when a single part or organ con-
tains more than its share of red blood ; but it may exist when there is
no general plethora ; and, indeed, local terminations of blood are ex-
tremely common in persons in whom the mass of the blood and its
nutritive particles have been much diminished by disease. This ten-
dency to unequal distribution of blood in the capillaries under such cir-
cumstances is thus explained by Dr. V/'atson : A due supply of healthy
blood is requisite for the performance of the functions of the brain and
nerves : and when this supply is defective those functions become de-
ranged, and in their turn disturb the functions of the solids and derange
the balance of the circulation. Persons endowed with grea,t sensibility
are known to be very liable to partial and irregular congestions of
blood. This local congestion may be produced by frictions on the
surface of the body, and by various chemical or mechanical means.
The congestion thus occasioned is not inflammation, but it is the first
step towards it, and is of the sthenic or active character. The arteries
have more to do with it than the veins. It is in the capillaries, which
are distinct from and interposed between the minute arteries and the
veins, that further changes are wrought, when the process advances a
stage beyond mere local plethora. {Lectures^ 1858, p. 62.)

As active congestion is the parent of inflammation, so it also often
causes haemorrhage and is relieved by it. The general or local ab-
straction of blood is a common remedy, but not always a safe one: Ir-
ritability of the nervous system may be aggravated by bleeding ; and,
in proportion as the nervous functions are irregularly performed, the
tendency to unequal distribution of blood in the capillary vessels in-
creases.

Mechanical Congestion, In this form the veins alone are con-
cerned ; and it is generally purely local, as when the principal vein of
a single limb is compressed. If there be disease of the liver to the ex-
tent of preventing a free passage of the blood through that organ, con-
gestion takes place in all those parts of the capillary system from which

PATHOLOGT 181

the blood is conveyed by the veins which ultimately unite to form the
vena portse.

Passive Congestion, This is the asthenic hypermmia of Andral.
The capillaries become loaded, and the course of the blood in them is
sluggish without any increased velocity of the blood in the arteries,
and independently of any mechanical obstacle in the veins. We see
instances of this in persons enfeebled by age, or disease, in whom the
lower part of the legs, the insteps and ankles, and the skin, which forms
the surface of old scars, are often habitually purplish, or violet-colored.
In these cases the capillaries appear to have lost their natural elasticity;
they readily dilate under the pressure of the blood, which being thus
retarded accumulates in the part. This state may occur without any
previous irritation acting on the part, or any previous active congestion.
There is, however, frequent connexion between these contrasted con-
ditions. Passive often succeeds active congestion : the vessels become
dilated under the force of the active hypersemia, and the irritation
ceasing, they do not at once recover their tone, but remain passively
distended. In the production of active congestion the arteries are prin-
cipally concerned; in mechanical congestion the veins, and in passive
congestion the capillaries. Internal as well as external parts are sub-
iect to passive congestion ; thus the lungs are very subject to engorge-
ment of their capillaries. Striking instances of this will be given under
the head of Congestive Fever, It has been observed that both active
and passive congestion are liable to reeur in persons and organs once
attacked.

Passive aud mechanical congestion often exists together. If the ca-
pillaries of a part are much enfeebled, the mechanical effect of the
gravity of the blood may suffice to bring them into a state of congestion.
This explains the occurrence of a gorged condition of the posterior
portion of the lungs (evinced by symptoms during life) in persons who
have had no previous pulmonary disease, but have been confined for a
long time to the supine position. Mechanical congestion, when it
reaches a certain point, is the source of haemorrhage, and the almost
constant precursor and immediate cause of several dropsical accumu-
lations. Blood, poor in its materials, though not deficient in quantity,
may also occasion dropsies. { Watson^s Lectures^ p. 67.)

2. The blood may be deficient in quantity, or in its essential elements.
This state is called anmmia^ under which title it will be treated of at
large. It constitutes the condition opposite to plethora^ and is char-
acterized by poverty of blood. It may be produced by repeated ab-
stractions of blood, by impoverished food, by various forms of hsemor-
rhage. In such cases when blood is drawn from a vein, we observe a
small clot floating in an abundance of serum. It is remarked that the

182 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

red particles require more time for their restoration than the other con-
stituents of the blood.

GENERAL OBSERVATIONS ON THE CAUSES OF DISEASE AND
THEIR MODES OP OPERATION.

We hold that it is the province of the physician not only to cure dis-
eases, but to point out the surest methods of preventing them. In order
to do this successfully, it is necessary that he appreciate those con-
ditions which constitute health, so as to guard against the numerous
causes of its disturbance. In all living bodies, certain states are es-
sential to this condition. The most important of these states are : —
1. a soundness of the organs and tissues; 2. an adequate supply of
nutritious food; 3. pure air, that the blood in the lungs may be oxyge-
nated ; 4. a calm activity of mind^ so that the requisite stimulus of the
intelligence shall produce its peculiar effects upon all parts of the body;
5. an avoidance of the various causes which debilitate, overtask, or in
any way impair the integrity of the nervous or muscular systems ; 6. the
practice of those means which are calculated to ensure the due per-
formance of all the functions, as exercise, amusements, the cultivation
of a cheerful temper, bathing, and moderation and regularity in^all the
habits of life. Thus will the functions be performed in a certain de
finite and uniform manner, the requisite equilibrium between the s-w^j??^
and waste of the body be retained, and that state secured by whicl:
health is constituted.

The Causes of Disease are generally divided into : Determining^
predisposing^ exciting and ^proximate. It is important that these
terms should not be confounded w^ith each other; and also that certain
conditions of the body, called^r6?<^2*s;p6><92^z5^6>n', be carefully distinguished
from the predisposing cause^ which has produced that state.

1. Determining Causes, — These are such as give rise constantly to
the same affection; as poisons, asphyxiating gases, and wounding
instruments.

Specifio Causes produce individually each a particular, peculiar dis-
ease ; as syphilis, hydrophobia, variola.

2. Predisposing Causes. — General predisposing causes are usually
diffused in the atmosphere, or arise from local conditions.

Individual local causes embrace the various conditions peculiar to
each person, and those external circumstances, such as change of
climate, food of bad quality or insufficient quantity, compression by
various articles of dress, &c. The word ^^ predisposition^'^ says M.
Chomel, " includes all that is usually implied in the so-called "dia-
theses," as the varicose, melanotic, ulcerative, hsemorrhagic, gangrenous,
aneurismal or more properly atheromatous^ purulent. {Gen, Pathology.)

Z, Exciting Causes, — These include the common causes of disease

OBSERVATIONS ON THE CAUSES OF DISEASE. 183

which excite it in persons already predisposed. They consist of atmos-
pherical changes of temperature, epidemic or other deleterious influences;
errors of diet, regimen, &c.

Heat and Cold. — The same overruling Power "that tempers the
wind to the shorn lamb," has within certain limits, and those not very
narrow, endued man with a power of resisting the extremes of temper-
ature and of becoming "the child of every climate and the tenant of
every soil," from the burning sunshine of the tropics to the profound
frosts of the polar regions. Persons of feeble constitutions have ail-
ments frequently recurring from the effects of agencies which they have
not strength to resist, others pass through life meeting continually
these same morbific causes, and successfully resisting them. In some
parts of India the temperature ranges for a long time together from
80^ to 100^ and even 110° of Fahrenheit ; sometimes it has been said
to reach 120°, and yet these tropical climates are thickly peopled. On
the other hand, in arctic countries where the sun appears above the
horizon for only a short portion of the year, and the thermometer sinks
to 40° or even 50° below Zero, we find inhabitants still, though they
9.re few in number. But for a short time — and under certain cir-
eu7nstances—msin. is capable of enduring a very much higher degree
of heat than the general atmosphere ever attains in the hottest portions
of the eartti. It has been ascertained by repeated experiments, that
the human body is capable of sustaining a temperature of 240° or 260
degrees without detriment or much inconvenience. The vital resistant
power varies in degree at different periods of life : it is feeble in infancy,
becomes stronger as years and physical health increase ; and then de-
clines as old age advances, till it becomes so w^eak that slight disturbing
causes may stop the current of life.

Effects of high hut not excessive degrees of Seat,-— -It stimulates the
organic functions of the body ; and the action of the heart is much ac-
celerated. As in the vegetable kingdom we see the influence of in-
creasing warmth in returning summer, in renewing the leaves and
flowers, and their decay and fall as cold weather approaches, the same
observation applies to man and animals in the expansion or repression
of all those functions which they possess in common with plants. To-
wards the Poles both man and animals are smaller than at the Equator,
or in temperate climates. On the other hand, considerable heat, when
applied for some time together, has a sedative influence on the animal
functions ; that is, upon the nervous system, causing languor and lassi-
tude, a disinclination to exertion, both mental and bodily. There are
many forms of disease distinctly traceable to heat as their cause. The
effect of hot weather in promoting the cutaneous perspiration is well
known. Dr. James Johnson first distinctly explained the effects of high
temperature on the skin, and indirectly on the liver, through the com

184 GENERAL PEIIsrCIPLES OF MEDICAL SCIEN^CE.

munication established hj the sympathy which exists between these
extensive organs. Experience proves that a high temperature, long
continued, increasing the quantity of bile secreted, and altering its
sensible qualities ; and this disturbance of function is often followed
by inflammation of the liver itself. (J'ohnson on the Liver,) (See
Liver, Diseases of. — Lndex)

In colder climates we witness the eifects of heat in those attacks of
vomiting and diarrhoea which are common when hot weather is fol-
lowed by that which is colder, particularly when warm days are followed
by colder nights. The distinction between predisjposing and exoiting
causes of disease may here be clearly stated : It is well known that a
secreting organ is never so likely to be affected by any exciting cause
of inflammation as when the process of secretion is going on actively.
This undue activity of the hepatic function constitutes d^ predisposition
to hepatic inflammation, whilst the hot atmosphere which produces this
predisposition holds the place o^ predisposing cause of the inflammation ;
but the exciting cause is exposure to cold ^ one of the most common
and best ascertained causes of inflammation in general.

The effects of cold are in many respects directly opposite to those of
heat. When the application of moderate cold is long continued, it acts
as a sedative on the organic functions of both animals and vegetables.
This appears from the shrinking of the external parts ; the superficial
arteries become unable to transmit the blood in the usual quantity
through the integuments. One of the earliest eff*ects of cold is to pro-
duce drowsiness. (See the case of Dr. Solander among the hills of
Terra del Fuego, in " Cook's Voyages.") In many instances before com-
plete torpor comes on, the action of intense cold blunts the nervous sen-
sation and confuses the intellect, giving the person exposed to it the
appearance of one intoxicated.

Sudden vicissitudes of temperature are usually regarded as danger-
ous; and it is asserted that 2b previous hot state of the iody augments
the hurtful effects of cold, whether applied externally or internally.
This broad proposition, though not quite true, may be the safest general
doctrine, as it includes as much truth as the popular mind can generally
be induced to receive. But the truth is, that when the heat-evolving
power in the body is active and persistent,- — ^if it has not been weakened
by debilitating circumstances, — if it be not rapidly subsiding from the
evaporation caused by perspiration,— no danger need attend even violent
alterations of external temperature. Unusual heat of the body at the
time when the cold is applied, so far from implying danger, is really
the condition of safety, provided the heat is steady and permanent. The
The more correct statement respecting the application of cold is, that
it is dangerous,-^not when the body is hot, but when the body is cooling
after having been heated; — and this principle applies whether the cold

OBSERVATIONS ON THE CAUSES OF DISEASE. 185

be applied externally or internally, to the surface of the body or to the
mucous membrane of the stomach. The instances of death from drinking
cold water, when the bod}^ had been heated by the rays of the sun, or
by exercise, are of very common occurrence.

The power of cold in exciting disease, is increased by all the circum-
stances which debilitate the system and diminish its capability of
evolving heat. Fasting, evacuations, fatigue, &c., lessen the vigor of
the circulation; and the power of evolving heat is very feeble in old
persons, in those newly born, or previously weakened by disease. The
bad effects of cold depend partly on the intensity of the sensation it
produces, but still more on the duration of that sensation. Cold is
more likely, other circumstances being equal, to prove injurious when
it is applied by a wind, or current of air, and also when it is accom-
panied by moisture. Certain circumstances have been noticed as
counteractive of the effects of exposure to cold, as exercise of the pas-
sions, which engage the attention closely to one object ; diminished sen-
sibility, as in maniacs; the power of habit.

Among the conditions of the body which diminish its power of re-
sisting cold, sleep has been considered one of the most remarkable.
Now, while we sleep, sensation is in a great measure suspended, and
this seems to furnish a contradiction to the principle, that the effect of
cold on the health depends upon the strength and duration of the sen-
sation excited by it. This difficulty has been disposed of by asserting
that the sleeper, who thus suffers, really does feel and is conscious of
the sensation of cold.

Influence of the Seasons on Health. — It is well known that the
general health of the community fluctuates with the changing seasons.
Thus it is noticed that diseases of the chest a,re most severe in Winter
and Spring; abdominal diseases preponderate in Summer and Autumn.
The perfection of the power of vital resistance requires prudence and
a proper attention to external circumstances ; the proper nutrition of
the tissues must be supported by pure air, good food, the natural sti-
mulus of the nerves and the healthy play of the different organs. It
is reduced or destroyed by whatever lowers the nutrition of any part,
rendering it more liable to disease from deleterious influences.

Impurity of Air, as it commonly exists in cities, is a powerful pre-
disposing cause of disease. It may not generate continued fever, but it
certainly favors its propagation, and increases in a high degree
t/phoid fever in all its forms, as well as other diseases. (See Typhoid
Fe'ver) Impure air is a powerful agent in calling scrofula into ac-
tive existence and in aggravating the strumous diathesis. Malaria
causes intermittent and remittent fevers, with many others, which will
be treated of in their appropriate places.

186 GENERAL PEHSTOIPLES OF MEDICAL SCIEITCE.

Contagion will be treated of under the head of contagious exanthe-
matic fevers.

Hereditary Tendency, — This subject will be treated in full under
the head of Psora and Hereditary Disease, There can be little doubt
that the health and peculiarities of the parents influence the physical
characters of their children ; it is a matter of daily observation, and
one of the best possible illustrations of the fact is to be found in what
are called family-likenesses. The transmission of such diseases as
sc/rofula^ phthisis, gout^ insanity and many others are subjects of
common observation.

It should be firmly impressed upon the mind, that the important
offices of respiration, circulation, digestion, assimilation, absorption, se-
cretion, &c., are dependent upon the chemical action, which is con-
stantly going forward within the body, between the elements of the tis-
sues and the inspired oxygen on one hand, and a uniform supply,
through the nerves, of spiritual stimuli on the other. When these ele-
ments are supplied in due proportion, from the food and air, and no un-
natural or injurious cause acts on the system, health must result.

But if the quantity of oxygen absorbed to unite with the elements
of the tissues, is insufficient to generate the natural amount of animal
heat and motion, or if the strength of one or more of the tissues becomes
from any cause, so impaired as to be incapa,ble of offering the requisite
resistance to the oxygen of the blood, disease ensues. In the latter
case, the impaired state of the diseased structure does not offer suf-
ficient contractile power to prevent the intromission of red globules
into those parts which, in the normal state, contain only the ordinary pro-
ducts of the transformations of the tissues. The result is, that the
pores are obstructed, the sweat is retained in the system — thus afford-
ing additional fuel for combustion, with the oxygen of the blood, and
from the unnatural irritation which it causes, giving rise to accelerated
respiration, circulation, and the other phenomena of fever. If the re-
sisting power of the tissues continues impaired for a length of time,
and the oxygen continues to act as usual, disorganization must follow.

It has been proved that 32i ounces of oxygen enter the system of
an adult daily, the whole of which goes into combination with the ele-
ments of the food, and is thrown off through the lungs, and skin in the
form of carbonic acid and watery vapor.

The same quantity of carbon and nitrogen is supplied to the blood
from the elements of the food to reproduce the material of the organs,
which is lost by the waste or exercise of the functions. According to
Liebig, " the quantity of oxygen absorbed determines the amount of
food necessary to be assimilated."

If then the food be properly digested and assimilated, a due quantity
of pure air be respired, and the normal integrity of the organs remain

OBSEKYATIOKS OK THE CAUSES OF DISEASE. 187

unimpaired, all tlie structures will act with uniformity, and a healthy
equilibrium will result. To ensure a continuance of such a condition,
it is not only necessary to avoid all of those causes which are directly
capable of disturbing this complicated series of functions, but to make
use of those means which tend to invigorate the system, and aid nature
in her operations. In civilized life, these sources of disturbance are
almost innumerable ; but we shall endeavor to point out some of the
more prominent, and show in what manner they operate in causing
disease.

In the healthy state of the system, certain structures possess the
power of effectually excluding the red globules of the blood ; thus pre-
venting a too great change of matter, which an event of this kind would
inevitably produce. This power is dependent for its normal action
upon the presence of two conditions, viz.: an adequate amount of re-
sisting power in the muscular fibres, w*bich modern writers term eon-t
traGtility^ and an unimpaired state of the nerves, in order that the in-
telligence may communicate with the extreme parts, and thus afford the
muscular fibres an additional stimulus or power of resistance. This
stimulus^ of which the nerves are the conductors, is an agent of im-
mense importance in modifying and altering the functions of the struc-
tures. In the normal state, its effects are apparent during the various
perceptions and emotions which are constantly agitating us. When
these two properties remain unimpaired every office must be duly per*
formed.

It is true that the muscular or the nervous system may be tasked,
for a short period, without detriment, provided that a corresponding
degree of rest be allowed, for the weakened energies to be restored to
their natural state. This is witnessed in severe bodily or mental labor ;
the immediate effects of which are, fatigue, lassitude, and diminished
muscular and nervous energy. If this be succeeded by a due allow-
ance of sleep, the waste of force is repaired, and the body resumes its
healthy tone. If, however, this labor be continued beyond a certain
point, and the requisite quantity of rest be withheld, the capillaries lose
their vital power, become incapable of resisting the entrance of red
blood and hiflaviTnation with fever is the consequence.

Indeed, it may be laid down as a general rule, that most of those
causes which are capable of producing disease, act by impairing the
muscular and nervous force of the tissues to such an extent as to render
them incapable of excluding the red globules. We know that these
red globules are charged with oxygen, and that this gas, when in con-
tact with parts of which the elements consist of carbon and hydrogen,
must effect chemical changes. It matters not whether these changes
are produced within the body or in the air, the results are in both in-
stances the same.

188 GEiq-EKAL PRINCIPLES OF MEDICAL SCIENCE.

It has been proved by the experiments of Bichat, Buniva, and Philip,
that the capillaries of a healthy living animal effectually resist the in-
troduction of fluids, even when a powerful syringe is used; but as the
energies of the animal sink, they gradually lose their power of re-
sistance, and allow the fluids to pass into them like " passive and yield-
ing tubes." From these experiments it is evident that the capillaries
are the first to lose their vitality, since the large arteries have been ob-
served to retain their contractile power some hours after death. Thus
it is that the first manifestations of disturbing causes are upon the
surface, in the condition of chills, succeeded in a short time by unnatural
heat and inflammation. " Push into the aorta of a living animal by
means of a syringe, different fine fluids and you will never see them fill
the capillary system or issue by the exhalents ; but when the experi-
ment is performed soon after the death of the animal, the fluid will,
pass readily into the serous capillaries, and pass out by the exhalents,
excretory ducts, &c." (JBicJiat)

From the above facts it is evident, that whenever the integrity of the
extreme parts becomes impaired, the introduction of the red globules
is permitted, which, according to chemical laws must give rise to in-
creased evolution of heat, inflammation and thickening of the capillaries,
and consequent obstruction to the passage of the excretions. The re-
tention of the products of the combustion of the oxygen of the blood
and the elements of the food, is an additional source of disturbance.

These irritating substances induce accelerated respirations, in order
that sufficient oxygen may be absorbed to neutralize them, and thus
cause exaltation of temperature, increased activity of the organs and
the phenomena ^ofy(S'^;^r.

In all our pathological inquiries, it is of the first importance, that
we have a distinct appreciation of the laws which produce and regulate
the phenomena of life, and, as far as practicable, of the influence of
external agents in modifying these phenomena..

First, the primary source of animal heat and motion, is the chemical
action which takes place in the lungs, secondly, when the blood arrives
at the extreme vessels, other and important chemical changes occur
between the oxygen of the blood and the elements of the tissues, giv-
ing rise to a great amount of caloric and motion. Now as the combus-
tion at the lungs is the principal cause of propelling the blood through
the arteries into the capillaries — so it is probable that the combustion
which occurs between the oxygen of the red globules, and the elements
of the changed tissues at the extreme vessels, is the principal source
of the motive power which forces the blood back through the veins to
the heart and lungs. There can be no chemical change v/ithout the
evolution of heat, no heat without expansion, and no expansion without
developing m6>^^^^'(S power. We are obliged to reject the doctrine that

OBSERVATIONS ON THE CAUSES OF DISEASE. 189

the blood is brought back through the veins to the heart, by a kind of
suction, which this organ exercises on account of the vacuum which
constantly occurs within its walls ; for if this motive force is all located
at the heart, there is no way of accounting for the expenditure of the
large amount of motive power constantly generated at the extreme
points. We see two parts of the body where combustion is constantly
occurring, viz., the lu7igs, and the extreme vessels/ and when we re-
member that the laws which govern chemical action, whether in the
body or the air, are similar, we can appreciate the probable force
which must be produced at these extremities.

Since then, the animal heat, motive force, &c., are generated prin-
cipally at the lungs,' and in the capillaries, it is evident that any cause
which can disturb the healthy operation of either of these important
parts, must produce immediate and serious disturbance throughout the
whole system.

The agents capable of inducing disease here, are numerous and dis-
similar. In hot climates, the atmosphere being highly rarefied, a less
volume of oxygen is absorbed at each inspiration, and consequently
a less quantity afibrded to enter into combination with the carbon
of the system.

On this account we observe a greater prevalence of liver and bilious
affections in torrid than in temperate latitudes. Unless extreme care
be taken to avoid animal food, liquors, and other articles which produce
a large amount of carbon, this element will so abound, and the rarefied
air which is inhaled will be wholly inadequate to effect those changes
which serve to retain the equilibrium between the supply and the waste
from the transformation of tissues. Here a greater quantity of the
elements of nutrition are usually assimilated than the inspired oxygen
can decompose. This excess of carbon and hydrogen being retained,
the nervous and muscular force of the tissues become relaxed and en-
feebled, so that from slight exciting causes, diseases of a bilious or
congestive character are originated.

We have said that the same quantity of carbon and hydrogen should
be supplied to the blood from the elements of the food, to reproduce
the disintegrated portion of the organs which is lost by the waste or
exercise of the functions. That which is not acted upon by the oxygen
in the lungs 'and at the skin,. is taken up by the veins and carried to
the liver, which separates those substances, (carbon, soda, &c.) inca-
pable of reproducing the tissues, and finally depositing them in the
gall-bladder in the form of bile. When the amount of bile exceeds the
retentive capacity of the gall-bladder, the surplus must run over, and a
large portion of it be conveyed into the system, thus impairing the in-
tegrity of tissues, and laying the foundation of those diseases incident
to warm and tropical latitudes.

190 GENERAL PEINCIPLES OF MEDICAL SCIENCE.

In cold climates, a state of things the reverse of this ensues. Here
the air being highly condensed, a large volume of oxygen is taken
into the lungs at each inspiration to combine with the carbon of the
system, and thus generate, sufficient caloric to compensate for that
which is abstracted by external cold. For this condition, all causes
which can impair the normal state of the digestive organs must be
avoided, in order that a sufficient amount of carbon, &c., may be assi-
milated, to combine with the oxygen and secure the healthy equilibrium.
The greater the exposure to external cold, the larger must be the
supply of food and oxygen to make up for the loss of heat.

Cold, acting unduly upon the external parts of the body, produces a
train of symptoms similar to those caused by miasmata and other
noxious exhalations when inhaled. The first effects in either instance,
are to impair the energy of the extreme vessels, inducing constriction
and chills, to be succeeded by diminished resisting power, and other
phenomena which characterize inflammation.

The increased action of the circulatory vessels which usually follows
the chills, has been referred by some writers to the stimulus of a
greater volume of blood being thrown upon these organs than is natural,
and the increased heat which accompanies this exaltation as a result
of the action itself. No greater error than this could be promulgated,
for the entire source of animal heat is chemical action, and all of the
involuntary motions must bear a direct ratio to this evolution of heat.
If the skin, lungs, brain, or any other part, becomes from any cause in-
capable of affording the normal resistance to the oxygen which is
constantly brought into contact with it, an augmented chemical action
must occur in it, with the invariable concomitants, increased heat, con-
gestion, and fever.

*' If a given part of the body is acted upon by continued and intense
cold, while the other parts retain their natural temperature, there
occurs, after a time, in consequence of the loss of heat, an accelerated
change of matter in the cooled parts. The momentum of the force of
the vitality, in the parts which are not cooled, is expended, as before,
in mechanical motion; but the whole action of the inspired oxygen is
exerted on the cooled part. In the cooled part of the body, the living
tissues offer a less resistance to^the chemical action of the inspired
oxygen ; the power of the oxygen to unite with the elements of the
tissues, is, at this part exalted. In the cooled part, the change of
matter, and with it the disengagement of heat, increases; while in other
parts of the body, the change of matter and the liberation of heat, de-
crease. But when the cooled part by the union of the oxygen with the
elements of the metamorphosed tissues, has recovered its original tem-
perature, the resistance of its living parts to the oxygen conveyed to
them again increases, as the resistance of other parts is now diminished

OBSEKYATIONS OK THE CAUSES OF DISEASE. 191

a more rapid change of matter now occurs in them, their temperature
rises, and along with this, if the cause of the change of matter coritinues
to operate, a larger amount of vital force becomes available for mecha-
nical purposes. If the heat is abstracted from the whole surface of
the body, the whole action of the oxj^gen will be directed to the skin,
and in a short time the change of matter must increase throughout the
body." {Liebig.)

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

The immediate effect of the above enumerated, as well as of almost
all other causes of disease, is to impair the integrity of the capillaries
to such an extent a's to render them incapable of excluding the red
globules. The intromission of these "carriers of oxygen," must of ne-
cessity give rise to an increased and unnatural change of matter, with
its concomitants, augmented heat and motion. This inflammation of

192 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

parts produces obstruction to the passage of the excretions, causing
them to be retained within the system to serve as an additional source
of disturbance. The nature and activity of the exciting cause, the
part affected, and the constitution of the patient will determine the
violence and danger of the disease. It may then be assumed with
safety, that the chief influences which predispose to disease in all
countries, are, extremes of heat and cold, and abrupt changes of tem-
perature.

In cold latitudes, those a.ffections prevail which are induced by undue
exposure to cold, and from the condensed state of the air respired.
Hence pneumonic and other diseases of a purely inflammatory character.

In hot regions, where the respired air is highly rarefied, we observe
those disorders which proceed from a deficiency of oxygen to neutralize
the elements of the food, and from exposure to the burning rays of a
torrid sun. Liver-complaints, yellow and congestive fevers, and those
diseases which an excess of carbon, circulating in the blood, would pro-
duce, are here found in abundance.

The diseases of moderate latitudes are of a more mixed character
milder and more subservient to the power of remedies. Here frequent
and sudden atmospheric changes exert the greatest influence in dis-
turbing the healthy equilibrium, and in inducing disease.

Every living body possesses a certain definite and limited capacity
of resistance. This capacit;^ can only be taxed to a fixed point, without
deranging some of the functions and causing disease. We have seen
that the first and most essential requisite to ensure health, is a due
proportion between the elements of the food and the inspired oxygen.
Now, if moderation and regularity be exercised in all the duties and
habits of life, a sound state of the organs and a due performance of all
the functions will follow.

Among the parts of which the normal action is highly essential to
the well-being of the individual, and upon which disturbing causes
usually act, are the digestive and respiratory organs, the skin and
nervous system. Of these, the lungs and skin are far the most fre-
quently affected. Exposed incessantly to noxious exhalations, impure
air, extremes of heat and cold, and sudden changes of temperature, it
is not a matter of surprise, that most of the exciting causes of disease
operate primarily upon one or both of these important portions of the
general system.

Almost all inflammations of important organs are ushered in with
feelings of general lassitude, pains in different parts of the body, irre-
gular respirations, and chills. It matters not whether the first im-
pression haS' been made by atmospheric changes, — ^extremes of heat or
cold, — or undue mental or corporeal exertion: one important phe-
nomenon is witnessed in nearly all instances, that is a spasmodic or

OBSERVATIONS ON THE CAUSES OF DISEASE. 193

constricted state of the extreme vessels. This constriction of the ca-
pillaries is always attended with more or less debility, which prevents
them, when reaction comes on, from resisting the intromission of red
blood. Thus result obstruction to the excretions and accelerated
changing of matter in these parts, and the other phenomena of inflam-
mation and fever. Now, whatever organ or structure is most predis-
posed to diseased action, must receive the greatest detriment from the
retained secretions, and the exalted and unnatural action which per-
vades the system.

According to many authors the causes of inflammation may be either
predisposing or exciting. If two individuals, one robust and regular
in his habits, and the other delicate and irregular, be exposed to the
same morbific influence, the former will escape, while the latter will re-
ceive injury ; or, if the exciting cause be still more active, an impression
will be made upon the first, which will predispose his system to dis-
ordered action, while in the latter the same influence will cause actual
disease. If the morbific agent bo very virulent, actual disease may be
induced in both instances, but in diflerent degrees of severity.

It is true, it may be asked, why it is that in hot climates the robust
are more liable to be attacked with fevers than those of a feeble ap-
pearance ? The reason is obvious. The system of the vigorous man
abounds with those elements which, when properly decomposed by
oxygen, generate the vital activity and produce strength and health.
Now, if he indulges his appetite as usual, while he inhales a highly
rarefied atmosphere, disease must of necessity result ; for unless the
amount of oxygen absorbed into the system be proportionate to the
elements of the food assimilated, much of the latter must remain un-
acted upon, and thus serve to contaminate the blood and derange the
functions of the organs. - Here a cause of disease exists, to which the
feeble man is but little exposed. His system is characterized by a de-
ficiency rather than an excess of carbon; his digestive organs being so
weak that no more of the elements of nutrition are assimilated than the
inspired oxygen can neutralize. Thus, in his case, the equilibrium
between the supply and waste of matter is retained, and the organs re-
main healthy.

In the first example, a strict abstinence from animal food, liquors,
and other articles abounding in carbon, with care that the healthy
function of the skin be not disturbed, will secure as great freedom from
disease as in the other instance. It is not that the robust man is ne-
cessarily .more prone to disease than the other, but because, either from
ignorance or imprudence, he often exposes himself uselessly to an ex-
citing cause to which the latter is not liable.

We contend that the man of a stout frame and vigorous constitution
is better able to resist diseases in all climates than one of a more feeble

Vol. L— 13.

194 aENERxiL PEmCIPLES OF MEDICAL SCIENCE.

organization, provided, that lie adapts himself by his habits and dietetic
regulations to the climate in which he resides. The grand essential
consists in keeping up a due proportion between the elements of the
food and the inspired oxygen. So long as this proportion is preserved, a
vast amount of exposure can be sustained in any climate without
detriment.

In northern latitudes, those who are feebly organized, or of nervous
or sanguine temperaments, suffer far more than the robust and bilious.
In such cases it is necessary that the amount of carbon and hydrogen
assimilated to repair the waste of the tissues, be very large, in order to
supply the system with sufficient material to resist the action of the
absorbent oxygen. Let it be remembered, that, disease ensues when-
ever any part of the body becomes incapable of affording a definite
amount of resistance to the action of this gas. The principal source
of this resistance is the carbon and hydrogen of the changed tissues;
and if no unusual or deleterious causes operate to depress the system,
all will be well. If, however, the digestive organs become disordered,
and assimilation checked — the body being at the same time exposed to
excessive cold.— The oxygen will act upon the debilitated structures
themselves, in order to find sufficient fuel for combustion, so that the
animal temperature may be retained.

The phenomena of life depend upon the constant operation of two
antagonistic elements. Their presence and activity, in suitable pro-
portions, impart heat, strength and life, while the absence of one makes
the other an active agent in causing disorganization and death. Ac-
cording to Lavoisier, a quantity of oxygen is constantly being inspired
by the healthy adult equal to 32^ oz., or 46,037 cubic inches, daily, the
tendency of which is to neutralize and destroy the elements of the body.
To counteract this destructive agent, the elements of the food are con-
stantly assimilated, and are finally brought into contact with it. In
this manner, so long as the proportion between these agents is equal,
those chemical changes take place which generate the animal heat,
corporeal vigor^ and motive power, serving to keep in operation the
whole machine, and ensure the normal action of every organ. The im-
mense importance, then, of fully comprehending a,nd appreciating the
mutual influence and dependence of the respiratory and digestive or-
gans upon each: other will be understood by all.

Extreme cold produces disease by permitting more oxygen to be ab-
sorbed by the blood than can be decomposed by the products of the
metamorphosed tissues. Those parts of the body possessing the least
vitality must then be acted upon, and inflammation and extreme dis-
organization ensue.

Extreme heat generates disease from causes directly the opposite,
viz., a deficiency of oxygen, to neutralize the assimilated carbon and

io-

OBSEEVATIONS OK THE CAUSES OF DISEASE. 195

hydrogen. In both instances the nervoics and muscular force of the
capillaries is so impaired as to render them incapable of excluding from
their structure the red globules. Obstruction is thus caused, a large
amount of heat is evolved, and the redness, swelling and pain, which
characterize inflammation, is present.

The primary/ GSiUQe of most inflammations is a disproportion between
the action of the oxygen of the blood and the elements of the changed
tissues. The cause of this disproportion— -acting upon those parts of
the body most susceptible to its influence — gives rise immediately to an
impaired ste.te of the nerves and muscular fibres of the extreme vessels,
rendering them incapable of preventing the intromission of the red
blood. The first effect upon these vessels is stimulant^ indicated by
contraction^ or sjgasm and chills. This is soon followed by the secon-
dary or atonic stage^^N\\\Qh is indica.ted b}^ distention or congestion of
\hQ capillaries with red blood, heat, redness, and other symptoms, which
show that the small vessels have lost tlieir power of resisting the en-
trance of the destructive "carriers of oxygen," The immediate cause
of the disturbance and disorganization which results in inflamed parts,
is dependent solely upon the chemiccd actio'n of the oxygen of the red
globules upon the elements of the affected structure. If this is the
case, it will be asked, why, then, disturbance and inflammation do riot
take place from the red globules in the act of hhtshing^ or from fric-
tion? Because in these instances, the nervous and muscular force of
the capillaries remains unimpaired, and they are thus enabled speedily
to throw off this temporary accession of red blood, and resume their
normal resistance to its further entrance. It is only by impairing the
resisting force of these vessels in such a manner that the arterial blood
continues to enter them, that inflammation can occur.

Even in the act of hlushing, a perceptible increase of heat is ap-
parent, and when the emotion acts intensely, and for a considerable
period, phenomena similar to those which occur in very slight super-
ficial inflammations, are observed ; as uneasy sensations, fulness, per-
spiration, &c.

The virulence of the morbific influence acting upon the extreme
vessels and the extent to which their resisting power is impaired will
determine the violence and danger of the inflammation.

It has been ascertained by Wilson Philip, and others, "that where
the inflammation of a part is greatest, the vessels are more distended,
and the motion of the blood is slowest." This is owing, undoubtedly,
to the diminished contractile j^ower of the capillaries; and it is pro-
bable, in inflammations of a congestive character, that this contractile
or resisting power is almost entirely destroyed. This fact is important,
in a therapeutical point of view, inasmuch as it directs us to apply our

196 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

remedies in such a manner as to; restore tlie loss of tone of the extreme
vessels, as the most direct method of cure.

The most important doctrines of modern pathology in regard to in-
flammation are briefly presented by Dr. Richard Hughes.^ "Inflamma-
tion is merely a perverted nutrition. Let us consider what takes
place when an irritation is applied to the web of the frog's foot. The
blood-vessels are seen first to contract and then to dilate beyond their
normal calibre, thus admitting a larger quantity of blood to the part.
This is congestion. If the irritation was not severe or prolonged, this
condition gradually passes off without leaving morbid effects behind.
Now in this case we have a direct excitation of the blood-vessels, caus-
ing their contraction, and a secondary paralytic dilatation, probably
from exhaustion of their irritability.f But the hyperaemia thus pro-
duced does not go on to true inflammation, if the vital powers of the
part or of the whole body be not otherwise impaired. In healthy ani-
mals on which the division of the cervical sympathetic has been
practiced, no inflammation results from the increased afflux of blood to
the corresponding side of the head and face. But Claude Bernard has
found that if animals have been staxved for a few days before the opera-
tion, and then the vaso-motor nerves,-^ — say those of the plura — are
divided, intense inflammation going on even to suppuration is set up in
the part.

" On the other hand, let a more intense and prolonged irritation be
applied to the web. Here also we shall have the primary contraction
and secondary dilatation of the arteries ; but further phenomena will
also result. There will be increased activity of circulation all about
the part, and stagnation of the blood-current within it; and exudation
of liquor-sanguinis will take place. This . is true inflammation, ^ In
this case the irritation has affected, not merely the vessels but the tis-
sues of the part itself, which by its abnormal action has perverted nu-
trition into inflammation.

^^Upon one or other of these principles we can explain well-nigh every
form of inflammation. The latter mode corresponds to all cases arising
from external irritants ; from morbid poisons conveyed to the blood to
the tissues they afiect, — as the endo- carditis from the lactic acid of
rheumatism {Hichardson)^ and arthritis from the uric-acid of gout,
((9(^rr(96Z); and from the effects of drugs, as the gastritis of Arsenic, the
nephritis of Cantharis, &c. It is in this manner, also, as we shall see,
that sympathetic or reflex inflammations are produced, in this case
through an irritation of the tissue nerves. On the other hand, the
mode in which Claude Bernard excited pleurisy in animals seems to

* The Nervous System of the Human Body. London, 1861.
t Aconite, Belladonna, and Ergot will produce these phenomena, as well as irri-
tants m general.

INFLUENCE OF DRESS ON DISEASE. 197

give the rationale of the numerous cases of inflammation caused by ex-
posure to cold. If this agent be applied locally, we have first coldness
and paleness from contraction of the arteries, and then, — if its applica*
tion be discontinued — warmth and redness from their secondary dilata-
tion. Here the sequence of phenomena ends. But if the cold has been
severe and prolonged — as for instance, in frost-bitten parts — the re-
action will go on to inflammation, and even to gangrene. This is on
account of the vital depression of the tissues, as in the animals under
Bernard condemned to starvation." So again, six persons shall be ex-
posed to cold : two shall escape all injurious consequences, two shall
have simple catarrh; but the fifth shall be laid up with pneumonia, and
the sixth with nephritis. Now, in all these persons the cold will have
produced throughout the frame the contraction and dilatation of the
arteries characteristic of its local action. But in the first two cases,
the high state of the general health has caused the process to stop here.
The third and fourth, not being quite up to the mark, suftered from a
sub-acute inflammation of the upper respiratory mucous membrane
which is most exposed to the air. The fifth, being in still poorer health
had a pneumonia — the seat of the inflammation being again determined
by local reasons; while in the sixth the kidneys were already, from
local or other causes, in a state of impaired vitality, and thus inflam-
mation is set up in them. This subject will be more fully illustrated
when we come to treat of inflammatory diseases.

INFLUENCE OF DRESS IN CAUSING OR PREVENTING DISEASE.

The radiating power of an article of dress becomes an important
quality in our selecting or rejecting it for a given purpose. It is well-
known that, in general, the worst conductors of heat are the best radia-
tors. Those who have not made the trial would be surprized to learn
that a polished metallic vessel, filled with hot water may be made to
cool more rapidly by giving it a covering of flannel. This radiating
power of flannel, in addition to its bad conducting quality and its power
of absorbing. moisture from the skin or the atmosphere renders it of all
articles of clothing the safest for the invalid. While it holds the heat
of the body from passing too rapidly ofi*, it absorbs the extra moisture,
with evolution of heat. It is therefore not by " warming and heating
at the same time" that it becomes as conservator of health, but by
regiolating the ter)iperature.^

The diflerent degrees of inflammability of the silk, wool and flax, the
common articles of dress are easily shown by the simplest experiments.
If a slip of each, in a woven state, is placed on a support of platinum
foil, and held over the flame of a candle, the silk and wool will become

* British and Foreign Medico-Chir. Review for April, 1859.

198 GENERAL PSmCIPLES OF MEDICAL SCIEJSrCE.

charred without inflamingj whilst the cotton and linen will take fire and
consume with flame; but of the two latter, the cotton more readily and
rapidly than the linen. Further, if slips of each be wound round a
copper, wire of |th of an inch in diameter, and used as a taper, the cotton
brought to the lighted candle, will inflame readily, and, held perpendi-
cularly will burn to the bottom, leaving only a trace of white ash ; the
linen will do the same, but more slowly, leaving a similar ash ; but not
so the w^oolen and silk, — these hardly break into flame ; the flame, when
it occurs, lasts only for a moment, and leaves a coal, wdiich burns with
difficulty and soon goes out. The application of such results as these
to dress, especially to women's dress, who are so much exposed to danger
from the taking fire of their clothes, is easily seen.

Fitness of Clothing Materials for Washing. — The only point worthy
of notice here relates to wool. The structure of its fibre, not smooth
like that of silk, cotton and flax, but having minute processes or ofi*-
shoots, is subject to entanglement or felting, giving rise to a shrinking
of superfices with increase of thickness ; but this peculiarity can be al-
most entirely overcome by the necessary skill in washing and drying.

The chief obstacle to comfort in the use of linen and cotton arises
from the use or abuse of starch, which by hardening and stiffening
collars and handkerchiefs, it even renders them more cumbrous, and
less convenient and agreeable. Its universal use can be seen by
testing the diff'erent articles with Iodine.

Infiuence of Color in Dress, — Experiments show that, other cir-
cumstances being equal, dark colored bodies become soonest and most
heated on exposure to the sun; and the degrees of intensity of heat are
variable according to the degrees of intensity of color, the extremes of
the scale being black and white. It is also proved that when the sun's
rays are absorbed by a dark surface, the heat evolved ceases to be
radiant, in a grea,t measure; and then it loses, consequently, its
peculiar powers, one of which is that of exciting inflammation as wit-
nessed in sun-burn.

These facts tend to show that the fullest protection in hot climates
against the heat of the sun is attained by using two colors at the same
time, white in the outer garments exposed to the sun's rays, black in
the inner clothing to prevent these rays from acting injuriously on the
skin. In the African, with a black skin, there is a strong taste for
white clothing ; in the Arab horse of purest breed, the hair is white?
the skin black ; and universally it is observed that though the sun's rays
bleach the hair, they equally darken the skin. The child that plays
bareheaded in the sun has his hair bleached to a purer white, at the
same time that his skin becomes tawny or nut-brown. It has even
been proposed to make umbrellas of two colors, — white outside and
black beneath. To illustrate this point more fully: five vials of the

PATHOLOaT AND THERAPEUTICS OF BIFEEilENT PERIODS OF LIFE. 199

same form and size filled with a prepared mixture of ^Yeak mucilage
and a little nitrate of silver, were placed in the sun's rays ; No. 1 was
left uncovered; No. 2 was covered with white silk; No. 3 with black
silk; No. 4, white silk over black silk; No. 5 with tin foil. Examined
after three hours, the fluid in No. 1 had become almost black, its tern
perature 75^ ; No. 2 dark-brown, temperature 68° ; No. 3 just per
ceptibly colored, temperature 75°; No. 4 just perceptibly colored, tern
perature 69° ; No. 5 just perceptibly colored (the tin foil had some
minute holes, allowing the passage of some rays) its temperature was
71°. The air at the time was 61°; water in a vial, without the addition
of mucilage and nitrate of silver, was 64°.

The power of the human constitution to resist the causes of disease
is under many circumstances astonishingly great. The utmost extent
to which this power may with impunity be tested has perhaps been
correctly measured by the trials and privations to which the explorers
of the polar regions have been subjected. During the recent efforts of
American navigators in search of Sir John Franklin it has been ascer-
tained that the power of seamen to endure fatigue may be thus
measured: the maximum weight per man proper to be carried is two
hundred and twenty pounds. Of this weight three pounds per day
will be consumed for food and fuel, thus : one pound of bread, one
of meat; the other pound comprise his tea, cocoa, sugar, fuel for cooking
and other necessaries. It was found that upon this estimate the riien
could march ten miles per day for one hundred days, and endure with
impunity a temperature of fifty to sixty degrees below the freezing
point. [Dr. Ilays^—Narratwe, &c., 1861.)

PATHOLOGY AND THERAPEUTICS OP DIFFERENT PERIODS OF

LIFE.

I. Pekiod. — Infancy,— '¥mm birth to the completion of the fi^st

dentition.
II. GhUdhood>- — ^From completion of the first to the completiontof

the second dentition.
IIL Youth,' — Boyhood,— -Girlhood, — From the age of seven, or

eight years to commencement of puberty.
IV. Adolescence, — From commencement of puberty to adult age,
V. Adult (2^^.— Virility and mature age.
VI. Declining age,
Nil, Old age,

I. PepvIod. — Infancy^ (in/aTi^my from privation of speech,) extends
from birth to about the end of the second year, or completion of the
first dentition. 1. Preceding the sixth or seventh month all the struc-
tures are in the course of development. The bones are in process of
ossification, the functions acquire strength and activity ; the movements

200 GENEKAL PRINCIPLES OF MEBICAL SCIENCE.

are little under the control of the will ; the perceptive powers are im-
perfect ; the attitudes are without variety, the countenance is capable
of expressing little more than pleasure or pain to the spectator ; though
the experienced eye of the physician may read in it the character and
probable course of obscure diseases; aided by observations of the mo-
tions and positions of the limbs, the tones of the voice ; the changes
of countenance, the states of the eyes and eyelids, the openness and
contraction of the eyebrows, the appearance of the lips, nostrils, mouth,
gums, and tongue, he may generally discriminate between the various
forms of infantile diseases.

Diet of Infancy. — Nature seems to have furnished the milk of the
mother as the only suitable food ; the digestive powers of the infant
are little suited to digest anything else ; and, although substitutes for
it have to be in many cases tried, not more than one in six or seven
live to pass through childhood. {See Infancy.— Index)

PeculiaTities of Infantile Diseases. — The infantile system is ex-
tremely susceptible of external impressions, which very often excite
disease in the lungs, suspend the action of the skin, or derange the
digestive organs. Having passed the first stage of its existence in a
condition of uniform temperature, the infant can but slowly accom-
modate itself to the vicissitudes of cold and heat in the external world ;
and the surface of the body and the organs of respiration require the
most careful protection from atmospherical vicissitudes. The digestive
mucous surface is equally susceptible to the effects of all unsuitable
kinds of food, and easily irritated or inflamed ; but nature has provided
for a redress of many evils by a copious secretion of mucus from the
internal surface of the stomach and bowels to shield that delicate sur-
face from substances too hai-sh, or to lubricate the way for their speedy
expulsion.

The skin is also peculiarly susceptible to the effects of irritants and
stimuli in infancy; and the intimatesympathy between it and the diges-
tive canal gives nature the means of relieving the internal organs from
many serious invasions of disease by throwing an exanthematous erup-
tion on the surface. The brain at the same epoch of life is in process
of development ; and during the first months of life vascular action is
rapid in perfecting the organization of the organ. An extra quantity
of blood is sent to the brain, and various external causes conspire to
excite its easily disturbed circulation ; its substance or its membranes
are, therefore, frequently the seat of congestions, inflammations, or efiu-
sions into the cavities between the membranes.

The infantile organism is also frequently injured by medicines or
other influences which affect the nervous system. Opium, which is
most commonly given to children to quiet their complaints excited by
pain of any kind, has the most deleterious influence on the brain, in-

PATHOLOGY AND THEKAPEUTICS OF DIFFEEENT PEEIODS OF LIFE. 201

creasinc' its vascular action, and afterwards favoring congestion. Dras-
tic cathartics are also often used, and are always injurious. In general,
the clothing should be soft and warm; the head should be exposed to
the mild and equable temperature of a well- ventilated room ; and the
skin, generally, subjected to frequent ablutions with water, warm at
first, but as the strength of the infant increases, the water may be gra-
dually diminished in temperature, remembering always that the sensa-
tion of cold can not be endured for more than one or two minutes by a
child without endangering the vital functions, producing injurious de-
pression, checking the healthy action of the skin, causing catarrh or
other disease.

The period of the first dentition is attended by all the peculiarities
of infantile health and to these are now added the dangers of teething^
weaning y and the development of the powers of speech and voluntary
locomotion, the farther manifestation of instinctive desires and emotions-

Teething is not necessarily&a cause of serious disordered health, ex-
cept in children originally feeble, imbued with hereditary orpsoric dis-
ease, and weakened by bad food and impure air. In such cases it fre-
quently excites the most dangerous maladies. In the early stages of
the process, itching and irritation of the gums become a source of ex-
citement which extends to. the salivary glands as well as pancreas, pro-
ducing a flow of viscid saliva. The itching alone becomes a source of
distress, and the child presses between them whatever it may find
within its reach. The nervous system generally becomes excited by
the local irritation, fever and deranged digestion follow ; and sometimes
they excite inflammation of the brain or of the digestive mucous sur-
face. The irritation extends the whole length of the intestinal tube;
food is imperfectly digested, and becomes, with the acrid secretions a
new source of diarrhoea, dysentery or sympathetic convulsions. In the
general febrile condition the lungs become involved also; and we fre-
quently find inflammatory irritation of the digestive and respiratory
surfaces associated in the same case ; and it is only by judicious treat-
ment that the brain or its membranes can be saved from participating
in the same morbid action. [See Dentition)

Weaning, — As soon as a few teeth have made their way through the
gums the infant begins to be capable of subsisting on other food be-
sides the milk of the mother. As early as the ninth month both mother
and child will generally be benefitted by separating them entirely, or
at least suspending the process of lactation which should never be ex-
cluded beyond the fifteenth month. As this period approaches the
child should be gradually accustomed to take other food, increasing the
quantity and the frequency of taking it. Animal diet in some form will
be necessary after the mother's milk has been cut Qff. It should at
first be in small quantity, of pure quality, easily digested, and increased

202 GEKEKAL PRINCIPLES OF MEDICAL SCIENCE.

in proportion as the age of the child advances : it should be combined
with or alternated with pure, bland and nutritious materials from the
vegetable kingdom, varying in quality as well as quantity, and given at
intervals varying with the advancing age and growth.

During this whole period of lactation and dentition the infant con
tinues liable to all the diseases of infantile life, with the addition of
those that arise from the irritation of the teeth, and defects in the milk
dependent on the health of the mother or nurse. At this age also infec-
tious and exanthematous disorders are common ; the mucous surfaces,
the lymphatic glands of the abdomen and thorax are liable to disease ;
worms, and changes in the infant's food, cause depraved or imperfect
digestion and assimilation and conspire to originate some of the many
diseases of infancy ; among them are aphthae, rickets, tubercles, maras-
mus, tabes mesenterica, infantile remittent fever, scrofula, and numerous
cutaneous eruptions, all of which will be treated of under their respec-
tive heads.

Of the general treatment of the diseases of infancy it may here be
said that the greatest care is always required in distinguishing the real
source of the febrile irritation which is usually present. The head
should always be guarded from the vascular excitement to which it is
liable. The gums should always be examined; the child should be
permitted to relieve the itching by biting on a ring of ivory, hard gum-
elastic, or, still better, a gold ring. As soon as the gums are much
swollen they should be relieved by lancing them. Other remedies
must be employed with care, according to the indications pointed out
under the separate diseases.

II. Period, Childhood. — This extends from the completion of the
first to the completion of the second dentition or to the eighth year. During
this period the different textures and organs are rapidly developed, their
functions are more perfect, the intellectual and moral faculties are ex-
panded. The different textures become more solid, acquiring firmness,
elasticity, and strength. The powers of resisting external influences
have increased, but disease when excited is more disposed to a sthenio
inflammatory character, effusing coagulable lymph, particularly on the
serous surfaces. There is great susceptibility to infectious diseases,
to pneumonia, bronchitis, inflammations of the" brain, or membranes,
stomach or other abdominal visera ; glandular obstructions, chorea,
verminous diseases, epilepsy, angina, croup, &c.

At this period of life more active treatment can be borne than would
be appropriate in younger children. There is a tendency to accumula-
tions in the bowels which furnish a nidus for the generation of worms,
and produce irritation of the digestive mucous surface, as well as of
the nerves that proceed from it. These accumulations should be re-
moved, or more wisely, prevented. Wholesome nourishment, active

PATHOLOGY ANT> THERAPEUTICS OF DIFFERENT PERIODS OF LIFE. 203

exercise in the fresh air, ventilation of school-rooms and sleeping apart-
ments are of the highest importance. The mental faculties should
rather be exercised in ways of amusement and the gratification of curio-
sity than exerted in close attention to book-studies; but the moral emo-
tions, particularly those connected with temper and disposition should
be moderated, restrained, or judiciously directed. Children should not
be allowed to sleep with persons in bad health or advanced age. (Cop-
land's Diet, Vol. 1, p. 49.)

III. Period. Youth, — Boyhood. — Girlhood. — From the age of
seven or eight years to the commencement of puberty. At this period
the structures of the body and the powers of the mind are undergoing pro-
gressive improvement. There is in constitutions free from scrofulous
or hereditary taint, a sthenic diathesis, a predominance of the sanguineo-
nervous temperament ; greater liability to idiopathic continued fever,
with scrofulous enlargements &.nd inflammations, affections of the lympha-
tic glands, with various nervous affections, as epilepsy, convulsions,
chorea; also cutaneous eruptions; inflammations of the throat and air
passages ; tubercles of the lungs or alimentary canal, curvatures of the
spine, intestinal worms, &c. The nervous system is highly impressible
to physical and moral impressions ; inflammatory action is strongly dis-
posed to give rise to new formations ; and in the advanced stages of erup-
tive or infectious fevers, inflammation is peculiarly liable to terminate
in serous or sero-albuminous eflusions.

In the diseases of this period the same leading considerations apply
as in those of earlier childhood. Active exercise in a pure and whole-
some air is indispensable to full growth and permanent health. In cities
too many persons occupy the same room ; the young and the old are
crowded into small and unventilated apartments ; and academies and
boarding-schools generally admit the same prolific source of broken
constitutions within their walls. The mental powers are now capable
of a further degree of improvement and growth ; and habits of life should
be formed and encouraged which may promote future health, happi-
ness and usefulness.

IV. Period. Adolescence. — Prom the commencement of puberty
to adult age, or to about the twentieth year in females and the twenty-
fourth in males. The age at which puberty appears va.ries from twelve
or fourteen in females to sixteen ; and from fourteen or sixteen in males.
In northern climates it is later than in southern in both sexes ; and in
sanguine and plethoric constitutions puberty is hastened by luxurious
habits, sleeping in crowded apartments, lying on feathers, indolence,
the extra-excitements of modern society, the associations of boarding-
sqhool-life, &c.

At this epoch in human life the mental and physical distinction
which exists between the sexes are developed to their fullest extent ;

204 GENERAL PRINCIPLES OF MEDICAL SCIENCE.

and with these organs and faculties the whole body, and mind expand to
their most perfect condition, except in those mental powers which grow
and strengthen by the struggles and experiences of life. The organs
of respiration reach now their full growth, the muscles acquire their
size and due proportions. The spine, and the whole nervous sys-
tem become completely organized ; intellectual power displays its full
supremacy over the physical and brute creation ; the observing faculties
are actively employed in observations of the varied and wonderful phe-
nomena of external physical nature ; the treasured wisdom of past ages
is eagerly grasped by the mind of the aspiring student ; and the rea-
soning powers, gathering new strength from every trial, trace effects
back to their remote causes, generalize and reduce to clear principles
the facts already known, and advance through the known and the pro-
bable to the unknown, the possible, and finally to the wonderful, the
certain, the true.

PERIODICITY IN THE ACTIONS OE THE ANIMAL ECONOMY.

The different periods of the day are marked by certain fluctuations
in the vital movements of the a.nimal economy, which have long re-
ceived a share of the attention of scientific men. The following general
facts on the subjects seem to be generally acknowledged. Vitality ex-
pands during the day and concentrates during the night. 1. The
morning is the period corresponding to youth and spring, to growth and
reproduction. There is a higher manifestation of external life. Man
in health feels renovated and re-invigorated by rest. As the day ad-
vances our external senses become more acute, the memory and ideas
more precise. Those desires manifest themselves that are the evi-
dences of strength, of exuberant health. Spontaneous seminal emissions
take place in the morning or in the second sleep. The greater num-
ber of long-lived persons have been early risers.

The internal organs, especially in persons in whom the functions
are not nicely balanced, are more feeble in the morning. We have
gastrodynia, anorexia, colics, nausea, as in pregnant women ; bitter
taste in the mouth, &c., denoting debility of the viscera ; evacuations
are more frequent, as in diarrhoeas, cholera, salivary discharges, and
expectorations.

Second Period, From 9 A, M. to 3 P. M. — Excitement is at its
highest, and diseases of excitement exacerbate. This extreme expanse
of vitality gives the highest thoughts, and the fiercestpassions ; genius
shines in all her splendor ; the sentiments are developed in their fullest
energy. The chylopoetic viscera and hepatic system, are agitated ;
bilious diseases are increased ; stimulants are more hurtful ; the mu-
cous membrane of the stomach is in an irritable state. In hot climates

PERIODICITY m THE ACTION OF THE ANIMAL ECONOMY. 205

a short sleep is required, hence comes the siesta of the Spaniards.

'Tis now that

" Amid his subjects safe,
Slumbers the monarch swain."

Third Period, From Sto 9 P, M.—At this time too large a meal
may not digest well, as the vital powers are so much drawn to the sur-
face. The various diseases of excitement have raised the pulse from
ten to twelve beats. {Swanche^ SoBmatologie, p. 96.) The limbs
swell; the menstrual and hsemorrhoidal flow commonly begin, from
being long in the erect position, or from venous plethora. The laborers
of many countries have made their principal meal at sunset. The old
Eomans and Chinese did so. This is the hour which calls for amuse-
ments to dissipate the ideas of death, which arise in the mind when
the body is exhausted. Melancholy is aggravated. Persons who sleep
late become nervous and serious.

Fourth Period, From 9 P, M,toSA, M. — Injkcence of Night,
Horizontal position increases the blood in the brain. ' The diseases
from cold, dampness, and debility increase, almost all spasms cease.

In natural sleep the pulse is slower, and there is a general remission
in the animal functions. Towards 2 or 3 A. M. the pulse rises ; a pe-
culiar shock is felt by some gouty, hypochondriacal or asthmatic sub-
jects ; even epilepsy and various critical paroxysms occur at this period.
The second sleep is lighter from the coolness of the air. At this time
are felt other irregular actions in the diurnal circle, as the shocks felt
by rheumatics, headaches, pain in old luxations, announcing almost every
atmos|)heric change, as rain, hailstorms or dry weather. The symp-
toms affect differently according to the time of life. In infancy the head
is the weakest point, as the throat and chest are most vulnerable
in youth, the stomach and liver in the adult, the bowels, urinary organs
and hasmorrhoidal vessels in old age.

The day calls into activity the life of relation ; the night increases
the force of the organic, the nutritive life ; cutaneous transpiration is
double what it was in the day. (Bell on Periodicity^ Great sleepers,
says Darwin, " become fat and fair skinned." Sleep is but the result
of the inaction of all the apparatus which compose the machinery of
the external functions ; and the human body could now be excited to
many different actions at the same time, with benefit to all. The soft
whisperings of ambition may prompt the aspiring student to encroach
upon the hours allotted to sleep, but it will always be done at the ex-
pense of indigestion, irregular circulation and respiration, and other
departures from true health. Eespiration and circulation are per-
formed with energy in proportion to the numbers of organs in action ;
tiios long sleep chills the body, diminishes the circulation, and the fre-

206 GEXEKAL PEINCIPLE3 OF MEDICAL SCIENCE.

quency of the pulse. When digestion is completed, the increase of
fluids thrown into the circulation, excites the heart and lungs to greater
action ; but if digestion and secretion be retarded they react by sym-
pathy on the heart and lungs and precipitate their movements. If we
go to sleep with a tranquil condition of the system generally, and
digestion has been imperfect, on waking in a few hours we find the
heart beating strongly, the chest full, and the skin hot. Respiration
and circulation are performed more slowly in the first part of the night.
About two or three hours after midnight the external senses begin to
awake and these two important functions are aroused also. Hence
parturition generally takes place in the night and the morning.

Influence of the Dmrnal Revolution on Disease. Morning. —
Most diseases remit in the morning. In mucous and intermittent
fevers, persons who had been in agony during the night have strength
enough in the morning to go about. Insensible perspiration is more
abundant, hence dropsies and oedemas are diminished. Hectic fever
ceases at this time only. There is remission in spasmodic diseases,
and phlegmasias ; asthenic diseases are milder.

But this same morning amelioration with increased general vigor be-
comes the cause of the invasion of several sthenic diseases. Angina,
vernal agues, and simple synocha increase the first hours of the day.
Ophthalmia is more .acute ; haemoptysis in young persons more ge-
nerally commences. The sweat of pthisical patients, hysteric swellings,
pyrosis, and the irritation of worm's are increased ; in typhus the
morning exacerbation is more violent than that of the evening. Wounds,
ulcers, gangrene, carcinoma and phlegmons are increased in intensity.

Influence of Mid-day. — Solar mania only comes on in the heat of
the day and disappears at night. One woman became deranged pre-
cisely at one P. M. The phrenitic become violent tovmrds two or three
P. M. with chills and remarkable exacerbations. An acute arthritic
cephalalgia came on daily at noon. [Sauvages) The eruption of distinct
small-pox commences at this hour. Coma, vigil, typhomania, the vio-
lent delirium of complicated intermittents of warm climates causing
tetanus, trismus, erysipelas, sun-stroke, are all more severe during the
heat of the day.

Influence of Evening. — All quartans come on in the afternoon ; quo-
tidians at early morning, and tertians toward mid-day. All catarrhal or
heav}^ plilegmonic affections, inflammations of the organs of animal life or
of the external relations are aggravated in the evening. Sick head
aches are increased, comatose afiections and apoplexies strike in th
evening or the night ; lethargies, palsies, faintings, sudden attacks of
hypochondriasis and hysteria, slow nervous fever, the oppression from
dropsy, articular and rheumatic pains are aggravated in the evening
and night.

PEKIODICITT IN THE ACTION OF THE ANIMAL ECONOMY. 207

An intermitting febrile hemiplegia commenced at four P. M., ceased
at six A. M. and was cured by Bark ; and a periodical cough begin-
ning at seven P. M, was broken by Opium. Suppurative fever comes on
with the wounded, restlessness and jactitation of nervous lesions are
especially prominent at this period. In consumption with Vomica there
is an insupportable anxiety at this time of the day. Itch, herpes and
chilblains are worse in the evening. Hectic fever is worse then, though
the patient sleeps during the day. Diseases of the throat when inflam-
matory are worse in the evening.

Diseases of the spleen, mesentery, obstructions of the viscera, haemor-
rhoids, gout, dysentery, and affections of the urinary organs in the aged
are aggravated in the evening. [Bell on Periodicity,).

Inflitence of Night. — Sthenic diseases remit in the night, others
that are milder during the day, as furious phlegmasias, catarrhs,
croups, lymphatic disease, dropsy, cachexia, asthenic diseases increase
in the night. But the living body is in this respect like a living clock
wound up by nature and kept going by the rapid movements of our pla-
net and the sun. A countess at Madrid lost her voice at sunset and
only recovered it at early dawn. This paralysis of the recurrent nerve
of the eighth pair ceased when she arrived at ISTaples, but returned when
she reached Borne. {Ilumboldt^ Other cases of nocturnal paralysis,
delirium and vertigo, beginning at the same hour have been noticed. A
tavern-keeper at Tarentum was rational during the day and became in-
sane every evening as night approaches. [Aristotle) Persons affected
with hemeralopia can see during the day, but lose their sight in the
evening, all objects appearing as if covered with an ash-colored veil.
{Scarpa) Those who have nyctalopia can see little or nothing during
the day, but can see quite well at night with small light. Some head-
aches begin at night, others cease at that time. A woman became in-
sensible at sunset, and recovered her powers in the morning. Incubus
or night-mare comes on during the first sleep of night.

Toward two or three in the morning when the pulse has risen, ac-
tions of another sort begin. Sydenham was surprised that gout, and
Floyer that asthma should always begin at this time. Dropsical
spasms, violent palpitations which wake the alarmed hypochondriac,
or frightful dreams are then experienced. The somnambulist rises and
moves about. Aged persons and others in slow fever are troubled with
i-estless wakefulness. After this state of spasm there is a condition of
excitation ; the consumptive sweats and hectic increases ; aphthae and
miliary eruptions of children effloresce, critical sweats in mucous fevers,
different eruptions, as tinea and others begin to appear. The dyspep-
tic wakes at midnight, and finds his tongue moist ; at early morning his
mouth is parched, rough and loaded. In 1691 there was an epidemic
in which the sick after sunset were in a state of extreme depression

208 GENEEAL PEINCIPLES OF MEDICAL SCIENCE.

and almost dying during the night. In 1743 an epidemic prevailed in
the English Army in Flanders in which there was entire remission
during the day, and the pulse little accelerated; but, on the approach
of night, withotit any chill, the fever rose suddenly and the patient was
delirious ; in the morning it had all passed away, and there appeared
no danger during the day.

Influence of the Diurnal Bevolution on Mortality, — The greatest
number of deaths happen at early morning or after sunrise; more die
during the day than the night by one sixth. In the evening the great-
est mortality is upon the approach of night.

Comparative mortality of the present with former times. According
to the Kegistrar General's Report (England).

For every 100,000 persons living there were

deaths by small-pox

" " fever

« " childbirth

" " dysentery

" " cholera

" " scurvy and purpura

" " syphilis

" " dropsy

" " consumption

" " diseases of digestion

" " children by convulsions 1175, 186.
The statistics make the average duration of human life in England
42 years ; in France 40 ; Germany 87 ; Holland 88 ; Naples Z'o ; show-
ing an increase for each country of about 6 years since 1679.

M. Flourens asserts that " the duration of life is in proportion to
the duration of growth; the duration of .growth to that of gestation ;
and the duration of gestation to the height of the animaL" He further
declares that his researches show that: 'Hhe duration of growth is
limited by the union of the bones with their epiphyses, and that in all
animals which he has subjected to his observation, the duration of life
is five times that of their growth. This union of the epiphyses takes place
in man at twenty years, and hence he concludes that the normal dura«
tion of life must be one hundred years. Nature then demands that the
average duration of human life shall be extended up to this point."

The comparative muscular power of man at different ages has been
approximated by M. Quetelet in "experiments" on this subject. His
conclusions drawn from experiments on sea-faring men are :

1. Muscular force increases up to forty years.

2. The strength of back, or renal force begins to diminish at an
earlier age than muscular force.

in 1679

in 1859

357,

42.

749,

59.

86,

17.

753,

130,

142,

21,

12.

298,

26.

1079,

611.

146,

95.

PERIODICITY IN THE ACTIOIT OF A2!?IMAL ECONOMY. 20^

8. The renal force of a seaman at fifty is no more than that of a novice
of sixteen years old.

4. Those little advanced in age, and i\o^Q fully advanced^ are equal
to each other in the development of muscular force.

5. Renal farce, or strength of back, doubles between the age of eleven
and fifteen years, triples between fifteen and forty; and after that age
decreases. Manual force in its augmentation and decrease follows an
analogous course.

Food is taken into the stomach for the purpose of supplying the
body with material to rebuild the physical structures which are in tho
perpetual process of dilapidation through i]ie wear and tear of life.
Its value as food is estimated first by the time it requires for its con-
version into assimilable material, 2. the quantity of Hood it will make,
and, 8. the quality or specific nature of the blood after it is formed.

1. DigestiMlity of Food. — Authors on this point have generally
considered solution as the whole of the process of digestion. The
following general principles are derived by Moleschott from chemical
reasoning:

" As all the secretions concerned in digestion contain a considerable
proportion of water, the simple alimentary principles must^ as a
general rule^ l)e the more digestible^ the more soluhle they are in
vmter. The chlorides and alkaline salts pass more easily into blood
than earths ; and the organic acids than^ dextrin, sugar, starch, cel-
lulose, or fat ; soluble albumen or legumin easier than the coagulated
vegetable albumen or fibrin." It is also laid down as a further law,
" that alimentary principles are digestible in the ratio of the
nearness of the relation in which they stand to the last link of the
series of allied formes, (^Handhuch der Didtetih.)

The infiuence of cookery on food is of great importance in promote
ing its digestibility. In the common process of roasting meat, the-
outer layer of albumen becomes coagulated, and thus it prevents tha
exit of that which is still fluid within. The cellulose tissue, which
unites the muscular fibres, is converted by gradual heat into gelatine,
and is retained in the centre of the mass in a form ready for solution.
At the same time the fibrin and albumen take on a form more highly
oxydized and more capable of solution in water. The fat also is melted
out of the fat-cells, and is directly combined with the alkali from the
serum of the blood. (Mulder.) Thus the external layer of albumen
forms a sort of box which keeps together the important parts of the
aliment till they have undergone the desired modification by slow heat.
Rapid boiling may produce the external solidification of the albumen,
but it also dissapates the acetic acid, hardens the interior albumen
and muscular fibre, and renders them less digestible.

Vol. L— 14.

210

GENERAL PEOTCIPLES OF MEDICAL SCIENCE.

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AREAKGEMENT AND CLASSIFICATION OF DISEASE. 211

ASRANGEMEMT AND CLASSIFICATIOIT OF
DISEASES,

Diseases may be arranged under two grand divisions : acute and
clironic.

The first division, or acute diseases^ consist of rapid operations of
tlie vital power in conditions more or less differing from those of the
same organs in health. They terminate in a shorter or longer period
of time, but are always of moderate duration.

2. Chronio Diseases are less distinct, often almost imperceptible on
their first appearance. They *' seize upon the organism, each according
to its own peculiar manner, and remove it by degrees so far from the
state of health, that the automatic vital energy which is destined to
support the latter, and which is called the vital power, can not resist
but in a useless and imperfect manner ; and not being potent enough
to extinguish them herself, she is compelled to allow them to grow un-
til, in the end, they destroy the organism." These sloAvly-operating
diseases are usually dependent on some constitutional infection or
miasm.

Acute disease are distino-uished under two heads.

1. Sporadic. — They attack single individuals, and arise from some
pernicious cause to which the patient has been exposed: Eating or
drinking too much or too little, violent impressions of physical agents,
as cold, heat, fatigue, or mental excitement. But there is also an ag-
gravation of the latent psoric affection, which is commonly only lulled
by the treatment which is called successful.

2. Epidemics, — These begin to attack individuals here and there
[sporadically) under some meteoric or telluric influence of whose action
but few persons are at tfie time susceptible. But the true epidemics
attack many individuals at the same time ; the eases begin from similar
causes, exhibit analogous symptoms ; and the diseases usually become
contagious when they act upon close and compact masses of human
beings. These different maladies are of a distinct nature ; the individual
cases of each disease being all of the same origin ; the patients pass
through the same conditions, run an acute course and terminate speedily
in recovery or death.

The whole number of deviations from a state of perfect health can
scarcely be estimated ; and it may not be possible to niake any syste-
matic arrangement of them into separate diseases specifically distinguish-

212 AREANGEMENT AND CLASSIFICATION OF REMEDIES.

able from each other, as individual specimens of 'Natural History
have been classified and described. But inasmuch as no subject of
scientific inquiry can be successfully prosecuted without methodical ar-
rangement of its most important facts and principles according to some
system, we shall proceed to distribute the principal branches of the
great subject of Practical Medicine into a series of natural groups of
diseased manifestations, without claiming that any classification of dis-
eases can ever be devised that shall be free from defects, or that a more
perfect arrangement could in any considerable degree facilitate the
successful application of remedies in the cure of those diseases. It is
not in this day believed, that the proper treatment of a given case can
ever be determined from its systematic name or position in the noso-
logical catalogue of diseases ; it is not even pretended that truly correct
or expressive names can ever be given to each of the vast assemblages
of symptoms that we meet with in individual cases of disease. But we
still find that the purposes of study and conveniences for reference to
special subjects of research are facilitated by some arran^gement^ (which
may not be the most symmetrical that human genius might devise,) and
by giving names to those groups of symptoms which are most likely to
be found together. By the name of a disease in this work we do not
mean a specific entity which like a bird or a plant will always be found
to present the same precise characteristics. The name is simply
meant to announce a group of phenomena^ which are so generally
found in company that they may be supposed to have some relationship
with each other, and which, taken together, present a picture easily
recognized.

"In such classifications," says Lord Brougham, "we should be guided
by views of convenience rather than by any desire to attain perfect
symmetry ; and that arrangement may be best suited to a particular
purpose, which plants the same things in one order, and separates them
and unites them in one way, when an arrangement which should dis-
pose those things differently might be preferable, if we had another
purpose to serve."

Our classification of diseased conditions will be derived from that
classification of functions in a state of health,, which is most obvious to
the senses as exhibited in normal human physiology. We prefer this
arrangement, because it is already familiar to every student of physio-
logy, and beca-use it presents a sufficient range for subdivisions.

Class I. Diseases of the Digestive Function, — Derangement of
organs employed in receiving, preparing and appropriating food for
physical support of the body.

Class II. Diseases of the Respiratory Function, — Derangement
of the apparatus employed in exposing the blood to the influence of the
atmospheric air.

DISEASES OF THE DIGESTIVE FUNCTION. 213

Class III. Diseases of the Circulatory Function, — Disordered
action of tlie apparatus employed in the mechanical circulation of the
blood throughout the body.

Class IV. Diseases of the Nervous Function, — Disordered action
of the apparatus for regulating the movements and feelings of the body.

Class V. Diseases of the Hejproductive Function, — Deranged
action of the apparatus designed for the continuance of the species.

Class VL Diseases of the Secernent Function, — Deranged action
of the organs designed to carry off impurities and to remove superfluous
and effete materials.

CLASS I.

DISEASES OF THE DIGESTIVE FUNCTION.

OUTLINE OP THE PROCESS OP DIGESTION.

In all animals we find some organ that answers the purpose of a
STOMACH, which seems the most important and indispensable of all the
animal structures ; and there are some of the lower animals that con-
sist of scarcely anything else. " A stomach," says Jones in his Na-
tural History, "is absolutely all that is required. A stomach, provided
it can live, is an animal." In man we see the most perfect and com-
plicated arrangement of organs for the accomplishment of the process
of digestion. The apparatus b}^ which the materials for the nutrition
of the body are furnished in a form available for the purposes of main-
taining the life of the individual provides for : 1. The taking of food ;
2. Mastication or mechanical division of it, including its mixture with
the saliva; 3. Deglutition or its conveyance to the stomach ; 4. Chy-
mification or the solution and reduction of the food preparatory to its
being brought into a condition favorable for absorption; 5. Chylifica-
tion OY the separation of the portions of the food which contain the
chief nutritive principles in a condensed form, and freed from the coarser
and useless parts which are left in the lower portion of the intestinal
tube to be expelled from the system.

1. The food, consisting of animal, vegetable or mineral substances, is
presented to the lips in which the powers of sensation are so perfect
that the quality of the food is perceived before it has touched the teeth.

2. Mastication. The incisor, or front teeth begin by cutting up
the food at the same time that the finer parts pass to the tongue, while
the harder pass to the molar teeth at the sides of the tongue to be ground
by their broader surfaces. As the teeth differ in size and in position,
their power and mode of action are different; and the juices pressed

214 DISEASES GE THE DIGESTIVE FUISrCTIOIyr.

out at different parts of tlie mouth are applied to the surface which is
fitted by nature to receive and transmit to the brain the impression made
upon the sense of taste at the same time that the nutrient juices are
met and blended with the living fluid called the saliva. This fluid had
begun to flow from the salivary glands before the food was taken into
the mouth, and now, the movements of mastication, the pleasant taste
and the suctional power of the tongue, continue to draw the saliva from
the glands on every side, and to blend it with the food which it assists
in dissolving, and thus fitting it for more perfect digestion in the stomach.

The saliva secreted by the different glands differs widely in its
characters and quantity; that of the parotid is the more watery and
abundant, and is secreted principally during the act of mastication ;
that of the submaxillary is more scanty, but more viscous, and is more
plentifully secreted during excitation of the nerves of taste; that of the
sublingual and buccal glands being the most scanty, but excessively
glutinous, facilitating the act of deglutition; the viscous element is called
ptyalin. The reaction of the saliva is very alkaline. The secretion is
not constantly the same in quantity, but is intermittent, depending on
the presence or absence of its exciting causes. It is increased by dry
and pungent foods, lessened in amount by moist and sapid food.

The saliva exerts no influence on albuminoid and fatty matters ; but it
has long been known that it possesses the property of converting starch
into sugar; this has been attributed to a certain special substance con-
tained in it called salivary diastase. It is observed that this property
is more conspicuous in morbid saliva, as that of salivation; complete
putrefaction destroys it : The presence of acids also arrests decomposi-
tion and prevents the further action of saliva on the starch. The sole
action of insalivation on alimentary matters is to convert starch into
dextrine and glucose or grape sugar.'^

From the pleasing and instantaneous effect produced by the sapid
bodies on the tongue it is believed, though it can not be proved, that
the most refined elements of savory food are in some way transmitted
to the sensorium through the tongue, or by absorption from the sides
and pores of the variously formed prominences of the papillae of the
tongue. It is known that the bodily and nervous powers are sometimes
rapidly recruited by the taking of food which there has been no time to
digest, and by wine or other stimulants which have been only held in
the mouth. If the finer essences of the food are absorbed before the
mass leaves the mouth, then the stomach only receives it to complete
a process already commenced. The higher attenuations of homoeo-
pathic medicines often produce their most striking effects when applied
to the tongue in quantities too minute to be swallowed. Like the

* See Bernard. Lecons de Physiol. Vol, II., 1856.

OUTLINE OF THE PROCESS OF DiaESTION. 215

" Quintessences'^^ of tlie old alchemists they produce their effects on a
principle which is above the comprehension of the materialist

8. The act of swallowing is effected by the rolling of the masticated
food back into the pharynx, or the chamber between the mouth and the
oesophagus. ( Wilkinson) The pharynx contracts on the soft mass ancl
forces it into the oesophagus, which gives way to receive the food, and
then contracting; behind it, forces it onwards to the stomach. The
passage for the food, having been lubricated by the saliva, and moistened
by ail the fluids taken into the mouth, the transmission to the entrance
of the stomach in easily effected; and the action appears to be volun-
tary, though all the parts of the process of deglutition are completely
beyond the voluntary control of the will.

4. Ghymijication, — The stomach is a vaulted chamber consisting of
three walls or coats which extend throughout the whole of the intestinal
tube. Its inner wall or coat is made up of a series of small compart-
ments placed side by side, and which open into its cavity. They differ
in construction in different parts, and are pervaded by the most delicate
nerves and blood-vessels. The inside of the stomach consists of a kind
of honey-comb surface, crowded with little mouths, which, when the or-
gan is aroused are red and turgid with blood. At the same time also,
numerous little points or papillae on the surface pf the membrane are
awakened to action, and bring forth a dissolvent liquid called the
gastric juice. These honey-comb structures are the inferior or sub-
stomachs, which form the natural components of the organ.

The muscular coat of the stomach forms its middle wall. Its fibres
run "circularly, spirally, and vertically," and, by their systematic and
various contractions, they agitate the food.

Process hy which Chymification is effected. — The earliest theory of
the process of digestion, given by Hippocrates was, that the food was
reduced to a proper state for the support of the body hj putrefaction,
Galen thought the effect was brought about by heat; Van Helmont
thought it the result of the vital energy of the soul which resided in
the stomach. Boerhaave attributed much to the grinding action per-
formed by that organ. Pringle and MacBride considered the process
of digestion to be one of fermentatiok. At last Cheselden happened
to conjecture that the food was dissolved "by some unknown menstru-
um." This hypothesis guided Spallanzini and Ueaumer who first:
proved the solvent power of the gastric fluid. The present theory of
digestion was more distinctly set forth by Dr. Beaumont in 1834, ami
has been variously modified by other observers.

A young man named St. Martin was accidentally wounded by the-
discharge of a gun in 1822. The charge of powder and duck-shofc:
entered his left side, passed obliquely forward and inward, '*blowing>off
mteguments of the size of a man's hand, fracturing and carrying; m\&f

216 DISEASES OF THE . DiaESTIYE FUNCTIOIf.

the anterior half of the sixth rib, fracturing the fifth,, lacerating the
lower portion of the left lobe of the lungs, the diaphragm, and perforat-
ing the stomach." After some weeks of fever, inflammation, and sup-
puration the sides of the protruded portions of the stomach formed ad-
hesions to the pleura costalis, and, the external wound being still un-
closed, an aperture remained through which the communication could
at any time be had with the cavity of the stomach. After the lapse of
one year from the accident the aperture in the stomach remained two-
and-a-half inches in circumference, and was ordinarily covered by a
compress and bandage. After a few months more, a fold or doubling
of the coats of the stomach formed a covering for closing the aperture,
preventing the escape of the contents of the stomach, though it could
be easily depressed with the finger. Three years after the injury was
received Dr. Beaumont of the U. S. Army commenced a series of ex-
periments on the process of digestion and the nature of the gastric
fluid. They were continued with some intermissions up to 1838. They
have since been resumed by Prof. Sewall, and the results of further ex-
periments are given in the, Amer. Jour, of Med. Sciences, 1857.

As soon as the food swallowed enters the stomach it becomes mixed
with the gastric juice, a fluid strongly acid from the presence of lactic,
or perhaps hydrochloric acid, and containing the animal principlcj
pepsine.

The Gastric Fluid, — Its Properties^ Origin^ and Mode of Action.
The pure gastric fluid when taken directly from the stomach of a
healthy adult, and mixed only with the portion of mucus of the stomach,
with which it is almost always combined, is a clear transparent fluid,
inodorous, a little saltish, and very perceptibly acid. Its taste when
applied to the tongue, is similar to thin mucilaginous water, slightly
acidulated with muriatic acid. It is readily diffusible in wine, water,
or alcohol; it effervesces slightly with alkalis, and is an effectual
solvent of all substances proper for food. It coagulates albumen, is
powerfully antiseptic ; checking the putrefaction of meat, and effectually
restoring to healthy action old foetid sores and foul ulcerating surfaces^
when externally applied. {Beaumont^

The mucus mixed with the gastric juice may be separated from it
by filtering the mixture through fine linen or cambric; the mucus and
frothy part of the saliva, when retained, the mucus gives the fluid a
ropiness which may gradually subside to the bottom in loose flocculi.
Saliva imparts to the gastric juice an azure tinge and frothy appear-
ance; and, when in large proportion, renders it foetid in a few days;
whereas the pure gastric juice will keep unchanged for many months.
Professor Silliman says it may be kept for years.

The secretion of the gastric fluid is affected through what is called^
r<?/?^a? action^ which is ordinarily excited by the impression of food upon

OUTLINE OF THE PKOaRESS OF DiaESTIOK. 217

the nerves of the stomach. The nervous influence thus excited ciuses
the sudden and rapid pouring out of this fluid, just as the nervous in-
fluence called into action by mechanical irritation of the conjunctiva
produces a flow of tears. The same secretion may also be excited by
irritating the mucus membrane of the nostril.

" The gastric fluid appears to be secreted from numberless vessels,
which are distinct and separate from the mucous follicles. These
vessels, when viewed with a microscope appear in the shape of small lucid
points or very fine papillse, situated in the interstices of the follicles.
They discharge their fluid only when solicited to do so, by the presence
of aliment or by mechanical irritation. Beaumont says when the coats
of the stomach were seen perfectly clean and healthy and no fluid was
in the stomach, the irritation of an elastic tube in the cavity excited a
sensible flow of acid liquid which flowed from the tube drop by drop.
On giving a piece of bread to eat the flow increased. {See Budd, p. 19.)
The pure fluid never accumulates in the stomach until the presence
of alimentary matter excites the secretory vessels to pour out their
contents." It then begins to exude from the surface of the stomach, in
quantity proportioned to the quantity of food received or required. On
abstracting the contents of the stomach after the bread was eaten it
was found partly mixed with saliva and mucus and tinged with bile,
yellow or clear limpid fluid then spread over the surface, trickling down
the sides of the cavity; and after slight exercise more fluid, a very
clear gastric juice was collected, in all about five drachms. A definite
proportion of aliment only can be digested in a given quantity of the
fluid. "When the fluid becomes saturated, it refuses to dissolve any
more," and when an excess of food is taken, it remains undigested in
the stomach or passes into the bowels in a crude state, where it causes
irritation, pain or nervous symptoms in other sympathizing organs.
Though varying in physical properties from the changing condition of
the stomach, and from the difierent other fluids mixed with it, the
gastric fluid is believed to be always essentially the same substance.
Derangements of the digestive organs, slight febrile excitement, fright,
or'other sudden affection of the passions, over-eating, and many other
causes may produce acidity or even rancidity in the contents of the
stomach, and lessen the solvent power of the gastric juice; and general
febrile irritation seems entirely to suspend its secretion, at the same
time rendering the villous coat dry, red, and irritable. Fear and anger
check the due secretion of the fluid, the latter causing an influx of bile
into tLe stomach, which produces nausea or vomiting according to its
quantity. {Budd, — Diseases of the Stomach.)

Recent researches have led to the inference that the am.ount of the
gastric juice and consequently the amount of materials needed for its
supply, is much greater than has been hitherto imagined. Lehmann

218 DISEASES OF THE DIGESTIVE EUITCTIOK.

estimates that not less than four pounds of gastric juice is secreted daily
by a man in health. (Lehmwnn^s '' Physiological Chemistry,''^ Day'* 8
t/ranslation. Vol. II. p. 53.)

The researches of Dr. Prout led him to consider muriatic acid
as the proper acid of the gastric juice. When acid is vomited,
when a gall-stone is passing the renal duct, and when the stomach is
empty and containing no other acids, the acid vomited is the muriatic.
{^^^Z4 p. 155.)

Plienomena of the Process of Chymification, — When the food is
first received into the stomach this organ is stimulated to contract and
embrace firmly the substances presented to it. The orifice at which
the aliment entered contracts closely, to prevent its return, and the
pyloric orifice is still more firmly constricted, to prevent its escape until
it shall be softened and changed into chyme. The muscular fibres of
the stomach towards the cardiac end persist in a firm and steady con-
traction, which slowly pushes the mass towards the pylorus. Towards
the pyloric aperture the movements of the fibres resemble those called
the vermicular contractions of the muscular fibres of the intestines,
clasping and pressing forwards the yielding material, which the vigilant
pylorus refuses to admit so long as the softening mass contains portions
imperfectly dissolved, or capable of irritating its excitable fibres to
contraction.

During the process of digestion "there is a perfect admixture of
gastric juice and food — the particles of food are constantly changing
their relations with each other, and they are mixed with a quantity of
fluid consisting of the gastric juice and the fluids taken during the
meal." Beaumont, having often observed a large quantity of fluid in
the stomach when little had been taken into it, suspected that water
was synthetically formed during the process of digestion. It is more
probaoly secreted as mucus in an unusually fluid state. The mixture
of food and the solvent fluids is "perfectly heterogenous at first;'' but
the "churning motions of the stomach" and the active powers of the
gastric juice change its appearance very rapidly. If the contents of
the stomach be taken out in from thirty to sixty minutes after eating*, a
mixture of perfectly formed chyme and particles of unchanged food
will be found blended together in various proportions, according to the
condition of the stomach and the quantity of food taken.

It has been supposed that the gastric fluid was only secreted at the
moment of its expulsion from its secreting vessels, inasmuch as no such
fluid is found in the stomach when empty or unexcited by irritants of
any kind. But it is more probable that the gastric fluid accumulates
in its own proper vessels during some time preceding the taking of
food.

"On applying aliment to the internal coat of the stomach, which in

. OUTLmE OF THE PKOGEESS OF DIGESTIOIS". 219

health is merely lubricated with mucuSj innumerable minute papillae,
the orifices, undoubtedly, of the gastric vessels, immediately, throw out
a quantity of the fluid which mixes with the food. The eifect is too
sudden and the secretion is too copious to' be accounted for on the or
dinary principles and laws governing secreting surfaces. The quiescence
and relief," says Beaumont, "from the unpleasant sensation which is ex-
perienced as soon as the vessels are emptied, furnish additional proofs
that the fluid was already secreted, and only discharged from the
secreting vessels when their mouths were excited by the stimulus of
food."

The precise nature of the changes effected by the process of digestion
on the various substances used as food has never been perfectly ex-
plained. Within a few years the opinion has become prevalent that
digestion consists in a "peculiar fermentative process." Ure says "the
gastric fluid is a genuine ferment." And many eftbrts have been made
to furnish by chemical combinations a substitute for the digestive fluid
when deficient in quantity or defective in quality. Tiedemann,
Gmelin, and Prout have shown "that the gastric fluid contains muriatic
acid:" and Eberli has made experiments ^^ on the digestion of food out
of the body with water containing a few drops of the same acid." The
fluid used by him needed a minute quantity of the mucous secretion o
the stomach. Schwann and Vogel have produced this digestive prin-
ciple in a pure state and called it jpejpsine. Rennet, with which milk
is congulated in making cheese, is of nearly the same nature as pepsine
But the simplest digesting liquor is the following: "If 10,000 parts of
water by weight be mixed with six parts of ordinary muriatic acid and
a little rennet, a liquor is obtained capable of dissolving hard-boiled
white of egg, beef, gluten, &c., into a transparent jelly in a few hours."
( Ure's Diet. Arts. &c.. Sup. p. 94.)

The gastric fluid has no influence on living bodies, as is shown by
the experiments of Spallanzini and others. If the legs and feet of a
living frog be thrust down into the stomach of a lizard, and be confined
in that situation, the gastric juice has no action upon them so long as
the frog lives; but if the frog be killed and be replaced in this situation,
they are digested to a pulp in a few hours.

When a living frog in a state of magnetic torpor is swallowed by a
serpent the gastric fluid does not commence digesting the skin of the
frog while the latter continues alive. After remaining some days in the
stomach the imprisoned victim may be liberated, and he will return to
his place in the neighboring brook, and join his comrades in a song.
In one instance of this kind we observed the frog's skin entire, though
it showed evidence of long maceration; and the whole body and limbs
were reduced to the most extreme degree of emaciation.

On fatty matters the gastric juice exerts no influence; the fat is

220 DISEASES OF THE DIGESTIYE FUNCTIOISr.

simplj liquefied and left to float in the mixture known as cliyme. This
fluid has no effect on starch or sugar; but the action of the saliva on
the starch becomes arrested as soon as the saliva becomes acidulated
by the gastric juice. But albuminous and gelatinous substances are
dissolved by the gastric juice, and their properties are so modified that,
although previously not transmissible through an animal membrane
they become capable of permeating it readily; "they become more easily
soluble, less coagulable, gelatin ceases to gelatinize ; they lose the pro-
perty of forming insoluble combinations with most metallic salts, but
they are so precipitated by Tannic-acid, Chloride of Mercury, and Acetate
of Lead when mixed with Ammonia."

In addition to the gastric juice the stomach secretes ordinary mucus?
and this sometimes in such large quantities as to interfere with the
action of the gastric juice upon the food : containing more or less ex-
crement! tial matter, this mucus often becomes the exciter of fer-
mentation.

Atmospheric air and carbonic acid are often conveyed into the
Stomach, and from its surface they and other gases are readily absorbed.

The ^anoreatiG juice is a highly albuminous alkaline secretion formed
in the pancreatic gland under the stomach. Its office, according to
Bernard, is to redissolve albuminous matters after they have been pre-
cipitated by the bile, from their state of solution in the gastric juice.
Others suppose "that fat is absorbed as neutral fat, emulsified by means
of the pancreatic secretion, or divided into small particles each of
w^hich is surrounded by an albuminous envelop."

The Bile is one the most important fluids engaged in the process of
digestion. Its precise o|fice has not been well settled. It is supposed
"to assist somewhat in emulsifying fat; it probably possesses decided
antiseptic properties; and may precipitate albuminous matters from
their state of solution. Its water serves as a means of transit of biliary
matters from the .blood, and of nutriment and of other soluble matters
from the intestinal tube back again in the blood stream."

Other glands, opening on the inner surface of the duodenum, jejunum,
ilium, and coecum, furnish still further supplies of fluids for the solu-
tion, elaboration and absorption of nutritive matter ; and the venous
radicles, originating* at all points of the intestinal tube, collect the
absorbed food and pour it by the vena portarum into the liver.

" As a summary, then we may state, that albuminous matter, whether
vegetable or animal, is absorbed as albumen, gelatinous matter as ge-
latin, these being both modified by other fluids. Starch and saccharine
matters are absorbed as grape-sugar and dextrin, and fat principally as
neutral tat, a small portion of fatty or other acids being formed." *'f

* Dr. Teed, Animal Chemistry, &c Amer. Jonr. Med. Sci. July 1860.
t Molescliott on Food. Zurich.

OUTLINE OF THE PEOGEESS OF DIGESTIOI^". 221

Absorption of mctritious Tnatters jprejpared for supplying the waste.
of the different structures of the hody. — Every part of the digestive
apparatus is furnislied with absorbing vessels which possess the faculty
of taking up from the fluid mass, called the chyme, the purer portions
fitted to replenish the blood with the elements necessary for the sup-
port of life. The absorbing vessels of different parts of the intestinal
surface select different materials suited for the wants of organs or func-
tions with which they are respectively connected. The principle of
" series," says Wilkinson, "governs here as elsewhere; what is re-
nounced as useless in the first cavity becomes the especial food of the
next;" and the material rejected in the second chamber is welcomed to
the third. As the entrance to the mouth is guarded by muscles and
teeth, a muscular guard is placed at the cardiac orifice pr entrance of
the stomach. When this cavity has assimilated its portion of the food
it has no longer any affinity for the substances which have become un-
welcome. The muscular coat contracts upon the mass and it passes
into the next chamber, where it undergoes a new digestion, and is
again pressed forwards to the next compartment of the digestive tube.

In each of these portions of the alimentary canal solvent and appro-
priate fluids are poured out to dilute, soften, and dissolve the food.
They draw out its essences, alter them into suitable forms, sheathe the
sides of the delicate conducting passages, and enable the extracted
nutrient particles to glide smoothly to their destination. After the sa-
liva and the gastric-fluid have done their work in the stomach, the de-
scending pultaceous mass enters the duodenum, where it meets the more
powerful salivas of the bile from the liver, and the secretion from the
pancreas. These fluids complete the process of chymification, and,
when that work is over, they stimulate the intestines to carry forwards,
and expel the exhausted materials which a,re to be rejected from the
system.

If it be true that the finest essences of the food have, speedily after
being taken into the mouth, found their way into the blood, or in some
way made their impression on the sensorium, we need not doubt that
much of the grosser food is directly assimilated in the stomach and
absorbed into the general circulation directly from the stomach. " The
little veins which stand open throated on every portion of the distinctly
ventriculated surface carry crowds of these slower individual particles
into the bosom of the general circulation. The possibility of an imme-
diate reception of the food by the blood, appears for the most part to
end with the stomach." ( Wilkinson.) — A large portion of all the fluids
received into the stomach is directly absorbed from its surface, especially
water, spirituous, weak saline, saccharine and albuminous solutions.

Beyond the stomach a lower order of vessels than the veins receives
the nutritious particles of the food; these are the lacteals. The fluid

222 DISEASES OF THE DIGESTIVE FUNCTION.

absorbed by them is in an intermediate form between tliat in which it was
received into the stomach and the blood to which it is going. The lac-
teals arise from the inner surface of the alimentary tube, decreasing in
number towards the lower parts. They converge from their origin to
the receptacle for the chyle, called the thoraciG duct^ a fine pipe-like
vessel seated in front of the vertebra. It extends all the way to the
left side of the neck, where it empties its contents into the left sub-
clavian vein, from which it flows directly to the heart. In the thoracic
duct the new materials for the ever-changing blood come in contact
with some of the old materials of the ever-changing body, the lymph
which is composed of the matters absorbed by the lymphatics, and
collected from every part of the body. It is represented as " the old
spirit of the blood serving to inaugurate the new body, and thus is the
last of the salivas, which digests and introduces the chyle itself, as the
salivary fluids digest and alter the food."

The chyle, as it passes through the lacteals, bears but little resem-
blance to the blood; but, as it advances sloAvly through the vessels, the
mesenteric glands and the thoracic duct, its similarity in properties to
the perfect blood becomes more and more marked ; and, by the time it
reaches the heart, it is intimately mixed with the venous blood.

The Blood. Physical jproperties. — Arterial blood is of a red ver-
million color, whilst the blood of the veins is of a deeper and darker
hue. Its temperature in the vessels is equal to that of the body ; its
mean specific gravity is 1.055, and its quantity according to Valentin,
in weight to that of the whole body as 1 to 4.25. When drawn from
from the vessels its consistency changes ; it becomes solid or coagu-
lated. From this state it goes on contracting until the clot floats in
the surrounding serous fluid.

Sanguification, — The regeneration of the blood is chiefly effected by
the flowing into the blood-vessels of the lymph collected by the absorb-
ents, and chyle from the stomach and intestines.

The lymph appears in two forms ; the one which is less perfect takes
its origin from the blood which has transuded through the vascular
parietes, and has not served for nutrition ; returning from all parts of
the body, it has to pass through the lymphatic glands before it can
reach the blood. The other species of lymph is*the chief product of
what are called the sanguineous glands. The lymph passes imme-
diately into the blood, excepting that portion of it which mixes first
with the chyle.

The lymph and chyle (the white blood of some writers) having
reached the heart, undergo some chemical change, and are immedi-
ately conveyed to the lungs, where* they reject carbonic-acid gas and
take in oxygen. From the lungs the blood is returned to the heart
from which it is thrown out by the aoeta to every part of the body.

OUTLINE OF THE PROaEESS OF DIGESTIOl^T. 223

In passing through the different secreting organs the blood furnishes
the materials for the various secretions. Some of the fluids separated
from the blood are thrown off from the body entirely ; others as the
saliva, pancreatic and gastric juices, return in part to the common re-
servoir the blood. (Mafidl,)

The blood thus forme'd consists of many ingredients, of which the
most important are : 1. The mature blood-cells, or red blood globules,
and the colorless or young blood-cells. They derive their nourishment
from the plasma, and give off the residua of their nutrition, and* the re-
sults of their destruction to be separated by the eliminating organs.
Those molecules which under any form have been used in the processes
of life, having once passed through their stage of vitality, are no more
capable of again entering into the formation of animal principles of the
sam6, or of a higher order, but are immediately eliminated by the ex-
cretory organs ; thus the iron particles which have once entered into
blood corpuscles which have lived their day and are being broken up,
are no more taken into the new corpuscles ; and their place must be sup-
plied with fresh iron from without. "No particle that has become effete
will be assimilated again, but must be expelled ; " and the organ chiefly
containing these residua — as" the spleen (and sometimes the liver)--r
forms an article of food of very indifferent quality, and frequently
causes great intestinal disturbance. In the case of the liver other
effete matters may be also concerned. An excessive destruction, a
diminished supply, or a faulty assimilation, will therefore have the same
ultimate effects, and a condition of anaemia or of chlorosis will be the
the result. In some cases an increased supply remedies the mischief,
in others the destruction must be checked, and- again in others the
powers of assimilation must be increased."''''

2. In addition to the water, sugar, albumen, and fat, the blood contains
saline matters combined with the nitrogenous principles. These become
separated when the albumen suffers decomposition, and then they obey
the general laws of excrementitious matter. Sulphur, Phosphorus, Iron,
Lime, and Magnesia are- seldom used as dietetic articles, but they are
very generally found in the blood in varying quantities ; common salt
is more constantly taken in with the food, and is always found there.

8. The blood also contains the residua of nutrition on their way towards
the excretory outlets through which they are to be expelled from the
body ; other unassimilable or unnecessary substances which have been
absorbed during the process of digestion are also found in the blood
stream till they are expelled by excreting organs. The chief of these
are carbonic-acid, urea, uric, phosphoric, sulphuric, hippuric, lactic, and
oxalic-acids, creatine, creatinine, biliary coloring matter, extractive, &c,

* Dr. Teed, Amer Med. Jour. July, 1860. p. 73.

224 DISEASES OF THE DIGESTIVE FUNCTION.

Nutrition. — " The idea of life, or vital action, obviously involves
that of change. We do not consider any being as alive which is not
undergoing some continual alteration perceptible to the senses." Thus
the plant grows from a germ to a fabric of great size ; a bud or a seed
grows to an immense tree. It is seeji as an organized structure con-
taining within it many organic compounds. It multiplies its species
by the production of germs similar to that from which it originated ;
and seems to perform all these complex operations without feeling or
thinking — without consciousness or will. Such are the functions of or-
ganio or vegetative life. These functions are divided into those which
maintain the structure of the individual, or nidrition, Sind those which
are employed in the reproduction of the species.

In 'the animal body a large number of the operations are of the same
character with those of vegetable life. The processes of nutrition in
animals are essentially the same as those of plants, but, on the whole,
much more active, in consequence of the great law impressed upon or- .
ganic beings, that all vital action causes a waste or disintegration of the
instruments or organs employed. It has been known from very early
periods of the world that there is a perpetual change in the molecules
of which the body is composed ; and there can be no doubt that this de-
structive process is not confined to the muscles, of which organic che-
mistry treats, but also occurs in the nervous and all other tissues, even
the most dense, as the granules of the bone and ivpry of the teeth. Ife
was upon this incessant change of the nervous tissue that Butler (in
his " Analogy,") founded one of his strongest arguments for the con-
tinuance of the soul in a state of separate and conscious existence after
the whole of the material body shall have been entirely abandoned.

It is now generally admitted that the process of nutrition mainly
consists in the growth of the individual cells composing the fabric ; and
that these derive their support from the organic compounds with which
they are supplied by the blood, just as the cells composing the simplest
plants derive theirs from the inorganic elements which surround them:
" and as different species of the latter select and combine these in such
modes and proportions as to give rise to organisms of very diversified
forms and proportions : so is it easy to understand how the different
parts of the fabric of the highest animals should exercise a similar
selective power, in regard to the materials with which the blood sup-
plies them. The structure comprising every separate portion of the
body has a special affinity for some particular constituents of the
blood, causing it to abstract from that fluid, and to convert into its own
substance certain of its elements. This conversion is termed Assimi-
lation. [Carpenter^ s Physiology ^ p. 487.)

^^As the first act of nutrition consists of an interchange between the
cells and vessels, of portions holding certain matters in solution, it is of

OUTLINE OF THE PROGRESS OF DIGESTION. 225

necessity, that the molecular changes occur in the cell-fluid and cell-
walls and not in the vessel-fluids. The parts to be nourished consist
chiefly of C, H, N, 0 ; their elements being no longer used in up-
building tissues, but entering a course of descending transitions, are
finally expelled by the system ; the matters given off by the cells un-
dergo a splitting into two portions or classes, of which one is rich in
nitrogen, the other containing little or none of that element. This
latter under the influence of oxygen forms 0 O2 and H 0, and thus
generating heat. Hence nitrogenous food is absolutely essential to
nutrition in proj>ortion sufficient to cover this loss, while carbo-
hydrates chiefly serve the purposes of animal heat. Where a due
supply of nutriment is not afforded, the matters dissolved in the exos-
mosing fluids cannot be fully replaced from the vessel-fluids ; and this
decrease continues side by side in the cell-fluids and in the vessel-fluids,
the latter always retaining the predominance as long as any nutrient
matter remains capable of being assimilated ; and when an osmotic
balance is reached, the cells neither give off nor receive ; life is, there-
fore, extinguished, and, after death, they are found pale and shrunken,
but they are not dissolved, nor is there any trace that a single cell has
been removed, from a muscle for instance, it is only the cell contents
that have disappeared, that is their nitrogenous matters held in solution,
a larger portion of the water still remaining and the muscles are said
to be watery." ^ '

"As soon, therefore, as osmose ceases, the maintainance of animal heat
ceases, because after the carbo-hydrates and fat have been consumed,
nothing remains but this splitting of nitrogenous matters ; and as soon
as this is suspended, although there may be still inspiration of oxygen
and absorption of it into the circulating fluid, there is no material
on which it can act, as its action is neither on the nutrient fluid nor on
the tissues, but on the matter given off from the tissues, which matter
is replaced from the nutrient fluid. When, therefore, osmose ceases, the
matter ceases to be given off, the action of the oxygen ceases from
want of matter on which to act, heat ceases to be developed, and with
this is the cessation of life."f

The quantity of food necessary for the support of the human body
in a state of health can only be settled by repeated observations. Sir
John Sinclair says: In the British naval service each seaman is
allowed 26 ounces of dry nutritious vegetable food per day, to which
is added from five to nine and a half ounces of meat ; the latter if salt
is extended to nine ounces, if fresh to only four and a half. Sugar and
cocoa are also given. A soldier is allowed a pound of bread and three-
fourths of a pound of meat. In the London Hospitals convalescent

* Virchow's Archiv. Yol. XVIII., p, 174.— f Teed op. cit.
Vol. I.— 15

226 DISEASES OF THE DIGESTIVE FU:N^CTI0K.

patients receive a pound of meat with twelve or fourteen ounces of
bread, half a pound of potatoes, a pint of milk, and sometimes a pint
of beer, or a half pint of porter. In the prisons in England a prisoner
confined for three months at hard -labor has a daily allowance of about
thirty-six ounces of food, of which not more than four ounces given at
four different meals in the week, consist of meat. In the work-houses^
where many of the poor seek little more than a shelter, a diet some-
what lighter is given ; the hard labor, the restraint, and mental depres-
sion which confinement produce, demand for the criminal a larger
amount of nutriment than is needed by the man who labors and suf-
fers le^s. In general terms it may be said that between twenty-five
and thirty-five ounces is sufficient to support health. Of this, one-
fourth or a fifth should consist of animal food. If more than this be
taken it famishes material for disease ; if a less proportion is from the
animal kingdom, the blood will be poorer, the cohesive powers of the
tissues will be lessened, and diseases of a different character will result. =^'

The following is the allowance for a soldier in the U. S. service, as
directed by the Surgeon General, Nov. 1862 : F%ill Diet — Meat 16
oz. avoirdupois ; bread 18 oz. ; potatoes 8 oz. ; other vegetables 8 oz.
rice, hominy^ or Indian meal 1.60 oz. ; salt 0.16 gill; coffee 0.80 oz.
tea 0.12 oz. ; sugar 2.40 oz. ; milk 8 oz ; butter 1 oz. ; flour 0.25 oz.
molasseSj gill, 0.82; vinegar 0.32 gill.

Low D^'^z^.— Meat 8 oz. ; bread 14' oz. ; salt 0.16 gill ; tea 0.240 oz. ;
sugar 2.4 oz. ; milk 8 oz. ; butter 1 oz. ; rice, farina, corn starch, or bread
made into pudding 2 oz,

OKDER I -AFFECTINQ THE ALIMENTARY CANAL.

I. Diseases of the Teeth and Maxillary BoiieSp
1. DENTITION.

Teething, — The teeth are divided into three classes; namely s
incisors or cutting teeth, canine or dog teeth, and molars or
grinding teeth. The first set, called the uiilh teeth, are tw^enty in
number, consisting of eight cutting teeth in front, four canine, and
eight grinding teeth. They are smaller and narrower than those of the
permanent set, and generally appear in the following order : the two
cutting teeth in the middle of the lower' jaw pierce the gums about the
end of the sixth month, and are followed in a few weeks by the two
corresponding teeth of the upper jaw^ After another similar interval^
the two lateral cutting teeth in each jaw appear; sometimes the upper,
and sometimes the lower appearing first. Four of the grinders pierce
the gums towards the end of the twelfth month, the canine teeth (first

* Todd and Bowman's Physiology. Vol. 1. p. 519.

DISEASES OF THE TEETH AND MAXILLABY BONES. 227

the lower and tlien tlie upper) about the end of the second year, and
lastly the remammg four grinders at the beginmng of the third year.

The process of teething generally takes place regularly and without
much distress provided the child possesses an organism ordinarily
healthy, has been accustomed to breathing the open air, has been fully
nourished by the mother's milk, herself being in good health. The only
symptoms observable as the fifth and sixth months are passing, are,
slight pain and tension in the gums, with increased flow of saliva, a
slight diarrhoea, with some evidence of increased sensibility and irri-
tability of the nervous system. In children of less favorable consti-
tutions the natural process of dentition is liable to be variously
deranged.

The complicated apparatus by which the teeth are. to be formed con-
sists of a vascular and nervous pulp, covered by a very delicate mem-
brane, and these again are invested by a fibrous membrane of very firm
texture composed of two distinct layers. The body part of the tooth is
secreted by the fine membrane of the pulp; and, as the ossification ad-
vances from within outwards, the cavity occupied by the pulp is con-
tracted, until reduced to the dimensions of the hollow of the perfect
tooth. As soon as the ossification is completed, the inner surface of
the fibrous coat takes on the ofiice of secretion, and furnishes, the tooth
with its covering enamel ; and, as soon as this is completed, the fibrous
membrane is no longer of any use, and must be removed to give way to
permit the tooth to advance above the gum. The removal of the in-
vesting membrane is accomplished by the action of the absorbent
vessels; and the increased flow of saliva, and the increased flow of
mucus from the bowels carry off the effects of increased excitement.
Thus, in a state of health, the process of dentition consist in a progres-
sive growth of the tooth, and absorption of the membrane; and the two
operations are going on at the same time, the latter progressing just
fast enough to remove the investing membrane out of the way of the
advancing tooth. In a state of disease this does not occur, and the
growth of the tooth may be irregular, imperfect, or entirely suspended.
Pressing against the investing membranCj it excites irritation and then
inflammation. The gums become red, tumid, painful and ulcerated.
From this focus of irritation a similar state of excitement extends down
the prima-via to the stomach and bowels ; and is also conveyed to the
brain, and thence, by reflex . action through the nerves transmitted to
distant parts of the alimentary canal, producing the symptomatic vomit-
ing, follicular diarrhoea, fever and convulsions which are so common and
so fatal to children who encounter the dangers of the " second summer."

Thus almost any disease of infantile life may be excited by the irri-
tation of dentition, and almost any symptoms of any of these diseases
may be excited or augmented by this cause. Children seldom acquire

228 DISEASES OF THE DIGESTIVE FUNCTION.

their teeth without some local irritation and constitutional derangement
In most cases the gums become red, enlarged and painful; fever with
unhealthy action of the liver and digestive organs follow.

In these cases the local irritation often furnishes its own remedy by
exciting the salivary glands to greater action, secreting an unusual
quantity of saliva, which diminishes the febrile action and thus gives
relief.

When the irritation is higher the constitutional excitement becomes
more alarming. There is then diarrhoea attended with severe griping,
fgeces discolored and foetid, sometimes of clayey consistence with large
quantities of viscid mucus ; urine turbid, discolored, in small quantities,
and sometimes accompanied with purulent matter, and excoriating pain
in passing it Skin dry, hot; pulse rapid and fluttering, respiration
quick and labored, countenance marked with extreme anxiety and pain,
Every symptom of pneumonia is often present, the child being subject
to taldng cold as well as the usual, other causes of disease.

Continued moving of the head indicates the existence of affection of
the brain. There are then, distressing moaning ; dilated pupils ; spasms
of, the muscles, increasing to alarming convulsions, which sometimes
end in death. In this case, in a robust child, there is a real hyperaemia
or overcharged condition of the vessels of the brain.

TREATMENT. — So loug as the febrile excitement is not excessive and
the gums are not extensively swollen, the child may be expected to pass
through the process of teething without danger. If medical treatment
be considered necessary, the following remedies maybe consulted:

Gliamomilla, — ^^Vhen the discharges are greenish or foetid.

Mercurius. — There is much ptyalism and diarrhoea; discharges
slimy, watery, bloody, and thrown off with spasmodic force of the irri-
table intestine.

Pulsatilla. — Cough with oppression of the chest, stomach disordered
by rich food.

Ipecac, — Nausea, vomiting and diarrhoea.

Aconite. — Fever and restlessness; the patient starts up from sleep;
skin flushed, hot and dry.

Belladonna.^ after Aconite, when the head and hands are hot, and
the face is flushed.

CalGarea-Garb. — In children who progress too slowly: imperfect de-
velopment, tendency to rickets.

Coffea. — Not unfrequently an irritable condition of the nervous
system is induced by dentition, causing the child to be fretful, slightly
feverish, and sleepless. Convulsions with grating of the teeth. Coffea
removes this group of symptoms.

IIyosGyaw,us.^—li\ strongly marked nervous temperaments when the
child is irritable, there is spasmodic motion of the eyes, restless, sleep-

DISEASES OF THE TEETH AND MAXILLAEY BONES, 229

less, inclined to cry much, grasps at things in the air, and about the
bed, starts during sleep and smiles ; this remedy -will usually afford
relief.

CannabiS'indica. — ^Is indicated, when the face often flushes suddenly,
when the head and extremities become hot during the night, when the
child often starts and screams as if frightened, and there is an evident
determination of the symptoms towards the brain.

Ignatia.—WiYi. be required in spasmodic twitchings, tendency to
throw the head back when put to bed, with a persistently irritable and
intractable mood. Diarrhoea of bloody mucus, with prolapsus of the
rectum, ascarides, convulsive twitching of the corners of the mouth ;
nausea, vomiting, abdominal spasms; face red or blue: spasmodic con-
striction of the chest.

When dentition is progressing too slowly and the gums are much
swollen, it is often necessary to cut the gum through with a sharp lan-
cet. This should only be done when other remedies are failing, or where
violent symptoms are threatening, or when the tooth is seen to be
nearly through.

A common case is that of a child which, for a day or two, has been in
great distress with the general fever, diarrhoea, or constipation and
determination to the brain. The gums are in a state of high inflamma-
tion, stomach and liver deranged;. tongue furred, pulse rapid. The gums
are slightly incised with a sharp lancet; they, bleed freely: There is
immediate relief. Aconite reduces the general fever still further ; and
the digestive organs are corrected also, whether diarrhoea or constipa-
tion has been present. In more severe or more advanced cases
further treatment is required.

In every case of disease of the stomach or bowels, of the brain, or of
general fever occurring during the period in which dentition should take
place, the gums should be carefully examined; and when the gum is
swollen and inflamed, it should be so lanced as to take off the tension
of the membrane, permitting a single drop of blood from each tooth,
though giving little or no pain. The objections made by ignorant
people to this simple operation are always overcome by an explicit
statement of the principle on which it generally gives early relief, and
at least lessens the danger, without ever doing harm when judiciously
performed.

The inflammation excited by the evolution of the wisdom-tooth some-
times extends to the establishment of ostosis^ periostosis^ neurosis, or
lisoesses which by burrowing into the sub-clavicular region have
proved fatal.

It may also be the cause of enlarged tonsils, or of the velum palati
or uvula. In one case it caused hypertrophied uvula, with anorexia
and vomiting. Fistulous ulcers from this cause are often overlooked*

230 DISEASES OF THE DIGESTIVE ORaAKS.

as ordinary examination of the teeth shows them all to be sound. The
fistula is slightly depressed, the skin around it is plaited or wrinlded,
and, when the lower jaw is involved adheres to the bone. In one case
cited by M. Robert, [Gaz, cles Hopit^^ a second molar tooth was ex-
tracted without relief, a sinus was then found and traced back to the
concealed wisdom-tooth ; this was extracted and gave full relief. We
have met with no cases in which free lancing of the swollen gum
failed to relieve the swelling and permit the tooth to appear. These
teeth generally decay early, and, having a short root, are then better
extracted.

2. TOOTH-ACHE.— ODONTIA DOLOROSO.

Caries. — -This most common disease of the teeth has received the
name caries by common consent, though perhaps Bell was more correct
In saying that gangene would be a more proper name.

Caries generally begins immediately under the enamel, either on the
grinding surface or the side.

Causes. — I^recUsposing.'—The predisposing remote causes are :
1. hereditary predisposition. The tendency to caries of the teeth has
often existed in a whole family, where one of the parents was similarly
affected ; in other families, however, though the parents lost the teeth
the children kept theirs to the age of forty or fifty years.

The Teeth are affected in a peculiar manner by the sycotic poison
The most obstinate algias, loosening of the teeth, degeneration of the
gums, with sponginess and fiat ulcers are the consequence. Thuja
alone is a remedy for this condition.

2. Many diseases of infancy, especially inflammatory diseases operat-
ing on the pulp of the teeth are more disastrous to the young and tender
texture than any other cause of caries, except Mercury^ If the bony^
structure of the teeth, like other bones, would admit of re-union we
would not despair of similar recoveries. If bones be broken they unite
so as to become stronger than before. If they become diseased and
dead, new bony matter is deposited around the dead bone, and in time
the latter is removed by the absorbents. Not so with the teeth. When
they are injured by fracture, inflammation or Mercury, no such pro-
vision is made for them. A tooth is a bone within a bone ; its vessels
are few and minute, but interspersed in a membranous substance which
is liable to be injured by slight causes, even by a sudden change of
temperature. Thus inflammation of the pulp of the tooth must pro-
duce injurious effects, as the tooth has' not the means of a complete
recovery.

Teeth generally decay in pairs ; a fact which shows them to be
capable of becoming diseased from internal causes. Thus the pulp of

TOOTHACHE. 231

each tootli of the pan-, though on opposite sides, must be in the same
stage of advancement at the time they are attacked by inflammation;
they are therefore liable to decay together.

Mr. Tomes^' says, vitiated secretions of buccal mucus, generally con-
nected with dyspepsia are the chief cause of destruction of the teeth.
The morbid mucus clings round the teeth, in other cases the saliva is
perverted.

Exciting Causes.-— TliQ disease is developed and rendered sensible
in a greater or less degree by various exciting causes :

1. Hot Drinhs.'—A.TLj fluid warmer than the blood is destructive to
the teeth; cold drinks beyond a certain degree are no doubt injurious
but not equally so. The teeth of men and animals are chemically the
same, yet the former suffer much from diseases of the teeth, while the
latter seldom if ever have caries or pain in the teeth. Savages are
clear of this disease. Two cannibals brought by Capitain Cook from
the South Sea Islands never heard of tooth-ache till they came on
board of his vessel. The American Indians knew little or nothing of it in
their uncivilized state. Domestic animals fed according to their natural
habits have no diseases of the teeth ; but it is developed by feeding them
with hot food from the distilleries. It has been said that persons em-
ployed in surveying in the Western woods for several months and sub-
sisting on dried meat and hard bread, noticed that their teeth became
white without the use of the brush or the least care ;. and persons who
live on cold food never lose a tooth or suffer from tooth-ache. Slaves
on tropical plantations seldom complain of it, except they be em-
ployed as cooks and drink hot coffee or tea.

The teeth of man are the last part to decay after death, resisting all
chemical agencies and destructive gases of the grave, they remain sound
for a century. The teeth of the Celtic chieftain exhumed at the gate
of Paris, in 1859, had preserved their texture and enamel of perfect
whiteness through the twenty-five centuries during which he had oc-
cupied that tomb.

While the body lives, the teeth are the first part of the body to decay*
If they were foreign bodies independent of all connection with the sys-
tem, the agents that now act upon them would be harmless. But when
they become foreign bodies their beauty decays, they become dark in
color, and decomposition follows.

The texture of the teeth varies in different persons. Some contain
more carbon in the enamel than is found in others. In some the ena-
mel is thick, in others thin. Some teeth are yellowish in color, others
blue mixed with pearly white. These last are very frail and decay in
early life, the bone of the teeth and the enamel in such cases are not
so firmly united, hence they are more liable to be injured by heat.
* System of Dental Surgery.

232 DISEASES OE THE DIGESTIVE EUi^rCTIOK'.

Prevention of Caries. -r-l. Avoid all the exciting and remote causes.
In infancy all inflammatory diseases should be immediately arrested,
scarlet fever or other febrile disease should be treated with care : but in-
flammation from diseased state of the deciduous teeth should be noticed;
as in some cases these teeth are decayed as soon as they are cut through
the gums ; this is commonly due to the effect of Mercury. Some think
it corrodes the teeth by coming in contact with them when given; but it
destroys the chance for good permanent teeth in many cases in which
it does not produce ptyalism. In some children before all the first set
are through they inflame, become loose and are removed. In these
children the succeeding teeth are sure to decay early, even before they
are fully grown. When the first teeth must be removed it should be
done before suppuration takes place.

Treatmsnt of Caries or Go.ngrene of the Teeth.— R^mo^Q the dead
portion from the living ; and, if practicable, the cavity should be filled
with gold, so as to exclude air and water. If the gangrene is super-
ficial it should be removed in the same w^ay, and the bony part polished^
If the bone is extremely sensitive beyond endurance, the cautery or
caustic should be passed over its surface.

Tooth-ache is a natural consequence of gangrene of the teeth. When
they are decayed so as to expose the inner membrane, it would be strange
if it did not produce pain, especially in a sanguine or nervous tempera-
ment. The pain is generally the effect of inflammation in the inner or
outer membrane. When it is slight some application may relieve it.
But if it involves the outer as well as the inner membrane, the relief
becomes more difficult, and extraction is the common resource. In all
teeth that have antagonists which meet and press upon them, the con-
tinued pressure keeps up the inflammation, and common "tooth-ache"
specifics prove to be only a piece of quackery.

The temporary teeth should not be removed too early. If they are
painful and decayed, remove them, as other teeth would be. If the per-
manent teeth begin to protrude in wrong positions from their places be-
ing occupied by the infantile teeth, the latter should be removed to
make way for them to come in their proper places.

The effect of heat and cold on inert bodies is to expand and contract
them. On living bodies like the teeth it is the same. Iron begins to
expand at 120° or 130° of the thermometer; the enamel of the teeth is
much harder, more compact and more liable to crack by pressure ; and
the location of the teeth is such, that the least expansion must produce
injury. They are firmly fixed in the jaw-bone which surrounds them,
and on each root is a membrane containing minute blood-vessels and
nerves, in which consists its life. Heat expands the tooth and presses
those delicate parts between two bones — the most certain way to destroy
them. When the vitality of any part is destroyed we expect it to de-

TOOTHACHE. 233

cay and enter into decomposition. The enamel is fractured by this ex-
pansion of the teeth which are firmly in contact with each other.

The effect of cold within certain degrees is less injurious to the teeth ;
and, if the change be not too sudden from great heat, and if it only ex-
tends from blood heat to 60° or 70° no injury can result from it. It is
even supposed to be beneficial.

Derangements of Digestion always exert a deleterious influence on
the teeth. Disease of the liver is often followed by speedy decay of
the teeth.

The use of acids, whether given in the treatment of fevers or eaten
in sour fruits are destructive to the teeth. The mineral acids are
the worst.

Negligence in the proper care of the teeth, leaving fragments of food
between them. Lavater, the physiognomist, says, there is one point
on which the admirer of his art cannot possibly be mistaken : " Who-
ever neglects his teeth, sufiering them to go to decay through indolence
or contempt of public opinion, may be safely pronounced an unhappy
character, with many evil propensities.''

Injuries hy Violence, — If the teeth are loosened by a blow or a fall
they should be immediately placed accurately in the sockets and
secured by ligatures ; the gums should be allowed to bleed freely; and
Arnica or Calendula in dilution should be employed till the inflamma-
tion subsides.

The effects of Mercury, — This deadly mineral is the most destruc-
tive of all the causes of diseases of the teeth. We have an immense
collection of cases before us which at this day need not be transcribed.
One author describes a case of a female under its use aged 27. " A
few of her front lower incisors remain, but they are loose and can be
removed by the fingers. A portion of the frontal and parietal bones
have been removed, about two and a half inches square. Ulcerations
cover nearly one half the head; the integuments which protect the brain
appear soft and spongy. At first view it would appear to be a case of
syphilis, but the attending physician assured me that it is the effect of
Calomel. And strange indeed ! he was trying to cure it with corrosive
sublimate P^ externally applied.

Another case from the same author, — "A young lady of nineteen
had been long confined with fever. I found the molar and bicuspid
teeth just ready to drop out of the lower and part of the upper jaw.
The alveoli nearly absorbed, as if the teeth had been extracted six
months before ; the teeth covered with a black oxyd of Mercury. The
medicine had been administered when she was lying on her left side,
a blister being on the right ; it had remained long in contact with the
teeth and gums.^"

* Dr. Crane, U. States Med. and Surg. Jour, Apr. 1836. p. 334. ~

234 DISEASES OF THE DIGESTIVE EUNCTIOl^.

The New- Yorh Med. Times (Sept. 1863^) complains of the populai
prejudice against calomel and steel when prescribed in "occasional and
appropriate doses " to cachectic children. The writer admits " that calomel
if given in excessive quantity will cause salivation, and that in profuse
salivation teeth are apt to be lost;" but he still maintains "that these
teeth are not necessarily unsound. Often they are not decayed at all."
They only drop out from "actual destruction of gum substance." We
think such arguments will not lessen the growing prejudice against the
allopathic use of mercurials.

Sym/ptoms of Mercicrius. — Tearing, shooting pains in the carious
teeth or in the roots of the teeth of the whole affected side; pains in the
head and face extending to the ear; painful swelling of the cheek and
submaxillary glands; salivation; pain worse in the evening or night;
aggravated by warmth of the bed, cool-damp air, or drinking any thing
cold; "teeth on edge;" they feel loose and too long, gums swelled,
blanched, ulcerated, discolored, readily bleeding ; itching, burning pain
as from excoriation*; nightly perspiration, vertigo, rheumatic pains in
the limbs ; peevish contradictory humor; tendency to shed tears; shiver-
ing, with redness of the cheeks.

In a case of caries occurring after small-pox, Hecker used various
medicinal compounds with success. Fortunately, says Hahnemann, "a
portion of Mercury was contained in each of these mixtures, to which
it may be imagined that this malady will yield (homoeopathically), be-
cause Mercury is one of the few medicinal agents which can produce
caries, as proved by the many excessive mercurial courses used for the
cure of syphilis, and even of other diseases." This metal which becomes
so formidable when its use is prolonged, on account of the caries of
which it then becomes the exciting cause, exercises, notwithstanding,
a very salutary homoeopathic influence in the caries which follows
mechanical injuries of the bones, some very remarkable instances of
which have been given us by J. Schlegel, Jordens, and J. M. Miiller.
Another kind of caries (but not venereal) has been cured with Mercury
by J. F. G. Neu, and J. D. Metzger.

jBeUadonna.—-'Fsim of neuralgic character in one side of the face;
the gums feel as if ulcerated ; drawing, tearing, shooting, excessive sad-
ness, tendency to shed tears, cutting pain in the teeth, face^ and "ears,
worse in the evening after lying down ; congestion of the head and
teeth ; gums hot and swelled, and teeth bleed on sucking them ; ery-
sipelatous swelling of the cheek ; salivation or dryness of the mouth ^
thirst ; aggravation in the open air, or on touching food, cold or warm,
to the tooth, which feels elongated ; heat and redness of the face : pul-
sations in the head or cheeks; worse at night; burning redness of the
ej'CS ; pain appears to be in several teeth ; glandular swellings ; spasms
and convulsions ; delirium in children teething.

TOOTHACHE. 235

Anguisli and inquietude Avliich compel constant change of place ;
pain in gums and teeth as if ulcerated ; boring in the carious tooth as
from congestion, itching vesicles, and burning ; renewal of the pains by
mental labor, or after eating ; heat and redness or the face ; pulsations
in the head or cheeks.

C^A^^m(9miZfc.-— Tooth-ache caused by abuse of coffee ; the patient
is irascible, and sheds tears diiring the pain, which is violent, jerking,
drawing or pulsative and shooting ; worse at night when warm in bed ;
hot swelling redness of the cheek ; gums shining, swelled ; submaxillary
glands enlarged ; pain occupying the whole of one side of the jaw, not
fixed to a single tooth; semilateral, shooting or pulsative pain in the
affected side of the head, ear and face ; pain aggravated by hot or cold
drink, especially coffee ; pain, heat and redness of one cheek ; hot per-
spiration ; agitation and tossing ; weakness and fainting ; teething, with
v/atery, greenish foetid diarrhoea; spasmodic symptoms.

Btajphysagria. — -The pains proceed from decayed teeth or from
stumps ; it extends to the head and ears ; the cheek is swollen but not
hot; pain excited by inspiring cold air or by cold drinks; worse during
or after eating, on touching the tooth, or only after midnight ; the teeth
become black and decay, exhibiting exfoliation; there are tubercles or
painful excrescences on the gums which are liable to bleed. It corres-
ponds in some respects with Sulphur.

xSi<^^Atw\— Chronic tooth- ache ; tearing, jerking, boring, stitching,
with or without swelling of the cheeks. The teeth feel loose and
elongated. Aggravation at night: the gums detached and diseased ;
they bleed freely ; cutaneous eruptions have in these cases been sup-
pressed by ointments or washes.'

PiolsatiUa. — The patient is of a mild, quiet, timid character ; the
pain accompanied with otalgia and pain in one side by the head ; it is
tearing, drawing, shooting, jerking, pulsative, or gnawing, with pricking
in the gums ; pains extend to the face and head, or eye and ear ; face
pale, head hot ; some shivering ; dyspnoea ; pain worse in the evening
when warm in bed ; or after midnight ; pain relieved in some by cold
water, aggravated in others.

Ilyoscyamios, — Violent tearing pulsative pain extending from the
cheek to the forehead ; swelling of the gums ; pulsation in the tooth ; pain
worse in cold weather, in the morning. Congestion of blood -in the
head, with redness and heat of the face ; spasms in the throat, con-
vulsive jerkings of the fingers and hands or arms; nervous excitability
redness and brilliancy of the eyes.

Aconite,— y^h^n the disease is excited by recent cold; there is fever,
and the pain is extremely severe ; lancinating shocks or pulsative pains
with congestion of blood to the head, heat in the face, redness of the
cheek, and great agitation. When the patient is subject to rheumatism,

236 DISEASES OF THE DIGESTIVE FUNCTION.

Colchicum and Rhus are successful alone or in alteration mill Aco-
nite.

Other remedies, are Iodine, Kali-hydriod., Nitric-acid, Phosphorus,
and Silicea : Iodine, and Kali-hydr. in scrofulous subjects who have
taken much Mercury :-— Nitric-acid in cases connected with syphilis in
the second and third stages: — Phosphorus and Silicea, in cachectic
and rachitic mdividuals. ,

Local Remedies.- — Creosote. — Caries of the teeth, commencing by a
small dark spot immediately under the enamel, which breaks down from
losing support; the central cavity and the contained vessels become
exposed. The only eifective treatment here consists in the reiterated
application of some highly stimulating specific. Camphorated spirit
has generally been relied upon ; Nitrate of Silver sometimes answers
well, mineral acids would do better but they act upon the surrounding
bone, destroy the teeth. Here Creosote alone will often be found
specific. It may be tried in cases of pure tooth-ache from exposure of
the internal membrane without inflammation of the periosteum. It
will generally answer to apply a small piece of cotton wet with Creo-
sote to the cavity, permitting none of the fluid to escape outside of the
tooth, as the caustic liquid causes a true hum wherever it touches the
cheek or gums. It is more easily applied to the lower than to upper
teeth. The Creosote does not exert any curative power over the
destructive caries of the teeth. It only alleviates the present symptoms.
(London^ Med, Ga^.j July 1838.)

Arsenic. — This is still more effectual than Creosote. It was formerly
my habit to wet a minute quantity of cotton on the point of a small
hook, and lay upon one side of the cotton a small portion of white oxide
of Arsenic. On inserting the cotton in the cavity of the tooth I
generally found the pain almost immediately arrested. Of later years,
noticing that the Creosote is likely to burn the mouth, I use the Ar-
senic as before, but instead of the Creosote I use some other less cor-
rosive fluid to wet the cotton. Tincture of Camphor, Aconite, Bella-
donna, and various other fluids have been tried with success. The Ar-
senious Acid or White Oxide of Arsenic is the best application I have
found, and has saved from extraction many a condemned tooth.

Nitrate of Silver, — When the tooth-ache is caused by a carious
tooth it may very frequently be cured by a piece of solid Nitrate of
Silver, as large as a pin's head, inserted into the cavity. It is imme-
diately dissolved by the moisture it finds in the tooth, it immediately
destroys the diseased nerve and the pain ceases. {Bulletin de Tlwrap.y
1860.) Both of the two last named remedies are strictly homoeopathic
in their action. When the pain is confined to a single tooth, the ap-
plication to the gum by friction with the finger, a saturated solu-
tion of cochineal, will usually arrest the pain immediately.

TOOTHACHE.

287

The treatment of tooth-aclie has always been empirical, but it may
be remarked that no remedy has e^er given relief that did not act
on the homoeopathic principle. All the local applications are of
this character, and only act by exciting a new and similar action
in the nerve of the decayed tooth to that which had been excited by
some other cause. Thus relief which was sometimes permanent has
been given by a drop of Arnica, Aconite or Belladonna tincture ap-
plied in the cavity of the aching tooth. Oil of Cloves, Camphor and
Oleum-carophylli, Gum-mastich dissolved in Oleum-terebinthinse, have
often succeeded. Boerhaave employed Camphor, Ol.-carophyl., and
Alcohol on Cotton. Better than these things is strong Nitrous-acid,
diluted with three or four times its weight of Alcohol. Camphor dis-
solved in Aqua-ammonia or Ether will often succeed, but none of these
agents are reliable.

Minor Opeeations on the Teeth. — Extraction of the temporary
Teeth. — ^When the temporary teeth are diseased they should not be un-
necessarily removed. If, however, the child is four or five years old,
and there is much pain or inflammation the ulcers threatening to injure
the other teeth, the diseased tooth may be carefully extracted with
the forceps.

Cutting the Gums to facilitate Dentition, — Make the incision to-
wards the external alveoli so as to avoid injuring the membrane and
sacs of the permanent teeth, particularly those of the incisores and
cuspidati. Those of the bicuspides are more easily avoided being
broader on the surface. {Blake on the Teeth))

Filing and Sawing the Teeth. — None of the purposes for which the
operations are performed can be effected by them. In place of these
instruments it is now recommended to use small crooked knives or
other cutting instruments which may be used with less injury to the
teeth.

Plugging the Teeth when carious. ^-—^Vy^ process may in some per-
sons preserve the teeth from ten to forty years; it may be done with
little trouble or pain. Pure tin is softer and may be worn better than
gold. But both tin and lead are corroded by acids. Gold is therefore
preferable and is not changed by any food or medicine except Mercury
when long continued.

Bleeding of the Gums after the Extraction of Teeth. — First wash
the mouth in cold w^ater, holding it for a minute in the mouth. If this
fails to stop the bleeding try a solution of Tannin, or other common
astringent, as Sugar-of-lead.

Tincture of Hammamelis, or Witch Hazel, or any other preparation
of Hammamelis that may be at hand, will almost certainly succeed.
Pond's extract can generally be obtained where others can not.

Dry flour of Wheat has often succeeded, when the haemorrhage was

288 DISEASES OF THE DIGESTIVE FUNCTION.

excessive, owing to some lisemorrliagic icliosyncracy. It may be packed
down dry into the cavity from which the tooth has been extracted, and
permitted to remain there. Soot wetter^ mentioned mider wounds^ may
be used with success where nothing better is at hand. For pain and
swelling, following the extraction of teeth, give Arnica, or Aconite and
Belladonna in alternation.

IlyosGyaimis.—^QY throbbing pain in the bone ^extremely severe.

Silicea,'—^(^Y swelling of the jaw followed by tedious suppuration.
It may be taken often, if given in low dilution ; if higher, a dose a week
is sufiicient in a chronic case.

Local AncBsthetics. — Dr. Fournier, of Paris, lately communicated to
the French Academy of Sciences a mode of produ.cing local anaesthe-
sia, consisting in what he calls chloracetization. He says : "If in an
apartment, the temperature of which marks more than 63° Fahrenheit,
the orifice of a thin glass phial, containing a quantity of pure crystal-
lizable acetic-acid, equal to one-fourth of its capacity, and an equal
quantity of chloroform be exactly applied to a healthy clean skin, not
deprived of its epidermis ; and if this phial be constantly maintained at
the temperature of the hand, a complete insensibility of that part, and
some of the deeper ones, will be obtained in five minutes, and at the
cost of a very slight sensation of pain. The vapors of acetic-acid and
chloroform mixed together and applied with a glass retort to a part
which it is intended to render insensible, the adjoining parts being pro-
tected by a diachylon plaster from the action of these vapors, may be
employed as anesthetics in all operations of low surgery, and in many
of the higher branches, in all cases where general anaesthesia may be
considered dangerous, or declined by the patient."

Mr. Richardson says, "immerse the affected part in chloroform, and
include in the part immersed as much of the adjacent structures as
may be required ; the plan consists in preventing the escape of chloro-
form by covering it with a cup, and thus intensifying its local effect."

The cup is about half filled with cotton-wool, which is then saturated
with a sufficient quantity of chloroform, generally from ten to fifteen
drops. The time within which local insensibility is produced varies
from seven minutes to fifteen. The local anesthesia is not in all cases
complete ; but even where pain occurs, the remedy will be found to
moderate it to a point within which it becomes perfectly tolerable, and
has lost the distressing agony of tooth extraction. As soon as insen-
ibility of the part ensues the cup should be removed, and the extrac-
tion immediately performed. Of sixty cases the remedy only failed in
twQ to mitigate the pain. In ten cases the local insensibility during
the extraction was complete.

Galvanism and electro-magnetism have been successfully emplo^^ed

TOOTH EDGE. — TARTAU. 239

in this city as local anaesthetics, both for the cure of tooth-ache, and
for the purpose of extracting teeth without pain.

3. TOOTH EDGE.— ODONTIA STUPORIS.

Darwin says, this disease is only an imaginary one, " first caused by
our biting the edge of the glass or porcelain cup in infancy, and
afterwards is re-excited by imagination alone." He says, to '' think
of it strongly or to see it in another, excites real pain in my teeth.''
This depends upon the reiterated motions in these nerves, that
were formerly disagreeably affected. The influence of the asso-
ciation of ideas in recalling disagreeable feelings formerly existing is
illustrated in the case of Baron Van Swieten, who once saw a putrid
carcase of a dog explode with putrefaction, and was sickened by it ; he
says, that several years after he travelled the same road, and the mere
recollection of it threw him into the same sickness and vomiting.

Tooth-edge generally caused by allopathic use of Mercury, or the
eating of acid fruits.

The following remedies have been recommended for this affection :
Berberis ; Capsicum ; Lachesis; Mercurius; Mezereum ; Silicia; Spongia;
Sulphur ; Sulphuric-acid ; Tartaric-acid ; Oxide of Zinc. Of these,
Mercury and the acids are perhaps most directly homoeopathic.

. The teeth feel dull. Phos. Sep. Zinc.-m.^^

The teeth feel dull as from acids. Mez. Phos.-acid.

The teeth are dull, painful when chewing. Sulph.

Dull teeth, afterwards stinging pains in the same. Ran., Seel.

The teeth are set on edge. Aeon.

The molares feel dull. Aur.

Teeth set on edge and insensible. Dulc.

4. ODONTIA INCRUSTANS.— TARTAR.

Tartar has generally been regarded as an accumulation of earthy
matter from the saliva. Its quantity depends on the natural or con-
stitutional state of the fluids of the mouth. In all cases its influence
on health as well as on the teeth is highly injurious. On its first for-
mation it is soft, and may be easily removed by a soft brush ; but it
soon assumes a strong hardness, increasing in quantity on the necks of
the teeth ; the gums are irritated and inflamed, the sockets and neck
of the teeth are next destroyed ; and the teeth, being left without sup-
port, are pushed out by the tongue aiid lips. In children it sometimes
increases so much as to cause separation of portions of the jaw, the
temporary teeth, and sometimes portions of the permanent ones.

Microscopic observation has shown that tartar is produced in the

* Jahr, Repertor}'. p. 417,

240 DISEASES OF THE DIGESTIVE FUNCTION.

same manner as Goral by ammalcute, resembling the Medreposa ogu«
lata. By aid of a solar microscope of strong power, we have seen them,
says Mr. Le Baume, " in a very lively state ;" and from the cellular
organization of the tartar we have no doubt of flie correctness of this
theory, which is confirmed by observations of Mr. Cooper of London.
Le Baume thinks that after the tartar, which like coral is a mere
nidus ^ adheres firmly to the teeth, the animal culae burrow in the teeth ;
and, by insinuating themselves between the teeth and gum, occasion
disease in both. But the secretion from them is often so offensive as
to contaminate the breath.

Treatment.— Many efforts have been made to find some acid, mineral
or vegetable, or other compound that will destroy the animalculse and
their habitation, but without satisfactory results. Le Baume thinks
that the true mnegar^ (not the pyroligneous-acid sold for it,) the most
effective. It promptly killed the animals and decomposed the concre-
tions, so that they were easily removed by a brush. The more powerful
acids did not answer. Let the true vinegar (Acidum Aceticum Verum)
diluted with rose-water, be applied to destroy the animalculae. After-
wards the local use of powder of the Areca-nut is better than charcoal
to prevent their re-formation.

Remoyal. — If it has become hard, cutting instruments must be em-
ployed to scrape it. carefully off, in such a manner as to avoid injuring
the enamel or gums. To prevent its return, use daily a stiff brush
with pure water, occasionally salt and water, tincture of Bark and rose-
water. The brush should be as stiff as will not injure the gums, should
be used every morning and generally after eating. There is no danger
of injuring the enamel by brushing. Tooth powders when used should
contain nothing that can act on the teeth, and should be completely
washed off. Artificial teeth need as much washing and brushing as
the natural ones or more.

Dr. Bowditch of Boston, after making microscopical observations with
tartar or animalcular deposit upon the teeth, found that soaps and den-
tifrices generally failed to destroy it; but the bland soap sold as
" Babbitt's Cytherean Cream" was effectual in dissolving it.

5. AFFECTIONS OF THE GUMS.— GUM-BOILS.

This name is wrongly applied to abscesses of the alveoli arid cellular
substance. Causes, Nearly always caused by the irritation of decayed
stumps, though Dr. Bell says, they occasionally occur " on the perios-
teum of sound teeth." The disease commences with inflammation of
the periosteum, which becomes thickened, and, of course, raises the root
from its socket so that it becomes loose and feels too long. The inflam-
mation then rapidly extends to the surrounding parts, causing swelling

DISEASES OF THE MAXILLARY BONES.

241

of the face with severe pain, and soon progressing to suppuration,
which is announced by occasional sharp shooting pains through the

part.

Tkeatmejset. — Removo the cause. Generally the root or diseased
tooth that caused the irritation is a foreign substance, the removal of
which in the early stage will effect a cure. If matter be already formed
it must be removed by a free incision near the stump that caused the
mischief. If the gums remain inflamed and spongy it indicates the pre-
sence of tartar^ which should be removed, allowing the gums to bleed
freely at intervals till they are entirely healed.

Bleeding of the 6^t^m5.— Carb.-v., Merc, Natr.-mur., Nitric-acid,
Phos., Phos.-ac, Sil., Staph., Sulph.

UlGeration of the 6^^m5.— Alum., Carb.-v., Kal., Lye op.. Mercury,
Natr.-mur., Staph., Sulph.-ac.

ExGTescent Gums. — Staph., Chlor-potash.

SoorbutiG . affections of the Gums, — Caps., Carb.-v., Natr.-mur.,
Nitr.-ac, Staph., Sulph., Arsen., Bry., Caust., Chlor.-potash, Creos.,
Mur.-ac, Sep.

AffeoUons of the Gums oaused ly Mercury. — Carb.-v., Chin., Hepar.,
Nitr.-ac, Staph.

Affeetions of the Gums caused ly excessive use of common Salt
Carb.-v., Spir.-nitr.

For persons who lead a sedentary life, or who are phlegmatio oi
PLETHOEio, Capsicum.

For persons who are lean and of a lively temperament: N.-vom.

11. Diseases of the Maxillary Bones.

The mucous membrane lining the large cavity in the middle of the
superior maxillary bones, is liable to several morbid affections. The
most important of these are: 1. Inflammation and secretion of pus.
This a true abscess which is commonly caused by irritation and ulcera-
tion excited by the penetration into this membrane of disease originat-
ing in a decayed tooth. The original cause of the disease in the tooth
may have been a blow on its surface ; a fracture, or the pressure of a
plug upon the nerve ; the irritation of food or other foreign bodies ia
the cavity, or extreme degrees of heat or cold.

1. Abscess of the Antrum, Maxillare. — When the pus formed in
the body of the tooth escapes outwardly, no effect is produced in the
maxillary antrum. But if the outlet from the tooth be obstructed^ the-
matter " oozes through the extremity of the fang, where the nerves and
vessels entered, and, coming in contact with the periosteum, it separates
it from the fang and a sac is formed precisely at the foramen/' This^
sac now continually enlarges until it bursts. " If the fang penetrates-

YoL. I.— 16-

242 DISEASES OF THE DIGESTIVE FUNCTION.

the antrum, the membrane of this cavity being always continuous over
the fangs, the pus is effused between the membrane and the bone, thus
forming a true abscess in the antrum. The pus now accumulates by
secretion/ from the surrounding parts until the distended membrane
bursts, and the pus escapes from the antrum through the duct into the
nose."— (i>r. Hullihen, West, Med, Jour, Jan. 1887. p. 835.)

When the fang containing pus terminates in the cells of the alveoli^
the distension of the sac produces great pressure on the surrounding
parts, the external, or thinner plate is absorbed, the ^ sac enlarges and
then bursts, effusing the pus between the alveoli and the periosteum,
and forming an "alveolar abscess." A fistulous opening thus "esta-
blished, remains as long as the discharge continues to be furnished from
the highly vascular membrane, w^hich lines the cavity of the offending
tooth ; and a similar discharge is kept up ii^to the antrum, which con-
tinues to irritate its lining membrane, which becomes more extensively
diseased. A constant discharge from the antrum into the nose may
thus be kept up for years; the functions of the membra-neare destroyed,
and ulceration of the membrane gives rise to small fungous granula-
tions, which may in time produce fungous tumors of the antrum
maxillare.

Besides the irritation of decayed teeth, abscesses of the antrum may
originate from violent blows on the cheek ; inflammatory affections of
the adjacent parts, and especially of the pituitary membrane lining the
nostrils ; exposure to damp and cold air; a blow on the under jaWj
driving the molar teeth upwards, may cause a fang to penetrate the
antrum. (See Cooper^ Siirg, Diet, p. 151. — Boyer^ Traite des Mai.
Ghir, tom. 6. p. 181. — Jourdain^ Abenethy^ Gibson^ &g.)

The first symptom of maxillary abscess is a pain which is at first
imagined to be a tooth-ache, and usually referred to a carious tooth
with which it may seem to be connected. The pain, however, extends
more into the nose than that caused by a tooth ; and it affects more or
less the orbit, the eye, and the frontal sinuses. The pain if not ex-
tremely severe is more obstinate in its persistence ; and its seat is soon
occupied by an elevated circumscribed hard tumor below the malar
bone. In some cases this is not visible, in others it extends over the
whole cheek, and ends in suppuration. In some again it communi-
cates with abscess within the antrum, and in others the matter makes
its way towards the palate, causing the palate bones to swell, and ren-
dering them carious. It may also be discharged between the fangs or
alveoli of the teeth, or through the nostril of the same side, when the
patient lies with the head in a low position and turned towards the op-
posite side. This discharge of the abscess usually takes place in three
or four days from its commenc'ement.

Purulent Secretion of the Antrum Maxillare,- — This disease origin-

DISEASES OE THE MAXILLAET BONES. 243

ates in an inflammation and closure of the nasal duct, which, by retain-
ing the mucous secretion of the lining membrane of the antrum within
its cavity, irritates the membrane and causes it to secrete a purulent
fluid. The usual exciting causes are, a blow on the nose, a wound in
the nostril, polypi of the nose, severe colds and ulcerations of the
pituitary membrane. " When the duct first closes no pain whatever is
experienced in the antrum, and indeed not until it hecomes jelled with
mucus; then the following are the most common symptoms: a slight
uneasiness in the antrum, sensation of great weight or pressure, after
which a dull deep-seated pain supervenes, followed by an acute pain
darting into the ear, over the eye, and in the direction of the frontal
sinus, accompanied by a greater or less degree of tumefaction of the
cheek." After the walls of the antrum have been for about one or
two months pressed upon by the accumulating secretion they give way
and the purulent matter escapes. This fluid is of a dark color, a slimy
consistency and the most offensive foetor. The disease progresses ra-
pidly along the bony parietes of the maxillary sinus, rendering the bones
carious, and resisting the treatment, which might be sufiicient for the
cure of ordinary abscess.

Treatment. — The treatment of abscess of the antrum maxillare con-
sists usually in little more than in extracting one of the molar teeth
from the affected side, and perforating the floor of the antrum to per-
mit the escape of the accumulating fluid. The sinus may then be
thoroughly Avashed out occasionally with some mild astringent or al-
terant solution to restore the parts to healthy action ; and the ordinary
means for the removal of local, infl-ammatory and ulcerative disease may
be employed.

The treatment of purulent secretion of the antrum is much more dif-
ficult. The discharge of the puriform matter is not effected by the ex-
traction of the teeth which seem most diseased ; the destructive caries
of the bone demands a surgical operation to remove the whole of the
offending part of the upper maxillary bone, and the general treatment
given under the section on Necrosis, (See Bones^ Diseases of,)

Fungous Tumors of the Antrum originate from ulceration of the
lining membrane of the antrum maxillare, as described under abscess
of that cavity. The ulceration, says Dr. Hullihen, ( WesL Jour, Med.
Sci, 1837. p. 339,) generally occurs in patches over the surface of the
membrane, and in time occasions a lesion of its vessels. At this stage
coagulations of a bright red color may be discovered in the fluid dis-
charged, intermixed with pus of thicker consistency. Small fungosi-
ties now sprout up from the ulcers, which, in some states of health
may remain for months without perceptible increase. '' But when
once these morbid affections become confined, should the slightest
irritation occur, their mushroom-like growth is astonishing. When

244 DISEASES OF THE DIGESTIVE FUNCTION'.

the antrum becomes filled with a fungous growth the cheek be-
gins to enlarge, and the symptoms resemble those of purulent secre-
tion; but it may be distinguished from that disease by discharge
through the nose and by the foetor peculiar to fungous affections.

Treatment. — Extermination is the common remedy for fungous tumors
of the antrum; and the whole morbid growth should be removed at the
first operation. The difficulty is greater in a second attempt than in
the first. The fungus will grow up again and again if the extirpation
be not thorough and complete. Homoeopathy has cured some Bad cases.

The mode of performing the operation recommended by Desault was
to " remove the molar teeth and their alveolar processes, corresponding
with the floor of the antrum, by a tooth-key or by two or three strokes
of a chisel and mallet." (See Gibson^ s Surgery, vol. 2. p. 16.) The
process devised by Dr. Hullihen is to perforate the floor of the antrum
through the alveolar cell left by a tooth previously removed. Through
the small opening made by the trochar, the tumor was found to fill the
antrum in one case ; and was so sensitive that fainting and convulsions
were excited by touching it. After some days delay, during which a
decoction of poppy leaves was repeatedly injected, the operation was
continued. The gums were removed by a scalpel, and the alveoli and
floor of the antrum were sawed out by means of a small saw. The
cavity of the antrum was thus exposed from the second bicuspid tooth
to the last molaris, the tumors were removed by scalpels prepared for
the purpose, and the haemorrhage was checked by the application of
the actual cautery to all the parts where the fungus was visible. In
this case the general health was bad, the fungus repeatedly grew up
and was repressed by successive applications of the actual cautery.
When it had ceased to grow, the cavity was frequently washed out with
fine soap and astringent injections ; in four weeks the cavity was en-
tirely lined with a new membrane. In another case the fungus was
permanently destroyed by the first application of the cautery. (For
Medical Treatment ^qq Fungus Hmmcvtodes)

3. Lower Jaw. — This "bone is said to resemble a horse-shoe and
is the largest bone that enters into the structure of the face. It con-
sists of the chin between the anterior foramina, the sides between these
holes and the angles, the angles and the rami or branches ascending
from them. It has five processes ; the two condyloid at the extremity
of the rami, placed obliquely transverse, separated by a cervix and
adapted to the glenoid cavity of the temporal bone with which it forms
a double arthrodial joint ; the two coronoid processes (from their re-
semblance to the beak of a crow) proje^cting upwards about one inch
on the front of the condyloid ; being thin its use is for the attachmeni;
of strong muscles ; lastly, the alveolar arch extending from the base of
one Qoronoid process to the base of the other, being broader behin'J

DISEASES OF THE MAXILLARY BONES. 245

than before, and serving to give insertion to the teeth. In each socket
for the teeth is seen a great number of small holes for transmitting the
vessels to the alveolar periosteum, which is a membrane, common to
the fangs of the teeth and their sockets. We find one transverse ridge
called the symphisis menti, and some other small eminences within
and without the bone.

No trace of suture is found in the alveolar arches, either in man or
animals. An important fact to be remembered when we speak of the
simultaneous growth of these processes with the teeth. This bone is
liable to be broken in preternat&ral labors, fractured by blows or falls,
but never by the extraction of the teeth, even of children ; for in them
the roots are much shorter, and the proportions which the sockets
bear to the jaw is so small that no dangerous power can be exerted over
it, in the performance of the operation. In accidents of this kind, two
more teeth are often thrown half out of the socket.^

The inferior maxillary bone varies in shape at different periods. In
childhood the angles are scarcely perceptible, and the rami nearly on
a line with the body of the bone. With the increase of the body and
augmentation of the bone, teeth are added, until that period arrives at
which decomposition equals deposition or when the nutritive matters
no longer exceed the excrementitious. Now the body stops growth,
and the bone has its full size.

The bone does not retain its full size to the age of decrepitude, but
returns slowly towards the form.it had in childhood. It shrinks to
one half its size; the coronoid processes fall back; the bone appears
to increase in length ; the chin projects more forward, the sockets be-
gin to perish by a new action ; and the teeth, no longer supported, are
necessarily thrust out. It is vain, therefore, to think that the teeth
might be kept to old age. On observing the jaw-bone of an old man
we see that the absorbent vessels have had the ascendancy and con-
quered the depositing or secretory vessels. It thus seems that nature
has declared that the food of the declining man shall be the same as
that of the child."^

The temporo-maxillary joint is composed of ligaments, cartilages,
fibro-cartilages, synovial membrane. These condyles are covered with
cartilage, so also are the glenoid cavities lined with them, and inter-
posed we find the fibro-cartilage which serves as a friction wheel.
These surfaces are kept together by three ligaments, the temporo-
maxillary, the external, and the internal. There is no connection be-
tween the upper lining cartilage which is developed downwards over
the upper surface of the intermediate cartilage and the lower one which
invests its lower surface and attaches to the condyle, unless the fibro«
cartilage is so worn as to have a hole in its middle.
"~""^ " * Dr. Stout^ U. S. Med. Surg. Jour.

246 DISEASES OF THE DIGESTIVE FUNCTION.

The posterior surface of the fibro-cartilages hang very loosely at
their back parts and are full of holes for the transmission of vascular
twigs* The lining cartilages are connected to the entire articular, and
the whole are covered and kept in situ by the temporo-maxillary w^hich
covers them as a cap, and is hence called the capsular ligament. On
the inner side of this ligament are attached tAvo small glands which se-
crete the synovia to lubricate the joint, and which is forced out in great
abundance during its action by the pressure exerted on them.

The natural motions of this joint are : elevation and depression, pro-
jection and retraction, and lateral action. In the carnivora, as the lion
or tiger, the action is confined to opening and shutting; the locking of
their huge teeth preventing any other motion. In the rodentia, as the
rat or the beaver, we find the action limited to projection of the lower
jaw forward and retracting it backwards. In the herbivira, those which
chew the cud, the grinding is provided for by large pterygoid muscles^
In man, who is truly omniverous, we find the combined action of the
three classes.

Diseases of the Lower Jaw, — 4. The articulation is liable to
disease from injiammation^ caused by the use of Mercury in scarlatina ;
and it often ends in permanent immobility of the joint.

The treatment consists in opening the mouth forcibly and dividing
the cicatrices; the patient must then exercise the jaw by feeding on
hard biscuit. Ineffectual attempts have been made by surgeons to in-
troduce instruments to force open the jaw after sawing off most of the
teeth which had to be replaced by an artificial set.

6. Luxation of the Lower Jaw. — Partial luxation of the joint-
In this case the jaw is thrown to one side by exerting great power in
extracting a tooth : one of the condyles thus becomes engaged and
thrown forward on the temporal ridge. The accident is rather rare :
the mode of reduction is the same as in

Dislocation or Perfect Liixaiion. — This occurs in persons of lax
muscular fibre, and sometimes from gaping, or blows; when it happens
the chin projects ; the teeth of the under jaw are in advance of the
upper teeth : the saliva dribbles, and the patient is unable to speak.

Treatment.— Press the rami downward and backward, and elevate
the chin. Another method is to insert a stick between the teeth and
then knock the chin upwards. Mr. Fox says he succeeded with an or-
dinary ruler.

6. Fracture of the Lower Jaw, — The existence of fracture is ren-
dered evident by the crepitus heard and felt by gently rubbing the
broken ends of the bone together. To remedy the accident, keep the
teeth of the two jaws asunder by inserting a piece of cork which will
enable the patient to be fed. Then co-aptate the parts and apply an
appropriate bandage. The teeth should be re-placed and the patient

DISEASES OF THE MAXILLARY BONES, 247

confined to a fluid diet, then wait four weeks for union. If the bone is
broken in two places, after fixing the cork, wet a piece of paste-board,
place it externally, and apply the bandage ; and if inflammation oocurs
about the teeth, give Aeon., and bathe with Arnica.

7. Caries of the Maxilla Inferior, -^Dv, Markwick gives* the case
of a clerk aged twenty-three, who had suffered nine years ago from
tooth-aohe and swelling of the gums ; in after years the cheek swelled
and abscesses formed, bursting sometimes externally, and not healing
perfectly. On Jan. 18th 1860, there was " on the right cheek corres-
ponding to the bicuspids of the lower jaw of that side a red shining
spot which had become adherent to the jaw, with a fistulous opening in
its centre ; and through this a thin whitish matter and sometimes saliva
was discharged. Within, the cheek was firmly united to the bone of
the jaw. Pain in the cheek and in the corresponding teeth, which are
decayed." Merc, sol 6, is given three times per day.

After twelve days the discharge had ceased, but the opening was not
healed, though he was free from pain. Mer. 12, twice a day.

Fourteen days after the fistulous opening had healed ; the patient
was quite cheerful. Gave Sulphur 80, one dose at bed time.

A week later there had been a burning pain in the cheek. Arse-
nicum 12. This relieved the burning. A fleshy painful growth now
occupied the fistulous opening. Merc. 6.

A week later, there was suppuration, fluctuation, burning and itching
in the part. Phosphorus 6.

After two weeks the ulcer had healed. He had two teeth extracted,
and for three days he had ofiensive rusty discharge from the alveola,
tasting like iron. From this the ulcer healed and he continued well
for five months. At the end of which, or

Oct. 20th, the pain returned, the cheek indurated and adherent.
There was suppuration again, after which, while using Silicea 12, it
was better, Silicea 18, was continued for about three weeks, then Sili-
cea 30. Under this he attained to good health.

Case hy Dr. Ilelmuth: — A child, aged nine months, presented an
opening immediately under the left eye, with a sinus running on the
outer face of the superior maxillary bone and opening beneath the upper
lip a few lines from the frsenum ; on passing a probe through the open-
ing, it distinctly felt carious bone, and it was proposed to lay open the
cheek by an incision, take away the diseased mass with a scoop or
chisel, and afterwards prescribe the usual medicines. The parents ob-
jected, and medicines were prescribed. Aurum-mur. 6, one powdei
every night for a week, then omit all medicine for one week:
follow this by Gale are a-carb. 2, a powder every night for a week. So

* Brit. Journ. Homceop., 1861, p. 523,

248 DISEASES OF THE DIGESTIYE ETJNCTION.

continuing in alternation, allowing seven days between the administra-
tion of the different medicines. This course was pursued for about
three months ; in which the child was perfectly cured.

III. PTYALISM.

1. Ao%ut6 Ptyalism. (Greek PtyalisTUUs, to spit.) Salivation or in-
creased flow of saliva from the salivary glands. \t is seldom seen as a
natural disease; and then it is easily cured by the following remedieSj
which have so often caused a similar state :

2. From Meroury. — Salivation, or ptyalism, is regarded as a local
indication that the system is under the influence of Mercury. The
name salivation refers to the most common symptom of this state, in-
creased flow of saliva. The following is the description of an extremely
severe case, one which has been quite common within a few years past-
" tumefaction and ulceration of the gums, the tongue swollen to such an
extent as to hang out of the patient's mouth, and incapacitate him from
either eating or speaking ; the salivary glands enlarged, very painful
and inflamed, and from four to five pounds of saliva dribbling away in
twenty-four hours ; the breath horribly foetid ; the inside of the cheeks?
the fauces, palate, and tongue ulcerated and even gangrenous ; the al-
veolar processes attacked by necrosis, with exfoliation of dead bone and
loss of teeth, leaving the patient, if life is spared, a hideously mangled
spectacle. In this group of symptoms several diseases are portrayed :
Inflammatio]^ of the salivary glands, or mitrnps j ulceration of the
cheeks going on to grangrene, or gangrenopsis, ulceration of the throat,
and those fearful cases of inveterate syphilis, in which the bones become
affected. Dr. Wood recommends Mercury in chronic cases of mumps.
[Praot Med,Yo\.22^^, 4zQd) Dr. Churchhill quotes Dr. Duncan, to
show that great benefit follows the use of Mercury and chalk, in gan-
grene of the mouth. {Diseases of ChUdren, Chiorchhill^ p. 489.) In
secondary ulceration of the fa,uces, tongue, &c., of a venereal character,
Mercury, in one form or other, is recommended by the majority of
surgical writers.

Iodide of Potassium produces salivation very similar to Mercury.
Iodine has been employed as a remedy in mercurial salivation,

8. Chronic Ptyalism, — Dispensary Case.— A man, aged 80, has
suffered greatly from soreness of the gums and salivation for several
months. He has not been under Mercury at any time to his knowledge^
He has taken some remedies without benefit. He was cured in a few
days with Merc. Cor. 8°.

The local use of Mercurius-corros., is very effectual m curing spon-
taneous ptyalism. Dissolve two grains of the second trituration in a
pint of water simply taken in small quantities as a wash for the moutl\

PTYALISM. 249

will cure obstinate cases whicli had resisted long courses of treat-
ment.

Tartar-emetiG produces inflammation of the mouth and of the
mucous membrane of the tongue, and buccal surface, violent salivation,
dysphagia. The lips are swollen and in places excoriated.

Dr. Maxwell advises Tartar-emetic in cases of ptyalism to be given
in repeated doses in warm water, so as to keep the system fully under
its influence, and the action to be assisted by warm diluent drinks^

It is also appropriate in vesicular and pustular eruptions within and
around the mouth, and in swellings and excoriations of the lips. High
dilutions should be given in such cases.

Nit/riG-aoid.—'EQdidiOQ^ and other English physicians found Nitric-
acid of great utility in salivation and ulceration of the mouth occasioned
by the use of Mercury. Hahnemann says, " it never could be useful in
such cases if it did not of itself excite salivation and ulceration of the
mouth. To produce these eifects it is only necessary to bathe the sur-
face of the body with it, as Scott and Blair observed.

Iodide of JPotassium.— This article is known to be capable of caus-
ing salivation similar to that of Mercury; and it has even been employed
in the old school as a remedy for the latter affection.

Other remedies are: Bell., Calc, Canth., Colch., Dulc, Euphorb.,
Hepar., lod.. Lack, Nitric-acid, Op., Sulpli.

JVitro-rnuriatio-acid increases the salivary flow, but does not
like Mercury cause mortification of the gums, except it be applied in
full strength and in large quantity. In dilutions it cures excessive
flow of saliva, tenderness of the gums, contaminated breath. It has
been thought to owe its properties to the chlorine only.

4. Morbid Scdiva. — Alumina.-— Case by Dr. Schleistcher. — Mrs. S.,
over 90 years old, a thin, but hale old* lady, after a severe altercation,
got a salty taste in her mouth, not relieved by anything she tried. I
found the lips pale red, the mucous membrane of the mouth and tongue
grayish white, as if macerated in vinegar, fauces pale and dry, saliva
tough, inspissated, in small quantity and of salty taste. Chewing and
speaking increased the secretion of saliva; water, kept in the mouth,
got the salty taste right off. Deglutition was difficult. Appetite good,
but food had no relish. Thirst great for cold water. Bowels moved
every four or five days, hard, lumpy; sleep restless, and head disturbed
for want of sleep ; pulse fifty-eight and small. Carbo 6, brought no
relief, but Alumina 6, five pillets every four hours, cured her entirely
in about two weeks.

5. Fcetid Odor of the Mouth,— This is commonly a symptom " of
some disease which must be cured before this symptom will cease.
When its origin is obscure, we may give as constitutional remedies i
Sulph., Arsen., Cinnabar, Nux-vomica, Puis., Sepia.

250 DISEASES OF THE DiaESTIVE FUNCTION

When there has been abuse of Mercury, the best remedies are:
Nitric-acid, Aur., Carbo-veg., Sulph., Lach., Arnica, Hepar, lod.-mer.

Bad smell of the mouth with foetid taste : Agar.

Fetid smell from the mouth like old cheese, Aur.-foL, Kali-carb.
Kal-chlor.

Smell sometimes like garlic, sometimes putrid. Petrol.

Smell of mouth as of pitch or cedar. Canth.

Metallic smell of the mouth. Berb.-v.

Smell as of clayey earth. Mang.^

6. Salivary Fistula. — This is generally found in the neighborhood
of the duct of the parotid : the course and termination of this canal
should, therefore, be carefully studied. Horiier^s Operation : " The
fistulous orifice should be first slightly elongated by a simple incision
made in the line of i]iQzygomatiGusmajormvi^G\Q : then the patient's head
being firmly supported by an assistant, who also holds a broad wooden
spatula against the inside of the cheek opposite the fistula, a sharp-
edged punch, like that used by saddlers, and large enough to excise the
whole fistula, is pressed firmly against the cheek, so as to remove the
diseased portion entirely, and at the same time to open the duct afresh,
and afford a new avenue for the escape of the saliva into the mouth
The external edges of the wound are now to be accurately closed by
the twisted suture, and the* cold-water dressing is to be applied, and
union is accomplished."

7. Salivary Concretions within Stenson^s Duct — These are white
friable, and either round, oblong, cylindrical, or ovoid, in size varying
from that of a millet-seed or a pea, to that of a hazelnut. They may
be single or very numerous, (twenty or more.) They are composed of
phosphate and carbonate of lime, held together by animal matter, and
give rise to obliteration of the ducts and great dilatation, consequent
upon the accumulation of the secretion. [EoTcitanshy^ Vol. 2, p. 142.)

Bilious Derangements of the Stomaoh. — The principal remedies
are : Bryonia, Nux-vom., China, Coloc, Puis., Sulph., Arnica, Arson.

General Remedies foe Affections of the Mouth. — Arsenicum,
Aphthge ; tongue hlach^ Irown^ Uue or red; boring pain ; cancer of the
tongue; tongue white, coated, cracked ; dryness of the mouth and
tongue^ with thirst ; inflammation of the tongue and mouth ending in
gangrene ; numbness of the tongue ; paralysis of organs of speech :
accumulation of saliva altered in quality to bitter, bloody ; offensive
smell from the mouth ; speech affected by inflammation of the organs;-
slowness or rapidity of speech ; swelling, ulcers of the tongue.

'Mercurius, — The tougue feels as if burnt : white, black or slimy thick
(^.oating on it ; mouth dry, bleeding ; tongue swelled, hanging out, sup-

* Jahr, Eeper , p. 447.

PTYALISM. 251

purating; hard, iiiflamedj moved with difficulty ; feels numb and rough
ptyalism ; ranulu ; saliva altered, acrid, foetid ; saltish taste ; offensive
smell from the mouth ; putrid smell ; palate, tongue and gums sore ;
swelled, ulcerated ; speech alte^;ed, hurried, stammering.

Mercury^ Abuse (^1— Aurum, Bar.-m.^ Bell,^ Calc, Lach., Sil.

Lachesis.—Khu^Q of Mercury ; difficulty of speech ; he is liable to
bite his tongue ; tongue shining, black or brown, burning ; rigid ; cancer-
like pain ; mouth and tongue dry, with thirst; froth at the mouth;
tongue swelled, hanging out ; inflamed tongue and palate ; accumulation
of saliva and mucus : paralysis of the organs of speech, tongue, &c.
Ptyalism after Mercury ; mouth and palate sore ; speech difficult, in-
distinct, confined to single words, suppressed, or hurried stammering ;
according to the degree of inflammation or paralysis of the organs ;
ulcers on the palate.

Belladonna. — Cracked tongue ; white, slimy coating on the tongue ;
it feels cold, or dry, heavy, inflamed ; mouth dry, with thirst ; froth at
the mouth ; bleeding.; palate swelled, velum enlarged ; abuse of Mer-
cury ; ptyalism ; the tongue moves with difficulty ; accumulation of
mucus, speech suppressed by paralysis or swelling of tongue, &c. ;
tongue red, rough, saliva accumulated ; tenacious ; thick, viscid smell
from the mouth ; sore mouth ; dumbness, or hurried altered speech
nasal twang, &c., caused by inflammation or spasm of the organs
stammering.

Aconite, — Spitting of blood ; burning in the tongue ; dryness of the
mouth and tongue, with thirst; inflammation of the mouth, palate,
velum palati, tongue ; accumulation of saliva ; defects of speech from
inflammation of organs ; stammering ; stinging in the tongue.

Nux-vomica, — Aphthae : tongue black, blistered, broAvn, burning,
thick coated, slimy, white, or yellowish, cracked, dry, heavy, red on the
margins, sore, swelled, ulcerated.

Palate blistered, sore, swelled, ulcerated.

Mouth dry early in the morning or at night, without thirst; bleeding
from the mouth ; inflammation of mouth, palate, velum palati, opening
the mouth with difficulty.

Mucus, accumulation of; smell from the mouth after eating.

Paralysis of organs of speech ; ptyalism at night ; accumulation of
saliva, altered in character ; speech difficult from paralysis and inflam-
mation ; stammering.

SuljyhitT. — Aphthae : blisters ; spitting of blood ; bad smell from the
mouth.

Tongue brown, burning, coated white or brown, slimy, thick ; cracked,
dry in the morning ; margins rough.

Mouth dry in the morning, with thirst; peeling off of the skin;

252 DISEASES OF THE DIGESTIVE FUNCTIOK.

'ptyalism after abuse of Mercury ; accumulation of saliva ; frotliy, salt,
or sour.

Defects of speech, difficult, organs of speech inflamed; stammering.

Remedies in Affections of the Fauces in general. — Alum, Bell.,
Carb.-veg., Ignatia, Lachesis, Merc, Nux-vom., Phos., Puis., Sulph.

IV. DYSPHAGIA.

(From Greek, cZys, with difficulty, and jphago^ to eat.) 'Difficulty of
deglutition. Five different forms of this disease have been described.
We will collect some observations of value on the following:

1. Dysjphagia from 7}ieohaniGal Injury of the (Esophagus. — The
effort to swallow hard and imperfectly masticated food, may result in
injury to the texture of the oesophagus. This tube is composed of in-
ter-twined fibres plaited together in a way that permits considerable
distention ; but distention carried too far and too often repeated causes
disease of the oesophagus, and this is attended by many symptoms
common to dyspepsia. A prominent one is pain in the centre of the
back and of the chest, which is distressing among the other anomalous
symptoms felt by dyspeptics. This, repeated swallowing of hard ill-
masticated masses of food may cause in unhealthy cachectic persons
a thickening of the lining membrane of the oesophagus, which often
ends in permanent stricture and difficulty of swallowing. Dysphagia,
when proceeding to its ultimate result, produces death by inanition, the
passage to the stomach becoming closed. When disease had proceeded
to a dangerous extent, Dr. Epps in one case condemned the effort to
force down solid food. He advised to " let it alone, subdue the excite-
ment and anxiety ; the oesophagus will not unlikely act upon the food,
and if not digested, it will so far act upon it as to dislodge it" or enable
it to pass gradually into the stomach, with the aid of pressure of soft
food. {Consti2:)atio9i, &,G,, p. 29.)

The effort to force foreign bodies down the oesophagus into the
stomach induces perpetually -recurring spasmodic action of this mus-
cular structure; and this contraction is only overcome by force, for
which an instrument is used. The forcing efforts persisted in, often
cause closure of the oesophagus, a condition ending in starvation.

Case iy Dr. Epps.- — An intelligent lady swallowed a fish-bone, which
she felt only half-way down to the stomach. A surgeon made persistent
efforts to push it dow^n. Her countenance indicated intelligence, but
the eye had an anxious brightness, indicative of fearful changes going
on in the system, caused by the deficient supply of food. The lady died
from the injury of the oesophagus, occasioned by the efforts to force the
hard substance into the stomach.

Foreign Bodies in the Throat. — When the effort is made to swallow

DYSPHAGIA* 253

substances too large or solid, and it lodges in the throat or oesophagus,
it is desirable to learn what the substance is. The effort first is to
compel the patient to throw it out by beating him on the spine between
the shoulders, or by tickling the throat with a feather, or by putting
snuff on the tongue. If the object' has passed too far down to be seized
with forceps, and its nature is known, it may be pushed down into the
stomach. A small gum-elastic tube, oiled, may be passed back into
the throat; its presence near the glottis excites it to close, at the same
time the patient makes an effort to swallow and the end of the tube
passes at once into the oesophagus. It can now be gently pushed down-
ward, giving no uneasiness till it touches the foreign body. If this be
soft or smooth or soluble it is easily disposed of; if it is hard or rough
it may still go down slowly, if aided by the swallowing of oil or butter.
After it has passed into the stomach there is sometimes a feeling of
something sticking there, but this soon subsides.^

When the pain is violent, with retching, great anguish or spasms, im-
mediate efforts must be made to bring up the irritating substance. A
violin string, or a fine wire may be bent at the middle into a loop. This
may be pushed down with the end of a whalebone probang made per-
fectly smooth, or with the smooth gum-elastic tube. If it get below
the point of obstruction it may b^ng the object up when it is with-
drawn.

2. Dyspliagia from Nervous Irritation,— -Thi^ disease generally
occurs in " young women of an excitable nervous system, with leucor-
rhosa, or painful menstruation and impaired digestion." The strongest
language was used by these patients to express their inability to
swallow, and they showed the greatest unwillingness even to attempt it.*|

Diagnosis,— lilhi^ is made out from tbe general symptoms and history
of the case. There is, in cases purely nervous, no emaciation ^ ih.^
attack comes on suddenly from slight cause, as a " nervous shock or
slight catarrh;" there is considerable nervous excitement but no pain.
In cases dependent on serious organic lesion there is progressive ema-^
ciation from an early period till the termination of the case.

A case is reported by Dr. B. P. Joslin, jr., which commenced with
symptoms of a purely nervous character ; but which afterwards pro-
ceeded to a fatal termination after a regular course of emaciation and
protracted suffering. This patient at first (1856) complained of
"choking in the throat," gastric irritation and a feeling of nervousness ;
there wa,s difficulty of swallowing, partially by Nux 6, MercuriuSj
Pulsatilla, Ignatia, Belladonna, and Natrum-muriaticum. After death
which occurred after three years of suffering, dissection revealed a tumor

* Bering.

t Diseases of the Alimentary Canal, by Dr. Habershon.

254 DISEASES OF THE DIGESTIYE FUNCTION.

an inch in lengtli, " hard and solid with numerous spiculas of bone
projecting from it. It was situated just above the bifurcation of the
trachea, inclining to the right side." Connected with the tumor was
^ a cardiac branch of the pneumogast^io nerve. The tumor had caused
the difficulty of deglutition, not by pressing on the oesophagus, but by
nterfering with the functions of this nerve."^

Dysj)hagia from Spasmodic ConstTietion of the Pharynx. —
Hyoscyamus. — Several authors observed it to produce spasmodic con-
striction of the throat with inability to swallow^ in a very high de-
gree. A similar case was cured by Withering with this article. {Edinb,
Med, Com,, Dec. 11, b. VI., p. 263.)

CoccuLTJS. — Case by Dr. Helmuth.-— A woman had been unable to
swallow either food or drink for some time and was absolutely in a state
of starvation. Partly deserted, and partly given over by former physi-
cians. There was stricture of the upper part of the oesophagus ; and
she was near dying from exhaustion. I dilated the stricture sufficiently
to allow the passage of a flexible tube into the stomach and injected
about a pint of weak chicken broth into the viscus. This was several
times repeated, at intervals. She immediately revived, and each day
I introduced a larger probang. For several days the dilators were con-
tinued without finding dilation mbre easy. As soon as she could
swallow at all I administered Cocculus and Nux-vom., and occasionally
Arsenicum, Gal.-carb. The results produced by these medicines were
surprising. The administration of the Cocculus in particular was al-
ways followed by the best results.f

Dysphagia is sometimes a cause of apoplexy. Food does not descend
instantly to the stomach, but is gradually and slowly carried downward
by " a kind of spiral gyre-like action of the gullet itself. The diameter
of the oesophagus gradually lessens as it nears the stomach :" It is im-
portant also to note that "the aorta lies close to the gullet, and this
explains why apoplexy so often follows upon the taking rapidly of large
quantities of food at public dinners." Swallowing in haste, there is
not time for the oesophagus to empty itself, and it becomes distended ;
a pressure on the surrounding parts takes place; the flow of blood
through the aorta is impeded ; this impediment causes the vessels in
the overworked and weakened part of the brain to become ruptured ;
effusion of blood takes place ; and, after some hours of stertorous breath-
ing, the patient dies. The case is regarded as one of death from apo-
plexy, though it is really death from over-distention of the oesophagus
and might have been averted by eating more slowly." {Dr, JEpps)

General Remedies for difficult Deglutition, — Agon., Alum., Ambr..

* Amer. Horn. Rev., Vol. 2, p. 314.

t American Horn. Review, Yol. 2, p. 114.

MORBID THIEST.

255

Ammon., Argent., Arsen., Aur.-nl., Baryt., Bell., Brom., Bry., Canth.,
Carb.-v., Omts,^ Cham., Cliinin, Oic, Con., Cupr., Dros., Fluor-ac, Hep.,
Hyos., Igk., Ip., Lack., Nux-vom,^ Puis., Rhus., Sepia, Steam., Teucr,^
Tart. -em.

Dysphagia often remains for weeks and even months as an effect of
diphtheria. Not unfrequently the muscles of deglutition and of arti-
culation become paralyzed during the progress of the malady, and the
patience of both patient and physician is severaly tried before recovery
takes place.

IV. MORBID THIRST,

Thirst is rather a symptom of many diseases than a disease itself.
It is only when it becomes excessive that it is regarded as a mani-
festation of disease. The desire to drink at reasonable intervals and
in sufficient quantities to supply the body with the necessary amount
of fluids is rather an accompaniment of health than of disease.

Symptoms. — Thirst consists of a feeling of dryness, heat, and con-
striction, in the back part of themouth, pharynx, oesophagus, and some-
times the stomach. When thirst has continued for a short time, these
parts swell, become red : the mucous secretion ceases almost entirely ;
that of the follicles changes, becomes thick and tenacious, the flowing
of the saliva diminishes and its viscosity is sensibly augmented ; there
is now inquietude, general heat ; the eyes become red, the mind is
troubled, the circulation is quickened ; respiration is laborious ; the
mouth is opened wide, in order to bring the external air into contact
with the irritated parts, thus producing momentary ease.

1. The causes of the development of thirst in an inordinate degree
are such as have diminished the amount of watery fluid in the blood;
when the atmosphere is peculiarly dry; when the body has been losing
undue quantities of fluid ; excessive fatigue ; eating of salt food ; all
other causes of febrile disease. Some persons have had such extreme
thirst as to drink from forty to sixty pints of liquid in twenty-four
hours.

Ali Bey in his travels through the deserts of Morocco thus describes
the

Symptoms of Egocesswe Thirst — " An attack of excessive thirst
is perceived suddenly by extreme aridity of the skin; the eyes appear
to be bloody; the tongue, and mouth, both within and without covered with
a crust about the thickness of a crown piece ; this crust is of a dark
yellow color, of an insipid taste, and of a consistence like the soft wax
from a bee-hive. A faintness and languor takes away all power to
move. A kind of knot is felt in the throat, and a stricture in the dia-
phragm, attended with great pain which interrupts respiration. Some

256 DISEASES OF THE DIGESTIVE FUNCTIOK.

wandering tears escape from the eyes; and, at last the sufferer drops
down to the earth, and in a few moments becomes unconscious of his
situation and of all around him. These were the symptoms I witnessed
in my fellow travellers, and which I experienced in myself."^

The following Remedies ha/ve relation to excessive thirst.

Desire for cold water. Arson., China., Eup.-per., Lob el.-card., Ruta.,
Sabad., Zinc.-m.

Great desire for cold drinks. Angus., Dulc, Euphorb., Ledum-pal.

Thirst for cold drinks, particularly water. Merc-sol.

Great thirst for cold water, with heat and dryness of throat
Carb.-am.

Great thirst for cold drinks in the evening, without heat. Bism.

Unquenchable thirst, particularly for cold drinks. Verat.

Great desire for cold drinks without heat. Bell.

2. Loss of Thirst— Arsen., Bell., Ferr.-acet, Ledum.-pal., Puis.,
Sep., Sassap., Tab.

No thirst for many days. Mang.
No thirst. Lycopod,, Natr., Sulph.
No thirst for four days. Cycl.
He drinks less than usual. Staph.

No thirst or else it is excessive.

Oaraph.
Absence of thirst, with heat in the

whole body. Hydroc.-ac.

V. DERANGEMENTS OF DIGESTION.— LIMOSIS.

1. ANOREXIA.— Want of Appetite. See Dyspepsia:

2. BULIMIA.— Piames Canina. Morbid Appetite.

A disease in which the patient is affected with insatiable and perpetual
desire of eating, beyond the wants of the system. It sometimes
amounts to simple indulgence in excessive quantities of food. It may
be attended with apparent good health, but it ultimately leads to ple-
thora, disorder of the secreting functions, apoplexy or paralysis. It
is often a symptom only of certain morbid states of the digestive
organs.

Causes. — 1. Remote : Hereditary predisposition ; the habit of eating
too much and without mastication. The American Indians frequently
excite it in this way ; chronic debility from obstruction of the mesen-
teric glands, liver, &c., suppression of chronic eruptions, old ulcers, &c.

2. Immediate : Concentration of vital energy in the stomach ; the
nerves becoming more sensible and muscular coats more irritable ; and
leading to increased secretion of the gastric-fluid ; this causes the sen-
sation of extreme hunger; and the food taken into the stomach is
rapidly dissolved, and pressed forward into the duodenum. The con-
centration and exp.enditure of vital energy is followed by torpor, debi-

* Wonders of the World, by 0. 0. Clark, p. 251.

DEEANGEMENTS OF DIGESTION. 257

lity, and a sense of faintness ; abstraction of vital influence from the
brain and heart ; imperfect assimilation ; irritation of the digestive sur-
face ; impure state of the blood. [Cojpland^ vol. I. 121.) Exhaustion
from habitual discharges, the state of pregnancy, rapid growth
onanism, &c.

Pathology.— Inordinate distention of the stomach and duodenum
vascular, corrugated state of the mucous surface ; hypertrophy of this
organ, or flabby, softened state of its coats ; dilatation of the oesophagus.
We have seen one case in which the degree of emaciation was equal to
that in the last stage of phthisis ; though very large quantities of food
were demanded. A stricture of the oesophagus near its lower extre-
mity prevented substances swallowed from reaching the stomach and
the oesophagus became distended to a large size. When about two
quarts of solid and liquid food had been forced into the oesophagus the
patient poured down after it a quart or two more of water; and, by some
peculiar muscular efibrts, so far relaxed the stricture as to enable the
contents, of the distended oesophagus to pass down into the stomach.
On dissection the oesophagus was found about four inches in diameter ;
all its coats being hypertrophied, thickened, irritated and in parts in-
flamed and ulcerated.

In some cases of bulimia tmnia or lumbrioi exist in the intestines
stomach or duodenum; in others there is structural disease of the liver
pylorus, duodenum, or organic changes in the mesentery, its glands, oi
other abdominal organs; it often exists in connection with epilepsy and
other cerebral disease.

Treatment. — It is usual to begin the treatment by restricting the
amount of food ; but this can seldom be done, as the patients can never
be trusted to govern themselves. One case is given in which three-
hundred and seventy-nine pounds of meat and drinks were swallowed
in the space of six days ; and yet the patient lost flesh rapidly. He
was cured by taking food boiled to a jelly, in small quantities often re-
peated. {Mem. Med. Soc. London. Vol. 8.) Copland saw a child seven
years old who seized upon an uncooked rabbit, half a pound of candles
and some butter and devoured them in quick succession, and who ordi-
narily ate more than six other persons. This case and a similar one
were cured by an active course of nauseating purgatives, chiefly Castor-
oil and Oil of Turpentine. In one case the remedies caused an erup-
tion over the body resembling porrigo favosa, accompanied by the sud-
den disappearance of the disease. On suspending the treatment the
eruption receded and the bulimia returned ; and it was finally cured by
Mercurials, Purgatives, Turpentine, external use of Tartar-emetic^
Ointment and strict diet. There is no case of this disease that will
not yield to a judicious homoeopathic treatment.

In one case given by Dr. Crane, {^Lond. Med. Be^os. vol. 17. p. 298.)
You I 17,

258 DISEASES OF THE DIGESTIYE FUNCTION.

the e'ating of large quantities of food was followed by vomiting. This
case was cured by compelling almost total abstinence from food for
several weeks ; the only aliment allowed being portable soup made into
pills. When the stomach has been inordinately distended by extra-
ordinary quantities of food, it is better to reduce it gradually, relying
much at the same time on an active course of anti-psoric remedies as
Kali-carb., Pod., lod., Sulph., exercise, and constant mental as well as
physical employments. In some cases stimulants in small doses have
changed the action of the stomach. In others the morbid sensibility
has been subdued by Opium; and M. Rostan recommends small pieces
of ice to be swallowed at regular intervals.

In some of the most remarkable cases recorded, no course of treat-
ment was persistently tried. Domery, the Polish soldier in Admiral
Warren's fleet in 1799,; inherited the disease, and began to eat in large
quantities at the age of thirteen. He would devour live cats, rats, and
dogs, also tallow candles and the entrails of animals. In one day when
aged twenty-one (1799) he ate four pounds of raw cow's udder in the morn-
ing; at half past nine A. M. he commenced on five pounds of raw beef
and one pound of tallow candles, with one bottle of porter ; one o'clock, P.
M. the same quantity of these articles were repeated, with three bottles of
porter. His room being guarded to see that nothing was thrown away,
he was found at two o'clock in good spirits, the skin cool, pulse regu-
lar, having had no evacuations of any kind. At a quarter past six ha
had devoured the whole, and declared he could eat more ; but, being
told that experiments were being made upon him, he desisted. [John-
son, Medical and Phys, Jour, vol. 3. — Brit Encyd, vol. 8.)

3. ABSTINENCE.— J&sjfinmjfm.

\, As a Remedy in the Treatment of Disease.-— The great power
of abstinence in both health and disease render all its symptoms im-
portant. The influence of fastiog was almost as well known to Hippo-
crates and Sydenham as it is now ; and it forms a part of the popular
knowledge of the people of difl"erent climates. Dr. Edward Miller says
the French and Spaniards who emigrate to the West Indies escape the
dolent diseases peculiar to the tropical climates by avoiding the strong
diet and stimulating drinks which the English and Americans are too
much disposed to use in all climates. (JV.- T,. Med. Repos. I. p. 194.)

When abstinence is relied on as a remedy it must, says Marshall
Hall, be carried much farther than is. usually prescribed as a part of the
antiphlogistic regimen, and must be severe in proportion to the severity
of the disease and the rapidity with which it is progressing. It may
be especially important in gastritis, hepatitis, dropsy, cancer, plethorn,
apoplexy. {Dr, 0. A. Lee. Oo^pland. vol. 1. p. 81.) Corpulent per»

ABSTmENOE. 259

sons and those suffering from febrile or inflammatory affections endure
abstinence to an extent that would be quickly fatal to one in health ;
and the middle aged ^sustain life longer without food than the young or
those far advanced in life. (See Remarlts at pages iri 190 — 192.)

II. Effects of proPixccted Abstinence on health,-— 'T)iq sensations first
excited by prolonged fasting vary according to the degree of mental and
physical power of the individual. The sensation of hunger is generally
strong, and every substance within reach is ravenously devoured to ap-
pease it. Every animal, the most loathsome reptiles, are welcome. In
a disastrous voyage to Brazil, Lerius says, " a mouse was more valued in
the ship than an ox had been ashore."

The native Australians composed a paste of ants and worms with the
bark of trees to appease hunger ; and the people of New Caledonia
swallow lumps of earth for the same purpose, and tie ligatures, con-
tinually increasing in tightness, around the abdomen. As the sensa-
tion of hunger increases the mind begins to become savage and brutal.
Men become wild and ferocious, quarrelsome, turbulent and reckless,
resembling beasts of prey. Of one hundred and fifty persons who in 1816
attempted to save themselves on a raft made from the wreck of the
Medusa, West of Africa, some became delirious and deliberately walked
into the sea; some sank into a state of drowsiness and passed hours
in delightful visions. Others bade adieu to their comrades, saying, "fear
nothing, I am going to get you assistance, and will soon return." In
the midst of the general madness some rushed on their companions
sword in hand, demanding something to appease the hunger that was
consuming them. Many believed they were still on board the Medusa,
and saw ships, harbors, and an elegant city in the distance. M. Car-
reard thought he was travelling through beautiful fields, when an officer
said to him " fear nothing. I am going to write to the governor ; and
in a few hours we shall be saved." Confused cries of the starving
people roused them from their visions. After a night in which pain-
ful dreams could not be distinguished from dreadful realities these
friends awoke and asked each other if they had not heard cries of com-
bats and groans of despair ; and every man believed he had been de-
ceived by the illusions of some terrible dream. Around was a scene
of horrors. Over sixty persons had died of starvation during the night
or drowned themselves in despair; and the deepest dejection was spread
on every face ; some sat down in sadness, bitterly complaining of their
hard fate, and the remaining wretches cut up the bodies of the dead
to eat.

In some cases the suffering from starvation, appears not to be so
great. Captain Inglefield, who survived the wreck of the Centaur in
1782, saw some die ; others hung twenty- three days in the shrouds and
were saved. Captain Kennedy did not taste food or drink for eight

260 DISEASES OF THE DIGESTIVE FUNCTION.

days, and yet felt none of the sensations of hunger or thirst In these
cases, as in many others, life was prolonged by the absorption of sea-
water from the surface of the body.

The length of time that entire abstinence can be endured varies in
different persons. Hippocrates fixed the utmost limit at seven days
This has in various modern instances been exceeded. In 1784 Thomas
Travers remained buried in a coal-pit two hundred and seventy feet deep
seven days and was living when extricated, and could raise his head ;
but his hands and feet were cold, and pulsation was almost extinct. He
only lived till the next morning after food was given him. In 1783
two girls were buried in the ruins of a house destroyed by the earth-
quake that desolated Sicily and Calabria. One of these girls lived eleven
days without food and the other six days ; both recovered.

Symptoms produced hy entire Ahstinence, — Paleness and lan-
guor of countenance; muscular debility and emaciation; weak small
pulse; thirst; quickness of intellect, constipation, flaccidity of the
muscles ; increased frequency of the pulse ; palpitations, leipothymia,
or full syncope; head-ache, delirium; flushes of light before the eyes ;
tinnitus auxium ; slight amaurosis ; dryness of the throat ; pains in the
stomach ; wakefulness, followed by delirium, mild or furious ; coldness
of the surface and extremities ; morbid sensiblity of the organs of sense ;
depressed temperature, followed by insensibility, stupor or coma, ter-
minating in death ; symptoms resembling these are often caused by
rigid adherence to the antiphlogistic treatment. [Copland^ vol. 1. p. 82.)

Pathology.— Emaciation and absorption of every particle of fatty
matter ; paleness flabbiness, softening and emaciation of the muscles and
heart ; paleness of all the viscera ; slight atrophy of the liver and spleen ;
diminished size of the stomach and colon ; increased vascularity of the
brain, and sometimes of its membranes, a large proportion of the blood
being sent to the brain to the very last. This is effected by the pres-
sure of the atmosphere on the surface of the body generally, whilst
the brain is guarded by the unyielding walls of the cranium. A limpid
serous effusion is also found in the ventricles or between the mem-
branes. [Copland) Magendie says, abstinence increases the propor-
tion of the albumen as the quantity of blood diminishes. The quantity
of lymph is considerable during the first third of the period of absti-
nence ; and it increases the longer the animal fasts ; after this or
during the other two-thirds of the time it diminisbes, and before death
there is but little lymph in the thoracic canal. [Jour, de Phys, 8.
1861.)

The instances in which life has been prolonged for an incredible space
of time by a very small amount of aliment daily given are numerous and
well attested. The negro couriers, who traverse the deserts of the
Western coast of Africa., perform long and fatiguing journeys on about

ABSTII^ENOE.

261

four ounces of food daily. The Moors often subsist eight days on three
ounces of gum daily, without sensible injury. A caravan of one thou-
sand persons subsisted on gum a part of the journey from Abyssinia to
Cairo in Egypt, and gum-water is often depended on to sustain life
when other food is exhausted. An American Indian can travel long
lourneys, carrying with him only a small quantity of parched corn.
Shipwrecked sailors have been kept alive for many dayson a^small
part of a ship's biscuit per day to each man. Captain Bligh of the
ship Bounty, having been placed by the mutineers in an open boat,
with eighteen men, sailed about -3 600 miles in the South Pacific Ocean,
allowing to each man only an ounce and a quarter of biscuit per day.
Religious visionaries have often tested the utmost powers of the human
constitution. In 1789 Caleb Elliott attempted to fast forty days, and died
at the end of the sixteenth of starvation. Two convicts lived in the jail of
Edinburgh fourteen days without food, receiving liquids only. A Scotch-
man confined in the tower of London fasted sixty days and was libe-
rated. Morgagni says, a woman refused all sustenance except twice in
fifty days. Dr. Willan says a visionary in 1786 refused all solid food
and drank only a half pint or pint of water acidulated with orange
juice, for sixty days. He was now reduced to the appearance of a ske-
leton on which the flesh had been dried, though the lustre of his eyes
remained and his voice was entire. He was treated by Dr. Willan, but
he died in a state of imbecility on the seventy-eighth day. An insane
man took nothing but a pint and a half of water daily, and stood in one
position thirty-eight days. He then lay down and lived nine days
longer. Janet McLeod of Scotland, after epilepsy and fever remained
five years in bed, receiving food only by constraint. In efforts to force
her mouth open two of her teeth were broken. Liquids forced into her
mouth were rejected. With her head drawn down on her breast she
slept much, and continued to live for four years, taking no food but
water. She afterwards gradually revived, and took a few crumbs of
bread with milk and water, sucked from the palm of her hand ; but she
perhaps, never entirely recovered. (See Gentleman^s Mag, 1789. —
Annu, Regis, 1768. — Encyc, Amer, vol. 13. p. 451.)

A young man confined in a coal-pit for twelve days, subsisted on
only a little water collected in the hollow of his hand. Dr. J. W.
Francis says, a negro woman lived seven weeks supported only by two
cups of water slightly medicated with wine. (iV^.- Y, Med, c6 Phys,
Jour, 1823.) Professor McNaughton reports the case of a young man
who confined himself chiefly to his room for three years, and in 1829,
May, began to refuse taking any sustenance but water. For fifty-three
days he lived on water alone. A few days before he died Professor
W.illoughby found his skin very cold, respiration feeble and slow ;
effluvia from the breath and skin offensive ; discharge from the lungs of

262 DISEASES OF THE DIGESTIVE FUNCTION.

foul reddish matter ; pulse slow and feeble ; arteries extremely con-
tracted, the radial artery communicating a wiry feel ; alvine evacua-
tions infrequent ; urine more natural. At the end of fifty- three days
he died. On dissection the gall bladder was distended with muddy
looking, bile ; stomach, mesentery and intestines thin and transparent
no fat in the omentum. {Tr ansae, Albany Institute, vol. 1. — Lee^s
Edit, Cojplai%d, 1. 31.)

The case of Mrs. Hays of Chester, Warren Co., N.-Y., attracted much
attention. She was injured by a fall in 18o4r. Confined to bed for
eight months, she was next affected with spasms lasting three or four
days. During one year she took little food; and from the 20th Feb.
1857 it was alleged that she took neither food nor drink. The persons
employed to watch her day and night for a month declared that she
neither ate nor drank; and that on food, tobacco or ardent spirits being
brought into the room, concealed in the pockets of disinterested visi-
tors, convulsions were always excited by any of them. Being in a state
of almost constant spasm, deglutition was impossible ; and the approach
of persons who had touched bread caused violent retching. All action
of the kidneys and bowels ceased after June, 1856. (AGGOunt ly A.
D, Milne,^ p. ^^,—AmeT, Horn. - Review , 1858.)

Treatment.— The only treatment generally required is the gra-
dual and cautious administration of nutritious but unirritating food
Begin with bland, farinaceous articles which are easily digested ; le6
the quantity be small, often repeated, and very slowly increased. When
animal food is considered safe, light broths and soups may be tried be-
fore milk, which requires good digestive power after it is coagulated.
Sweet cream, diluted with water is more easily digested. The usual
diet of convalescents from states of great debility will be by degrees
allowed. Of medicinal measures few will be needed. External
warmth, gentle frictions, mild stimulants, and mild sedative tonics will
generally be all that will be required. The supporting, cheering, invi-
gorating powers of hot coffee render it peculiarly serviceable in all
cases of this kind. Febrile excitement will be controlled by Aconite,
and determination to the brain by Belladonna.

In nearly all cases of slight gastric disturbance, and consequent
head-ache, nausea, lassitude, and general feelings of malai^e^ entire
abstinence from food for two or three days, will allow the stomach to
recuperate and resume its healthy function. Unfortunately, as a
general rule in such cases, both the patient and the physician re-
gard medical interference necessary, and thus add to the irritation by ca-
thartics, alteratives,, tonics, &c. In this manner a simple gastric irrita-
tion, or relaxation, from over-eating, drinking, irregularities in diet, or
improper food, which a proper abstinence of a couple of days would

ABSTmENOE. 263

cure, is often converted into troublesome disease 'of weeks or even
months duration.

III. Inanition^ as a Cmise of Disease,— HhQ morbid effects of a defi-
cient supply of food are generally encountered in connexion with other
deleterious agents. Thus in badly managed public institutions, and in
the homes of the poor we meet with the consequences of cold, insufficient
clothing, excessive labor, damp or impure atmosphere, mental depression,
(fee. From the combined influence of such causes we may have scurvy ;
purpura hgemorrhagica ; scorbutic dysentery, or diarrhoea. ; typhoid fever,
nervous or cerebral affections; emaciation; chronic ulcerations. A few
years ago the convicts of the Miltbank Penitentiary (which is situated in
a marsh and lower than the river adjoining), with all the above cases of
disease around them, were restricted to a diet almost entirely vegetable,
with no animal food but a very weak soup. The effects were: pale color,
loss of flesh and strength; diarrhoea, dysenteries, scorbutic dysentery,
scurvy, ataxic fevers, headaches, vertigo, convulsions, delirium, mania,
apoplexy, &c., inability to bea.r the smallest loss of blood ; though dis-
sections showed the brain in a highly vascular state ; also frequent
effusions of fluid in the ventricles or between the membranes.

Dr. Lee (in N,- Y. Jour, of Med, vol. 8. p. 53) says, ophthalmia in
the Orphan Asylums and Long Island Farms School owed its origin to
defective nutriment, and its propagation to want of cleanliness and ven-
tilation, and they disappeared when these abuses were reformed. In
1840 an epidemic diaicrhoea appeared among the children at the L. I.
Farms School, attended with mortification of different parts of the
body ; ulceration and consequent destruction of the eyes, thin, dissolved
state of the blood; offensive odor from the skin. It was caused by a
diet of poor bread and tea, sweetened with molasses, the water in which
coarse vegetables had been boiled, and the beef of which soup had been
previously made, on alternate days. The effects, says Dr. Morrell, of
this defective food were : loss of embonpoint^ dulness, inactivity ; the
eyes lacked lustre ; the skins exhaled an offensive odor, and medicines
failed in their accustomed effect. These symptoms were followed by
cholera morbus, incurable diarrhoea followed by mortification. The
latter commenced generally near the junction of the mucous mem-,
brane and skin, with a dark spot which spread rapidly, and involved'
the parts in one mass of putridity. When the mortification was ar-
rested atone extremity of the alimentary canal, it immediately commencejl
at the other. Ulcerations generally commenced in the cornea by a
pearl white speck near its junction with the sclerotica; this spread
over half the pupil, penetrated the iris and left it protruding. And
thus one or both eyes were commonly lost before death. During the
prevalence of the epidemic, scarlatina always terminated fatally, and
every trifling wound progressed to gangrene.

264 DISEASES OF THE DIGESTIVE EUNCTIOK.

The insufficient supply of food furnished to the inmates of prisons
and poor-houses causes derangement of the stomach and bowels, want of
appetite, from defective secretion of the" gastric-fluid. Chossat says,
birds fed with too little corn, but plentifully supplied with water, fail to
digest what they take ; it is thrown up by vomiting, carried off by diar-
rhoea, or retained undigested. [Hecher, Ewper, sur V Inanition,
Paris, 1848.)

In cotton factories the hurried manner in which the children eat,
and the meagre quantity of food allowed them, prevents their physical
development and shortens their lives. "The greater part of the time
allotted them for dinner, and often the whole of it" is occupied by the
children in cleaning the machinery ; " no time/' says one author, " was
allowed for the breakfast or afternoon meals, which were snatched in
mouthfuls during the progress of uninterrupted labor; the refreshments
not unfrequently remaining untouched till they became cold, and co-
vered with dust and dirt from the cotton flyings." The temperature of
many mills is " uniformly 80, 85 or 90 degrees." As a specimen of
the results of this system it was shown before a committee of Parlia-
ment that the number of operatives who reach the age of forty is in-
credibly small.

In 1881 of 1665 persons who " struck" for wages, and whose ages
ranged from fifteen to sixty, 1584 were below forty-five, three only had
attained the age of between fifty-five and sixty ; and not more than
fifty-one between forty-five and fifty were counted fit to work. Macnish
says, that of 1600 men in the factories of Lanark and Kenfrew, no more
than ten had reached the age of forty-five. Before this age they are
too infirm to do the required amount of work, their eye-sight fails^ and
they are turned ofi* to make room for younger men. {Lee^s Edit, Cqp-
lanWs Diet, vol. 1. p. 141.)

IV. Apjpetite^ vitiated, or depraved, — An appetite for substances
in their nature unfit for food is common among pregnant, hysterical,
and chlorotic females, especially at the age of puberty. It is consi-
dered the result of an altered state of the nerves or a perverted state
of the secretions of the stomach, connected with imperfect action of
the digestive organs, uterus or brain.

A form of this disease is of frequent occurrence in the Southern
states, where it is called by common people " cachexia." I have seen
many cases of it, generally in young females. They all show an irre-
sistible propensity to eat certain kinds of loam or clay, which probably
allays the painful sensations produced in the stomach by acidit}^ The
appetite for clay and other earthy substances among the negroes in the
West Indies was described by John Hunter, and is there considered
endemic. In some cases the inordinate craving of the stomach is only
assuaged for a very short time by clay; and other substances, often the

VITIATED OE DEPEAVED APPETITE. 265

most disgusting, are ta-ken : " cinclerSj spiders, lice, insects, toads, ser-
pents, wood, hair, paper, cotton, earth, chalk, thread, sand, vinegar, and
other things still more revoltifig are often swallowed with the strangest
v^oracity; and many continue till near the end of life to conceal from
physicians and friends the cause of their numerous complaints, and
their " clay color." Copland saw a seaman who would occasionally de-
vour a whole wine-glass without injury, having previously crushed it to
pieces with his teeth. [Lond, Med. Re2)os. vol. 17.)

A case of swallowing glass with impunity is given by Oamerarius,
[MemoraL Gent V.) In 1826 M. Orfila and others reported to the
Royal Academy of Medicine, that glass had been taken into the
stomach in many instances in even large quantities, without bad conse-
quences. {Lond, Med, Repos. Nov. 1826.) It must still be admitted
that the sharp cutting edges of broken glass cannot be safely taken
into the stomach. Even pulverized glass is popularly regarded as a
certain cause of death, and a woman was executed at Maysville, Ken-
tucky, in 1830, who confessed that she caused the death of several
children by giving them powdered glass.

In cases of depraved appetite in which bulimia is also present the
most incredible feats are said to have been performed. Fournier gives
a case in Diet, des Sci, Med. [Art* Cas, Hares,) of an insane galley
slave whose stomach had been enlarged into an oblong square shape,
extending over most of the abdomen and reaching into the pelvis. It
was found on dissection to contain a piece of stave nineteen inches
long, and half an inch in diameter ; a piece of broomstick six inches
long and another eight ; twenty-two other pieces of wood of three, four
or five inches long ; a wooden spoon ; a pipe of an Iron funnel; a pewter
spoon ; a piece of iron weighing nearly two ounces ; with various other
pieces of nails, buckles, horns, knives, &c., the whole weighing twenty-
four ounces, avoirdupois. ( Copland, Diet vol. 1. p. 124.)

In many marvellous cases unusual substances have been swallowed,
merely to excite the wonder of spectators. Some persons have swal-
lowed knives, bullets, billiard-balls, gold watches and pieces of money.
In June, 1822, a man in New- York, who had previously swallowed and
passed through the intestines a gold watch, chain, and seals, made his
last effort ; in the course of one day he swallowed fourteen knives. Two
months afterwards he died, and one of the knives was found in the
oesophagus, eleven were still in the stomach ; the remaining two had
traversed the whole line of the intestines and been discharged. {New-
York Med. Repos. Oct. 1822.)

In one case reported in the Boston Med. <& 8urg. Jour. voL 25, a
girl, aged seventeen, died from the efFect of eating slate-stone. In an-
other case of inordinate appetite nine gallons of urine was discharged
in twenty-four hours. [Ilid. vol. 27. p. 178.)

266 DISEASES OF THE DIGESTIVE FUNCTION.

Treatment. — In ordinary cases the appropriate liomoeopathic spe
ciflcs are the principal reliance in the treatment of depraved appetite
when it appears as an idiopathic disease. The propensity to eat
earths and other indigestible substances must be overcome by moral
means united with treatment directed to the digestive, uterine,.and other
functioDS. See Chlorosis.

Dr. Stevenson cured a lady, forty-five years old, of the clay-eating
cachexia Avith small doses of finely pulverized charcoal, given regularly
at short intervals. {Pittshicrgh Med, Soc, Hep, 1826.)

Depraved appetites, not acquired by the abuse of naturally noxious
substances, indicate a lack of some normal constituent of the body — acid,
alkali, or some other chemical ingredient of the fluids; and the "in-
stinct of the stomach," as Hahnemann has wxll termed it, calls for the
missing element. Thus in the chlorotic female who craves alkalies in the
form of chalk, lime, slate-pencils, &c., there is a deficiency of alkaline
principles in the system ; and when this want is obviated the morbid
appetite ceases. In these cases the cure cannot be accomplished che-
mically, by throwing into the system alkalies in order to restore the
proper equilibrium; but those homoeopathic medicines must be given
which will place the organs in such a condition as to enable them to
re-establish the normal alkaline secretions.

This can always be readily done by selecting and administering such
remedies as correspond to the morbid group of symptoms. Among these
remedies may be cited China, Sulphur, Calcarea-carb., Ferrum., Phos.,
Carbo.-veg., Cantharis.

Y , - Cardialgia, — Heart-pain.'— '^ Ueartbum,^^ — This term is impro-
perly applied to a pain in the stomach which is generally a symptom
of dyspepsia. There is a feeling of anxiety, heat more or less violent ;
some oppression, faintness, inclination to vomit, or a plentiful discharge
of clear lymph-like saliva. The pain may arise from different causes ;
as, flatus, acrid or rancid substances in the stomach ; the irritation of
the coats of the stomach by worms, acrid or pungent food, spices or
aromatics; the free use of tea, coff*ee, fermented or alcoholic drinks ;
surfeits, rheumatic, gouty diathesis, &c. The nature of this affection
and its proper treatment will be seen under Dysjpefsia, When neu-
ralgio in its character, its nature will be seen under Gastralgia. See
Index.

Pyrosis is generally is only another form of cardialgia. There
is a burning pain in the stomach attended with copious eructation,
generally of a watery insipid fluid. See p. 267.

VI. Flatulency, — -Flatus in the stomach.—- This affection is only a .
symptom of indigestion or dyspepsia. See also Catarrh of the Stomach,
Index,

FLATULENCY OF THE ABDOMEN. 267

Flatulency of the Abdcm%en, — Abundant formation of gas in the
biwels.

Symptoms. — Fulness and tension of the abdomen ; rumbling in the
bowels ; severe pain ; accumulation ; or copious discharge of wind.

Causes.— Indigestion; errors of diet ; free use of sugar, candies, &c.
exposure to cold. '

General Treatment. — Regulate the diet, rendering it plain, and
moderate in quantity ; restrict the quantity of sugar ; avoid exposure
to cold; keep the feet warm; rub the stomach with the warm hand or
flannel.

Medicinal Treatment. — 'N%ix-vom.iGa.—^QY common cases ; symp-
toms as given under dyspepsia ; accumulation of flatus in the stomach
or hypochondrium ; a sense of great anguish; worse in the morning ;
after drinking ; flatus incarcerated.

IpecaGiianlia. — Flatulency caused by over-feeding, accompanied by
nausea and vomiting ; bitter taste, nausea ; empty retching; violent
distress at the pit of the stomach ; flatulent colic.

Pulsatilla, — In cases in which there is diarrhoea and shivering; or
where Ipecacuanha has failed; eructations, with nausea ; taste as of
putrid meat.

China, — Much weakness ; derangement caused by eating sour fruit ;
flatulency persistent, gas formed in large quantity ; eructations tasting
of the ingesta ; heartburn ; pressure at the stomach.

Chamomilla. — When there is much pain or diarrhoea ; aching pain
at pit of the stomach; sour eructations; flatulent colic, with compres-
sion of the bowels.

Garbo-vegetahilis may follow the above remedies to prevent a
relapse.

Colocynth. — Great pain in the abdomen from incarcerated flatus.

Cartninatives.-^KB wind is generated in the intestines, and as such
generation is dependent upon a diseased state of the lining memb]:ane
of the intestines, it is plainly useless to iise remedies to expel the wind
mechanically. If these medicines do in some cases expel the wind, and
this in a very imperfect manner, they certainly do not alter the dis-
eased state in which production of the wind depends. Many fatal
cases of flatulent disease of the bowels have been traced back to the use
of ginger and other carminatives or stimulants for the expulsion of
wind, which had accumulated in the bowels and even in the stomach

VII. Pyrosis.— Water-hrash. — Diagnosis. — Fits of burning sensa-
tion at the pit of the stomach ; burning extending up to the fauces
followed by eructation of a thin colorless liquid, which seems to be
forced into the mouth by a kind of reversed or ruminating action of
the stomach and oesophagus,

CAUSES.~It may result from some irritation in the stomach itself

268 DISEASES OF THE DIGESTIVE FUNCTION.

or in some other organ which can affect it through sympathy It
often occurs in organic diseases of the stomach, especial^ cancer and
simple ulcer. It is common in pregnancy, and among people who live
on unwholesome food. Linnseus found it very prevalent in Lapland, in
1782 ; it is described as endemic in many parts of Scotland, Wales, Eng-
land, &c. It is ascribed to the common causes of dyspepsia. These
are, coarse and innutritions food ; sedentary life, intemperance ; cold and
damp climate ; excessive labor ; large losses of animal fluids ; consti-
pation ; mental depression ; pregnancy, and all other condition^ and-
influences which may interfere with the function of digestion, rbnder-
ing the secretions unhealthy and irritating.

Treatment. — The power of homoeopathic remedies over this as well
as other derangements of the digestive organs will be sufficiently dis-
played under the head of dyspepsia. It is only necessary here to men-
tion a few remedies.

Ntix-vomica, — This article was prescribed by Linnaeus among the
Laplanders, and is now known to homoeopathists as one of the best
remedies,

P'ulsatUla,— Bryonia. — SulphuriG-acid. — For symptoms, see these
articles, under the head of Dyspepsia.

VIII. Gasteodynia. See Gastrodynia, — -Index.
'' IX. Nausea and Vomiting. — Nausea. — Sickness at the Stomach.
■ — An inclination to vomit without effecting it; also a disgust of food ap-
proaching to vomiting. It is an attendant on cardialgia and various other
disorders, occasioning an aversion for food, an increase of saliva, dis-
gusting ideas at the sight of various objects, loss of appetite, debi-
lity, &c.

Yomiiing — consists in a spasmodic contraction of the diaphragm
and abdominal muscles, followed by a rapid discharge of the contents
of the stomach by the mouth.

Causes.— Intemperance ; indigestible food; indigestion and various
other disorders of the stomach ; mental emotions ; extremes of tempe-
rature ; fatigue.

Nausea and vomiting are best illustrated by the operation of those
poisons called emetics. As these agents produce the disease called
cmesis or vomiting, and also furnish us with remedies for curing it,
however it may be induced, wq.,will examine their mode of operation,
and the pathology of vomiting. In the operation of an emetic we may
discover a series of actions, which may be thus described. The emetic
makes at first an impression on the sentient extremities of the nerves
of the stomach. This sensation is referred to the brain; the natural
energies of the brain are now diminished by the prostrating influence
of the nausea ; and we observe a languor of both the mental and bodily
powers. The peculiar excitement in the brain produces tKe sensation.

NAUSEA AND VOMITING. 269

which is felt in the irritated organ, and the sensation of nausea is^ the
immediate and necessary result of the diminished and peculiar excite*
ment of the brain referred to the stomach. That this is the case is
demonstrated by the vomiting and nausea sometimes excited at the
sight, smell, taste, or even thought of a disgusting object.

But why does this certain degree of nausea jyroduce contractions
of the coats of the stomachy <&g. ? Here it may be sufficient to remark
that spasmodic contraction in the muscles, &c., is generally the result
of debility.

The first effect of an emetic is an uneasy sensation at the stomach,
which is followed by nausea ; this increases till the pulse becomes
feeble, frequent and irregular ; the face turns pale, the skin becomes
cold and shrunk. Vomiting at last comes on, during which the face is
red and turgid with blood. On the cessation of the vomiting, the sick-
ness goes off, leaving the system in a state of temporary languor from
which it soon recovers.

It is an important fact, that any extraordinary stimulus applied to
the stomach, instead of increasing its motions, as it would in other
instances, inverts them. The wisdom of such a provision will appear
when we consider that it is intended to prevent the intrusion of food
into the duodenum before it has undergone those necessary changes in
the stomach, by which it is prepared for the more elaborate process
of chyliiication.

The act of vomiting is not an act of the stomach alone; the brain
is an important accessory. Magendie attributes the operation of
vomiting exclusively to the agency of the brain upon the abdominal
muscles, and regards the stomach as a mere passive instrument in the
act. The influence of the nervous system is indispensable to the pro-
duction of the act of vomiting; and we accordingly find that vomiting
can not take place as an effect of any emetic in a case in which the
nervous energy i« suspended, — as in profound intoxication, violent
wounds and contusions of the head ; while, if tjie brain be only partially
influenced, as by incipient intoxication or by a less violent blow on the
head, — irritability is increased instead of being paralysed, and vomit-
ing, under such circumstances, is excited by the slightest causes. This
fact is curious and instructive.

Perhaps the best view of the subject of emesis is that given by Dr.
Richard Harrison, in his Gulstonian Lecture, before the Royal College
of physicians. He observes that although the experiments of Magendie
sufficiently demonstrate the importance of the , pressure of the ab-
dominal muscles upon the stomach in the act of vomiting, and w^hicli
can only be explained by the influence of the nervous system, yet Ma-
gendie attributed too much to their agency. He gives then, the follow-
ing explanation of the phenomena of vomiting :

L70 DISEASES OF THE DIGESTIVE FUNCTION.

"The irritation of the stomach makes a call upon the brain for the
aid of the diaphragm and abdominal muscles in order to expel its con-
tents : the diaphragm then becomes contracted and fixed, the ribs drawn
down, and abdominal muscles drawn inwards, so that the stomach is
pressed on all sides bj voluntary muscles, which together with its own
contractions expel the contents."

Now it must be obvious that where the brain from oppression or in-
jury is unable to transmit its influence to these muscles, and disregards
the call of the stomach, vomiting can only be excited with difficulty or
not at all. Thus, in the same manner, persons may die of suiFocation
from injury of the brain: the respiratory muscles not receiving ner-
vous influence, can not keep up respiration.

Genekal Treatment.— When vomiting has been excited by taking
too much food, it should be regarded as an effort of nature to free the
stomach from an over-load which would do injury if retained; and
free drinks of warm w^ater should be given to promote the free cleans-
ing of the stomach. After free evacuation of the stomach, a table-
spoonful of coffee will often restore healthy action.

Medicinal Treatment. — Pidsatilla. — When after violent vomiting
there remain loathing, nausea, and retchings; vomiting caused, by
greasy food or pastry ; also sea-sickness.

ChaTTiomilla. — ^Vomiting caused by passion; bitter bilious risings;
bitter taste in the mouth ; vomiting of green, bilious, acrid matters ;
fulness and pressive pain in the stomach; weakness; loss of appetite;
anxiety; dry heat; thirst; giddiness; semilateral headache. When
caused by the state of the nerves 'of the stomach. Ipecac.

Cfo^<?'wfe^.— -Sea-sickness ; cardialgia after a meal; nausea when
riding ; vomiting worse when raising the head.

Sickness of pregnancy. Cocculus.

Alumina. Creosote. Agaricus-musc, Veratrum-vir. Secali.

Antiinonium-GTudwin. — Eructations tasting of the ingesta; nausea,
vomiting of bile and mucus (also Ipecac, and Puis.) cardialgia; de-
rangements caused by overloading the stomach.

ArseniGum. — Violent vomiting of ingesta and liquids ; also of brown
or black substances ; aversion to farinaceous food ; burning pains in
the stomach relieved for a short time by warm drinks; Asiatic cholera,
last stage, with cold breath.

Cainphor, — Vomiting Avith coldness of the surface, sudden prostra-
tion of strength ; anxiety, and burning in the stomach, cramps in the
nuscles of the limbs ; pit of the stomach painful to the touch.

Disjpensary Cases. — 1. A girl aged six years, has vomited frequently
for twelve hours, has considerable fever. Cured by Ipecac.

2. A child aged eight years. Has vomited several times during the
day. Cured by Ipecac 3^.

DYSPEPSIA FEOM DEFICIENT SECRETION OF THE GASTEIC JUICE. 271

3. A girl aged ten years. Nausea and vomiting, commencing at
school; she looks pale and feeble. Cured by Ipecac.

Murray, (whom I select from numerous other authorities) informs
us, as does also daily experience, that among the symptoms produced
by the use of tobacco^ those of vertigo^ nausea^ and anxiety are the
principal. Now Diemerbroeck, when attacked with those very symp-
toms of vertigo, nausea, and anxiety, in th6 course of his close atten-
dance on the victims of epidemic diseases in Holland, removed them
by smoking tobacco, (Hahnemann)

X. Vomiting of Blood, — See Ilwmatemesis, — Index,

XI. Dyspepsia is an affection of the digestive organs, in which one or
more of the several processes by which the aliment is converted into blood,
&c. are imperfectly performed. In attempting to cure it we find it compli-
cated in its nature, and involving, not only the stomach, but all the
organs and distant outposts of the physical as well as the mental organ-
ism. In every well-established case the symptoms are extremely
numerous, ranging through all the structures and tissues of the body,
involving nearly all of them in endless chains of sympathies and reflex
actions.

Ghneral Symptoms of Deranged Digestion, — Loss of appetite,
nausea, languor ; aching, tenderness and distension of the epigastrium,
acidity, flatulency, eructations, sense ofw^eight and fulness in the stomach
after eating; also quick breathing, sensitiveness at the pit of the stomach
from pressure, light clothing, &c. ; pyrosis, vertigo, giddiness, sensation
when walldng, as if the pavement were rising up immediately in front;
constipation, pressure in the stomach and epigastrium, haemorrhoids,
sallow or yellow complexion, distention of the abdomen with flatus,
loss of ambition a.nd energy, sad, desponding, dread and apprehension
respecting the future, frequent inclination to commit suicide, nights
restless and disturbed by unpleasant dreams. In the advanced stages
of indigestion there often supervenes a troublesome cough attended
with occasional pains in the chest, and mucous or muco-purulent ex-
pectoration, which some writers have termed dyspeptic phthisis. It is
probable, in these cases, that the disease is confined to the mucous
membranes of the respiratory organs, being a continuation or extension
of the gastric disturbance to the pulmonary tissues.

II. DYSPEPSIA FROM DEFICIENT 'SECRETION OF THE GASTRIC
JUICE, WITH INORDINATE SENSIBILITY OF THE NERVES OP
THE STOMACH.

In health the stomach contains no gastric-juice, except at those times
when food has just been taken, and, by its contact with the surface of
the mucous membrane excites the secreting orjaiis to pour out the
gastric fluid in the needed quantity. The process ^ y which this

272 DISEASES OF THE DIGESTIVE FUNOTIOK.

mysterious secretion is thus called into existence precisely at tlie very
time and in the quantity wanted, displays a beautiful physiological
phenomenon, and points to the solution of practical problems of the
highest importance. The impression made by the food on the organs
of taste, and on the surface of the stomach is first transmitted by the
nerves to the nervous centres, and thence reflected to the secreting ap-
paratus, upon which devolves the duty of forming the gastric-juice. If
this apparatus is in a healthy state the quantity formed will be just
sufficient for healthy digestion ; if it is not in a healthy state, the
gastric-juice secreted may be either deficient in quantity or vitiated
in quality. (See p. 215.)

Diagnosis, — The > intimate relation existing between the stomach
and other organs associated with it by reflex nervous action renders
every form of indigestion a complicated disease. The liver and the
stomach react upon each other; the gastric fluid and the bile become
deficient in quantity or vitiated in character, and become additional
agents of irritation ; and in every functional derangement of any of the
digestive organs a " disordered condition of the gastric and intestinal
nerves " is gradually developed, in which all " natural sensibilities are
changed, becoming morbidly acute, obtuse, torpid or perverted." This
condition is never absent in dyspepsia when fully established, and it
forms the connecting link between the disorders of the stomach and of
other and far distant parts.

Symptoms GharacteristiG of this Gombination of Gast/rio and
IlejpatiG Disorder, Appetite ravenous^ annihilated or whimsical ;
unpleasant feelings after eating ; pain in the stomach and duodenum,
imperfectly relieved by the action of purgatives, which always ulti-
mately increase the bad symptoms. The patients who have been sub-
jected to the common purgative treatment become more subject to
constipation, and the result of their antipathic practice is found to be-
come constantly less satisfactory. The large intestines become laden
with solid and irritating matters, which continue in some cases to ac-
cumulate for months. "Even during the action of successive daily ca-
thartics," says Dr. James Johnson,^ " scybala may remain long in the
cells of the colon ; substances eaten two or three months ago, sometimes
come away in round balls, enveloped with layers of inspissated secre-
tions. These scybala keep up a degree of irritation, generally without
pain, but producing, in distant parts, the most strange and anomalous
sensations. It might be supposed that repeated cathartics had carried
off every vestige of the contents of the large intestines ; but this is
never accomplished by purgatives, however frequently administered."
A passage of small calibre, says Dr. Ware,t is indeed generally kept

* ''On the Morbid Sensibility of the Stomach and Bowels."
t On Purgatives, &c.

DYSPEPSIA FEOM DEFICIENT SECRETION OF THE GASTEIO JUICE. 273

open, and through it small quantities of feces, partially fluid, may al-
most daily find their way. But these matters are generally composed
of the substances more recently taken into the stomach, and mixed
with unhealthy secretions. Very often the hardened accumulations of
months continue to distend the cells of the colon, irritating the nerves
which convey morbid impressions to remote parts, and they furnish
" the most vitiated materials to the absorbent vessels, which pour their
contents into the portal circulation" to be employed by the liver in the
secretion of bile. These facts furnished by allopathic observation and
amply confirmed by our own experience we can cheerfully accept as
true ; and we repudiate the purgatives, usually trusted to by them,
only because they give such transient relief and then increase the
disease, — and, also because we possess better resources. {See Consti-
pation,'— Index)

Liver. — Always irregular in its action, generally torpid, as mani-
fested by paleness or want of the characteristic color of bile in the
evacuations. In some cases the liver occasionally pours out a quantity
of tenacious yiscid bile, which adheres to the inner surface of the
bowels, keeping up a high degree of irritation of the intestinal nerves,
and causing various uneasy sensations in distant parts of the body,
with fits of irritability and despondency of mind, which surpass in
hopeless wretchedness all physical sufferings. When the irritation
falls on the physical sensibilities, bilious colic and excruciating pains
and spasms of the stomach and bowels are caused by it. When the
nervous system has been much harassed by great mental anxiety and
other real misfortunes, the mind, instead of the body, may be the prin-
cipal sufferer. " It becomes," says Dr. Johnson, (who knew aM about
it from sad experience,) "suddenly overcast as with a cloud; some
dreadful imaginary or real evil is magnified into terrific proportions,
with a train of disastrous consequences from which the soul turns with
dismay. This state of utter misery may continue for twenty-four,
thirty-six, or forty-eight hours, when a change is effected by a discharge
of viscid acrid bile, with fche most horrible foetor; and the passing off of
the poisonous secretion from the sentient extremities of the intestinal
nerves at once dissolves the spell, which has power to weigh down the
strongest mind to earth." It is under the influence of such paroxysms
of despair as this, that the most melancholy suicides occur. In many
of these we know that there is no moral cause for weariness of life ;
the real cause for temporary hallucination of mind is a physioal one,
operating on the mind through its sympathy with the organs of di-
gestion.

Tong^ce.—'Fm:re^L in the middle, and at its root ; when the stomach
and duodenum are irritated by food, undergoing slow and imperfect di-

VoL. L— 18.

274 DISEASES OF THE DIGESTIVE FUlSrOTION.

gestion, the papillae are elevated, the edges and tips red, and there is a
peculiar constriction at the base of the tongue arising from sympathy
with the stomach. When the mucous membrane is highly irritated, or
in some degree inflamed, the tongue resembles beef-steak or cleanly
dissected muscle.

JEyes. -Sometimes tinged with yellow, muddy or " lack-lustre" expres-
sion, showing languor or irritability. Vision is sometimes remarkably
good in dyspeptics who have reached the age of declining sight.

Urine. — Turbid, scanty, high-colored, depositing a thick or white
sediment; sometimes limpid and clear, though exciting more irritation
in the bladder and urethra than when highly colored.

Skin, — Dry, contracted : occasional partial perspiration, alternating
with chilliness followed by heat especially of the palms of the
hands and soles of the feet ; complexion sallow, dark, or yellowish,
commonly described as " bilious," showing the reflex norvous influence
of the stomach, liver, and alimentary canal on the surface of the body*
EnnaGiation is a marked feature of dyspepsia, progressing most ra-
pidly when the disease of the liver is extensive.

Loss of Strength. — This is proportioned to the degree of nervous
disorder or irritation in the sentient nerves of the stomach and bowels.
It is a distressing feeling of debility, rather than acz^i^<2Z debility. The
slightest muscular exertion made w^hile digestion is going on, depresses
the spirits and produces an intolerable feeling of exhaustion and utter
feebleness. The same amount of exercise may be taken at another
hour without such depressing results, showing that the debility is a
sympathetic suffering from irritation of the alimentary canal ; and it is
always aggravated by the use of stimulants and tonics.

Tenderness of the Epigastrium. — This exists in some degree, in
every case, and is no evidence of organic disease, as the tenderness is
greater in functional disease of the stomach and duodenum, than in
actual scirrhus ; it is increased by antiphlogistic measures, and is often
diminished by good diet and even by tonics, though not generally so.

Pain in the Stomach. — This is common, and varies in degree from
the slightest uneasiness to the most excruciating gastralgia, and is al-
ways most severe when gastritis is not present.

Fulness of the Epigastritcm.'—Thmy when it exists, depends more
frequently on flatulence than organic enlargement. Permanent enlarge-
ment and hardness are often caused by chronic disease of the liver.

The Pulse. — This may vary with almost every emotion of the mind.
It is generally more variable in dyspepsia, and even more rapid, than
in cases of actual inflammation of the same mucous surfaces. The
action of the heart is so much under the influence of the stomach, that
little dependence can be placed upon its frequency. In dyspepsia, it
is usually quicker during digestion, and also during the passage of the

DYSPEPSIA FROM DEFICIENT SECRETION OF THE GASTRIC JUICE. 275

cliyle along tlie intestines. The pulse may be eighty or ninety per
minute during the day; and later in the evening, if the patient has not
eaten recently, it may be reduced to sixty or less. Persons in whom
the mind is active but who are physically feeble, have the pulse ge-
nerally quicker in the evening, whatever be their relative state of
health. The real dyspeptic always feels worse for some hours after
eating; and a late supper renders him miserable for the night and the
early part of the next day.

The effect of slowness of digestion is, that the food continues too long
in the stomach. Instead of being perfectly dissolved and passed for-
wards to the duodenum' in two or three, hours, it sometimes lies imper-
fectly digested for ten or twelve hours, and even in rare cases many
days. While thus remaining in the stomach, the partially digested
mass produces a sense of weight or uneasiness at the pit of the stomach,
which only subsides as the task of digestion is completed and the stomach
emptied. Sometimes a portion of some solid article remains undigested,
and excites distressing spasmodic pain at the pyloric orifice of the
stomach several hours after eating. In this case the pylorus is too ir-
ritable to permit any solid to pass, and it closes spasmodically when its
inner surface is irritated. When Dr. Beaumont was experimenting on
St. Martin's stomach, he on one occasion introduced the thermometer
through the fistulous opening into the stomach, and permitted the bulb
to pass into the pylorus. There was immediate contraction on the in-
strument accompanied with pain and distress. After several trials of
the experiment, a sense of soreness remained till the next ddjj. The
same kind of soreness is often caused by hard or imperfectly digested
portions of solid food remaining many hours in the stomach ; they irri-
tate its lining membrane, causing head-ache, furred tongue, depraved
gastric secretion, sallow complexion, and imperfect sleep. (See p. 215:)

The Srain is affected through the reflex action transmitted by the
nerves of the stomach : as a result of this sympathy, confusion of
thought, unsteadiness and irritability of temper, are more common
than pain in the head, dimness of sight or vertigo. The former often
rise to temporary alienation, and sometimes terminate in suicide. Be-
sides these symptoms, neuralgic pains in every form and situa.tion may
be induced by this morbid sensibility of the stomach and bowels, and
the irritability of nerves to which it gives Yise.

hwperfect Ntdrition.—^'he!!! dyspepsia continues long, it causes
imperfection in the process of nutrition in all parts of the body. The
blood becomes deficient in globules, the circulation is feeble, the extre-
mities are frequently cold, the spirits depressed, and all the vital
powers decline, till the patient becomes incapable of any considerable
mental or physical exertion.

276

DISEASES OF tHE DIGESTIVE FUNCTION,

DISTINCTION BETWEEN FUNCTIONAL AND MALIGNANT STRUCTURAL

DISEASE.

Functional Dyspepsia. Malignant Structural Disease.

Complexion and General Appearance.

Color of the skin yellowish, from

an irritated state of the gastric

and duodenal mucous membrane.

The countenance is "pinched,"

and expressive of dissatisfaction

rather than of thought and anxiety.

Dingy, sallow, ex-sanguine, but
opaque appearance of the skin.

The eyes sunken, adnata pearly :
the countenance expresses care
and depression, not dissatisfaction,
but introverted thought and pee^
vishness.
Emaciation a7id Loss of Strength.

Loss of flesh not great, and is
speedily followed by restoration,
with increased strength when the
more distressing symptoms subside.

Much pain; diffused, intermit-
ting, and better or worse according
to the stage of digestion, but seldom
of that extreme, lancinating char-
acter that belongs to cancer, and
is relieved by alkalies in solution.

In structural disease of the car*
dia and oesophagus, emaciation
proceeds to a degree not seen in
any other disease, while the loss
of strength is not in proportion to
the loss of flesh. When a cancer-
ous disease exists in any other sit-
uation, the emaciation is seen, but
not to the same extreme degree.
When in the stomach or external
to it, the prostration of strength is
greater than would be expected
from the violence of the other
symptoms.
Pain.

Pain not always present, at least
in the early stages, even when dis-
organization is insidiously pro-
gressing ; but it becomes severe in
latter stages, is of a peculiar lan-
cinating, grinding kind, and usually
confined to a particular spot. In
the structural form, pain is more
acute and more defined than in the
areolar or colloid.

The cause of the vomiting is ge-
nerally obvious; the stomach con-
tains food of bad quality, imper-
fectly digested, vitiated secretions ;
and is always a manageable
symptom.

This usually occurs in some stage
of structural disease. In the latter
stages, the action of the muscular
coat becomes imperfect, and the
act of vomiting is a mere regurgi
tation.

FUNCTIONAL AND MALIGNANT STKUCTUEAL DISEASE.

277

Functional Dtspepsla. Malignant Stkuotukal Disease.

TJw Fluids wmitecL

The fluid is usually dark colored,
having much the appearance of
venous blood.

The fluids ejected in functional
disease never possess this peculiar
dark color.

ConsUpation.

There are generally large col-
lections in the arch of the colon:
the relief obtained by purgatives,
though only temporary, is usually
accepted for the time as satisfac-
tory.

Always present in structural
disease. When in the latter stages
the disease spreads to the colon,
dysenteric symptoms supervene.
The discharges are covered with
blood, or resemble the washings of
flesh. When the seat of the accu-
mulations is the coecum, relief

from purgatives is very transient
and imperfect.

Tongue.

Foul and covered with fur: no
aphthae, but the acid eructations
from the stomach cause occasional
slight ulcerations.

It generally continues clean to
an advanced period of the disease,
when there may be aphthae on its
surface, caused always by failure
of power, as in other chronic
diseases.
Flatulence,

It is a common symptom, but is
less oppressive than in structural
disease : its escape gives relief.

Is imperfect; can generally di-
ciest animal food as well or better

than things considered as lighter.
Examination
The slightest pressure anywhere
over the stomach and upper part
of the abdomen produces pain :
dread of being touched; pain
chiefly caused by inflation of the
stomach and from gases : percus-
sion reveals its nature ; morbid
eensibility of gastric and enteric
nerves

The gas is continually rising, is
foetid in character, and affords little
or no relief.

Always imperfect; the patient
can only take farinaceous and ve-
getable food.
hy the Touch.

Pressure only gives pain when
made on the precise seat of the
carcinomatous deposit, but then
gives severe and lasting pain in
that particular spot. When this
is within the stomach the pain re-
sembles that which precedes vo-
miting. When the liver is the seat
of disease, the pain is felt on pres-
sure, unless the tumors be raised
above the convex surface and are
vascular, in which case, when the

278 diseases of the digestive function.

Functional Dyspepsia. Malignant Stkuctuijal Disease.

patient is thin, they can be felt
through the parietes.

Progress of tlie Disease.

The symptoms of indigestion
force themselves very early on the
attention. The patient regards his
symptoms as evidence of important
and extensive disease; and dwells
minutely on the circumstances of
his case.

The disease comes on insidious
ly, and its history is imperfectly
ascertained ; indeed considerable
disorganization often takes place
before any train of appreciable
symptoms can be observed.

Werves employed in. Digestion. — In the nervous system we dis-
tinguish two great classes of nerves. Those that take their origin from
the brain ; and those that a^rise from the spinal marrow ; and also those
which constitute the ganglionic system of nerves.

The nerves which originate in the brain transmit sensations to the
sensorium, and nervous influence to the voluntary muscles. The
nerves which proceed from the spinal marrow regulate the functions of
various vital organs, as the stomach, heart, liver, &c.

Of the nerves of the first division we notice that each has its peculiai
sensibility in health, but when inflamed or diseased they become exqui
sitely sensible to impressions which in health they would not have felt
Common food swallowed ceases to be felt as soon as it reaches the
stomach ; but a tea-spoonful of tincture of Capsicum produces a burn-
ing heat in the same surfa:ce by inflaming its nerves.

" Here arises," says Johnson, " one of the most useful precepts in the
art of preserving health. Whenever we call forth conscious sensation
in the stomach, whether of a pleasurable or painful kind we offer a
violence to that organ; the injury may be slight but it is re^l. When
food of the right quality, and in the right qicantity is taken into the
healthy stomach no sensation whatever is felt ; but when a full meal is
taken which includes some stimulating article, a sensible impression is
made on the nerves of the stomach. When this sensation is a pleasur-
able one, when a general exhilaration is produced, the pulse is
quickened, the face flushed, the mind more active, and the flow of ideas
more free. But this exhilaration is transient and partial. In propor-
tion as the ganglionic system of nerves is excited, the voluntary nerves
and muscles are disqualified for action. These nerves of the gan-
glionic system convey the vital power from the nervous centres to those
organs which continue their action independent of the will, as the lungs
or heart. In a state of health pleasurable sensations are diffused over
the body as well as to the mind by the presence of food in the stomach

DYSPEPSIA FEOM DEFICIEl^T SEORETION OF GASTKIO JUICE. 279

without any conscious sensations being perceived by it. Now, if these
^ame nerves in a state of health can diffuse over the system these feel
ings of comfort it is not strange that when in a disordered state they
are equally capable of exciting the most gloomy thoughts in the mind
and the most painful sensations in the body by the application of the
same stimulants, whether with or without any unpleasant sensation iu
the stomach itself.^ See p. 218, 281.

Thus wine in a state of health produces a pleasurable glow over the
whole system ; if Tartar-emetic or Digitalis be added to it, the peculiar
distressing effects peculiar to these substances are produced on both
body and mind. From these facts we may conclude

1. That from the stomach a diffusive energy and pleasurable feel-
ing may be extended to ail other parts of the body, including the brain,
which is the organ of the mind, without any distinct ^pleasurable sen-
sation in the stomach itself. And

2. That from the stomach may be diffused over the whole system,
intellectual and corporeal, a train of morbid feelings of the most dis-
tressing kind, with or without any distinct sensation of pain or uneasi-
ness of the organs of digestion.

Causes of deficient gastric Secretion, — When the eighth pair of
nerves are divided in the neck in experiments on animals, food taken into
the stomach remains undigested; and after death, the coats of the
stomach are not found dissolved by the gastric-juice, as they often are
when death has suddenly occurred at a time when the stomach contains
a large quantity of gastric-fluid. It is, therefore, proved that the di-
vision of the nerves, together with general injury and shock given by
the operation, arrests the secretion of gastric-juice for the time.

2. Feebleness of digestive power is produced by excessive fatigue,
great mental excitement, long-continued watchfulness, the depressing
passions of fear and anger. Men who overstrain the intellect in the
pursuit of wealth, or whose labors are mental rather than physical, are
liable to dyspepsia, even when their general habits of life are not the
worst. Victorious on every field where they encountered only physical
evils, votaries of literature and business are vanquished by that sterner
enemy — -Cabe. When business becomes his only pleasure, and weary
anxious thought his only recreation, the man who is the slave of reputa-
tion, wealth, or poverty, soon learns to read in his own care-worn feature?
the manifestations of that " Weae and Teab Malady" that embitterjl
life to so many mental laborers in every walk of city-life.

S. Congestion of the gastric-mucous membrane, or inflammation in a
slight degree, as well as inflammation of other organs exciting general
fever.

^ On Morbid Sensibility of the Stomach and Bowels,

280 DISEASES OF THE DIGESTIVE FUNCTION.

4. Indolent sedentary habits.

5. Habitual indulgence in eating too much. In some conditions the
wants of the system are large, as in day-laborers and nursing women.
In diabetes, though the stomach has sometimes an increased power of dis-
solving food, a large portion of it undergoes only imperfect digestion;
and instead of being converted into healthy chyle, it is only changed
into the low form of saccharine matter, which passes off by the urine
without nourishing the body. This leaves the different organs of the
body but poorly nourished, though the mucous membrane of the stomach
may become hypertrophied from the constant irritation of its contents ;
and the hunger of the system is expressed in a craving for food, which
all the nutriment swallowed cannot satisfy. But whether the quantity
of nutritive matter taken be that which health demands or far exceeds
that quantity, the stomach can only dissolve, in the process of healthy
digestion, a certain amount of food. The gastric-fluid then becomes
saturated and can dissolve no more. See p. 217.

6. The stomach is in some persons constitutionally weak, or has
been rendered so by the intemperate use of stimulants, the abuse of
irritating drugs, the effects of epidemic cholera, or of other diseases.
In all of these cases, as well as in those forms of atrophy of the gland-
structure, elucidated by the microscopic researches of Dr. Handheld
Jones,^ the the supply of gastric-fluid is generally deficient.

Such are a few of the causes of ordinary cases of imperfect digestion ;
but the stomach is so intimately associated with almost every other
organ of the body, that its condition is influenced by disorder located
in any one of them.

Spallanzini excited his own stomach to secrete gastric-juice by irri-
tating or tickling the fauces in the morning when it was entirely empty.
He then caused it to expel the pure digestive fluid by vomiting, and
found that this fluid had the power to dissolve meat and prevent its
putrefaction. The mode by which this secretory action of the stomach
was excited is now understood, and we are, therefore, enabled to ac-
count for the various sympathetic affections in which the stomach sym-
pathizes with other organs, and also to see how it transmits to distant
parts the morbid influences that originate in its own diseased condi-
tions. (See Reflex Action. — Index?)

The exciting causes of dyspepsia are generally such as follow :

Protracted depression of spirits, whether occasioned by want of occu-
pation, deprivation of the accustomed mental and physical exercise,
pecuniary misfortune, loss of friends, disappointment, or mortification,
is a prominent cause of dyspepsia. This cause is very general and ex-
tended in its operation, affecting not only the mucous structure of the

* ^' On the Morbid Conditions of the Stomach."

EFFECTS OF EATING TOO MUCH. 281

stomach, but the liver, the bowels, the cardiac nerves, and in soiie in-
stances the whole nervous system. It is to this variety of indigestion
that we should attribute many of those hypochondriacal affections,
which are often referred exclusively to disorder of the liver.

Next in importance to the above may be named the abuse of rich
and highly seasoned food, stimulating drinks, coffee, tea, tobacco, irre-
gular eating hours, and inattention to the daily faecal evacuations.

In a state of health the- sensations of the stomach are always de-
pended on to give the proper warning when sufficient food has been
taken. But, in that degree of soundness which exists in ordinary per-
sons, the feeling of satisfaction or satiety is never perceived till the
stomach is so far loaded that its sentient nerves are beginning to be
irritated. " There appears," says Beaumont, " to be a sense of perfect
intelligence conveyed from the stomach to the brain, which, in health,
invariably dictates what quantity of aliment, (responding to the sense
of hunger and its due satisfaction,) is naturally required for the pur-
pose of life ; and which, if noticed and properly attended to, would prove
the most salutary monitor of health, and effectual preventive of, and re-
storative from disease. It is not the sense of satiety for this is beyond
the point of healthful indulgence, and is nature's earliest indication of
an ahuse and overburthen of her powers to replenish the system."
When the needed quantity of food is taken into the stomach there is " a
pleasurable sensation of perfect satisfaction, ease and acquiescence
of body and mind." But this elysium of the reasonable epicure is not
reached except after due attention to the preliminary processes of mas-
tication, and deliberate deglutition which are always indispensable.

Effects of Eating too much, — First Grade of iNDiaESTioN.— The
symptoms which follow upon taking too much food of a highly seasoned
character are: a sense of distention occasioned by the swelling of sub-
stances in the stomach which the gastric-fluid cannot dissolve. This
distention, with the presence of the irritating mass of fermenting food,
causes a feeling of uneasiness, prevents sound sleep, or occasions a
paroxysm of night-mare ; in the morning it is followed by headache,
confused intellect, furred tongue, unstrung nerves, and deranged secre-
tions. A case of this kind, says Johnson, is not properly one of indi-
gestion, but of intemperance. It is only when such irregularities in
diet have been often repeated, and are joined to other causes which
have the power of arousing new trains of diseased sensibilities, and
when the nervous system, the liver, and the skin begin to react upon
the stomach and the gastric-fluid, that, this disease of many horrors,
called Dyspepsia, begins to be recognized.

The gastric-fluid is so much under the influence of the nervous sys*
tern that it is only secreted in its perfect state when the nervous sys«
tern is also in its best condition ; and the liver, skin, and stomach are

282 DISEASES OF THE DIGESTIVE EUNOTION.

in such, direct communication through the nerves that thej all become
involved in the long train of morbid sensibilities, vitiated secretions
and complicated sympathies which unitedly form this protean disease
{Johnson,)

Thus the habit of eating too much, too fast, and too carelessly, i
seen to be one of the principal causes of that terrible derangement of
the digestive organs, which soon involves the mental and spiritual
powers aiid destroys the energies of both mind and body. Indiscretions
in eating are said to have paralysed the spirit of the first Napoleon on
some of the most critical occasions of his life. At the battles of Leip-
zig and Borodino he might, by his accustomed decision in pushing un-
favorable events, have converted them into victories. At Dresden also,
it is asserted by Hoffmann that he would have done much more tha.n he
did, but for the unhappy "effects of a shoulder of mutton stuffed with
onions." {London Quar, Review, 1852.)

The influence of onental emotions in breaking down health, and pre-
venting its restoration has never been sufficiently appreciated. " If a
patient dies/' says M. Reveiile-Parise, "we open his body, and rummage
among the viscera, or scrutinize most narrowly all the organs and tis-
sues, in the hope of discovering lesions of one sort or another." One
thing only escapes the attention of the anatomist; he is looking for
organic effects, " forgetting all the while that he must mount higher to
discover their causes. These organic alterations are observed, per-
haps, in the body of a person who has suffered deeply from mental dis-
tress and anxiety ; these have been the energetic cause of his decay^
but they cannot be studied in the dissecting-room." Many physicians
of extensive experience are destitute of the ability to search out and
understood the causes of disease ; " they cannot read the book of the
heart; and yet it is in this book that are inscribed day by day, and
hour by hour, all the griefs and all the miseries, and all the vanities,
and all the fears, and all the joys of man, and in which will be found
the most active and incessantly operating source of that frightful series
of organic changes which constitute pathology."

II. FERMENTATION OP THE CONTENTS OP THE STOMACH PROiM
DEFICIENT SECRETION OP GASTRIC JUICE.

That the gastric juice in its perfect state prevents the putrefaction
of meat, and even arrests it when already begun, was first shown by
Spallanzini. It is also known to prevent the acetic, lactic, and alco-
holic fermentations; but, when the vital powers fail — when the gastric
fluid is deficient in quantity or quality, and chemical affinities over-
power vital forces, some of these changes may occur in the contents
of the stomach. In these cases Lehmann regards i]\Q ferment as an

FERMENTATION OF THE CONTENTS OF THE STOMACH. 2o3

unhealtliy mucus, wliich is mucli disposed to fermentation, and already
in a state of decomposition. In many cases, food undergoes the ordi
nary putrefactive changes, in which sulphuretted hydrogen gas i
evolved. This gas accumulates in the stomach, distending it painfully
hence efforts to relieve it by eructations of sulphuretted hydrogen
having the odor of rotten eggs ; symptomatic of this is severe fronta
headache and chilliness, followed by febrile excitement.

' Causes. — 1. Over-eating, — Eating too much, previous to severe ex-
ercise.— Delicate persons, who feel exhausted and weak, often eat freely
for a temporary invigoration, and immediately engage, in active exercise.
The vital powers being thus withdrawn from the stomach, the food
remains undigested, and what is called "a surfeit" occurs.

2. Carious Teeth, — When many decayed teeth exist, offensive saliva
imbued with the elements of that peculiar " gangrene" on which caries
depends, passes into the stomach. *

3. Structural Disease of the Stomach, — In cancer of the stomach,
morbid secretions are formed in that organ, which have little power to
digest the food taken. At the same time, there may be stricture or
morbid irritability of the pylorus, or impediment to the muscular mo-
tions of the stomach. Any of these conditions may detain the food
prevent its full digestion, and facilitate chemical decomposition.

4. Food of Invproper Quality, — ^Vegetables, fruits, new bread, ill
fermented malt liquors, or new wines, pass rapidly into a fermentation
by which carbonic-acid gas is evolved; the stomach becomes' distended
by the accumulated gases, and is only temporarily relieved by repeated
eructations. Dr. Beaumont says, that on one occasion, when St. Mar-
tin had been in the woods all day, and had eaten no food but whortle-
berries, from, eleven A. M. to eight in the evening, the stomach was ex-
amined through the aperture in its side. He found it "full of berries
and chimifying aliment, frothing and foaming like fermenting beer or

cider."

When food already fermenting is ingested, the chemical action con-
tinues ; the gas evolved is belched up, if no impediment exist at the
cardiac orifice, and the fermentation subsides when its material is ex-
hausted. But when this aperture is obstructed or spasmodically closed,
the gas evolved distends the stomach, and this may even destroy life.
Cattle, eating more clover than the stomach can digest, suffer much
distention; and, in consequence of the peculiar structure of ths stomach,
these gases can not escape through the oesophagus. They then cause
enormous distention of the organ, in some cases even to bursting.f

5. Flatulence and Distention of the Stomach from Imjjerfeci

* Ka^cker's Principles of Dental Snidery.

t Di Budd. Diseases of the Stomach, p. 177.

284 DISEASES OF THE DIGESTIVE FUNCTION.

Digestion. — This is commonly felt an hour or two after the principul
meals, when the lighter form of indigestion has become chronic. Fer-
mentation in the stomach gives rise to products which when absorbed
into the blood, have an injurious influence on the general health. The
food taken is only partially digested, the body is imperfectly nourished,
the spirits depressed and all the mental and physical energies are en-
feebled. When amid the products of unhealthy digestion, oxalic acid
is formed, crystals of oxalate of lime may be discovered in the urin'e.

Treatment. — In every form of dyspepsia we begin the treatment
by regulating the diet, restricting it to a moderate quantity of nutritious
but easily digested food. Every dyspeptic should avoid new bread,
tough meats, all alcoholic or fermented liquors, extreme bodily fatigue,
and nervous exhaustion from all other causes. But he should take
much active exercise in the open air, and should keep the mind habit-
ually and cheerfully employed.

The earlier homoeopathists insisted much upon a strict diet; and the
belief has become common, that the fine preparations we employ will
be neutralized by antidotal substances in the food or in the atmosphere.
If this were true we might indeed despair of success in a city, in which
few ever breathe uncontaminated air. The truth is, that ^ projjyer diet
should always be prescribed ; but we do injustice to our remedies, if
we admit that they have so little power that they can be turned aside
by a breath of impure gas, or the vapor of Camphor or Vinegar. " If,"
says Dr. Espanet of Algeria, "our infinitesimals are truly independent,
insusceptible of combination and imponderable, they must exercise
their special dynamic action, in spite of drugs, gases, or whatever sub-
stances may be present." "If this be not so, then, all infinitesimal
doses are an illusion, for long before entering the body they must have
entered into some new combination." What are the facts witnessed by
every homoeopathist ? One patient has been treated for days by
ponderous doses of Mercury, Opium, or Quinine. We give a proper
attenuated remedy and witness curative results in spite of the unfavor-
able conditions and surroundings. Another patient is laboring under
profound functional disturbance: "He is full of fluids, abdominal
gases, odors, and chemical principles in abundance; his tongue is
thickly furred, and yet a few globules penetrate the midst of this in-
fected mass and remove the whole disease."^ It is indeed necessary
to regulate the patient's diet, not because wrong food is incompatible
with proper remedies, but because it would injure the patient, if he
were taking no medicine.

It has been fully proved that quite as much depends on the quantity
of food as on its quality. There appears, says Dr. Beaumont, " to be a

* Espanet J Jour, de la Soc. Gallicane, 1852. 360.

FERMENTATION OE THE CONTENTS OF THE STOMACH. 285

sense of perfect intelligence conveyed from the stomach to the brain
centre, which, in health, invariably decides what quantity of aliment
(responding to the sense of hunger and to its due satisfaction), is
naturally required for the purposes of life, which, if noticed and properly
attended to, after thorough mastication and moderate and slow degluti-
tion, would prove the most salutary monitor of health." It is not the
sense of satiety, for this is beyond the point of healthful indulgence,
and is nature's earliest indication of an abuse and over-burden of her
powers to replenish the system. It occurs immediately previous to this,
and may be known by the pleasurable sensation of perfect satisfaction,
ease and quiescence of body and mind. The quantity of food required
by a person in full health, varies according to the perfection of the
digestive power, and also to the degree of exercise taken, and to the
age and habits of the individual. Dr. Southwood Smith Aveighed eight
men engaged in feeding the fires of a London gas company, and found
that in one hour one of the men lost two pounds eight ounces and another
lost four pounds three ounces by perspiration. The general result was,
that the men employed in that work lost from two pounds to five pounds
weight twice a day by perspiration alone.^ It is plain that those who
exercise little must perspire less, and consequently need less food.

As the sensation of hunger depends on the condition of the brain,
its impulses are not always correct. A voracious appetite is often a
precursor of fever ; and in a state of debility the stomach may crave
a large amount of food, which, instead of being digested, is frequently
retained twenty-four hours or more, causing the most distressing symp-
toms, particularly in children, amounting in some cases to convulsions
and even death. In a state of fever, little or no gastric fluid is secret-
ed. Dr. Beaumont examined the stomach of St. Martin at one time
when the villous membrane was red and dry. He complained of head-
ache, pain and distress at the pit of the stomach, lassitude and loss of
appetite. On making the effort to extract gastric juice from the stomach
in this state, nothing could be obtained but a little acrid and frothy
mucus, showing why food cannot promote strength in fever; and it
has been often seen that undigested food remaining in the stomach
produces all the phenomena of fever. The gastric juice not being able
to act upon the undigested food, the stomach is irritated, just as if food
had been introduced into the stomach, when the system was in a febrile
state.

In the treatment of chronic dyspepsia, independent of temporary
inflammation or fever, the selection of appropriate food has long been
regarded as an object of primary importance ; but, in nearly all that
we have read on this subject one essential principle has been entirely

* Philosophy of Health, p. 399. Vol. 2.

286 DISEASES OF THE DIGESTIYE FUNCTIOK.

overlooked. To this point it is necessary to call particular attenlion.
In nearly all invalid conditions, especially where evidences of im-
paired digestive power occur, there exists in the constitution a sicscej)'
tibility to the poisonous properties of all fermented or otherioise
deteriorated articles of food. In many cases susceptibility to occult'
poisons of the ferment and putrefactive order exists as a veiled idio-
syncracy under ^ variety of chronic disease-tendencies, between the
varying manifestations of which, the patient but oscillates in dilFerent
forms and degrees of suffering.-

In other cases this susceptibility may be a state temporarily induced by
impairment of the vital powers from whatever cause. An almost invariable
index of poisoning from impurities of this kind, may be found in a sour
or copper taste in the mouth, particularly on waking in the morning ;
also itching and smarting about the margins of the eyelids, with de-
rangements of the digestion, including the whole train of dyspeptic
symptoms, I have found most frequently and directly traceable to
this cause. Prominent among these, are offensive breath ; faint and
gnawing sensations in the stomach; acidity, morbid appetite, and more
or less constant and insupportable gastralgic pains, &c.

It is a common but extreme, mi stake to suppose that if the stomach
s not evidently disordered by what is eaten, no fault may be attached to
the food : it is on the contrary most true, that the ferment and its
kindred poisons being taken up into the blood, are active agencies in
stirring up, if not in originating a great variety of diseases through
their deteriorating qualities. I have known herpetic humor of the most
inveterate character, and which had resisted all medication, subside
entirely on the persistent use of a pxire diet^ and again be recalled
into activity on any deviation from the same, even to the extent
of eating one piece of fermented bread and butter, as ordinarily made.
And to what extent many diseases may be referrable to this class of
poisons alone, I do not pretend to decide. ^The subject at lea,vSt merits
a greater degree of attention than it has hitherto received from the
medical profession.

As suggesting a few of the common liabilities to poisonous impurities
in diet, I instance some kinds of food, or management of it, to be
avoided.

Bread made by any process in which it has stood to rise previous to
baking, contains incipiently" the elements of putrefaction. Cryptogamic
growths of the fungus order are developed in the fermentive process
which is cause sufficient for its pernicious effects upon many persons,
if not upon all who make use of it.

Butter made from soured milk, or kept, till ever so slightly deterio-
rated, is pervaded by a " hutyrie ferment^ which is composed of in-
fusoria or animalcule shaped like a cylindrical wand," as demonstrated by

FERMENTATION OE THE CONTENTS OF THE STOMACH. 287

tlie late highly interesting and important researches in these subjects
by M. Pasteur. (See NrA. Jour, Rommop. Feb. 1859, p. 307.)

Flour or meal too long ground, or kept in places not most dry and
airy, contract 7)^^lst in a poisonous degree before its existence may be
discernible to taste or smell. Vegetables and fruits as usually kept in
cellars and close places, contain similar health-forbidding properties.
.•Cheese is an article so surcharged with the mould poison in some
stage of development that few persons can be found proof against ill
effects from its use. Cured or smoked meats and fish are almost in-
variably tavfited to a poisonous extent. Cooked food and other things,
"kept over," as cold potatoes are most likely to have acquired the
same pernicious properties. Therefore, if fit for anybody to eat, they
are in no wise allowable to persons not in the most robust health.

From many experiences I am aware of the difficulties in the way of
obtaining and enforcing a thus rectified ^mipure diet ; but where the
case demands it, and hopeless suffering only is the alternative, it can
he done. In some constitutions the susceptibility to poisoning from
deteriorated food is so innate, that from infancy, health can only be
maintained in the degree that they are a'ooided entirely.

And there are multitudes who swell the list of habitual invalidism
and suffering till a premature end, to whom suggestions of a i/pue diete-
tie ])TinGi])l6 had been the most invaluable of medical advice.

While for the invalid, food should be selected with all reference to
other qualities of fitness, let it be essentially ^^^7'6 from every principle
of decay ^ which in its own nature belongs, not to the life and health,
but to the death side of things; nor is it strange, that if we would build
up a healthy organism^ we should be required to draw from the life
and health department in our nutritive material.

By what law or consistency of principle, we may reasonably in-
quire, shall a given organism be susceptible in a life and death degree,
to the potencies of homeopathic remedies— and at same time — keep
closed doors against the actually poisonous qualities of food?

In constitutions in which the health power is in the ascendant, a
great degree of positiveness to all disease-producing agencies exists ;
but our concern and effort is in behalf of the large proportion of
our humanity, in whom that health-power has proved insufficient for
its contest with the deleterious influences it has had to meet. And to
withdraw and abate these by every renovating and sanitary measure,
is the most worthful labor of the true physician.

In the field here indicated, radical and extensive is the principle
of dietetic reform urged ; and it may be long before our truer insights
shall cease to be pained by even the most common spectacle of a
delicate child endeavoring to maintain its hold upon physical existence
through a piece of stale hread and rancid butter !

288 DISEASES OF THE DiaESTIVE FUHCTIOK.

ExEECiSE.- — When the due amount of exercise has been long, neg-
lected, the nervous system becomes enfeebled and irritable ; the mus-
cles lose their tone and become more slender and flabby, and all the
functions of assiipilation and nutrition are imperfectly performed. When
the muscles remain too long inactive, physical energy is lost ; the calibre
of the capillary vessels is diminished, a deficiency of exhalation in the
synovia] membranes causes rigidity, and finally immobility of the joints;
obstructions of the capillary circulation lead to organic disease, and
inactivity of the absorbents causes the accumulation of fat, so common
in indolent persons. This condition requires other measures than
treatment by drugs, as these can never, unaided, restore to healthy
action the organs that have long remained in a state of inertia from
deficient exercise.

Exercise of each organ induces an afflux of fluids on which its growth
depends. Neglect of exercise enfeebles the nervous and muscular
systems, causing inordinate sensibility and irritability of the former,
and a flabbiness and want of tone of the latter, in which every organ
sympathizes ; it lessens the supply of nervous energy, the . activity of
assimilation and nutrition. When muscular repose continues a long
time, motion becomes impossible ; the muscles are debilitated, and the
calibre of the vessels diminished.

The effects of inactivity are manifested in the brain, abdominal and
thoracic viscera, and on all the assimilative organs. The circulation,
absorption and nutrition languish ; obstructions in the capillaries lead
to organic disease ; and the abundant accumulation of fat in indolent
persons only shows debility in the absorbent function, which in a healthy
person should preserve a proper balance between the diflerent tissues
and structures. In such cases the bulk of the body may be enormously
increased ; but the texture of the organs is less solid ; the muscular tis-
sue is soft, and locomotion is difficult and painful. The corpulence of
the butcher, who eats too much animal food and exercises too little,
furnishes no indication of firm health and long life ; butchers as a class
are much exposed to inflammatory diseases, fevers or apoplexy, &c.
There is a certain amount of excitability furnished by the brain and
nervous system to every organ and structure of the body, designed for
expenditure in the discharge of the functions of the various parts ; and
if it is not expended in exercise, it accumulates to a degree that pre-
disposes to disease ; melancholy, hysteria, or mania may result.

" The languid eye, the cheek
Deserted of its bloom ; the flaccid, shrunk,
And withered muscle, and the vapid soul,
Keproach their owner with his love of rest."— Cowter.

MEDICAIi TKEATMENT OF DYSPEPSIA. 289

Medical Treatment.- — An essential condition in the treatmt,nt of
dyspepsia consists in the maintenance on the part of the patient, of a
healthy, active, and cheerful state of mind. Unless this be accom-
plished, our remedies will either be of only temporary service, or entirely
unavailing. Next in importance, is a course of rigid dietetic regula
tions. In proposing a bill of fare for the dyspeptic, much must depend
upon the circumstances of each particular case. If the patient is of a
highly bilious temperament, a much more simple diet will be requisite,
than for one who is nervous or sanguine. As a general rule, an intel-
ligent person will be able to select a suitable diet for himself by ob-
serving attentively the effects which different articles exert on the
constitution. See p. 286, 287.

Another equally important condition in the treatment of this disease,
is perfect regularity in all the habits of life, as eating, sleeping, alvine
evacuations, exercise, &c. First, sufficient sleep should be allowed to
enable the system to recover entirely from the fatigues of the preced-
ing day ; second, moderate and agreeable exercise should be taken for
an hour or more previous to breakfast, bearing in mind that exercise,
in order to be beneficial, must not be undertaken and performed as a
task, but as a pleasant recreation; third, in partaking of our food, we
should never forget, while we are thus repairing the w^aste of the body
from the exercise of the functions, &c., that this also was intended by
our Creator to be a source of pleasure to us. Let the rational man
therefore, especially the dyspeptic, never eat with disordered rapidity
but slowly, so that, masticated properly, his food may be taken into the
stomach in a fit condition for the processes of digestion. This is the
true philosophy of eating. Finally, at a certain hour every day, perhaps
after breakfast, an evacuation from the bowels should be solicited. It
matters not whether the inclination be uniformly present, let the patient
never fail in his readiness, and the bowels will soon form the habit of
responding. So much are we the creatures of habit^ that we can train
our bodies, our organs, our appetites, tastes, &c., to almost anything we
desire by a steady persistence in our object.

The most approved remedies for the different grades of indigestion,
are : ,

WuX'Vornica^ Sulph., Pulsatilla, Bry., Lycopod., Calcar., Carb., Se-
pia, Graph., Ignatia, China, Antimonium-crud., Corn.-circ. Ferrum.,
Phos.

Num-vomica, — Defective or capricious appetite in persons subject to
haemorrhoids ; craving for stimulants or acid drinks ; sour or bitter taste
in the mouth, insipidity of food ; nausea, sour eructions, regurgitations,
waterbrash, accumulation of water or mucus in the mouth, vomiting of
food ; drinks, epecially acids, cause suffering, griping, aching pain in the
stomach ; , colic, pinching contractions, bewilderment or destruction of

Vol. I.— 19

290 DISEASES OF THE DIGESTIVE FUNCTION

mind, head-acbe, vertigo, general uneasiness or hypochondriacal ten-
dencies; oppression of breathing, chills, lassitude, indolence, drowsiness,
feeling of fatigue and sleep ; heaviness of the head, unfitness for intel-
lectual labor in an impaired constitution; vertigo, anxiety, paroxysms
of fainting. Epigastrium distended; it feels tense and excessively
tender, and burning when touched; and the clothes feel too tight. When
there is general gastric derangement, the tongue is dry and. white, or
yellowish towards^ the root; there is no thirst, and too little water is
habitually taken, at other times, there is burning thirst and heartburn,
or cardialgia.

Heat and flushings of the face common in persons who have been in-
temperate ; plethoric habit ; general disposition restless, choleric, iras-
cible, irritable, disposed to dispute or command ; violent passion, par-
oxysms of suifering caused by late hours ; complexion yellowish,
earthy ; deficiency of the secretions generally ; bilious constitution ;
bowels constipated, evacuations hard and expelled with difficulty;
disease caused by sedentary habits or intense study.

Nux-vomica is well adapted to the cases which occnr in sanguine
or bilious temperaments, and which have been induced by ** high living,"
sedentary habits, undue mental exertion, irregularity in eating, sleep-
ing, &c. The indications for Nux are, florid or pale, sallow or yel-
low complexion ; general expression of countenance, anxious and sad,
care worn ; tongue dry, or covered with a whitish coat ; occasional ful-
ness in the region of the stomach and bowels ; craving for stimulants
or acid drinks ; sour or bitter taste in the mouth ; insipidity of food.

Distress at the stomach after eating ; na-usea, and vomiting of food ;
eructations and regurgitations; pyrosis; distressing sense of debility;
accumulation of water or mucus in the mouth ; irritability of the ner-
vous system, with constant inclination to roam about ; symptoms worse
after meals and in the evening ; constipation; haemorrhoids ; tenderness
at the pit of the stomach on pressure ; drinks especially cause suffer-
ing ; griping, aching pain in the stomach; vertigo ; dizziness or swim-
ming in the head, headache, particularly when rising in the mornings
or walking about, bewilderment or distraction of mind; cramp-like pains
at the pit of the stomach, sometimes extending upwards to the dia-
phragm and oesophagus ; colic, pinching contractions*

Confirmed hypochondria ; constant dread of approaching misfortune.

When the dyspepsia consists simply of impaired activity of the
nerves of the stomach, from the causes just named, Nux is without
doubt the appropriate specific ; but it is almost an invariable oc-
currence, that this condition of the stomach is attended with more or
less derangement of the nervous system, manifested by loss of anima-
tion and energy ; depressing of spirits; an invincible tendency to look
on the dark side of affairs ; trifles are exaggerated into matters of im-

MEDICAL TREATMENT OF DYSPEPSIA. 291

portance; there is an indefinable sense of dissatisfaction, dread, and
uneasiness, which impairs the appetite, disturbs the sleep, and almost
unfits the individual for the ordinary duties of life, and often causes
an urgent inclination to commit suicide ; excessive nervous irrita-
bility. When this condition of the nervous system has (existed for a
considerable time, it receives the name of hypochondria. lor this com-
plication, Nux alone is insufficient, but one or more of the medicines
hereafter enumerated will be required.

Administrcttion. — ^In cases of this description, we usually prescribe
Nux-vomica from the third to the sixth potency ; a dose to be given
each night, as long as may be necessary.

8iblpli%iT, — In most cases of chronic dyspepsia, at the beginning of
the treatment; in persons addicted to alcoholic drinks, and debilitated,
nervous and irritable persons. Acid, putrid, or sweetish taste in the
mouth ; nausea, water-brash; smell from the mouth acid or foetid, espe-
cially on rising in the morning ; vomiting of food ; taste chiefly acid or
bitter; insipidity or too salt taste of food; repugnance to meat, bread,
fat and milk, and craving for acids and wine ; feeling of trembling
within the body; restlessness, such as makes long sitting very un-
comfortable.

SulpJiUT is peculiarly adapted to the treatment of cases occurring
in persons of a scrofulous dyscrasia, and to cases in which dyspeptic
symptoms supervene upon the disappearance of erysipelatous and other
eruptions from the surface, also from the sudden suppression of long-
continued hgemorrhoidal discharges. In many cases of this kind
Sidjjhur will be found to be a valuable remedy.

The external Qnarhs which indicate this medicine are : pale or sal-
low countenance; light hair; blue eyes; thin skin ; white teeth; glan-
dular swellings ; eruptions ; weak eyes, and other signs of scrofulous
diathesis ; distention and distress of the stomach after eating; nausea;
vomiting; pyrosis; frequent eructations, acid or bitter; the symptoms
occurring, for the most part, on the disappearance of these eruptions
or discharges.

Pulsatilla^ at the third potency, is a valuable remedy in dyspepsia
occurring in females, especially when the malady is complicated with
deranged menstruation. If the disorder has arisen from excessive use
of greasy and indigestible food, wine, &c., it will also prove a suitable
remedy.

Slight exertion in conversation causes prostration; fatigue causes
dyspnoea ; the patient is melancholy, despairing, and feels disgusted
with life; sad, hypochondriacal, morose, irascible humor; abdomen
tender on pressure, as if the whole inner surface was raw.

Head-ache, thirst, chest oppressed, chiefly after a meal; disposition
to an over-secretion of mucus in the principal organs ; inertia, and a

292 DISEASES OE THE DIGESTIYE FTTNCTION.

feeling of constriction in the abdomen, as from incarcerated flatus
worse toward morning, and in tlie left side; difficulty in digesting ani-
mal food; milK sours in tlie stomacli; unpleasant effects from acids,
or farinaceous food sweetened ; pains in the stomach, regurgitation or
vomiting of food, lassitude, shivering, and frequent eructations after a
meal ; eyes slightly sore as if from sand in them.

Sense of great fatiguC; shivering, confusion and pain in the head
or in the face ; burning heat in the hands ; flow of water from the
mouth.

Mental and Moral Symptoms. — Sadness ; irritability ; moroseness.

AdminnistTalion, — This medicine may be administered at the third
attenuation in the morning and middle of the afternoon.

Lycopodmrnj^ Galcarea-caTb. and Sejyia may be given in mild cases
of indigestion, occurring in weakly females and children, and persons
of a lymphatic or scrofulous constitution* They may be exhibited at
the third attenuation, a dose each day, as long as may be necessary.
In cases where the above remedies are indicated, a highly nutritive re-
gimen may be enjoined with great advantage, also the constant employ-
ment of all those means which tend to invigorate the system, like ac-
tive exercise, sea-air, and bathing; frequent amusement for mind and
body, &c.

GrajpMtes is valuable in dyspeptic symptoms which appear to be
connected with scrofulous or arthritic affections. It will be found par-
ticularly serviceable when they supervene upon the sudden disappear-
ance of eruptions from the skin, or the sudden suppression of old dis-
charges, or the drying up of old sores.

Adm>inistration^ same as Lycojpodiwin,

£ryonia,—Djsipej)Sm occurring in, or worse in hot or damp-warm
weather. Loss of appetite and great aversion to food, alternating with
morbid craving for improper articles, as wine, strong coff'ee, and acids ;
eructations of wind when the stomach is empty ; or after eating, the eruc-
tations are sour or bitter ; feeling of pressure and distention of the epigas-
trium; regurgitation or vomiting of food ; water-brash ; the epigastrium
is tender to touch ; bowels constipated ; the temper restless and irascible.

Bryonia, at the third attenuation or higher, is well adapted to per-
sons of a bilious temperarnentj with black hair, dark complexions and
black eyes. The particular indications for its employment are : yellow-
ness of the skin and eyes ; tongue covered with a yellowish fur ; bitter
taste ; vomiting or regurgitation of food soon after eating ; sensation of
fulness and burning in the stomach after meals ; fulness and pains in
the region of the liver; urine high-colored ; head confused and giddy;
pressure in the head ; loss of memory ; inability to transact business ;
great despondency ; frequent inclination to commit suicide ; constant
sighing; sleepless nights, or sleep disturbed by unpleasant dreams.

MEDICAL TKEATMEj^T OF DYSPEPSIA. 293

Bilious derangements, skin yellowisli, dry, hot at intervals, particu-
larly tlie palms of the hands and soles of the feet ; slight perspiration
towards morning ; strength variable, easily exhausted.

Lobelia-inflata, — Sphere of Action. — Noack [Ilygea^ 1841. vol
lo) concluded from his experiments that Lobelia acts specifically upoB
the pneumogash-'iG nerve. {Jeanes^ Amer. Instit. Somoeop, vol 1.)
Its most important symptoms are those displayed on the functions of
respiration and digestion.

Digestive Function.— Disagreeable taste in the mouth like that left
by corrosive sublimate ; pungent taste in the mouth ; flow of slimy sa-
liva; soreness of the throat; dryness of the mouth. Burning in the
throat ; dryness of the fauces ; frequent spitting ; dryness of the throat ;
tough mucus in the fauces, causing frequent hawking ; pricking in the
throat.

Burning prickling in the throat, increased secretion of viscid saliva;
nausea and eructations ; burning sensation rising up from the stomach ;
unpleasant sensation in the upper and back pa,rt of the pharynx; feel-
ing as if the oesophagus contracted itself from below upward ; feeling
of pressure as from a foreign body in the whole course of the oesopha-
gus, moving down with a vermicular motion ; drawing pain in the right
side of the throat extending up to the ear ; feeling of a lump in the pit
of the throat.

Loss of appetite ; cough often repeated ; flatulent eructations with
with flow of water in the mouth ; acidity and heat of the stomach, ris-
ing into the mouth with burning sensation; nausea with shivering of the
upper part of the body ; pain, heat and oppression of the stomach, feel-
ing of excessive uneasiness of stomach, affecting the respiration ; un-
easiness of stomach, followed by vomiting, then cold perspiration of the
face ; nausea and perspiration ; free vomiting, great prostration of
strength ; good appetite shortly afterwards ; w^eakness of the stomach
from theprsecordium to the chest and downward to the umbilicus; weight
and fulness of the stomach, worse on pressure ; pain from back part
of the stomach through to the spine ; painful constriction in the region
of the prsecordia ; warmth in the stomach ;'' burning heartburn; run-
ning of water in the stomach, of long duration; distention of the abdomen
with shortness of breath ; flatulence.

Pulsatilla. — Particularly suitable for females and persons of mild
disposition, lymphatic temperament, pale complexion, blue eyes, light
hair, who weep easily, are innocent, affectionate, peevish, and much dis-
posed to seek for sympathy; with disposition to an over-secretion of
mucus, or to heartburn. Dyspepsia originating in the abuse of Mer-
cury, Cinchona, fat, pork, wine ; also in fright.

The tongue feels as if burned, is covered with a thick, grayish, whit-
ish or yellowish coating ; the taste of meat is putrid, sweetish, or bitter

294 DISEASES OF THE DIGESTIVE FTJISrOTION.

in the mouth ; want of appetite, or greediness, with gnawing pain in the
stomach ; repugnance to hot food, with craving for acids and highly
seasoned things, wine, spirits ; want of thirst ; thirst deficient or extreme,*
longing for spirituous, spiced or acidulated drinks.

Pulsations in the epigastrium ; vomiting of greenish, slimy or bilious
bitter or acid substances; vomiting of food or blood, with dyspnoea
sadness and melancholy after eating ; sufferings from eating bread ; bittci*
or sour eructations, tasting of food recently taken, sensation of burn-
ing in the throat and oesophagus ; water-brash, hiccough ; borborygmi
and colic ; cramps in the stomach and praecordial region after a meal ;
melancholy, great anxiety and anguish ; temper excitable ; dread of
death or of appoplexy ; buzzing in the ears ; head easily fatigued by in-
tellectual toil ; dyspepsia, alternating with diarrhoea, from exposure to
cold and dampness.

CalGarea-Garhonica, — Sympathetic or scrofulous constitution, feeble
in body or mind, precocious or morbidly active; wide awake to suspect
ill motives in others.

The head feels as if compressed in a vice ; pulsative or shooting pains
in the head, with sensation of coldness; pain increased by alcoholic
drinks or mental exertion, extending to the cheeks ; nausea, eructations
or expectoration of acid secretions ; vesicles in the mouth and on the
tongue ; bitter, sour, or metallic taste in the morning ; clamminess or
dryness of the mouth; want of appetite and occasional hunger after a
meal ; heat or swelling of the abdomen, with constant thirst, and little
appetite ; craving of wine or acid stimulant drinks ; flow of water from
the mouth, water-brash after every meal ; acid regurgitations ; pinch-
ing, cutting pains in the epigastrium ; tension of the hypochondria ;
sour regurgitations after drinking milk ; inclination to sleep after eat-
ing. Constipation; stools hard, small, often consisting of undigested
matter passed only the second, third, or fourth day ; urine blood red or
brown; general debility in a plethoric, full constitution.

He2?aT-sidjphuris,—-'Gh.romG dyspepsia, following the abuse of Mer-
cury ; paroxysms of indigestion provoked by slight causes, with craving
for wine, or sharp acid a!id stimulating drinks ; nausea in the morning ;
eructations, or vomiting of sour, bilious or mucous substances ; much
mucus in the throat ; pain in the abdomen; hard, dry, and difficult
evacuations; pressure, distention and heaviness in the epigastrium;
bitter taste in the mouth, and of the food while eating ; aversion to fat ;
great thirst ; pressure on the abdomen gives uneasiness.

Ignatia,—'W.e have w^itnessed much benefit from the use of this me-
dicine in indigestion afilicting persons of a ^^r^'6>'W<? temperament. It
covers the following symptoms, viz. : countenance pale or sallow; eyes
constantly in motion ; general expression indicative of anguish and des-
pair; frequent sighing; constant inclination to move about; confusion

MEDICAL TKEATMENT 0¥ DYSPEPSIA. 295

of ideas ; loss of memory ; pressure and other bad feelings in tlie liead ;
distress at the stomach after eating ; appetite variable ; tongue covered
with a thin white fur ; entire despai^, of recovery ; feels as if getting
worse every day ; dread of misfortune, coming want, &c. ; frequent in-
clination to commit suicide; disinclination to see or converse with
friends or acquaintances ; seeks solitude, and broods over imaginary
troubles.

This medicine may be given at the third attenuation— or higher, —
a drop once in twelve hours, until an impression is made upon the
malady.

In cases where the nervous system is so much involved that the
patient desires to die, and continually contemptates suicide, rather
than suffer longer from his morbid and unfounded imaginings, and the
wretchedness and anguish which tortures him day and night, Aurwu-
'niuriat at the first or second or third trituration, will be found a re-
medy of the utmost importance. One grain may be given twice daily
until an amendment occurs.

Cedron, — -Sensation of heat and fulness in the stomach ; distention
and disposition to nausea; generally aggravated by rest, but relieved
by walking and eating.

Case. — A gentleman, aged fifty, sanguine temperament, sedentary
habits ; uncomfortable feeling of the stomach which compelled him to
lie down ; great sensitiveness of the prascordial region ; pulse small and
hard; mouth and fauces dry ; depressed spirits and inquietude ; relieved
by taking food. These symptoms appeared every day from ten to
eleven, A. M., lasting from one to two hours, after which there was pros-
tration of body and mind for an hour or two. The disease had lastad
for eleven months. All the symptoms disappeared after taking two
grains of Cedron first (decimal) trituration, during the apyrexia, every
day for three days.

The occasional use of mild aperients in certain cases of dyspepsia
as well as in convulsions, diarrhoea, &c., caused by the presence of in*-
digestible food in the stomach and bowels, may be advisable for the
same reason that paracentesis is recommended in urgent cases of abdo»
minal or throracic drospy. By evacuating the unnatural accumulationSj
we not only place the disordered parts in a more favorable conditioi?
to recover their lost energy, but we also secure a much better state of
things for the operation of our remedies. In obstinate constipation,
for example, the indurated and impacted faecal matter sometimes in
duces so great inactivity of the muscular and nervous structure of the
intestinal canal as to amount almost to paralysis. In these cases, both
high and low ' attenuations now and then prove inefficient; and it is
here that mild aperients and injections will sometimes prove service^
able, not, however, as curative agents, hut hy speedily removiny a

293 DISEASES OF THE DIGESTIVE FUNCTIOK.

cause of diseasB^ and thus placing the affected parts in the l)est jpos-
sihle condition to ensure the proper action of a homcBopathic me-
dicine.

On this subject, Dr. Madden, of Brighton, makes the following obser-
vations: "It not unfrequently happens that the benefit gained by an
immediate unloading of the bowels more than compensates for the sub-
sequent increased tendency to constipation. This is acknowledged by
all in the case of poisoning. No homoeopathist hesitates to give eme-
tics and purgatives when a person has swallowed a substance which,
if not speedily removed, will cause death; but does not the same hold
good with an indigestible meal? It is no doubt true that our reme-
dies are often sufficient of themselves to overcome the evil influence
of an occasional excess at , table; yet I am convinced that it not unfre-
quently happens, especially in childhood, that a judicious aperient
would at once remove a state of things, which, if treated otherwise,
would entail an illness requiring several days to overcome; There is
much unreasonable prejudice among homoeopathic practitioners on
this point; they will unhesitatingly condemn the use of the mildest me-
dicinal aperient, and yet will order their patients to eat prunes, figs,
roasted apples, green vegetables, brown bread, &c., in the hopes of pro-
ducing the same result. But where is the difference ? A dose of
Castor-oil, for example produces an increased action of the bowels, in
virtue of its being an indigestible oil, which passes through the whole
intestinal tube unchanged, and perhaps exerting some slight irritating
effect on the mucous membrane; whereas the aliments above named
produce the same results, in virtue of their having either a large indi-
gestible residuum which irritates by its presence, or by their contain-
ing vegetable acids, which directly and specifically irritate the mucous
membrane. The result, therefore, is similar in both csi,sesJ^--r(-British
Jour, of ITomoBop. No. XXIX. p. 311.)

In conclusion, we deem it proper to observe that aperients should
never be employed except in very urgent cases, or in those where our
attenuations have failed of producing the required effect. In all in-
stances such measures must be looked upon as merely temporary ex-
pedients.

Treatment of Feijmentatioit of the Contents of the Stomach,
1. Restrict the quantity of food, while attending to its quality. Insist
upon due exercise in the open air. Bad teeth should be removed; and
when this is not assented to, the carious parts, particularly when
there are large and offensive cavities, should be cauterized by Creosote
and Arsenic ; thus : wet ' a small quantity of cotton in Creosote, and
place on one side of it a minute quantity of Arsenic (vrhite oxide of Ar-
senic as usually sold), place this cotton in the tooth, pressing the Arse-
nic carefully down to the diseased nerve. A momentary pain is felt

TEEMENTATION OF THE CONTENTS OF THE STOMACH. 297

but entirely unlike toothache ; the tooth then ceases to be painful or
to cause serious trouble. Such teeth may be filled and do good service
for years. "When neatly performed the operation is generally painless.
2. Wate7\—Go\A water should be the common drink of dyspeptics.
I have often seen its prohibition prove injurious. " Water," says Pe-
reira, " repairs the aqueous parts of the blood expended in secretion
and exhalation. It is a solvent of various alimentary substances, and
assists the stomach in the act of digestion, though if taken in ^6r^ ter^^
quantities J it may have an opposite effect, by diluting the gastric
juice." This caution, though properly given, is seldom necessary, as it
is much more common to err on the side of drinking too little. Bad
effects from drinking too much cold water are caused by :

1, Previous over-heating, from which sudden death has often re-
sulted. General Bruat, who in the Italian campaign of 1859 was
leading the first division of the French army over the top of Mount
Cenis, was over-heated by exertion and drank a glass of snow water»
He suddenly fell as if stricken down by a cannon ball, and imme-
diately died.

2. Emptiness of the stomach at the time of swallowing.
8. Excessive quantity of water taken.

4. Extreme coldness of the water.

When taken freely under the precautions suggested by the above
considerations, cold water assists digestion, promotes the action of the
kidneys, skin and all the secernent and excreting organs. It soothes
morbid irritability of the stomach, promotes the gastric secretion ; and
enters into the living structure, forming three-fourths of the entire body.

If a glass of pure water be tal^n a short time before eating, it acts
as a real tonic, soothing that morbid craving which deceives those who
habitually eat too much, and who have vainly tried to goad the secret-
ing vessels to furnish gastric juice enough to dissolve all that a false
appetite may demand. The water is also digested and thus furnishes
the system with hydrogen and oxygen. The best effect will be obtained
by taking the water at 60^ to QO"^ Fahrenheit. When too cold its chill
is followed by too much reaction, increased afflux of blood, secretion and
absorption. Several glasses should be taken in the course of the day,
and the quantity may be gradually increased, so long as there is no
excessive perspiration, and when the body has not been previously
over-heated. The surface should be kept sufficiently warm to promote
the action of the skin, as, when the skin is cool, the water is carried
off too rapidly by the kidneys. For the first few days at least, remarks
Graham, the urine is limpid, colorless, highly stimulating, inodorous,
and apparently without urea ; but after the system becomes more ac-
' customed to it, the excess of water finds its way through the skin and
kmgs. When taken up in large quantities by the intestinal absorbents^

298 DISEASES OF THE DIGESTIYE FUNCTION.

it passes, by the vena jportafum^ througli the liver, increasing largely
the secretion of bile, which returns into the intestines to dissolve and
expel their accumulated sordes.

The power of water, when taken in unusual quantities to increase
the transformation of organic matter or hasten the metamorphosis of
the old tissues has been long acknowledged, but has been no where
acted upon, except by sojourners at mineral springs or water-cures.
Mosler, in a prize essay in 1857, communicated some experiments made
with the purest water he was able to obtain, containing only 2f grains
of solid substances, and 1-^^ grains of Carbonic-acid in the gallon. He
obtained the following general results :

Abstinence from water diminished the secretions and excretions,
principally those of the kidneys. Although the specific gravity of the
urine waa much increased, the actual total amount of solids excreted
within a certain period was considerably diminished. This diminution
was most remarkable in the urea, next in the chloride of Sodium and
the Phosphoric and Sulphuric-acids. Excretion through the skin and
lungs was also decreased, though in a less degree. The bowels were
constipated, the tongue rather dry, the appetite defective.

The effects of drinking an excess of water, observed by Mosler, were:
acceleration of the total metamorphosis of matter, with hyper-excretion
from the skin, kidneys, liver, &c. The urine contained a greater quan
tity of solid constituents ; most of urea, next of chloride of Sodium,
then of Phosphoric and Sulphuric-acids. The body lost in weight ; bu
on the days following the increased ingestion of water, the excretions
were diminished and the body gained in weight.

These experiments are important* in showing the scientific basis of
an old practice which has fallen too much mio disuse. The dyspeptic
drinks less water, than a man in health; and, although all his secretions
are of a more acrid character, containing an undue amount of "solid
matter in proportion to their bulk, every congested, torpid, indurated,
or hypertrophied organ is gorged with effete matter, which, for true
health, should have long ago been superseded by new matter. Com-
plete restoration depends, not on a supply of good food imperfectly di-
gested by an imperfect solvent fluid secreted from a stomach over sti-
mulated, but on complete removal of the effete matter in advance of
new deposition ; and no remedies quicken absorption without the co-
operation of that universal solvent pure water. This agent has often
succeeded in diseases that had resisted all medical treatment. In some
cases of mercurial paralysis, Mr. Piorry attempted to purge the system
of all poisonous matters by water alone. After various measures had
been tried in vain, the patients were directed to drink as much water
in the course of every day as could be borne without inconvenience.
Even three gallons per day seemed to produce no other effect than a

FEBMENTATION OF THE CONTENTS OF THE STOMACH. 299

rapid washing away of the old particles of the diseased body, and a
substitution of new-matter through a more healthy nutrition. By this
treatment, aided by long-continued baths, with friction, one case was
convalescent in forty-eight hours, and four others in frojn three to
five days. They all remained in the hospital, two or three weeks,
without a relapse in any case.

Medical Tii'EATM'E'NT.--Sanguina/ria-Ganadensis. — I have for many
years employed this remedy in some forms of dyspepsia, as well as in
many other affections of the stomach, throat, liver, lungs, &c. It is
especially useful in deficient gastric secretion, with loss of appetite,
and periodical nausea; heartburn, nausea, and irregular chills ; torpid
state of the liver ; dyspeptic headache, terminating by regurgitation
and vomiting of greenish bitter fluids ; soreness of the abdomen, in-
creased by eating ; feeling of heat in the stomach, chronic gastritis;
red tongue, which burns as if from the contact of something hot ; lips
red and dry, throat hot and dry ; tickling at the entrance of the larynx
which excites cough ; cough peculiarly severe, not relieved by expecto-
ration, with pain in the chest and redness of the cheeks. All these
symptoms, when caused by cold and damp w^eather, in consumptive pa-
tients with hective symptoms — as quick pulse, burning in the palms
of the hands or soles of the feet at night, I have often removed with
this remedy. When the cold especially affects the frontal sinuses,
nose, and tonsils, I have always succeeded in curing it with this agent
alone.

When digestion is imperfect from deficiency of the true gastric fluid;
when the food undergoes chemical decomposition, and gas is evolved
in large quantities, Sanguinaria will generally change the action of the
stomach, and digestion will become more complete. When the mucous
membrane is congested, the flatus formed by fermentation is retained
by a spasmodic constriction of the cardia. Its irritation is reflected
through the pneumogastric nerve upon the lungs, exciting a feeling of
tickling " in the entrance of, the trachea, with sympathetio cough.
See Gastric Catarrh. Index. — This peculiar dry cough will neither
yield to the expectorants of the old schooler to the usual specifics of the
new ; it often persists for hours, and is only relieved by eructations of gas
from the stomach. Aromatics and stimulants fail to expel the gas : they
only increase the erethism of the coats of the stomach. The Sanguinaria
affords a better resource. It only relaxes the constricted cardia,
permitting the flatus to escape, but excites a specific homoeopathic re-
action on the whole surface of the fauces, oesophagus and stomach, su-
perseding the morbid state by a healthy one,

Phosphorus,-— We have foun^ this remedy more successful than any
other for this gastric cough. It generally occurs in persons predispos-
ed to consumption, and corresponds to Phosphorus in all its principal

800 DISEASES OF THE DIGESTIVE EUNCTIOK.

symptoms. It is always excited by the same causes that produce a
common catarrhal fever, and Phosphorus cures it as hereafter described
under catarrh of the stomach.

Pepsine, — M. Bondault of Paris has endeavored to prepare a sub-
stitute for natural gastric juice from the Pepsine of the sheep's sto-
mach; adding to it a small quantity of starch and lactic-acid, he formed
what he calls ^'jpoudre nutrhnentatwer It is only a very imperfect
substitute for the natural secretion. The gastric fluid formed in the
stomach of a healthy animal is introduced with the food into the human
stomach ; and is found to act there as it does out of the body, under the
same conditions of heat and motion. In either situation it digests and
dissolves the food, and in so doing suspends putrefaction. The quan-
tity the Pepsine can dissolve is not large ; "but," says Dr. Chambers,*
of St. Mary's Hospital, London, "by its aid, a small quantity of solid
food can be relished and digested; the foetor of the evacuations changes,
flatulence and distressing eructations cease, there is renewed strength
and power of assimilation, sleep becomes more natural, night sweats
and hectic fever diminish ; dyspnoea, cough, &c. are mitigated." Though
all this be true it is only temporarily so. Our own well-known reme-
dies are far better.

IjpeGacuanha. — Aching pain in the head, particularly in the temple?
over one eye ; painful burning sensation of the mouth ; smarting on the
edge of the tongue, w^ith yellowish white coating ; sense of spasmodic
contraction in the throat and in the chest; nausea, eructations of air or
bitter fluid ; distress from taking cold drink ; vomiting, preceded by
pain in the head — the matter thrown up consisting of green jelly-like
or dark and tenacious substances ; sensation of emptiness and weakness
of the. stomach, followed by spasmodic pain; flatulent colic, alleviated
by rest.

Nux-vomioa, — Hypochondriac mood, and apprehensions of misfor-
tune and death. Excessive sensitiveness to external impressions. All
ordinary dyspeptic symptoms develop themselves in succession, from
the ordinary causes ; but a great many Nux symptoms, are strongly
marked. Among them are : putrid taste of the mouth ; appetite capri-
cious or entirely wanting; heat in the forehead; dizziness and cloud
over the eyes, while eating, or immediately after, then nausea and vo-
miting of acid or fermenting mucus occurs periodically. The stomach
is sensitive to the slightest pressure, and for some hours after eating
has the sense of something solid or hard; tension and cramps of the
stomach; cardialgia, from the abuse of cofiee; chronic gastritis, simu-
lating scirrhus or incipient cancer ; pressure as from incarcerated flatus
under the left side of the chest ; stitches under the region of the liver j
chronic hepatis, &g.

* Braithwaite's Retros., July, 1858, p. 78.

FEEME-NlATIOISr OF THE CONTENTS OF THE STOMACH. 801

N'ux-vomica combats the dyspeptic symptoms preceding the stage
of fermentation rather than corrects its consequences.

JSfuX'Vomica is directed by M. Trousseau in dyspepsias to re-establish
the activity of the digestive functions, especially when there is consti-
pation. "It excites the contractility of the muscular fibres of the di-
gestive apparatus." He prescribed Nux-vomica in a case of hysterical
tympanitis, with constipation, crampy pains in the stomach, aggravated
after meals by coffee, or late and early, with nausea, vomiting, water-
brash, hypochondriac humor. [Gaz, des Hdpit. 1859. p. 86.)

In dyspepsia with diarrhoea, M. Trousseau employs Belladonna, re-
marking at the same time, the common property of the Solanaceae, to
to relax the bowels. He adds, however, that it would be wrong to
neglect Belladonna in diarrhoeas dependent on an exaggerated excita«
bility of the intestinal muscular fibre.

MtoriatiG-acid,— In dyspepsias with excessive secretion of acids, M.
Trousseau advises acids, especially the M\iriatic, one to three drops in
water, after meals, and cites several remarkable cures by this method.
Concerning alkaline drugs and mineral waters in acid eructations he
remarks that their use is not chemical, but altogether vital, in modify-
ing the secretions. On the Benefits of a thermal alkaline treatment of
malarial cachexias, with visceral engorgements, he says :" What can
be, however, more contrary to chemical theories, than to use, in a state
of the blood so plastic as often to occasion dropsies, a medication re-
puted by chemical theorists the solvent par exoeUence of the blood ?"

The development of that fermenting mucus which decomposes into
foetid gases, may be prevented by any treatment that improves diges-
tion. Among the best remedies are ; Bryonia^ Sitlphur^ Oinnabar^
Mer.-Gorros.^ JSfitro-nhUTiatiG-acidj hypo-sulphite of Soda. These
and many others will be found useful, but they need to b§ assisted by
ictive exercise, judicious selection of food, and mental employments
consistent with habitual cheerfulness.

Hypo-phosphite of Lime, — For Symptoms, generally, see Galoarea,

Alcohol as a Remedy and as a nutritious Suhstance. — The special
use of Alcohol is to "arrest destructive assimilation — to stop the over-
active processes of life in their effects upon the organism; so that, for a
certain period, during the stay of Alcohol in the system, less urea, less
phosphates — less water are excreted by the kidneys, less Carbonic-acid
by the lungs, and less digestion goes on in the alimentary canal, showing
that the muscles, bones, nerves, &c., are not getting rid of their effete
tissue, but retaining it and making use of it as far as possible."

2. " But at the same t^me they give rise in the body to defensive re-
action^ which is prominent first, immediately after taking the dose, and
then gives place to the special action, and on this ceasing, is again
manifested to greater extent."

802 DISEASES OF THE DIGESTIVE FUl:fCTIO:N".

8. " So that if a suitable quantity be taken, and both action and reac*
tion are allowed to exhaust themselves before the dose be repeated^
more manifestations of life, represented by more excretion and more
consequent renewal of the body takes place in a given time with the
alcoholic drink than without. There has been a positive gain in vita-
lity, but if such a large quantity is taken at once that the reaction is
overpowered, or if it is arrested by a continuous repetition of the dose
the manifestation of life is kept down ; the body is not renewed, because
its effete particles are not removed and the amount of vitality must
certainly be reckoned at a loss."

Comhinations of Alcohol presenting pecicliar Advantages. — -In
some of the finer wines Alcohol exists in combination with sugar, ex-
tractive, vegetable essential oils, and ethers, which constitute.the aroma,
or JBoiiquet^ and give to each its peculiar flavor. It is supposed that
some of the favorite wines possess these elements in peculiarly happy
proportions, which give to each its especial merits, and render it appli-
cable to peculiar conditions. It is claimed that the Carbonic-acid gas,
protoxide of nitrogen or "lathing gas" and certain exhilarating ethers,
which according to Liebig, exist in sparkling champaigne, render this
wine capable of producing a higher and yet less injurious stimulation
than the same amount of Alcohol in any other form.

With this view of its action, Dr. Cotton admits the use of wine and
even beer. Turnbull condemns them in general, but employs them as
a " great solace to the patient in the advanced stage." (p. bQ)

AVhen wine is given to promote nutrition it should always be given
in small quantities largely diluted, and in combination with other nutri-
tious and easily assimilated substances ; of these the sugar contained
in good wines is shown by Dr. Becker's experiments to have a special
effect iii limiting the destruction of tissues containing phosphates, as
the bones and nerves, and the ethers may possess a similar powder.

The acids and extractive matter of wines lessen the injurious effects
which the Alcohol alone, though diluted, exerts on the mucous mem-
brane. It is important when Alcohol in any form is used for the pur-
pose of arresting the metamorphosis of tissue, that constant stimula-
tion, even in slight degree should not be too long persisted in. Some
intervals must be permitted during which its effect may subside, and
give the system time to " recover its metamorphosis, so that the effete
tissues may be duly eliminated and expelled.""^

If brandy or some other alcoholic fluid be preferred in a given case to
wine, it should always be diluted with a large proportion of water. In
any degree of dilution they can only aid in developing adipose, never

* Batilliat on the Wines of France.

* British and Foreign Medico Chir. Review.

FEKMENTATIG]^ OF Tlffi CONTENTS OE THE STOMACH. 803

of muscular tissue. Tliey do little then towards the furnishing of mus-
cular strength ; what they can do can best be done in ia highly attenu-
ated form. Troy was taken by heroes who drank their wine forty times
diluted with water ; it was wine '^mdiluted that subverted both the men-
tal and physical powers of the Macedonian conqueror.

III. FERMENTATION OF THE CONTENTS OF THE STOMAOH, WITH
DEVELOPMENT OF ORGANIC PRODUCTS.— SARCIN^.

This form of disease from gastric fermentation was first noticed by
Mr. John Goodsir in 1842.^ A young man, aged nineteen, had suffered
for four months from gastric disease, which resisted all ordinary treat-
ment. On examining with the microscope some of the fluid ejected
from the stomach, he found in it some peculiar organized living pro-
ducts to which he gave the name oi Saroince ; they have since been ob-
served by others.

Diagnosis. — Distention of the stomach on waking in the morning,
partially or entirely relieved by spontaneous regurgitation and expul-
sion of a large quantity of a transparent or light brown fluid, which
has the odor of fermenting wort, Midi is sometimes acid. After stand-
ing a few hours, it is covered with a mass of froth like that on a pot
of porter, and a glairy, ropy, granular matter is deposited. There is
sometimes but little complaint of indigestion, and the pulse is undis-
turbed; in one bad case it was from fifty-six to eighty per minute.
Sleep is disturbed more or less according to the quantity of ferment-
ing matter contained in the stomach. There is sometimes perceptible
enlargement at the epigastrium, deficiency of appetite, constipation,
pain or burning in the region of the stomach, which is distended with
gases, and the feeling of distress increases until it is relieved by vomit-
ing. The microscope reveals the organized sarcinae in a square or
slightly oblong plate, one-eighth as thick as one of its sides is long, and
divided into four equal squares by lines crossing in the centre.

Each quarter is subdivided by similar lines, more faintly marked,
and the whole is like a brownish or yellow packet -siT or tAt of an
inch in length, bound with cords crossing at right angles. The fluid
ejected from the stomach contains some lactic-acid and a trace of
muriatic-acid. No Alcohol was found by Mr. Hardwick, though it had
probably existed at an earlier stage of the fermentation. With sarcin%
sometimes occur small bodies resembling the torulcB of yeast. There
is seldom fever, but sleep is disturbed by distention of the stomach.f
Professor Graham found the fluid to contain free Muriatic-acid, Acetic-

* Edinb. Med. and Surg. Jour. Vol. 57. p. 430,
t Busk, i\licroscop. Jour. Vol. 2. p. 321.

304 DISEASES OF THE BiaESTIVE FUIsTOTIOK.

acid, Alcohol, and Sugar, while Carbonic-acid was not disengaged.^
When the fluid ejected is alkaline, and not acid, no sarcinse have been
found in it. The urine is generally clear, containing no albumen, and
is of a specific gravity of 1022 to 1011, revealing under the micros-
cope, crystals of oxalate of lime. The saliva is slightly acid, the appe-
tite good ; but free indulgence in eating is followed by distention of
the stomach, with burning uneasiness, or agonizing pain, if the stomach
be ulcerated. In less severe cases, the heartburn or other uneasiness
subsides with the absorption or expulsion of the gastric contents. When
the disease is more fully developed, the distress continues till relieved by
vomiting, or by the eructation of a clear sour fermenting fluid. When it
has continued long, the patient become emaciated, has a dry skin, slow
pulse, and that peculiar anxious expression of countenance observed
in persons suffering from organic disease of the stomach.

Causes. — 1. Organic Injury, In a case given by Mr. Busk, the
diaphragm of a man, previously in good health, was ruptured, and the
whole stomach, with portions of the other abdominal viscera, passed
through the aperture into the left pleura. From this injury resulted
the long train of symptoms peculiar to obstruction, detention and fer-
mentation of the contents of the stomach, and formation of sarcinse,
though the stomach itself was perfectly sound. In a second case, the
spine was fractured by a fall into the hold of a ship. The vomiting of
a fluid containing sarcinae occurred but once, and was followed by a re-
turn to perfect digestion, though paralysis, from injury of the spine,
remained. In another case, it was attendant upon the progress of a
pleurisy, in a boy with disease of the hip-joint. Sarcinse were expelled
from the stomach by vomiting, and after death were found in the stomach,
but in no other portion of the intestinal canal. [Bush.)-—'DY. Budd
says, a laborer, on whom a bank of earth fell, was thrown violently on
some pieces of board ; he was in consequence affected with this spe-
cies of stomach derangement, with palpitation and shortness of
breath.

Pathology. — The development of the fungi called sarcin^ with
fermentation of the contents of the stomach, is generally associated
with some local injury or with structural disease of the pylorus ; fre-
quently with that induration of the pyloric cellular tissue caused by
spirit drinking. In one case the pyloric stricture was so complete tha.t
a probe could scarcely be passed. Though the patient had taken bi-
carbonate of soda from | to one pound per week for months together, to
relieve the acidity, there was found, after death, no thickening of the
coats of the stomach, nor other indication of malignant disease.f

* Dr. Jenner, Med. Times. Aug. 1851.

f Budd on Diseases of the Stomach, p. 199.

FERMENTATION OF THE CONTENTS OF THE STOMACH. 805

The disease under consideration tlien presents the following pecu-
liarities : 1. a secretion of abnormal fluids by the stomach: 2. a specific
fermentation in these fluids and in the food imperfectly digested, ^Svith
the evolution of carbonic-acid and the production of toridm and sar-
oince, leading to the formation of acetic-acid." The essential patho-
logical feature consists in a structural change in the stomach, which
prevents this organ from fully discharging its contents, and causes an
abnormal secretion of fluid which rapidly ferments, AIgoJioUg fer-
mentation inay be the first step ; but the alcohol is rapidly decomposed,
no symptom of intoxication occurs, and the process ends in the forma-
tion of acetic-acid. Though much of the acid in the fluids vomited is
formed by fermentation after their expulsion, still the quantity formed
within the stomach, together with its distention by the gas, greatly in^
creases the suiferings of the patient.

Treatment. — -Allopathic clinical experience has not yet led to any
satisfactory system of treatment. Dr. Budd says, one patient already
mentioned after being dug out of the embankment of earth, insensible,
was treated two years afterwards for the dyspeptic fermentation. After
being restricted to a diet of lean meat and bread for five weeks, and
taking two minims of Creosote in pills, three times a day the general
symptoms abated; but the pain in the epigastrium, flatulence, and oc-
casional vomiting of acid eructations remained. In a second case, that
of a spirit drinker, the disease had lasted nearly a year, and was treated
with Creosote pills like the preceding. Colocynth and aloetic pills
were also occasionally given.

But slight improvement followed this treatment, and other measures
were ineflectually tried. On resuming the first, with a full diet of lean
meat, bread, and coffee, again there was improvement, but only up to a
certain point. Sulphate of Zinc emetics, and ^yq grain doses of Nux-
vomica, thrice a day, were useless. Common salt in doses of a table-
spoonful to a half-pint of water three times a day caused burning of
the stomaGh, (as well it might,) but it mitigated the fermentation. He
was never cured.

In reviewing the expedients tried in the above cases we at once ob-
serve that the remedies tried were all good, if they had only been ad-
ministered in an attenuated form> The Creosote, Nux-vomica and the table
salt are proper remedies in such a case. The last of these was tried
in the case of the man who took such large quantities of bi-carbonate
of soda. He ultima,tely died of complete stricture of tfie pylorus, the
passage being almost entirely obliterated ; and this termination was a
reasonable one to predict under the use of large and crude doses of
irritating drugs. Table salt or Natrum-muriaticum is, in every form,
an important antiseptic ; but it only acts well when largely diluted, as
we find it in some mineral waters, such as that of the Blue Licks,

Vol. I 20.

806 DISEASES OF THE DIGESTIVE FUNCTIOIf.

Kentucky. I have seen its influence on some obstinate derangements
of the stomach complicated "with torpor, or chronic enlargement of the
Hver and spleen of malarial origin. About four-fifths- of the solids
contained in this water consists of pure muriate of soda; but the me-
dicinal effect far surpasses that obtained bj so small a quantity in a
common solution, and is attributed to the large quantity of water with
which it is combined. When still more largely diluted the effect is
better.

JVatricm-muriatiGUTn, in higher attenuations, is appropriate where
there is fermentation or putrefactive change in the contents of the
stomach, whether saroince be discovered in the contents of the stomach
or not, and especially when ague complications are present.

Syonptoms : Bitter, sour, or putrid taste in the mouthy want of appe-
tite, aversion to food, or excessive craving for bitter or acid food or
drink, the stomach feeling full and oppressed when but little has been
taken; sour regurgitation of food, persistent heartburn, hiccough and
nausea after eating ; vomiting followed by extreme exhaustion, spas-
modic or convulsive action of the stomach, and throbbing or burning
at the pit of the stomach.

Bi-S%oI/phit6 of Soda,— li^ specific chemical properties constitute
its first claim to attention. As an antiseptic, it is employed to preserve
bodies for dissection. It also prevents the fermentation of vegetable
juices, but owes its virtues to the affinity of its soda for vegetable acids»
When it meets with acetic or lactic-acid, in the stomach, it is decom-
posed, and suVpMcrous-d^Qidi is liberp^ted.

jT/m acid has the power to prevent alcoholic and acetous fermen-
tation, and has been used to prevent the formation of acetic-acid in
cider. Dr. Jenner employed it to arrest fermentation in the contents
of the stomach. Dr. Budd dissolved two drachms of the salt in an
ounce of water, giving a tea-spoonful in a wine-glass of water, as soon
after meals as the fermentation began. Since the hypo-sulphite of soda
is relied upon for its chemiGal rather than for its clynaonio action, we
consider in prescribing it, whether the sulplnorous-acid formed by its
decomposition b^ appropriate to the case. The following are important
symptoms: Most of the common symptoms of confirmed dj^spepsia,
— sour eructations, strong acid* taste remaining long in the throat?
which feels rough as if scraped, bitter taste in the mouth, nausea with
bitter or acid vomiting, the stomach remaining sore to the touch, feeling
full and 'distended by something solid, a burning in the stomach ; ob-
stinate constipation ending in diarrhoea, with haemorrhoids, quick pulse,
emaciation.

I have for some years frequently prescribed the hypo-sulphite of
soda for dyspepsias in which gastric fermentation is a prominent symp-
tom. It is truly a dynamic, as well as a chemical remedy and may

SYMPATHETIC AFFECTIOISrS OF THE STOMACH. 807

well be tried in protracted gastric derangements in psoric constitu-
tions.

TV. SYMPATHETIC AFFECTIONS OF THE STOMACH.

1. Functional disorder of tbe stomacli from organic disease of other
organs, may result from an influence transmitted through the nerves,
as well as from the constitutional disturbance that may be produced by
some change in the blood.

Dr. Hall in his exposition of the direct and refl.ex action of nerves
has explained the process by which irritation of the lung, brain, liver,
or uterus so frequently leads to sympathetic vomiting—- that is, vomitx
ing caused by nervous influence reflected from the seat of the disease
upon the muscles that perform the act. In these cases the matters
vomited are often acid, showing that the reflex influence excites not
merely the act of vomiting, but also, as in the experiment of Spallan-
zani, a secretion of gastric fluid.

2. Sympathetic Vomiting in Phthisis.^ — It sometimes results from
the reflex action excited in the stomach by irritation of the lungs when
the cough is hard and dry, occurring as in whooping cough, only at the
end of hard fits of coughing, when there has been no previous loss of
appetite or of digestive power, and without pain in the stomach. This
kind of vomiting is generally controlled by sedatives.

A few doses of Lobelia 8d, will afford relief. See Dyspepsia,

Later in the disease, vomiting is attended by loss of appetite, pain,
sense of heat at the stomach, and the matter vomited is acid. These
symptoms often continue till death ; and, on dissection, the mucous
membrane of the stomach at the cardiac end is found thin and soft;
in some cases all the coats of the stomach are dissolved. {M, Louis
" OnPhtUsisr)

In these cases the disorganization does not originate in structural
disease of the stomach, but in undue and untimelysecretion of gastric juice,
and other functional disorder excited by reflex nervous influence. In
some cases the functional disorder may ultimately lead to an inflamma-
tory or catarrhal state of the mucous membrane, and this may be an
additional cause of disordered digestion ; but the softening almost
always takes place after death ; and depends on the quantity of gastric
acid the stomach may contain at death.

In some .advanced stages of phthisis there is often gastric disorder,
especially in females, from fatty enlargement of the liver. In this
ease the liver by its increased size overlaps aud compresses the pyloric
end of the stomach, and causes that enlargement of the stomach so
commonly found in consumptive subjects, and in some degree, to evils

308 DISEASES OF THE DIGESTIVE FUNCTION.

of obstructed pylorus. For this condition there is no remedy, as the
cause consists in an incurable disease.

8. Disorder of the stomach caused by abscess of the liver. See
that Article.

4. Disorder of the stomach from the effects of the passage of gall-
stones. This is treated of under the head of Chololithus, or gall-stones.
See Gall-stones-— Index. ■

5. Passage of a renal calculus may produce the same sympathetic
nausea and vomiting as that from the passage of a gall-stone.

6. Gastric Disorder from Disease of the Brain,- — In inflammatory
diseases of the brain, particularly in their early stage, when the symp-
toms denote irritation rather than compression, vomiting is a frequent
symptom; and in many persons who die of it, the mucous membrane of
the cardiac end of the stomach is even found more or less dissolved
or digested by the gastric juice. This shows that the irritation of
the brain can not only excite the mechanical act of vomiting, but also
that untimely secretion of gastric-acid that may prey upon the coats
of the stomach after death, Andral says, vomiting and especially
nausea, frequently attend on the first onset of inflammation of the
membranes of the brain; and, after twenty-four hours they generally
cease to attract attention. In some cases after death from brain-disease,
the stomach is entirely sound ; in a smaller number the coats of the
stomach have undergone ^^self-digestion" from the action of the free acid
which may continue to be formed so long as the gastric disorder con-
tinues as the result of the cerebral irritation. Andral says, some pa-
tients vomit only two or three times a day ; others every hour or two^
or even every fifteen minuteSj being unable to take even a spoonful of
drink without vomiting. Some throw up enormous quantities of green
bile, others with great effort can only throw up a. little mucus. Females
suffer more than meu, and children than grown-up persons. The vomit-
ing is sometimes attended by pain and tenderness at the epigastrium,
but the degree of this tenderness is mainly dependent on the duration
of the gastric disorder. When the pain of the head is severe the
slighter pain of the stomach is little noticed. This gastric disorder is
attended with secretion of much acid, is generally treated by Soda,
Magnesia, chalk or bismuth. (Budd, p. 158.)

7. Gastric Disorder from Organic Disease of the Uter^is. — Dr.
Denman caused in one case pain and vomiting, by passing a ligature
around the polypus of the fundus of the uterus. On loosing the liga-
ture the symptoms ceased ; on attempting to tighten it the pain and
vomiting returned. The ligature was left on, but loose. The patient
died in six weeks, and on post-mortem examination the uterus was
found inverted ; and the ligature had included the inverted portion^
{Goochy Diseases y dkc)

SYMPATHETIC AFFECTIONS OF THE STOMACH. 809

Cancer of the Z7^^rz^^ often causes frequent and distressing vomiting
fchrousli the reflex nervous influence transmitted first from the uterus
to the spine, and secondly reflected on the stomach. The vomiting in
these cases is often attended by pain at the stomach and thirst, and
the coats of the stomach after death may be found softened or digested;
the reflex action having excited the secretion of gastric juice.

Nausea and vomiting are common effects of ulcer of the neck of the
uterus, and the distress thus originating may be very severe, at the
same time that the uterine pain may be so slight as to be entirely
overlooked.

8. Nausea and vomiting are often dependent, in nervous females, on
trifling causes. In those in whom the sensibility has been exalted by
losses of blood or by anaemia otherwise induced, the digestion is habi-
tually feeble ; and any unwholesome or indigestible food may excite
high irritation and vomiting ; this may be kept up for weeks or months :
though most common in women it may occur in men who have excitable
nervous systems with feeble digestion. It generally begins in the
evening after fatigue. The vomiting is followed by pain, or uneasiness
at the pit of the stomach, loss of appetite and thirst, it returns after
swallowing any food whatever, and even the simplest drinks. There
is then severe pain at the stomach and the matters vomited are very
bitter. In slighter cases the food is retained for a time and the mat-
ters rejected are intensely sour. The acid thrown up may be in part
secreted by the coats of the stomach ; but the constant irritation to
which the mucous membrane of the stomach is subjected, greatly
weakens the digestive power ; and the unhealthy a,nd decomposing
mucus acts upon the starchy principles of the food, which pass into
fermentation and evolve large quantities of lactic- acid. The stomach
exerts a sympathetic influence on the liver, and after a few days the
countenance becomes sallow, though only in a slight degree. This
may remain but a short time, but the gastric symptoms often continue
longer than those caused by the passage of gall-stones; in some cases
for months. In one case the above symptoms were caused by loss of
blood from haemorrhoids, and frequently returned on occasions after
great fatigue or the taking of improper food. The haemorrhoids were
cauterized by nitric-acid ; the bleeding ceased and health improved.
At a later period the disease returned, and the patient was confined to
bed for four months, and vomited everything she ate. The proper

emedies in such cases, are Nux-vomica, Podophillin, Calcarea-carb.,
Cantharides, Antimonium-crudum, Pulsatilla, and China. {Budd,
161.)

9. SynypatJietiG Affections of the Stomach in young Children, — In
young children the secreting function of the stomach is very active,
and they are especially liable to reflex functional disorders of other

310 DISEASES OF THE DIGESTIVE FUNCTION.

kinds. In them this secondary gastric disorder is often excited by
tuberculous disease of the lung or inflammation of the brain; and,
though they are not liable like adults to disease originating in the liver
or uterus, they have in 'the process of dentition a source of irritation
which often causes gastric disturbance and convulsive affections. These
effects of irritation are more severe in children weakened by eruptive
fevers, by the use of improper food, impure air, or active purgatives.
On the change of food at the weaning stage the digestive organs are
liable to much disturbance.

" Atrophia AblojotatoTmnP—MciTasmus fTor)% weaning. — Sy^in]}-
j(6»m^.— -Frequent vomiting, thirst, fretfulness; writhing of the body
and plaintive cries expressive of pain. The matters vomited are sour
and bilious, and thrown up with great effort. Diar^rhoea, the evacuations
being greenish from the presence of bile rendered green by the free
acid secreted by the stomach, or formed by fermentation of the food.

Second Stage.: — " Sydrocephaloid Diseases of Infants^ {Mar--
shallHall) The child becomes rapidly emaciated, grows feeble, and
exhaustion becomes more and more observable; surface cold^ death.

Pathology. Sometimes no marked evidences of previous disease
are noticed after death ; in other cases there is seen that^ peculiar
softening of the coats of the stomach, and (when there has been diar-
rhoea,) of the coats of the bowel also, that is produced after death by
the action of the gastric juice.

Treatment.- — When dental irritation exists reduce it as much as
possible by lancing the gums. Feed the child on the best milk or milk
and baked flour, or with the milk of a healthy nurse. The best reme-
dies are. Hellebore, Arsenicum, Mercurius-corros., Chamomilla, Oxalic-
acid, China, Veratrum. For further treatment, see Follicular Enteritis.

If this disease be not speedily remedied, the stomach disorder im-
pedes nutrition and brings on fatal exhaustion. The constitutional dis-
order having exhausted the functional powers of the stomach, some-
times induces an inflammatory or catarrh ah state of the mucous mem-
brane ; on the digestive power becoming further weakened the stomach
secretes an unhealthy mucus w^hich promotes undue fermentation in
the starchy principles of the food, and thus leads to the formation of
large quantities of lactic-acid, or some other acid of the same group,
and this produces still further disturbance, ending in death.

Pathology. Softening of the stomach is very often found in these
cases after death; but we have elsewhere seen that this change takes
place after death, and does not depend oii the severity or duration of
the disorder, but on the quantity of free muriatic or lactic-acid, which
the stomach may happen to contain at death. In severe cases of long
duration there is often no perceptible change discovered after death ;
in other cases, much lesi^ severe, a large quantity of one of these acids

COLIC.

811

may be poured out into tlie stomach, and its coats may be found dis-
solved after death.

It has been common to attribute the vomiting, thirst, pain and tender-
ness of tlie epigastrium in these cases, as well as the softening of the
stomach found after death, to inflammation. But all of these symptoms
may arise from other causes ; and in the form of disease now desc3;ibed
they originate in the conditions above mentioned. At its origin, and
long after, the disorder is functional only ; and is more allied to the ex
cited and disordered state of the intellect, in delirium tremens, or the
excited involuntary, movements of the voluntary muscles, in chorea.
{Buddj Diseases of Stomachy 164.)

In health, when food is placed in the stomach, the quantity of gastric
fluid generated is proportioned, not to the powers and capabilities of
the stomach, but to the want of the occasion, and is just sufiicient for
complete and speedy digestion. But in disease the power is often un-
duly expended by irregular, unnecessary and ill-directed effort.

Genus VI.— OOLIOA-OOLIO.

Under this head we shall treat of several painful affections of the
abdomen, all of which are characterized by severe griping pains in the
bowels, with constipation, and often without vomiting. We shall notice
the following species :

1. Colica cibaria. From food improper in quality or excessive in
quantity, 2. Flatulent colic. 3. Bilious colic. 4 Colica pictonum.
5. Colic of children.

Bilious Derangement. — -This term, though without being correctly
applied to the affections here to be noticed, is in universal use, and
may at present be retained. The popular idea is that there is an ac-
cumulation of bile in the system which has been absorbed from the
gall-bladder and bile-ducts. Instead of this being true, there is gene-
rally deficient secretion of bile ; and the importance of this fact is also
much over-estimated by those who recognize its existence.

Symptoms. — It occurs most frequently in persons who eat freely and
use stimulants unnecessarily; the skin is dingy and sallow; the spirits
miserably depressed ; constipation; flatulence ; dull aching pain in the
right shoulder ; headache chiefly confined to the forehead, eye-brows
and eye-lids; smarting in the eye-lids and eyes ; eyes prominent, with
yellowish tint in their whites ; yellowness well marked on the side of
the nose ; tongue coated with brown fur; nauseous and bitter taste iu
the mouth on waking in the morning ; appetite defective ; sleep imper
feet, disturbed by frightful dreams ; melancholy despondent state of
mind, which is haunted by an oppressive undefinable dread. ( Wright)

I. SuEFEiT.— (7^5arm. The consequence of excess in eating or drinb

812 DISEASES OF THE DIGESTIVE FUNCTION.

ing, or of something unwholesome or improper in the food. It consists
in a heavy load or oppression of the stomach, with nausea, sickness,
impeded perspiration, and at times eruptions on the skin. (See Dys-
fepsia^ page 281.)

Definition. — Severe twisting, griping pains in the abdomen, with
vomiting, and rigid contractions of the abdominal parietes, followed, in
some cases by griping alvine evacuations, and looseness.

Causes. — ^Many articles of food disagree with some persons, whether
taken in large or small quantities. Among the worst things is fresh
pork, which often causes sickness, vomiting, colic and dysentery. A
similar effect is often produced by tainted meat, mildewed wheat or
rye, (called " sick-wheat" in the Western states) ; cold, sour, indiges-
tible or unwholesome fruits, cucumbers, melons, &c. ; injudicious use of
griping purgatives, as pills, senna, &c. In Africa the natives cause
dangerous colics by using freely when warm of acid drinks prepared
from the juice of the palm and other trees. Ksempfer says, that the
Japanese often excited it by drinking fermented beverages, prepared
from rice. Linngeus imputes its prevalence among the Laplanders to
the use of stagnant water containing animalculse. In other parts
of the North Europe buttermilk, whey and vegetable infusions are
fermented into acid liquors and used as a common drink. Severe
attacks of colic often follow their use. Dr. Chisholm says, it was
caused in his time in Devonshire by the acid cider drank by the
laborers. In this country we have all of these or similar causes in
constant operation. The markets are supplied by poisonous fish, mus-
cles, lobsters, mushrooms. The smoked-meat sausages, and old cheese
everywhere sold, often contain minute fungi, which not only cause
severe colics, but also distressing and dangerous affections of the ner-
vous and vascular systems. The symptoms are thus given by Dr.
Hering : " The poison of fat is 'generated in half-putrified, half-sour
meat, blood and fat, and also in cheese, blood-puddings, liver-puddings,
sausages, sour pork, bacon and hams, old rancid grease of any kind,
and substances not sufficiently or regularly smoked. It is generated
very rapidly, and things eatable to-day are poisonous to-morrow." The
Symptoms are : Heartburn and nausea ; a feeling of dryness in the
throat, extending by degrees into the mouth, the nose, oars and even
the eyes ; after a few days there may be cracking of the skin on the
eyelids, the sides of the nose and points of the fingers. The voice
soon becomes hoarse, the pulse is slow and weak ; hunger and thirst
are very great, but the patient can scarcely swallow anything ; the
strength now becomes less, the eyelids seem lamed, the pupil dis-
tended ; the patient does not see distinctly, but as if he were looking
through a fog, or he sees every thing double. The abdomen at the
same time is tight, with much pain and constipation; finally, the knees

COLIC. 813

and feet become stiff. If tlie patient does aiot die in a few days, a
tedious, incurable disease will remain. In the fatal cases observed
from the eating of Wurtemberg sausages, death is preceded by the
gradual wasting of the muscular fibre, and of all the like constituents of
the human body. The saliva becomes viscid and emits an offensive
smell. The patient becomes emaciated, dries into a complete mummy
and soon dies. After death the body is stiff as if frozen, and is not
subject to putrefaction. In the poisoned sausages no peculiar poison has
been detected by chemistry. It has been thought possible to destroy it by
the action of Alcohol or that of boiling water ; but this is probably not
true. Ordinarily it passes through the stomach unchanged by the
gastrin fluid, and is absorbed and carried into the blood where it acts
on the blood-constituents as yeast does upon wort*

II. Flatulent Colic, — Definitioi^.— Acute pain in the bowels,, with
occasional partial remissions, flatulent distention, or spasmodic con-
tractions, or both at the same time, relieved by pressure and the expul-
sion of flatus.

Pathology. — There is morbidly increased sensibility and irritability
of some part or the whole of the bowels ; irregular distention and spas-
modic constriction of difierent parts of the Qanal ; and more or less
generation of flatus in their tract, occasioning great distention and irre-
gular reaction of the muscular coats.

Nervous CoUg,- — The morbid irritability and increased sensibility
of the bowels are common in females and nervous persons, who lead a
sedentary life, permit the bowels to be constipated, give way to mental
excitement, and are susceptible to the influence of cold.

Symptoms.— The attack is usually sudden ; the pain is felt in one or
more points of the abdomen, may shift place frequently and be exacer-
bated at intervals. The face is pale and anxious ; abdomen irregularly
contracted ; and pressure on it affords slight relief. When the pain is
extreme, a cold perspiration. is forced out on the surface, and the patient
complains of a " sinking" feeling. The bowels are constipated ;
rumbling noise from wind constant. The attack lasts from one to
several hours, and generally terminates in gradual recovery. It is
liable to return repeatedly, ftom errors of diet or mental disturbance.

In cases most clearly consisting in accumulation of flatus, the expul-
sion of the wind gives ease ; the distention and pain are traced along the
course of the colon, and are felt worst in the sigmoid flexure and caecum.
The quantity of flatus is very great ; and it evidently proceeds from
.'rritation of the mucous surface of the bowels, the gaseous fluid being
excreted from the blood by the vessels of this surface. Even if some
of the gas be furnished from decomposing food imperfectly digested,
the quantity of matters retained in the bowels is not sufficient to fur-
nish all that is accumulated. In some parts the intestine is inordi»

814 DISEASES OF THE DIGESTIYE FUNCTIOJST.

natelj distended, in others irregularly constricted, and the retained
flatus is propelled from one part to the other, causing severe griping
pains and rumbling noises in the abdomen. If the attendant constipa-
tion is relieved by enemas or otherwise, the evacuations consist chiefly
of hard lumps, and accompanied with the escape of much flatus, the in
testinal secretions having been entirely suppressed or much diminished
In the more spasmodic form of the disease nausea and vomiting alter-
nate with the constrictive pain. Injudicious treatment often develops
ileus or enteritis.

Causes —Indigestible food, unripe or decayed fruits; beer; mental
emotions, or any other cause capable of morbidly altering or suspending
for a" time the healthy action of the stomach and bowels, in such .a man-
ner as to cause them to generate an unusual quantity of gas.
, III. Bilious Colic, — ^Diagnosis.— Severe griping pain, with vomit-
ing of the contents of the stomach, and bilious or other perverted se-
cretions; constipation or scanty evacuations, often with hiccough, tension
of the abdomen, and restlessness ; evident deficiency of the secretions
of the intestinal canal and associated viscera.

Causes. — The retention in the caecum and cells of the colon of those
excrementitious matters, which are required by nature to be thrown
off from the bowels, produces in many persons an unhealthy state ; we
see it oftenest in persons in whom the abdominal organs are in a state
of torpor from the influence of malaria ; in persons advanced in life, or
who lead an indolent or sedentary existence ; debilitated invalids, preg-
nant females, women of advanced age, or men who have old hernias.

The attack is preceded by indigestion, headache, nausea, heartburn,
constipation of the bowels, bitter taste in the mouth ; fulness about the
caecum, the sigmoid flexure or the colon. In many cases we detect
large accumulations of the hardened fasces in the cascum and ascend-
ing colon. Severe griping pain is followed by sickness and bilious
vomiting ; foul tongue ; loss of appetite ; thirst, and uneasiness in the
bowels are speedily followed by severe griping, twisting, or shooting
pains in the umbilical region ; hot skin ; painful distention of the
stomach and abdomen ; obstinate constipation, and finally, tenderness
of the abdomen ; yellow cast of the skiit>and eyes; coldness and tor-
por of the extremities ; cold sweats ; feeble or excited pulse, and other
signs indicative of a fatal termination of the disorder.

If irritating purgatives be now given, they produce increased pain
and tenderness, whether they operate or not. The abdomen becomes
tense, tender on pressure ; the pulse becomes quicker, the coating on
the tongue increases ; the tongue and mouth dryer, more red. When
not speedily cured this condition progresses to enteritis, ileus, or
dysentery.

During the first stage of the malady, the patient involuntarily makes

COLIC. 315

firm pressure over the umbilicus, which affords' temporary relief; and it
it is by this symptom that we may distinguish the disease from inflam-
mation of the bowels, in which pressure is attended with an aggravation
of the pain*

Causes. — Deranged function of the liver is supposed to be the chief
cause of this disease. Authors assert that this organ is in a torpid
condition, secreting only a small amount of bile, thus leaving the in-
gesta to be only partially acted upon by one of its natural solvents,
and thereby rendering the half-digested food an irritant to the diges-
tive organs. Atmospheric and other influences are known to originate
the disease in certain seasons.

The Endemic CoUg of the West Indies^ that of Madrid^ and se-
veral provinces of Spain, and that well-known as " Bilious Colid^^ in
malarious parts of the United States, seem to be only modified forms
of the same disease. They all owe their origin in part to errors of
diet, atmospheric vicissitudes, and other causes that derange the secret
tions. But these causes are in operation everywhere ; and they only
establish this peculiar malady when operating on persons saturated
with malarial poison. This specific poison is essentially the same as
that which causes intermittent and remittent fevers. Its effect is to
produce a torpor of the secreting organs; impeding the functions of
the liver and inner surface of the intestines ; there is accumulation ir
the hepatic ducts, gall-bladder, and prima-via of bile and morbid secre
tions, which , excite painful and abortive aggravation of peristaltic ac
tion for their expulsion. There is evident torpor or congestion of the
liver, irritation of the duodenum ; an acrid state of the secretions, which
are dark colored, causing great distress till removed.

Symptoms.— Dull aching and pressing pains in the course of the
colon ; loss of appetite ; irritability of temper, difficulty of evacuating
the bowels ; though constipation had not preceded ; evacuations small
in quantity, with much flatus ; feels easier in bed ; tongue moist, loaded
at the root only; much thirst. After these symptoms continue two or
three days the constipation becomes complete ; evacuations cease ; the
pain becomes more severe, fixed and constant at the epigastrium, with
a twisting pain at the umbilicus ; the countenance is pale, expressive
of pain and anxiety ; the pulse is slow, small, regular and constricted,
but not febrile ; the skin is dry,, but not hot; and the urine is scanty,
but not otherwise unnatural. The patient sits with his arms crossed
over, and pressed upon the abdomen, and the trunk pressed forwards.
When in bed the thighs are drawn up and pressed upon the belly.
Generally, soon after the constipation is established, bilious vomitings
come on accompanied with hiccough ; the matters thrown up consist of
those taken into the stomach, mixed with bile and glairy fluids. There
is no sleep, but continued restlessness ; the pain is novf nearly constant,

316 DISEASES OF THE DIGESTIVE FUNOTIOK.

most severe about the epigastrium and umbilicus: and it is not miti-
gated by any position. The thirst increases as the malady proceeds ;
but the fluids taken only aggravate the hiccough, and are immediately
thrown ofl". The eyes are slightly yellow, and the whole surface sallow,
in extreme cases the pain continues to be severe, the hiccough, and want
of sleep continue; wandering delirium, and sometimes deafness come
on ; epileptic convulsions and sometimes fseculent vomiting follow and
portend a fatal result. At this stage the abdomen which had been re-
tracted is much distended. Purgatives, which had hitherto failed to
operate, in the later stage excite dysenteric purging, wdiich increase the
prostration and hasten death.

Peognosis. — Favorable Symptoms : Free evacuations not the result
of drastic purgatives, followed by amelioration of abdominal pain and
vomiting ; the pulse remains below one hundred beats per minute ; the hic-
cough has not commenced, or is subsiding. — ITnJ^avorable Sy^n-pto^ns :
The tenderness, tension and tumefaction of the abdomen increase ; the
pulse becomes more quick, rising to and continuing at one hundred and
twenty or more (in an adult). Constipation continues obstinate ; hic-
cough is obstinate also ; tongue brown, or red and dry ; restlessness
and tossing continue.

IV. Oolica Pictonum,—-'RaGhialgia.— Painters^ C(9fo*(?.— Diagno-
sis.— This form of colic generally attacks house-painters, plumbers,
glaziers of earthen-ware, or workers in the different preparations of
Lead, It is characterized by dull remitting pain, becoming constant
and violent, extending to the back and upper and lower extremities ;
vomiting, obstinate constipation, often followed by paralysis.

Symptoms.— Lead colic usually commences with obscure pain of the
abdomen, which becomes at intervals so severe that the patient tosses
himself about, and vainly seeks a posture that will lessen his suffer-
ings. He lies for a while on the abdomen, or presses or rubs this part
with his hand. The pain is greatest at the pit of the stomach, but ex-
tends to the back, the arms, loins, thighs and legs. A twisting pain is
felt about the navel, which is first drawm inwards ; and cutting pains
shoot at times with great violence to both hypochondria and iliac fossae,
and through the abdominal muscles. The voluntary muscles become
so sore, that they cannot bear the slightest pressure ; and the pain fre-
quently alternates between the stomach and bowels and the external
muscles. Sickness and constipation are early symptoms. The matter
throw^n from the stomach consists of a slimy fluid, with or without acrid
bile, which continues to be secreted, causing its own evacuation. There
are bitter eructations, hiccough, severe headache, pains of the wrists,
hands, ankles, soles of the feet, shoulders or neck ; these symptoms are
worse during the night. The pulse is not affected at first, sometimes
not at any stage. In some cases it is below the usual standard, in

COLIC. 317

others quicker and weaker, rarely fuller or stronger. Tongue pale, soft
and moist; papillae not erected. Inmostof tlie diseases caused by Lead, a
tlue <dY ^urplisli line is seen running along the edges of the gums just
where they meet the teeth. The coloring matter is supposed to be
sulphuret of Lead, formed by union of the Lead with sulphuretted Hy-
drogen from animal matter absorbed by tartar on the roots of the
teeth. The skin is commonly soft and moist, rarely hot. Urine free
and often copious. Costiveness continues as the disease advances.
When there is griping with faecal evacuations, they are in small, hard,
dry scybalse, mixed with a dirty watery fluid containing a dark slime
and a little blood. The abdomen is insensible to pressure ; in some
rigid and knotted ; in the latter stage often distended and slightly pain-
ful from distention and affection of the muscles. In some cases the
distention is owing to inflammation and faecal engorgement of the colon,
which can be felt through its whole extent. The sphincters of the rectum
and bladder are constricted. In protracted cases the pains in the back,
loins and limbs become more violent, the debility, tremulousness, and even
paralysis of the extensor muscles progress. Dyspnoea, palpitations,
short dry cough, even epilepsy, coma or apoplexy supervene. Some
cases are cured in two or three days ; others run on for two or three
weeks or more. Many relapse several times.

Pkogistosis. — FavoirMe SymptomjS : The disease is mild and miti-
gated by treatment.- — UnfavoTohle Sym>jptoin8 : The attack is severe
there are hiccough, obstinate vomiting, tremulousness, and distention of
the abdomen. The worst cases are those in which complications of
deafness, blindness, fsecal vomiting and symptoms of ileus appear.

Treatment. — The specifics for the different kinds of colic, are Oolo-
cynth^ Plumbicm^ Nux-vomioa^ ArseniGicm^ Chamomilla^ Hyoscya-
miis^ Stramonium^ Yeratricm^ GoggioIics^ Senna^ ColGliiGiom^ Phos-
pJiorus^ Pulsatilla^ Podophyllumj^ Jalap,

Auxiliary to the above remedies, we may urge upon the practitioner
the importance oi fomentations^ and enemata of toarimoater. These
measures, conjoined in certain cases with the tepid bath, are worthy
of high consideration, and should never be lost sight of in the treatment
of this, as well as other maladies of a spasmodic character. The fomen-
tations should not only be applied to the abdomen, but to the extremi-
ties, more especially if these parts are cold, and inclined to cramp. In
moderate cases, fomentations, together with an ordinary enema, and the
proper specific, will suflice to effect a speedy cure ; but if the case has
been very violent and obstinate from neglect, or mismanagement by
Calomel and Opiitm,^ a general warm bath, with very copious injec-
tions of warm water while immersed in the bath, cannot be too highly
recommended. Indeed, we have in several instances, observed the
abdominal spasms to relax, the pains to cease, and free evacuations ol

318 DISEASES OF THE DIGESTIVE FUNCTION.

faecal matter and of wind to occur, while the patient was yet in tha
bath. By adopting this mode we secure the advantage of internal as
well as external fomentations, and thus bring a safe, yet efficient re-
medy to bear directly upon the parts affected. All who have, practi-
cally tested the soothing influence of warm water applications upon the
nervous system, when in a state of unnatural erethism, will appreciate
the truth of our remarks.

ColoGynth,—Th.Q mQ^\Q,m.Q which is most generally applicable in the
treatment of colic, is Colocynth. It is particularly appropriate when
the complaint has been caused by a chill, by mental emotions, as grief,
indigestion, mortification, &c., also when biliary derangement has been
the exciting cause.

Inflation of the abdomen ; position of the body bent forward, so as to
relax the abdominal muscles ; cramps in the calves of the legs ; general
agitation ; temperature of the skin about the natural standard, or cold
and covered with sweat; pulse natural, or but slightly increased in fre-
quency; tongue covered with a yellowish fur, or natural; face pale»and
indicative of intense sufiering ; rigidity and contraction of the abdominal
muscles, as well as of the tendons in other parts of the body. Violent
cramp-like contraction or cutting pains in the abdomen, generally in
the region of the umbilicus ; painful cramps in the calves of the legs ;
gensation of faintness, with coldness and shuddering ; bitter or insipid
taste in the mouth ; nausea ; loss of appetite ; disgust for drinks ; con-
stant inclination to move about, to grasp objects violently, and to make
pressure against the abdomen; empty eructations ; pains in the back
and loins, especially semilateral; obstinate constipation or small watery
evacuations. Most intense anguish and agitation ; dejection ; extreme
restlessness and desire to move about ; fear of speedy death.

Admmistration.— From the first to the sixth dilution may be em-
ployed according to the age, sex, constitution, temperament, and seve-
rity of the disease. A dose may be given every half hour in urgent
cases until amendment or medicinal aggravation occurs, to be resumed
and repeated as the exigencies of the case require.

Plitmfhbum. — On account of the very marked and decided specific
action of Lead upon the colon and ileum, whether introduced into the
blood through the stomach, rectum, lungs or skin, this drug is peculiarly
appropriate for the treatment of some of the varieties of colic. The
practitioner will, of course, avoid exhibiting it in that variety of colic
which has been caused by the absorption of Lead. Rigidity and con
traction of the abdominal muscles ; hard ridges or elevations in the ab-
domen ; borborgymus ; frequent expulsion of offensive flatus ; eructa-
tions ; tremblings, jerkings or cramps of the limbs ; face and skin pale,
bluish, or yellow ; surface cold, and covered with clammy sweat ;
mouth dry or moist and clammy; pulse weak, and somewhat frequent;

COLIC. 819

body bent double. Violent constrictive, sliooting, or pinching pains in
the umbilical region ; constant and urgent desire to eructate and ex-
pel flatus ; chilliness or shuddering during the paroxysms ; sensation
of faintness ; torpor, numbness, stiffness, and weakness in the limbs ;
desire to press the abdomen against something hard ; extremities cold;
dizziness ; sweetish or bitter taste ; thirst ; vomiting of bilious or fsecal
matters ; pressure and cramps in the stomach ; obstinate constipation ;
evacuations scybalous and difficult to expel ; shooting pains in the
loins, back, and limbs ; cramps in the feet, excessive agitation and
restlessness. Very great anguish and uneasiness ; melancholy ; dis-
couragement; impatience.

Administration. — Same as Colocynth.

Case.— A delicate woman, aged twenty-six, after some heavy work
and a fit of anger, was attacked with violent pain in the umbilical region,
soon followed by vomiting of faeces, as if from obstruction in the intes-
tines.. Drastic cathartics were used, but with no relief. Dr. Lohrbacher
found her with small frequent pulse, face of livid color, extremities
cold ; tearing, compressing pain; hard lumps could be felt in the um-
bilical region as large as a fist, abdomen tender to pressure ; violent
thirst, extreme anxiety ; constant vomiting of faeces. No hernia.
Plumbum, fifth dilution, three drops in f j. of water, a teaspoonful every
two hours. After the fourth dose there was a very dark faecal evacua-
tion, but without apparent relief; pain and tenderness of the abdomen
still increasing. Belladonna, 80°, five globules, one every hour, gave
amelioration of the pain. Plumbum, 80°, a dose every three hours.
Nine hours later a copious stool followed by cessation of the vomiting
and recovery.

Case by Dr. Marcy. (iT. A, Jour. Hommop, vol. IV. p. 848.) — A
lady, aged thirty-six, of sanguine nervous temperament: distention and
hardness of the caecum and ascending colon ; the whole region swollen,
and painful to the touch or on motion. Tongue dry, brown in the
centre, skin hot and dry, much thirst, nervousness, headache, general
depression, expression anxious, feeling of lameness in the lower extre-
mities, sour eructations, nausea, inclination to vomit, umbilicus retracted..
Plumbum-met. two grains, given every two hours, improved the condition
very much in a few hours, and in a few days more entirely cured, save
a few remaining symptoms, which disappeared after Sulph., Nux., and
Merc-sol.

Wux-vomica is very useful in colic, arising from torpor of the liver,
indicated by deficient secretion of bile, indigestion, flatulence, &c. It
is also useful in flatulent goUgj occurring in dyspeptic subjects after
the use of improper articles of food. In cases where Nux is indicated,
the face is pale or yellowish, the stools, previous to the attack, light
and clay colored ; the abdomen distended ; there are frequent eructa-

820 DISEASES OF THE DIQESTIYE FUNCTION.

tations, hiccough, sharp and cramp-like pains in the stomach and bowels,
and rumbling in the bowels ; giddiness, sensitiveness of the stomach and
abdomen when pressed upon.

^ Administration. — This medicine may be used at the second or
third attenuation ; a dose once in half an hour to two hours until relief
is obtained.

ATseniG%im is specific in colic pains, coming on in regular parox-
ysms^ and attended with decided remissions. In extreme cases, it
may also be resorted to with advantage, where the powers of the sys-
tem have been exhausted, and other remedies seem to be incapable of
arresting the disease. The first to the third trituration may be used,
and repeated as circumstances may require.

Ohamomilla is advised by Hahnemann in colics of pregnant and
parturient women, of new-born infants, and of children during dentition.
It is also recommended for the colics of nervous and hysterical females.
If this medicine does not afibrd the desired relief, resort may be had
to Hyosoyamus^ Si/ramonium^ or Senna,

Administration. — A dose of the third to the sixth dilution every
hour or two, as long as necessary.

Veratricm^ CocGulus, and Oolchicum will often prove valuable in
spasmodic and flatulent colic^ occurring in nervous and hysterical fe-
males, and in persons of a mild and phlegmatic temperament. In in-
stances where the above prescribed remedies do not correspond, let
the indications of these latter articles be considered.

Pulsatilla is principally useful in colics arising from the abuse of
crude, esculent vegetables, unripe fruits, and abuse of fat and greasy
articles of food. The pains are very severe, and usually occur a few
hours after eating, attended with borborygmus, and the expulsion of
large quantities of flatus. We have often seen the most prompt relief
follow a single drop of the tincture, and we have rarely been obliged to
repeat the dose more than two or threfe times.

Phosphorus will apply to cases occurring in persons of a feeble
organization, who have been weakened by long- continued gastric afiec-
tions, and especially for those who are afflicted with disease of the
mesenteric glands. A dose of the third attenuation may be administered
every two hours until relief ensues.

Cuprum, — Case hy Pr, Kissel, [Brit Jour, Homoeop, 1860, p. 554.)
A married woman aged twenty-four, nursing a child several months old.
Found her on the evening of Aug. 16, writhing in bed with outcries
and groans, able to answer questions with difiiculty. She had severe
constrictive, pinching, tearing pains in the pr^ecordium, remaining con-
centrated in the same spot for an hour at a time; but a more distress-
ing symptom was a sensation of swooning, in which she believed that
she was in the last extremity, — that her life was about to terminate.

COLIC. 321

Her eyes were without expression, her countenance collapsed; her ex-
tremities cold; pulse wiry; tenderness of the third and fourth dorsal
vertebra. Slight pressure on the stomach gave pain, though pressure
more severe gave relief. The first attack had occurred four weeks be-
fore this ; had been = free from pain in the interval. The excretions
presented nothing unnatural. Tincture Cuprum-acet., in divided doses,
every half hour.

The pains and swooning sensation continued two hours, till the medi-
cine arrived. The patient felt the influence of it every dos.e she took,
and was quite well of all the symptoms after two hours from beginning
it. The prescription was twice repeated, after which there was no
return.

Case II.— A lady aged thirty. Menstruation imperfect for the last year
and a half; has had within the last eight days repeated attacks, which
were successively more intense and lasting. On October 30, she had
an attack still more severe ; she had severe constrictive pains in the
prsecordium, which extended along both hypochondriac regions, and
quite into the neck, with oppression of the chest. She was in the
greatest restlessness and anguish, would get out of bed, tossing herself
about; then grasping again with both hands at the pit of the stomach,
leaning upon it and throwing herself upon her ♦face, she still cried
that she must die. The prsecordium was contracted ; a light pressure
upon it was painful, heavier pressure not so. The third and fourth
dorsal vertebrae were tender, and she shrank from gentle pressure.
The attacks appeared at irregular times, and gradually extended to
three hours. The extremities were cold, the pulse small and thin*
Every thing else normal. She is directed to take Acet-cupri daily.
From the first exhibition of Cuprum there were no more attacks;
but two days passed before the feeling of exhaustion was quite removed.
On November second the tenderness of the vertebrae had also di^
appeared. No fits occurred subsequently.

We have often used Sulphate of Copper, third trituration, with the best
results for nausea, vomiting, anxiety, gastric or abdominal pain, colic, &c.

Conjwmations of the HomoeopathiG Principle ly AUopathio
AutJiors. — Muralto, says Hahnemann, saw what we may witness every
day, viz. that Jalajp^ besides creating gripes in the belly, also causes
great imeasiness and agitation. Every physician acquainted with the
facts upon which homoeopathy rests, will find it perfectly natural, that
the power so justly ascribed to this medicine by 0. W. Wedal of allay-
ing the gripes which are so frequent in young children, and of procur-
ing them tranquil repose " arises from homoeopathic influence."

The remark made by Murray, that oil of Aniseed allays pains of the
stomach and flatulent colic caused by purgatives, ought not to surprise
us, knowing that J. P. Albrecht has observed jf>(^m5 in the stomach

Vol. I. — 21.

322 DISEASES OF THE DIGESTIYE FUISTCTION.

produced by this substance ; and P. Forest saw violent coUg likewise
caused by its administration.

It is also known and has been attested by Murray, Hillary and Spiel-
mann, that Senna occasions a kind of colic, and produces, according to
C. Hoffmann, flatulency and turgescence of the hlood^ ordinary causes
of insomnolency. It was this inherent homoeopathic property of Senna
which enabled Detharding to cure with its aid patients afflicted with
insomnolency, [Organon^ p. 62).

In cases of colic from the poison of lead, where there is reason to
believe that any portion of the absorbed metal remains in the system,
it is desirable to neutralize the poison by a direct chemical antidote.
Of those proposed for this purpose, the highest claims have been made
for Alum. It was first introduced into England by Dr. Percival from
Ireland in 1774. It acts by converting the salts of lead it may meet
with in the body into a comparatively innocent sulphate. It may be
given in doses of fifteen grains every two hours. In such doses it
sometimes purges, to restrain which it may be followed by Coloc, Senna,
Jalap, &c« Dr. Breschet says he tried it in 150 cases with complete suc-
cess. (Brit, and For. Med. Chir. Rev. Jan. 1851.)

6. Colic in Gbild'ke.'e,— Nature of the J9^5e«s^.— Spasm of the
muscular fibres in some parts of the intestines or distention of the
bowel with flatus. The affection may be acute or chronic.

Symptoms. — In children attacked with colic there is oft^n an in-
creased discharge of urine, followed by agitation and impatience, con-
stant weeping, sudden screams, contortions of the face, sleeplessness
and twisting pain, with retraction of the umbilicus. The legs are bent
towards the stomach; the body is twisted; and infants cannot suck
in a recumbent position. The pain is relieved by pressure.

PROGNOSIS. — If the bowels move and some relief of pain follows, the
case may be considered as progressing favorably. Unfavorable symp-
toms are : obstinate constipation continuing ; the pain being fixed in
o-ne spot and increased by pressure ; this may denote the termination
in inflammation of the bowels.^ See Enteritis,)

Causes. — Achiil,worms, flatulency, improper diet; mental emotions.
The mother's milk is often poisonous to children.

Treatment.— A warm bath and hot fomentations to the abdomen
may give temporary relief, but the chief reliance must be on appropri-
ate remedies. The diet must be light and nourishing, and free from
stimulants. (See Follicular Enteritis.)

Medicinal Treatment. — Chanrhomilla, — The pain has been excited
by a chill or a fit of passion; there is anxiety, restlessness; vomiting
and diarrhoea of bilious matters ; extremely violent pain, tearing and
drawing ; one cheek pale and the other red. =

* Dr. Wood's Edition of Hartlaub on Children.

CONSTIPATION. 323

Nux Vomica. — Colic accompanied by costiveness ; sensation as of
a heavy weight in the lower part of the abdomen ; rumbling in the
bowels ; great heat ; tension of the abdomen, with short anxious and
painful breathing ; sense of fulness in the abdomen; drawing, pinching,
pressive pains; pressure at the navel; stupefying headache; tender-
ness of the abdomen to the touch; loss of consciousness; coldness of
the feet during the attack.

Mercurius, — Colic caused by worms ; urgent desire to vomit ; copious
flow of water into the mouth ; contractions in the stomach and hard-
ness of the navel ; cramps in the muscles of the abdomen ; smarting
of the throat; frequent hiccough; voracity; distaste for sweet things;
constant desire to go to stool ; hardness and swelling of the lower part
of the abdomen; tensive and burning pain around the navel; risings
from the stomach ; general weakness ; diarrhoea ; evacuation of mucus ;
appearance of the abdominal symptoms chiefly at night. {Hartlaub on
Diseases of Children^ p. 111.)

6. Ileus, Iliac Passion. — See Obstruction of the Bowels. — Index,

7. Gasteodynia Cceliaca. — *8ee Neuralgia Oodiaca. — Index,

Genus VII.— COPOSTATRTS.— CONSTIPATION.

1. Constipation. — Alvine Obstruction, Costiveness,
Definition. — Prolonged retention of the faeces ; or slow, imperfect,
or difficult evacuation of them. In general and in health th6 intestinal
apparatus completes its revolution once in twenty-four hours. . Within
that period the whole process of digestion, the carrying forward of the
contents of the stomach, the absorption of the chyle, and the expulsion
of the faeces should be accomplished; and a sensation of relief should
be experienced by it. Any deviation from this condition may be re-
garded as resulting in a state of constitutional disease. The different
degrees of departure from health are thus distinguished :

1. The evacuations are either hard, causing pain, or hard and small?
but still causing pain.

2. Confinement of the Bowels, — They do not act more than once
in forty-eight or seventy-two hours.

3. Irregular Action of the Bowels. — They are alternately consti-
pated and again relaxed.

4. Belayed and Imperfect Action of the Bowels. — The patient
continues to expel only small portions during a lengthened period, ex-,
tending sometimes to a half an hour or an hour, or the action is' soon
completed, but the sensation following is not that of relief.

5. Inaction of the Bowels. — There is no action of the bowels for a
week or nearly so long. There is a total absence of want to relieve
them or it is attended with no result. It is said by Dr. Edwd. Johnson,

824 DISEASES OF THE DIGESTIVE FUNOTIOIT.

that this condition is not always one of disease, but that the habit ex
ists in many persons in comparative health.

In general, the contents of the bowels are carried forward until they
reach the sigmoid flexure of the colon. When they have passed through
this portion of the tube they enter the rectum, which is stimulated by
their presence to contract, and thus grasp the intestinal contents and
expel them. In a case, however, in which the bowels do not act regu-
larly, this inaction being dependent on the diseased constitutional state,
a&Gtmg specially the rectum, the stimulus from the intestinal canal ia
not sufficient to cause the expulsive effort to be effective.

L Mechanical Obstruction. — 1. Some cases of constipation, or non-
expulsion of the faeces,' are dependent on mechanical obstruction; the
intestine is diminished in calibre by a stricture formed of a part through
which the intestine is protruded, forming a strangulated hernia.

2. One portion of the intestine sometimes passes into another portion^
forming, what is called an intussusception.

8. Mechanical obstruction may arise from thickening of the internal
coats, or by the forming of a transverse band, causing a stricture.

4. Enlargement of surrounding organs may cause pressure upon the
intestines and thus cause obstruction. Enlarged and hardened uterus
often causes pressure. .

IL Constipation proper is not dependent on mechanical causes, but
upon the modification of the vital powers associated in carrying for-
wards the movement of the intestinal canal. It is dependent on a con-
stitutionally diseased state^ effecting either the whole or special parts
of the entire apparatus ; and for such state the only proper treatment
must consist in measures calculated to remove these constitutional
conditions.

OAifsES. — These are often obscure, and consist of constitutionally
diseased states, which are not cured by purgatives, but increased by
them. If homoeopathic remedies properly selected cure the case, they
often do not begin to remove the constipation till other attendant symp-
toms give way. The remedy should cover the whole case, and then the
whole of the symptoms in due order will give way. Dr. Epps says :

In a common case the bowels do not act for three or four days; the
patient has never had an action without purgatives ; and when they do
not act he is sure to have headache. If now a proper remedy be given;
" though the bowels do not act for a week, there is no headache ;" thus
proving that the medicine is curing the constitutional state, and conse-
quently, the headache, which, like constipation, was one of the mani-
festations of that state, does not occur, although the constipation be
not yet removed. Constipation appears to occur principally in the largo
intestines, more especially the caecum, sigmoid flexure and the rectum.
The latter seems to be less a receptacle than a conveyor. Generally

CONSTIPATION. 325

when the feces enter the rectum from the last portion of the sigmoid
flexure, the rectum at once contracts, comes forward or draws forth
from the last portion of the sigmoid flexure the feculent portion, and
carries it on to expulsion. In many cases of constipation the rectum
has lost the power, and that power is very great, of grasping the in-
testinal contents; the cure of constipation depends much upon the re-
storation of this power. The inaction of the bowels does not depend
on the hardness of the faeces ; they ought to acquire a certain solidity
before expulsion, having already lost nearly the whole of their fluid
portion before reaching the rectum. The want of grasping expulsive
power of the rectum is the chief condition associated with constipation,
and that want is dependent for its manifestation on the general con-
stitutional diseased state. It seems to depend on an exhaustion or
suspension of the nervous power of the rectum, a kind of palsy of the
muscular fibres of the intestine itself.

Constipation often consists in nothing more than a deficiency of the
fluids necessary for digestion, and depends on a deficiency of the se-
cretions or a diet in which too little liquid is taken into the stomach.
In its simple form it generally originates in sedentary habits, and the
neglect of attention to the regular evacuation of the bowels at a par-
ticular hour of the day. As most persons can best go to sleep at a
certain hour of the night or day, so are almost all other vital actions
influenced by the law of periodicity. Any unexpected business
or detention at the usual hour which breaks in upon the habit of a
regular daily evacuation, may postpone it for the day. Among students
and literary persons profound application of the mind diverts it from
attention to objects of mere physical concern; also indolence, or de-
tention and want of a convenient place near at hand, cause many to
put off making the effort till the contents of the bowels become hardened
by the absorption of their more fluid parts. Chemical changes may
cause acid eructations, heartburn, flatulence, colic, diarrhoea, headache
and fever, flushing of the face, constant fulness of the head. One of
the usual causes of troublesome constipation is the practice of flying
to purgatives on the slightest deficiency of the intestinal action. Many
a slight case, which if left to itself would soon have been spontaneously
relieved, is converted by unnecessary purgings into obstinate constipa-
tion, ending in paralysis, spasmodic obstruction of some part of the
bowels or complete obliteration.

The disease then is not a primary one, but constitutes the absence
of action in a given way; and that absence of action is caused by a
peculiar state constitutionally diseased, which suspends the harmonic
actions of various parts of the human frame, of which suspension of pe-
ristaltic action is one of the manifestations. We therefore do not treat
the constipation as a disease in itself, but as a part of the whole.

826 DISEASES OF THE DIGESTIVE FUNCTIO]Sr.

Mr, Abernathy announced the idea in 1827 (on tlie ConstiUttional
Origin of Local Diseases^ p. 35.), that constipation is a constitutional
disease. . He said the increased discharges from the bowels under the
influence of purgatives consisted of the morbid secretions from the
bowels themselves ; and gives a case of a child born with the oeso
phagus impervious, though it was otherwise healthy* No food could
pass to the stomach, and it died of starvation after thirteen days
Though it took no food, the alvine evacuations were natural, correspond-
ing in color and consistence with those of children of that age, and
continued, though diminishing in quantity, to the last. Persons who have
had the oesophagus obliterated by disease, and been supported by ene-
mata, have still had the faeces naturally formed and expelled, [Dr.
Ejjjps^ p. 154.)

Dr. Edw. Johnson goes so far as to say, "that none of the food taken
is ejected as faeces from the body, but all is absorbed, all is assimi-
lated ; and that the faeces are really the intestinal secretions formed
into a mass and expelled." Though this last assertion goes, in our
opinion, beyond the truth, it still embodies an important idea of the
highest practical importance.

Gitrvature of the Sjpine is a common cause of constipation which
becomes both a cause and an effect of general ill health. It is probable
that the curvature produces pressure on the spinal nerves and modifie
also the nervous communication with the parts of the great sympatheti
symptom of nerves; thus by causing imperfect supply of nervous powe
to the rectum producing constipation.

8. Pregnancy is a cause of constipation; and injurious results often
result from efforts to remove the constipation by purgatives.

4. Over-excitement of „the genital organs produces constipation, by
exhausting the nervous energy of the nerves which supply the digestive
system as well as of the spinal column generally. The loss of the
nervous powers causes paralysis of the muscles and loss of expulsive
power of the muscles of the rectum. Accumulations follow ; and when
the sphincters become paralysed the power of closing them is lost and
faeces escape. •

5. Old age is attended with diminution of vital powers generally ;
torpor of the intestines is common.

Pathology. — The whole gastro-intestinal cavity is affected with
torpor, but is free from all signs of structural disease. The natural
peristaltic action of the bowels is deranged through causes that dimin-
ish the secretion of the fluids which are naturally poured out of their
surface, rendering the faeces hard and difficult to more forward; and
by causes that diminish the contractile power of the involuntary mus-
cular fibres of the bowels. There is probably in this disease a defi-
cient supply of healthy arterial blood to the glands which secrete the

coNSTiPATioiNr. 827

intestiDal fluids, with deficient nutrition of muscular fibre and secret-
ing glands. (Taylor^ N, A, Jour. Homm. 1857, 191.)

There is in nearly all cases of constipation a torpid state of the
liver and great deficiency of bile. It constitutes a prominent difficulty
in jaundice and nearly all febrile diseases, as catarrh, measles, fever
excesses of food or stimulants, melancholy, spermatorrhoea, impotence
i^jmale sterility from defective menstruation, amenorrhoea, chlorosis
The appetite is capricious, digestion difficult; pain in the stomach or
intestines, heartburn, acidity, flatulence, oppression of the stomach
after meals, nausea and occasional vomiting; headache, slight fever,
thirst, coated tongue, depression of spirits, melancholy, imperfect sleep ;
alvine evacuations performed with great difficulty. See p. 272.

Treatment. — The common treatment of constipation by purgatives
is not in accordance with any scientific law. It is only the treatment
of a symptom to the neglect of its cause, and is always unsuccessful.

To cure constipation requires a true knowledge of, 1. The constitu-
tional disease of which the constipation is only a symptom. 2. Of the
special medicine suited to the diseased state, the constipation being
only a manifestation of that state. 3. Of the law regulating the action
of the remedy to the diseased state. Purgatives can not cause the
regular and permanent expulsion of the proper amount of faeces of
the proper character. The error (says Dr. Johnson), consists in
the manufacturing functions of the secreting arteries, there being no
faeces to expel ; an active purgative will force some kind of an eva-
cuation, but its object is not achieved. An "excess of secretion is
attained, but it is not a natural foecal product ; it is only the exfiltration
or outpouring of the serum of the blood into the bowels." . Though
some temporary relief be sometimes attained in this manner, it is only
such a relief as we could get by diminishing the volume of blood. The
capillary system has been Med^ but only depleted of its watery con-
tents. Nothing is done towards the cure of the constipation. The
next day the bowels are more constipated than ever. {Dr. Johnson^
p. 167.)

Constipation must be cured by improving the secretory powers of
the arteries.

Auxiliary Measures towards the Cu/re of Constipation, 1, En-
deavor to establish the habit of relieving the bowels at a certain time
every day. There is a natural tendency to the establishment of a rule
of this kind, and it should be encouraged. The time most likely to be
successfully fixed will be a short time after breakfast every morning
The act of taking food having given a slight impulse to the peristaltic
action of the intestine, it is comparatively easy to propagate this im-
pulse along the whole alimentary tract. In persons troubled with pro-

828 DISEASES OF THE DIGESTIVE Er:NCTIOISf.

lapsus of the rectum, it is better tliat the bowels be relieved on going
to bed.

2. Moderation in the quantity of food, and regularity in the hours
of eating ; several hours should interpose between the different meals.

8. Frequent ablution of the body with cold water; delicate persons
can use it as warm as is necessary to prevent chilling the surface.

4. Frequent drinking of water, cool, but not iced. See p. 297.

5. Frictions to the spine over its whole length.

6. Exercise, walking or other modes of exerting the muscles of the
limbs and abdomen. See p. 288.

7. Avoidance of late suppers; a heavy supper keeps up digestion
through a great part of the night.^

Medical Treatment. — The medicine that is properly adapted to
remove the morbid condition of the system is the proper remedy for
the constipation, which forms a part of the said morbid condition. It
is, therefore, impossible to enumerate all the proper remedies by which
constipation has sometimes been cured, and give the specifics symp-
toms of each ; but since this condition is very frequently the predomi-
nant feature of the case, and that for which we are requested to pre-
scribe, we will give the principal remedies and the symptoms which
direct us in the choice of each in ordinary cases.

Opium, — Constipation caused by external circumstances exerting a
debilitating influence on the nervous system. In acute cases when
constipation is not habitual, but there is a want of power to relieve the
bowels, with a feeling of constriction ; desire to relieve the bowels, with
a sensation as if they were obstructed ; pulsation, sense of weight in
the abdomen, dull heavy pain and pressure in the stomach ; beating in
the abdomen ; parched mouth, want of appetite ; thirst ; determination
of blood to the head ; redness of the face ; headache ; constipation in
young children, after Nux has failed ; repeat the dose, if hot relieved in
twenty-four or forty-eight hours.

Of its power to cause or cure constipation, Hahnemann says, in the
Organon :

Ojpium^ of all vegetable substances is the one whose administration in
small doses produces the most powerful and obstinate constipation. How
is it possible that it should, notwithstanding, be the most efficient remedy
in those cases of constipation, which endanger life, were it not in virtue
of the homoeopathic law? Opium, whose primary effects are so power-
ful in constipating the bowels, was discovered by Trallesf to be the
only cure in a case of ileus, what had been ineffectually treated by
evacuants and other remedies. Bohn found, that nothing but opiates
could act as purgatives in the colic, called Tniserere ; and Hoffmann, in

* Pr. Epps On Constipation p, 249, f Uses and Abuses of Opium.

CONSTIPATION. 829

the most dangerous cases of this nature, placed his sole reliance upon
Opium and the Anodyne, called by his name. It is true that " two
hundred thousand volumes have been written upon medicine, and out
of them all we can not extract a simple explanation of the mode, in
which Opium cures constipation ; the law of homoeopathy alone gives it."

Bryonia. — Constipation occurring in warm weather ; in the puerpural
state, accompanied with inflammatory irritation of the abdominal organs.
In persons of an irritable or obstinate disposition, with a tendency to
be easily chilled and subject to rheumatism; constipation arising from
a disordered stomach ; determination to the head and headache.

Enemata, — A mild cathartic enema, employed at a particular hour
a short time after breakfast, will generally give present relief to the
bowels ; and the habit persisted in will restore the habit of acting at a
certain hour. The quantity thrown up must be large, and the patient,
lying on the left side, should retain it as long as possible. It is im-
portant that this habit be persisted in till the regular habits of health be
restored. It is immediately after breakfast that the bowels are most
inclined to act spontaneously, as the pressure of the distended stomach
upon the transverse arch of the colon disposes the latter to contract
and propel its contents into the rectum. This natural tendency should
always be encouraged at the moment, for the activity of the absorbents
in the bowels soon removes the more fluid parts, and the bulk being re-
duced, the disposition subsides. [Hull)

Injections should be large in quantity and their efficacy is not per-
manently increased by the addition of stimulants, which have been
supposed to exert a salutary influence on the colon. — The patient
should lie on the right side for the purpose of enabling the in-
jected fluid to reach the ascending colon and caecum, where accumu-
lations always exist. Here the contents of the bowels are compelled
through sixteen out of twenty-four hours to ascend in opposition to the
power of gravity ; and here we find fulness and hardness in many cases,
especially in chlorotic persons. Inflammation or ulceration of the
mucous membrane of this part may be caused by long contact of har-
dened f£eces ; and irritating foetid compounds are formed by chemical
decompositions ; and irregular fatty looking masses of inspissated
mucus secreted from a highly irritated surface, are often found in the
evacuations. When long retained this matter becomes purulent. To
assist in clearing out the large intestines gentle pressure and kneading
by the hand of an assistant may aid in pressing the delayed masses
forward. This process has sometimes been made a special basis of
success in constipation. A German practiced it successfully in Lon-
don, in 1847. He kneaded the abdomen over the small intestines ; and
then, beginning from the right groin, he continued the process till the

830 DISEASES OF" THE DIGESTIVE FUJStCTIOK.

object was attained. But a true cure can only be readied by homoeo-
pathic remedies.

Nux-vomica, — Constipation resulting from too heavy a meal ; from
indigestible food, or stimulating drinks, as coffee, and lasting severa
days ; adapted to persons of irascible and lively temper ; determinatio
of blood to the head ; giddiness, stupor, intoxicating heaviness in the
head, especially in the morning, redness of the face and headache,
person of sallow complexion, loss of appetite, tendency to vomit, flatu-
lence, pressure at the stomach, dry cough, dryness of the mouth, acid
and bitter taste, unfitness for exercise, disturbed sleep ; general oppres-
sion and heaviness, lassitude and drowsiness in the morning; heart-
buruj nausea in the morning, swelling of the stomach after eating; fre-
quent ineffectual efforts to relieve the bowels, constriction of the sphincter
and shooting pain in the abdomen, constrictive pain in the chest, rest-
lessness, general depression; in individuals subject to haemorrhoids;
tenesmus, pain in the rectum, and loins, constipation in young children.
After it fails try Opium 2d, then Bry. 10, Veratr. 10, Sulph. 10,Calcar.«
Oarb,, and particularly Zincum.

Tincture of Nux. one drop night and morning, increasing the dose
one drop every day. (^^(?A^^, p. 49.)

Abstinence from coffee and other heating drinks, exercise in the open
air. Nux at bed-time and Sulph. in the morning are sovereign reme-
dies for constipation ; fseces are hard, dry, and evacuated with great
pain and effort. {Becker^ p. 57.)

Case by Dr. Henderson. — A lady, long subject to constipation, took
Nux, third attenuation, a half drop twice a day. She began soon to
feel "extremely weak, sleepy all day, headache all over the forehead ;
creeping tickling feeling in the lower limbs ; extremely cold feet; cold
sensation in the chest ; extreme exhaustion." She did not attribute the
symptoms to the medicine, but persevered for four days, when her symp-
toms became alarming. The physician pronounced her suffering under
over-doses of strychnine." She had been taking only the one millionth
of a drop of the mother tincture of Nux-vomica per day. (p. 263.)

A case of constipation is given in the Medical Hegister^ vol. 2. p.
168. A man had been long suffering from constipation, and in the
course of six months passed under the care of thirty different phy-
sicians and fifty surgeons. For two weeks there hkd been scarcely
any evacuation. " His skin was nearly the color of mahogany ; there
was a horrible sphere flowing out from him which was intolerable, there
was scarcely any flesh upon his bones, and he scarcely resembled a
human being. The abdomen was filled with scybalae, like a wallet of
pebbles ;" of these "near a peck were afterwards discharged which re-
sembled black marbles."

Cases by Dr. Epps.— -1. A man, aged twenty-two. Has to take me<

CONSTIPATION. 331

dicine twice a week, has uneasy sensation at the top of the head and
heat in the scapula. He took Nux ; and a week after reports that the
bowels have acted four days out of the seven. Other symptoms im-
proved. After taking Opium 2°, he took Sulphur which confined the
bowels. But he was entirely cured.

2. Constipation in a Case of Ovarian Dropsy. — A woman, aged
twenty-seven, mother of three children, had an ovarian tumor on the
left side after confinement. In April, the tumor was tapped, and eleven
pints of fluid drawn off. She was getting large again ; has had con-
stant pain down the left groin, and in the back down the left side ;
bowels confined ; menstruation failed for the last two months. She has
taken Merc.-Iod. and Elixir- Vitr. (under other hands). She took
Nux-vomica .twice, when the bowels became regular, which had never
been the case before. See p. 291.

StdpInor.—ILBhiiuQl constipation, with haemorrhoids.

It cured an elderly man who had suffered from constipation twenty
years, accompanied by severe headaches, fulness of the stomach after
eatingj dry loaded tongue, hitherto only relieved every second day by
aperients; dyspepsia caused by repeated purgatives, also disease of
lower intestines ; dull pain in the liver, increased on pressure. In five
weeks the bowels were enabled to act daily and the headaches sub
sided. {Be6^er, p. 50.)

Pulsatilla, — The same indications, as Nux-vomica. But Pulsatilla
is particularly suited to females and children of mild phlegmatic dis-
positions ; generally want of thirst rather than thirst, repugnance to
fat and rich meat, suffering after taking pork and pastry, frequent, and
loose or difficult and slow evacuations ; bad effects of rich greasy food,
accompanied by moroseness and shivering.

Graphites, — It has cured a large number of cases, generally com-
plicated with certain other diseases. Dr. Epps gives thirty-two cases.
Usually four globules were given each week; in one case eight glo-
bules in sixteen days. In all constipation was a prominent feature.
Of the second series of cases :

1. A case of confined bowels with crusts on the face, caused by the
application of oil to an erysipelatous surface. 2. The same with scaly
brownish eruption. 3. Another in combination with erysipelas. 4. The
same. 5. Another with ulceration on the toe. 6. A case with dry
skin and an eruption on the skin and uterine disorder. 7. One case
with a crustaceous eruption on the head ; stools solid. 8. Another of
confined bowels and eruption on the skin. 9. Two with ulcerated leg,
pains in the ulcer; shooting like pins and needles; all cured, — the
ulcer relieved. 10. Case of constipation with diseased knee. 11. Con-
stipation with large stool, headache, eruptions on the hands, dry skin.
12. Constipation Avith pains produced on action of the bowels, with erup-

5dZ DISEASES OF THE DIGESTIYE FUNCTION.

tion on the skin. 13. A case with dry skin and dizziness, causing the
patient to falL 14. Four cases with dry skin. 15. A case with dry
skin, great depression of spirits on which the remedy produced re-
markahle effect. 16. Constipation with great mental distress ; eight
globules given in sixteen days.

Additional Cases. — 1. A woman, aged twenty-five, has been nurs-
ing a child for eleven months. Eyelids weak since the child was born,
being inflamed, with angry, reddish yellow margins, having pricking
pains in them ; water comes into the eyes and prevents her seeing,
especially at candle-light, the eyelids seem to draw down ; skin dry ; con-
stipation has been long treated without benefit ; stool large and causes
bleeding. Under the use of Graphites 12° for nine days the sight be-
came better ; the bowels regular, acting every day ; the bleeding ceased>
{On Constipation,)

2, A man, aged thirty, had pleurisy three years ago. Under old
treatment he was laid up five months. Has pain through the left side
to the shoulder ; food causes a sense of weight and pain ; throat sore
from slight exposure ; pain in the back ; skin dry ; great difficulty in
passing stool and after long effort. He took Graphites, and in eight
days was entirely better. The remedy was repeated with increased
benefit.

A woman, aged twenty-nine, bowels habitually confined; stools large,
passed with blood and great pain, lasting for a whole day, following the
passage. Graphites was given. A week after, the bowels act better,
there is heat all over the surface, attended with faintings. Graphites
repeated — cured.

Her child, aged eight months, had since the fifth week a whistling,
wheezing, with burning heat in the skin; skin dry; constipation.
Hepar-sulph.

The whistling got better, also the wheezing and burning heat;
bowels better. Hepar continued.

The heat at night afterwards returned, with constipation. Graphites
cured.

Constipation complicated with Hepatic Disease, — ^Veratrum.—
An officer, after having yellow fever several times, suffered for thirty
years with constipation and liver-disease, bowels never moving with-
out purgatives, distressing headaches, and great depression of the
nervous system. He was greatly benefitted by Nux 30, Bryon. 30,
Verat. 12 every second or third day in succession for two months.

Dyspeptic symptoms ; acid *and bitter eructations, fulness of the
stomach and bowels after eating, pain in the region of the liver, constipa-
tion, and eruptive disease covering a great part of the body. Veratrum
first cured the skin-disease and afterwards the stomach-symptoms and
constipation yielded. [Becher^ p. 37.)

TREATMENT OF CONSTIPATION IK CHILDKEN 833

Teeatment of Constipation in Children. — The greater the dread
of costiveness the greater are the objections to the use of purgatives.
In healthy children the bowels move twice in twenty-four hours ; but
no uneasiness should be felt if these intervals should be prolonged to
two days, and in older children to four or five. The difliculty can be
safely overcome if we are not too impatient ; if Tnild aperients could
be made to answer they need not be used ; violent purgatives
are especially dangerous when the constipation is accompanied by
hernia or other mechanical obstruction. Lobelia is a better remedy.

A permanent cure may be promoted by exercise in the open air, by
avoiding indigestible food and stimulating drinks, by 'eating slowly,
and the avoidance of too early use of solid food, especially meat. If
purgatives have been habitually used they must be abandoned gra-
dually. The child should gradually be accustomed to drink cold water,
and when the bowels must be relieved promptly it can generally be
done by a mild injection of milk and water. Neither the nurse nor
child should drink strong coffee.

Medicinal Treatment. — Nux-vomioa. — Dissolve only two globules
in a tablespoonful of cold water, to be taken at bed-time every night
till the bowels move naturally.

Symptoms.— Constipation caused by indigestible food or by over-eat-
ing ; after a diarrhoea has ceased spontaneously ; when there is loss of
appetite ; unpleasant taste in the mouth ; tongue loaded with white
mucus ; loathing, and nausea ; cuttings and painful shootings in the
lower part of the abdomen, with tension and pressure ; heat; flush-
ing of the face; stupefying headache ; disturbed sleep ; oppression;
much heat in the lower part of the abdomen ; protrusion of the bowel.

Pulsatilla : in addition to the above symptoms ; there is : bitter taste
in the mouth ; desire to vomit ; sour .eructations ; flow of mucus into the
mouth ; burning sensation in the oesophagus; tension and pinching in
the lower part of the abdomen ; sallow complexion ; shivering ; dejec-
tion ; mild and gentle disposition.

Suljphur, — Obstinate cases resisting other remedies, one pellet at
bed-time once a week for a month, in psoric constitutions.

Lycopodium. — Case T)y Dr, Ejpjps. — ^A man, aged twenty-three, had
constipation four years. Active temperament, appetite good, urine
natural when passed, though often thick when cold; at times large
quantities, pale. Heaviness in connection with the constipation. Hands
and feet cold, Lycopodium.

In the same month he had some numbness of the hands in the morn-
ing for two days, Causticum.

He afterwards wrote that he was always relieved of the irregularity
of the bowels by alternating Nux-v. with Lycopodium or Sepia. He

834 DISEASES OF THE DIGESTIVE FUNCTION.

was permanently cured by them. For four years lie had been com-
pelled to often take Castor-oil, pills and other purgatives.

II. Intestinal Obsteltotion. — 1. Any mechanical obstruction of the
bowel causes a,n accumulation of its contents above the obstructed part;
and this accumulation provokes such a peristaltic action as insures
their mixture, and, strictly speaking, their reflux.

2. Increasing distention finally brings about paralysis and inflamma-
tion of the intestine, ending in the collapse and death of the patient.

8. The symptoms of the several forms of obstruction (referring more
generally to the nature of the obstacle and its situation,) usually per-
mit an accurate diagnosis, even in the earliest stages of any given
case. It is therefore desirable to inculcate the importance of an early
a.nd accurate diagnosis, which will have an important bearing on the
treatment. Mechanical obstruction must be clearly distinguished
from enteritis.

Prognosis, — The cases that recover 2.y^ almost invariably the jpro-
traded ones. Intussusceptions which end by the expulsion of the
affected part or segment of the intestine have a duration of twice to
thrice as long as that of the fatal cases. In those cases which finally
recover it is only in the second, or third, or even the fourth week that I
have witnessed that remission of symptoms which announces relief of
the obstruction, and which often precedes by a day or two the first
healthy evacuation. {JBrinton^ Oroonian Lecture,)

Medical Treatment. — General principles, — 1. To protract the
duration of life by every means in our power. If we can lessen the
rapidity and increase the duration of the malady, we multiply the
chances of recovery. . The constriction or inflammation may possibly
end of itself by resolution, or retraction of the intusception, by efforts
of the vis medicatrix naturce. A gradual accumulation of fluid leak-
ing into the stricture forms a kind of wedge there ; and, transmitting
equally in all directions whatever force it may receive, it allows even
the most distant wave of peristaltic contraction, applied at a distance,
to tell with undiminished energy as an agent of dilatation at this point.

Chief Indications of Treatment. — 1. To prevent distention; 2.
to assuage pain; 3. to mitigate extensive peristalsis; 4. to support the
patient's strength during what is necessarily an exhausting and often
a long illness.

1. To prevent distention, reduce the food and drink in every avail-
able way. Give only small and frequent sips of cool, even iced liquids
Give the food in the shape of beef-tea, soups, &c.; and, if these ar
tides disagree or excite vomiting, diminish the doses and try other
articles : soda water in small quantities; wine or brandy in some cases.

2. To lessen the pain. Opium' has long been the only reliance, and
in many instances it has been used to very great extent, far exceeding

INTESTINAL OBSTRUCTIOK.

what could be usually borne. Belladonna, tbougb less effectual tban
Opium in easing pain, bas a specific power in this disease, that must
not be passed lightly over. Lobelia is often successful.

Tobacco has a specific power in an antipathic way to produce relaxa-
tion of the constricted portion of the bowel. But in the dose it requires
it is very dangerous, Whatever be the means we resort to, we have
before us a task of great difiiculty, audit is only, as Mr. Brinton says:
"by close and even unconscious reasoning; by strict scrutiny; by deep
insight, and by a truthful and teachable habit of mind, that the treat-
ment of diseases of such severity must be wrought out."

3. Enemata. — They may effectually support the patient's strength,
and by their mechanical action they may sometimes remove^** the ob-
struction. The water they contain, when absorbed, is important both
for the purposes of nutrition and lessening the fever and inflammation.
Milk, broths or gruels may be employed in this way and may long
maintain life. They may act also, by distending the bowel on the lower
side of the obstructed point, and thus effect such a change in the posi-
tion or arrangement of its parietes, as may release the impacted or in-
tuscepted part. They aid also by their gentle warmth and the water,
which may be absorbed in the immediate vicinity of the point of
disease.

It is chiefly in their earlier stage that they are likely to be benefi-
cial. They should be injected slowly and gradually, and with con-
siderable force, though with caution ; — ^with such care that the tension,
which an additional ounce may cause, shall subside before we attempt
to introduce more. The patient should be willing to bear some pain,
and the operator to give the least he can.

PuKGATiYEfs in such a case can do no good. They can not remove
the obstruction. The enormously distended state of the intestine
clearly indicates the folly of attempting to force a passage by purga-
tives. This is the decided opinion of the highest living authorities. Long
before the advanced stage of obstruction, at which purgatives could do
good, long before the f^cal vomiting which usually precedes it for
some time, physical examination of the abdomen shows an accumula-
tion of liquid, and the creeping, flatulent peristalsis, beneath its per-
haps still smooth, relaxed and flattened walls. This condition shows,
not indeed that purgatives are useless, for they have sometimes given
relief, but rather that nature herself is preparing, within the obstructed
bowel, the best of all purgatives : a mass admirably adapted by its
quantity and quality, and especially by its consistence, to do whatever
any aperient can towards opening a passage. And if, as we have con-
cluded, there is any danger of even this stimulus being too great; if
it is distending the bowel with such rapidity, as to paralyze its muscular
coats, or to provoke an excessive and exhaustive peristalsis, or to ex-

336 DISEASES OF THE DIGESTIVE FUNCTIOIT.

cite a diffuse inflammation which so aggravates and distorts the local
phenomena, as to destroy all chances of their restoring the permeability
of the obstructed canal; — -withhold purgatives in these cases, because
they are not merely useless, but positively hurtful, not only in the late,
but even in the early stage of the obstruction.

ObstruGtion in the Colon. — AmAiswSs Operation. — ^Either the right
or ascending, or the left (descending) colon may be opened to relieve
the distention produced by an obstruction near the lower part of the
large intestine. This operation generally permits an unwounded state
of the peritoneum ; but it can hardly be doubted that its success is
due to other causes. Indeed, considering the circumstances of many
of the c^tructions, for which it is performed, the serious lesions, (can-
cer or stricture,) by which they are caused, and the scarcely less serious
accidents, (diarrhoea and haemorrhage,) by which they are often long
preceded, practically, no doubt, this unpromising measure is mostly
undertaken merely to palliate the suffering or to defer the approach
of inevitable death. And yet it has been in "every way more success-
ful than any other operation hitherto practiced for the relief of obstruc-
tion." This striking result is greatly favored by the circumstance that
the physiological relations of the large intestine render, the phenomena
of its obstruction altogether slower and of later occurrence than are
the same phenomena in obstruction of the small intestine.

The cases, then, for which gastrotomy may with propriety be prac-
ticed are reduced to a, small number. They are : obstructions, such as may
be caused by a band of organized lymph by an adhesion ; a diverticulum,
a rent in the mesentery; a malformation of the peritoneum; a twisting
of the intestine.

Either one of these cases might be removed by an operation ; spon-
taneous cure is scarcely possible; if accumulation, distention and
leakage fail to dilate the constricted segment against the pressure^
which is often feeble, of the band or adhesion, or fail to retract it from
the peritoneal or mesenteric aperture into which it has slipped, death
seems inevitable. And even for these very cases gastrotomy should
not be considered as the exclusive remedy. It would be hopeless if
practiced on persons of advanced age or broken constitutions, when
there is violent inflammation of the obstructed bowel or general peri-
tonitis.

Aconite, — Dr. Gr. H. G. Jahr, says : Aconite is the best remedy in
all cases of incarcerated and inflamed hernia. According to the sus-
ceptibility of the patient, we may administer it in the third, twenty-
fourth, or two-hundredth attenuations in globules or in water, at inter-
vals of one or two hours. In recent cases, with violent and persistent
pains, this medicine should be employed until the violence of the symp-
toms has subsided. It is equally appropriate in all ether incarcera-

DIAPHEAaMATIO HERNIA.

837

tions accompanied by inflammation. {Gauwerhy^ Qaz. Horn, de Leip-
zig, vol. XI. p. 220.)

In two cases of incarcerated hernia, accompanied by a high degree
of inflammation, AG07iite, eighteenth and twenty-fourth, repeated every
hour, effected cures in eight and twelve hours, both patients being quite
well on the next morning. {Goidlon, Arehiv de Stwpf, vol. XIV. cah.
11. p. 138.) We have also seen prompt relief from one drop of Lobelia.

When there are, in the incarcerated parts, violent pains, burning
like live coals, with great pain and sensitiveness at the least touch,
nausea, bitter bilious vomiting, anguish and cold sweat, Hering says,
Aconite is the appropriate remedy, and should be given till the pains
subside.

When the affected parts are already rigid, painful, swollen, tense,
hot, and red, a single dose of Aconite, twelfth, will often cure in a few
hours. (Kreussler, Therap. Horn. p. 99.)

PartiGular Symptoms indicating Aconite. — -Severe inflammation
of the affected parts ; burning pains like coals of fire or pulsations ; nau-
sea and bilious vomiting. {JaJir)

Elect/ro- Magnetism., — ^^In Hernia par engouement I have found this
agent most valuable. Every effort I had made for a reduction, proved
useless, when, finally, I inserted the positive pole connected with a
proper instrument, into the rectum, and the negative pole, connected
with a silver plate, was placed upon the tongue ; this immediately pro-
duced an undulating motion of the bowels, previously motionless ; no
shock, was received, nor was there any contraction of the abdominal
muscles. The patient was soon in a state of diaphoresis, the muscles
relaxed, and the hernia was spontaneously reduced. Aft^r removing
the instrument from the rectum, it was followed by a copious evacua-
tion of hardened faeces." [Dr. H. Lassing)

4. DIAPHRAGMATIC HERNIA.

Definition. — A protrusion through the diaphragm of the parts below
it. It occurs in consequence of congenital absence of a portion of the
diaphragm ; perforation by rupture or wounds, or a yielding of this sep-
tum at certain points, permitting the stomach, intestines, or other abdo-
minal viscera to enter the cavity of the chest, or to encroach more or
less on the thoracic space. The disease is so rare that no individual
may expect to meet more than one case in a life-time.

Dr. Bowditch, of Boston, presented before the Boston Society for
medical improvement in 1847 a coAdensed report of all the cases then
known to have been published ; and he found in the books eighty-eight
cases. In connection with these he gave the history in full of a case
" m which nearly the whole of the left side of the diaphragm was want-

VoL, I.-22.

838 DISEASES OF THE DiaESTIVE FUNCTION.

ing; so that the stomach and a great part of the intestines lay in the
left pleural cavity ; compressing the lung, and forcing the heart to the
right of the sternum." This condition was evidently congenital. The
subject of it died at the Massachusetts General Hospital, with fracture
of the spine caused by a heavy blow upon it." {Buffalo Med* Jour-
naly June and July. 1853.)

Yarieties of the Disease,-— 1, " Parts of the abdominal viscera are
forced through some one of the natural openings of the diaphragm, viz.,
that of the aorta, vena-cava inferior, an intercostal nerve, or the oesopha-
gus, 2. When portions of the diaphragm are wanting," resulting from
congenital arrest of development. 3. "Hernia from accidental wounds
or lacerations. 4. When one side of the diaphragm is violently forced
up into the chest, producing compression of the lung."

The effect of this displacement of the viscera is various in the dif-
ferent conditions in which it exists. In some cases there is found in-
flammation, after death, extending to the pleura, lungs, or abdominal
organs. The lungs are compressed in proportion as their space is in-
truded on ; the condensation thus caused is easily removed by infla-
tion. . Pneumonia in some produces solidification of the lung. There
is often displacement of the heart, generally to the right ; and also
pleuritic eflusion.

Diagnosis. — ^When the stomach or large intestine has ascended
into the chest, a proportionate tympanitic resonance is pe]?ceived on
percussion, and it differs in degree in proportion as the ascended vis-
cera is distended with gas. The presence of the liver must cause dul-
ness of sound, liquid eflusion must do the same. So far as the lung is
compressed the percussion sound elicited must be proportionately dull ;
as also when it has become solidified by inflammatory exudation.

Auscultation reveals tympanitic resonance over that part of the
chest upon which the hollow viscera have encroached ; the degree
varying in proportion to the extent of space within them occupied by
gas. Over compressed portions of the lung, the percussion-sound is
necessarily dull, still more so when the lung is solidified by exudation.
■ Auscultation will show the absence of the respiratory vesicular mur-
mur in parts compressed by intruding organs ; and the same exagge-
rated in portions of the lung of the opposite side ; Dr. Bowditch found
in the case observed by him "gurgling, whistling, blowing" gastric or
intestinal sounds over the seat of the hollow viscera. They were ex-
cited at times by the act . of respiration, and also when the patient
held his breath. Metallic tinkling also was heard like that heard
over the stomach. Some of these sounds were probably produced by
pressing suddenly on the abdomen and thus forcing air into the intes-
tines while yet in the pleural sac.

The cardiac sounds are heard in the region to which it may be dis-

DIAPHRAGMATIC HERNIA.

839

placed. The affected side of the chest is generally enlarged and its
motion constrained. . The lungs are much compressed.

The GharaGteristiG symptoms relate to the respiration. This is
generally though not always embarrassed, oppressed, increased in fre-
quency ; some dyspnoea, or orthopnoea. The difficulty of breathing is
increased by the recumbent posture, which favors the pressing of the
AHScera into the thorax. The difficulty of breathing occurs in paroxysms,
from the greater distention of the hollow intruding viscera containing at
times more gas, and taking up more room. In the single case, reported
by Dr. Bowditch, the patient, aged seventeen, was able to perform the
duties of a laborer ; he did not suffer from embarrassed respiration; and
died, not of this affection, but from fracture of the spine.

The diagnosis is so difficult that of the eighty-eight cases collected
only one was determined before death. That just mentioned was also
detected by Dr. Bowditch by physical signs. These in general are :
dyspnoea, coming on suddenly or going off suddenly, when congenital
the embarrassment of breathing is observed from birth. If from a rup-
ture or wound, the dyspnoea dates from the time of the injury. The
symptoms of the respiration are characteristic : Tympanitic percussion-
resonance ; absence of respiratory murmur ; presence of sounds iden-
tical with those observed over the stomach and intestines, as, berbe-
ry gmi and metallic tinkling when the respiration is suspended ; dilata-
tion of the affected side ; difficult motion, or immobility, probably ab-
sence of vocal fremitus.

Though these symptoms occur in emphysema the latter may be dis-
tinguished by : its being accompanied by paroxysms of asthma ; more
or less cough and expectoration ; the sonorousness revealed by physical
exploration is not purely tympanitic, but vesiculo-tympanitic ; dilatation
and deficient motion especially marked at the upper part of the chest ;
bronchial rales or a modified respiratory sound more or less diffused ;
with absence of borborygmi and metallic tinkling.

Pneumo-hydrothoeax.

Generally suddenly developed as
the result of perforation, commen-
cing within the pleura in the course
of chronic pleuritis, which has pre-
viously existed.

PhysiGol Signs, — Tympanitic
resonance, absence of respiratory
murmur, dilatation, and deficient
mobility, abolition of fremitus.

PosiUve Signs, — Metallic tink-
lino; occurs in connection with re-

DlAPHRAGMATIO HeRNIA.

Only suspected where these an-
te cendents cannot be ascertained.

These symptoms a,re also com-
mon to diaphragmatic hernia.

Borborygmi is a positive and pe-
culiar sign. Tinkling and ampho-

340

DISEASES OF THE DIGESTIVE FUNCTIOK.

spiration, voice, and cough ; caver-
nous amphoric respiration and
voice. Succussion-sound general-
ly can be produced; fluctuation
absent.

ric sounds occur, but not in syn-
chronism with acts of breathing,
speaking, coughing; without re-
spect to the movements of the body.

5. INTESTINAL INTUSSUSCEPTION.
PASSIO ILIAC A.

Treatment. — Manipulation or Pressure. — This expedient has been
employed to relieve obstruction, perhaps by lengthening and effacing a
twist in the intestines. In one case a moderate palpation necessary
to physical examination forced onward an impacted gall-stone. But in
other cases the same degree of pressure has been sufficient to burst
a distended and rotton bowel, and thus to kill the patient.

GastrotoTYiy, — In very few instances has this operation accomplished
any good compared with the number in which it has been performed.
In one case intussusception has been withdrawn, in another a band has
been divided, in another a portion of the intestine cut out, with a tumor
attached to it.

But there have been other cases in which by manipulation of the ab-
domen, or by giving crude Mercury, or by violently shaking the patient^
the obstruction has been removed. Therefore there must be very few
cases that can justify an operation.

Question of the Propriety of an Operation, — The following cases
must be excluded from consideration: 1. All intussusceptions, which
constitute nearly half of the fatal cases of obstruction recorded.

About thirty or forty per-cent of all intussusceptions undergo a
process which permits, and often really accomplishes the recovery of
the patient by casting off the intussuscepted part.

2. In the early stages of the lesion and often in the latter, that state
of the obstruction which chiefly indicates the operation is often quite
subordinate to those local lesions which cause the pain, tenesmus
and other signs of irritation present; so that there is a transit, and
not any accumulation of the intestinal contents at the intussusception
itself. The characteristic tumor, too, is a sign which belongs, not so
much to the occurrence of the intussusception as to its progressive
increase of length on the one hand and to the tenesmus, the enormous
infiltration and swelling of its various layers on the other. Hence, if
the operation were deferred until after the access of these signs, (in-
deed if it were not practiced almost instantly) it would generally be
rendered incapable of successful completion by adhesion of the opposed
coats of the middle and outer layers, or in withdrawing the inflamed
and rotton portion of the intussuscepted portion it would, at the same
time literally withdraw the patient's only chance of recovery.

INTESTINAL INTUSSUSCEPTION. 84:1

8. The next group of obstructions to withdraw from consideration
in deciding upon the operation of gastrotomy, include, one already
alluded to — namely, that of the strictures and tumors which experience
shows to be chiefly (though not exclusively), related to the large in-
testine. Occupying this bowel in the great proportion of eight-ninths
of their total number ; coming on gradually; and further, suggesting
an accurate diagnosis by their symptoms, on the one hand, and their
signs accessible to an examination of the abdomen and the rectum
on the other; they are grouped here, however, unscientifically, by the
practical considerations, that 1, their nature may be generally recog-
nized at once ; and 2, the operation indicated is that of opening the
distended colon, and not gastrotomy, and is palliative and not cura-
tive.

In stricture of the large intestine the institution of an artificial anus
has been resorted to above the obstacle.^

In obstruction from bands, diverticula, &c., mostly affecting the small
intestine, gastrotomy and division of the cord-like cause of strangula-
tion has been thought necessary ; a procedure which, if interrupted by
unforeseen impediments, may further require the institution of an artifi-
cial anus in the most distended part.

In obstruction by stricture the relaxing power of a tobacco enema
has been considered to deserve one trial at least (^Brinton),. It has
also been used with success in obstruction, by bands, especially by gall-
stones. We much prefer Lobelia in only drop doses.

In all cases opium and spirits have been used freely from the ear-
liest stage of the disease. The bulkier liquid constituents of the food
may be given as sparingly as possible by the mouth, but introduced
in sufficient quantities in enemata.

Distensive Enemata^ to precede all operations as a means of relief,
and also to assure diagnosis. Where vomiting is excessive, nourish-
ment sufiicient to be given in this way, in sufficient and frequent quan-
tities.

After recovery all food that can cause indigestible accumulations
within the intestines must be avoided; as the bowel may have under-
gone a change of calibre which may not permit subtances to pass which
in health could pass without difficulty.

Belladonna,' — Elanius proposed this remedy; "knowing its action
n diminishing the contractile force of muscular fibre, he thought that
when applied directly to the intestinal surface, it would lessen and
put a stop to the spasmodic constriction which occasioned the charac-
teristic phenomena of this dangerous malady." The theories of dif-
ferent schools have since been invoked to explain its mode of action

* Brinton's Lecture, 1859.

342 DISEASES OF THE DiaESTIYE FUKCTIO]^-.

and its apparently contradictory effects. Though classed as a narcotic
it was found to produce wakefulness, and to dissipate the stupor ex*
cited by Opium. How it acts in dilating the pupil? how in nocturnal
incontinence of urine and involuntary alvine evacuations? these are
questions which can not be answered by enrolling Belladonna in any
of the systematic categories philosophers. have invented. Dr. Debreynej
who took up the question from the homoeopathic stand-point, found it
able to cure the same diseases it was capable of causing. In his
monograph oh this remedy, he says: "We shall observe that Mydriasic
dilatations of the pupil are cured, and speedily too, by the direct appli-
cation of Belladonna." He found the same to be true of simple,
epileptiform and hysteriform convulsions, partial or general tremblings,
unusual motions of the arms, hands and fingers, and says : " These
phenomena are all occasioned by its toxical affects." It was therefore
a "proper agent for the restoration of those laboring under these mala-
dies."

Synvptoms wpplioaMe to PassiO'lliaca^ observed as Pathogenetic
PTienomena produced iy Belladonna, Authors have observed ;
Frequent and abundant vomiting. Epigastrium sensitive to the touch.
Sharp pains in the stomach and lower belly. Extreme distention of
the stomach and intestines, lancinating, cutting pain in the pit of the
stomach, obliging him to hold the breath and bend the trunk. Pressure
in the stomach as from a stone. Inflation of the abdomen, with bor-
borygmus of the intestines of the left side. Tumefaction of the ab-
domen which is very sensitive to the touch. Borborygmus, sensation
of general mixture in the abdomen, with blinding headache. Sensation
of heat mounting upw^ard in the abdomen, with sweating. Painful con-
traction within the abdomen, retraction of the belly, with pain in the
abdomen, lasting a long time. He is awakened by colic and borbo-
rygmus, inflation of the belly ; sits with the body drawn forwards ;
desire to go to stool, without result, but followed by vomiting. Pinching
in the intestines, in the ascending and transverse colon ; pain increased
by retraction of the integuments and throwing the trunk forward to
the left side. Spasmodic tension of the entire abdomen, preventing the
least movement; drawing pain in the abdomen ; pain as if the intestines
had been seized by pincers ; violent colic below the umbilicus ; the pain
constrictive and returning periodically ; painful contraction in the um-
bilical region, commencing in the flank and ascending to the sternum;
sensation under the umbilicus as if the viscera were about to escape.
Alvine evacuations retarded. Constipation and absence of stool and
urine. Constipation and meteorism are common. In a case in which
tV^y ceased there was amelioration; but they returned with delirium.

In a case treated by Wagner, " the abdomen was tense, hard, me-
teorismic; the slightest pressure increased the pain and caused the

INTEcTmAL INTUSSUSCEPTION. o43

patient to cry out." There were also, " twitchings, syncope, convulsions,
with insupportable anxiety. The effect of Belladonna was surprisingly
favorable.

M. Sollier, fils, treated a young girl suffering from spasmodic ileus^
with fever, great thirst, abdomen painful, inflated to an enormous de-
gree, occasional loss of consciousness. Dr. Fiessinger treated a woman
in whom the abdomen was enormously distended, very painful to the
touch and covered with phlyctenae around the umbilicus; features
greatly altered, eyes fixed, body bent, extremities cold. In a patient
mentioned by M. Brunet, pressure gave no pain; but there was great
agitation, and he complained of burning heat, while the body was cold
and pulse feeble. Reaction commenced immediately after the exhibi-
tion of Belladonna ; skin became warm, pulse developed, &c. In other
cases have been observed intense cold, alternating with vomiting, ab-
domen distended, sensitive to pressure, meteorism, face pinched, pulse
accelerated, contracted or strong and febrile, abdomen hard, meteo-
ristic very sensitive ; anxiety, burning thirst, dry, red tongue ; eyes
haggard, features pinched ; agitation alternating with exhaustion. In
the exacerbations, the face becomes suffused, eyes injected and hag-
gard, febrile aggravation; delirium both by night and day; confusion
of ideas ; fainting and unconsciousness. In all of these symptoms we
perceive peritoneal inflammation which plays an important part in
passio-iliaca. These are the same symptoms that M. Fredault gives
as indications for the use of Belladonna in strangulated hernia. Two
characteristic symptoms are : 1. A sort of nervous erethism manifest-
ing itself in extreme sensitiveness of the abdomen ; great agitation ;
features rapidly and profoundly altered ; — 2. Inflammation in the hernial
tumor.

These same symptoms have been regarded by physicians of the Ita-
lian school as indications for the use of Belladonna, which they con-
sidered as one of the most important and certain modifiers of perito-
nitis.

The effects of poisonous doses of Belladonna exhibit also the same
general features, though they have been often misinterpreted. In one
dissection, reported by Faber, the abdomen was distended, and the
stomach filled with gangrenous patches.

Case iy Dr. Dufresne of Geneva,^-— A painter aged thirty-six, had
two attacks of lead colic; and, on a third attack of pain in the ab*
domen and vomiting, he took purgatives and four grains of Opium daily
with warm baths and injections for three days, followed by leeches
without relief. The abdomen was now greatly distended, the convolu
tions of the intestines visible ; a sensitive point to the left of theumbili-

* L'Art Medical, 1860.

844 DISEASES OF THE DiaESTIVE FUNCTION.

cus; urine scanty, features pinclied, pulse feeble, incessant moaning,'
vomiting on swallowing a drop of water. Directed two hundred
grammes of water with five drops of tincture Belladonna — one spoonful
every half a hour. Frictions on the abdomen, with an unguent of ex-
tract Bell, eight grammes and Axungia fifteen ditto. In eight hours the
pain diminished ; he took iced and Seltzer-water and tea; swelling less;
urine increased. Next day he slept; fifth day convalescence establish-
ed. Bell, discontinued as it begins to occasion agitation and wake-
fulness. A second case was cured by simple injections, cataplasms, and
Belladonna 6°* Frictions with ointment of extract Bell, four grains
to fifteen of Axungia.

A third case presenting all the same features was cured by the same
treatment.

Plur}ibu7n, — Lead produces the most obstinate constipation, and
even the iliac passion, as shown by Thunberg, Wilson, Lazuriaga and
others. From the same authors we learn that this metal has likewise
the virtue of curing these two affections. Angelus Sala cured a species
©f ileus, and J. Agricola another kind of constipation which endangered
the life of the patient, by administering Lead internally. Many other
physicians have cured the iliac passion and obstinate constipation j,
with Saturnine or lead pills ; and they acted only homoeopathic ally.

Introd'UGtion of a Flexible Tube through the Sigmoid Flexure, — »
"This can only be done by a skilful hand. It may be arrested by folds
or displacements or curvatures of the rectum, or may turn back upon
itself, or may pass through the stricture without bringing any relief,
or it may aggravate the distress by transmitting fluids to increase the
distention of the dilated and paralyzed canal above the obstruction.
It is said to be of great service in the distention associated with en-
teritis." [Brinton) I have many times resorted to this expedient and
always with success. I never found any of the difliculties mentioned
by this author and others ; and feel satisfied that no case should be
permitted to progress to a dangerous point without having this opera-
tion carefully and skilfully performed.

Inflation of the Lower Intestines, — There are cases on record of
an obstruction having every symptom of an intussusception being re-
moved by the inflation of the rectum by a bellows. ' Relief instantly
followed from that severe pain accompanying the complete distention.
In another case inflation was successfully accomplished by injecting
the solution of a carbonate and an acid so as to cause considerable
effervescence within the intestine, but we have always better resources.

Crude Mercury, — It has often been given in ounce-doses, and in
some cases with success. Its mode of action was supposed not to be
well settled ; it has certainly often done harm by increasing the dis-

DIAEEHCEA. 345

tention and the pressure whicli is already disposing to paralysis, in-
flammation and gangrene.

In intussusception of the large intestine repeated injections may be
employed to distend the bowel to its fullest extent.

Genus VIIL— DIARRHCEA.

1. Fceculent Diarrhcea, — Diagnosis.— Looseness of the bowelsj
with or without griping pains ; frequent discharges of feculent or thin
and watery secreted or undigested matters ; respiration, circulation,
skin and the organs generally in a natural condition.

Acoompanymg Symptoms. — Partial or complete loss of appetite ;
pain in the stomach ; swelling and tension in the lower part of the
abdomen; rumbling in the bowels; cold and dry sldn; thirst; urine
scanty ; dejection ; irregular and intermittent pulse ; cutting or tearing
pains which shift their position ; occasional desire to vomit; in severe
cases there is burning in the rectum; violent straining, extreme weak-
ness, even fainting.

The discharges are painful or painless. The secreted discharges
are mucous^ serous or jpuruleofit. These when feculent are, in re-
gard to GoloT^ designated as hlaok^ Ir own, gray, green, red, white
and yellow ; by difference of odor, as of spoiled eggs, putrid, acid, &c.

Causes. — Dentition, worms, irritating articles of food; raw vegeta-
bles, as cucumbers, melons, salads; various unripe or acid-fruits, as
plums, pine-apples, apples, green corn ; food partially putrid ; some kinds
offish, shellfish; depressing passions, as grief, fear and anxiety; fa-
tigue, sudden changes of temperature, hectic fever, repelled eruptions,
epidemic influences, &c.

Peognosis.-— This is generally free from danger. But when it is ac-
companied with much pain and fever, it may, if not properly treated,
prove fatal, or degenerate into some other disorder. It may progress
into dysentery, or when cholera prevails epidemically, diarrhoea may
terminate in that malady.

General Treatment. — Warmth, a light farinaceous diet, a small
cup of warm coffee and rest may cure moderate cases. In those more
severe, the patient should be confined to bed, should keep the feet warm
and wear flannel.

Medical Treatment. — For the diarrhoeas which supervene during
("^.entition, suitable remedies will be found in: Ohamomilla, Ipecae,
Didoamara^ Merourius, Sulphur, CalGarea-oar'b,, Rheum, Coffeaand
Aconite, Pulsatilla is appropriate when the disease has been caused by
the use of fat and indigestible food, and the discharges are pultaceous,
mucous, liquid or foetid, attended with burning or excoriation of the
anus, nausea, regurgitation, colic, and aggravation of the symptoms ii>

846 DISEASES OF THE DIGESTIVE FUNCTION.

the night. Discharges green or white mucus, very acrid. Pain hefore
the evacuation, is attended with much rumbling of the bowels ; the
disposition of mind peculiar to this drug,

DulGamara is a remedy of the highest value in diarrhoeas, and it
covers a much wider range than has generally been attributed to it.
It has been employed principally in watery diarrhoeas, which have
arisen from cold ; but we have used it with distinguished success in
bowel complaints, which have been caused by teething, worms, repelled
eruptions, errors in diet, &c., and in which there were mucous, slimy,
bilious, greenish and sanguineous evacuations. Dr. Eummel expresses
the opinion, that nine-tenths of all cases of diarrhoea may be cured
with DulGainara. White or yellow mucous, slimy diarrhoea, with pros-
tration of strength. The color frequently alternates between green,
white and yellow ; the desire to evacuate, attended with nausea^ and
the attack is generally the result of a gMU.

1. Painful Diarrhoea. — For severest pain : Arsen., Coloc, Jalap,
Rheum., Rhus-tox., Senna. [Dt, Wells on Diarrhwa^ c&c, 1862.)

Pain less severe : Bryonia, Carb.-veg., Caps., Cham., Merc, Nux-v.,
Petrol., Puis., Sulph., Veratr.

Still less pain : Agar., Aur.-mur., Anac, Asaf., Spigel.

Arsenic, — Pain burning, affecting the whole intestinal tract, dis-
charge brown, green, red, white, or yellow, or black and watery; a
mixture of mucus and faeces. Symptoms violent ; great restlessness,
prostration, cold sweat.

Ccijpsicurri. — Burning confined to the lower part of the rectum, with
throbbing and sense of excoriation and pain in the back, continued after
the evacuation.

2. Bilious Diarrhoea. — If the discharges are mucous, slimy, or
sanguineous, and are preceded and accompanied by griping and tenes-
mus, our best remedies are Acid-nitr,, and Jfercurius-soL, in alterna-
tion. We may use the third attenuations, — a dose after each evacua-
tion. Other remedies are : Arsenicum, Ipecac, Sulphur, Acid-jphos.,
Acid'Suljph., Petroleum, Colocynth, Verai/rum, Phosphorus, and
Dulcamara,

Merciiry. — This article is familiar to all, as the agent commonly em-
ployed to cause Diarrhoea, for the purpose of drawing off the increased
vital action from some distant organ. Thus it has been used as a pur-
gative. In moderate doses mercurials act without great irritation,
merely increasing the natural secretions of the liver, pancreas, and
mucous follicles of the bowels. In large doses, or when by the repeti-
tion of smaller ones, the mineral has accumulated in the system, violent
purging is often the consequence. It is attended with griping, and
sometimes with sanguineous evacuations. The evacuations are frothy
whitish, tough, and often greenish." [Pereira vol. 1. p. 817.)

DIAERHCEA. 347

Dr. Wood says, "I have seen the operation of Calomel in some in-
stances so exactly like cholera morbus, that the most experienced eye
could scarcely have detected the difference." [Pract. Medicine,
vol. 1. p. 674.)

Mercury has long been a chief allopathic reliance in the treatment
of diarrhoea, and it has succeeded best when given in minute doses,
triturated with chalk or white sugar. Those who prescribe it in this
form do not know that they are marching under the banner of Hahne-
mann. The symptoms of diarrhoea most characteristic of Mercury are :
Pain in the large intestines ; discharges of green or red mucus, with
tenesmus.

Symptoms, Chills between, and flashing heat during the stools ; tenes-
mus ; great uneasiness before the stool ; cold perspirations on the face ;
anxiety and trembling before the stool ; heartburn and bitter eructa-
tions after it ; pain in the back and tenesmus continuing after it. Cin-
nabar is one of the best forms of Mercury.

Ghamomilla, — White mucous discharges, painful, more common in
children than in adults. Diarrhoea caused by taking cold, anger or
chagrin ; diarrhoeic stools of odor of spoiled eggs. Fever and sweat
during sleep; excessivesensitiveness of feeling, with intolerance of noise.

Oolooynth, — The pain very sharp, doubles the patient up ; he cries
out, has slight nausea ; pain relieved by the evacuations ; returns in
paroxysms, rather neuralgic than inflammatory, affecting the whole in-
testinal tract.

Pluonhnm. — Constricting pains. See p. 318.

PodojphylhbWj, — Sense of constriction, but the parieties of the abdo-
men are retracted. Discharges foeculent, yellow or dark green, of the
odor of carrion, often accompanied with prolapsus ani, especially in
children ; diarrhoea occurs most commonly in the morning ; pains in
abdomen and back worse dwring the evacuation and continue after.
Discharges excited by eating and drinking, (fir, TF^Zfo.)

Nux-vomica. — Pressing or squeezing pains ; pressure more in the
upper part of the abdomen and sides, in the colon : discharges brown,
offensive and slimy, green, small in quantity, more frequent after eat-
ing ; tenesmus, drawing pain in the back ; prolapsus ani.

Thuja. — Discharges frequent and with a gurgling noise ; great pros-
tration ; short and difficult breathing ; intermittent pulse ; pressing
pain in the back, rapid emaciation.

Sidphur, — Pain with excoriation; red inucous discharges, with
fener^ loss of appetite and cutting pain in the bowels.

When diarrhoea occurs during dentition, and is connected with some
chronic cutaneous eruption, it will be necessa,ry to exhibit Suljphur^
either alone, or in alternation with Pulcamara^ GhamoTnilla^ or Mer^
curiiis. It has often occurred to us, that after Mercurius, Chamomilla,

848 DISEASES OF THE DIGESTIVE FUNCTIOK.

and other apparently appropriate remedies have failed to arrest the dis-
charge, a few doses of Sulphur have effected it.

If the complaint appears to be characterized by prominent biliary
derangement specific medicines will be found in Merourius^ Cliamo-
milla^ Pulsatilla^ Nux-vomioa^ ArseniGum^ and Bryonia,

Sul^hv/ric-acid. — This is one of the best remedies in almost every
form of diarrhoea. In children who are teething, and suffering from
nausea and vomiting, fever, thirst, bleeding spongy gums, frequent dis-
charges mixed with bloody mucus. A single drop or two in a glass
half full of water gives it a pleasant acid taste, and may be given by
spoonful doses.

For the diarrhoeas which supervene during dentition, a suitable re-
medy will be found in Arsenicum when there are : watery, slimy, green-
ish evacuations, with burning pain, great thirst, debility and emaciation.

When diarrhoea arises in consequence of violent mental emotions, we
employ Chamor}%illa, Ignatia^ Colocynth, Yeratrum, Antimonium-
GTud,^ Ooffea^ Nux-vomica^ Phos^horus^ ArseniGum, Pulsatilla, and
PerruTTh.

If the discharges can be attributed to the presence of worms, we
give Sulphur^ Oinay S^pigelia^ Aloes ^ MexGurius, JSux-vomiGa,
Carlo. -veg,^ Ferrum,

For the diarrhoeas which occur during hectic fevers, especially if
connected with a scrofulous dyscrasia, the appropiate medicines are
SuljphuT, CalGarea-Garb.^ AGid-nitr., AGid-jphos., Iodine, Ferrunn^
Merourius, Sej}ia, Kahnia.

For painless chronic diarrhoea, we suggest, Phosj>horus, Phos,-
aGid, Ferrum, Arsen,, ITyos,, LyGOjpodium, Cham., 8ulph,, Caloar.,
Seoale-Gornut., Yeratrum, China, Natrum-rrhuriatiGum, AGid-nitr,,
Suljph., Laohesis, Ly go f odium, Graphites, ArseniGum,

Tris-nitrate of Bismuth, — Dr. Theophilus Thompson says, its effi-
cacy is not surpassed by any other remedy in the wasting diarrhoea
Accompanying phthisis.

Nux-mosGhata. — Case by Dr. Leon.— A lady, aged forty-five,
lymphatic temperament, diarrhoea, evacuations every two hours, small
in quantity, and not watery, but a peculiar feature of the case w^as
that after each evacuation the ^^\A^Vii fainted entirely away. Nux-
moschata, first dilution, two drops to a half tumblerful of water ; a
dessert spoonful every two hours. After the first dose the patient
said, she felt the remedy pervade her whole system, and that its in-
fluence was especially perceptible at the seat of the disease. There
was no more of the diarrhoea or the faintness after taking the remedy,
and she was quite well next day.'*' Hahnemann also mentions the

* U. S. Jom*. Homoeop. vol, 1. p. 44

DIARRHOEA. 849

homoeopathicity of Nxitmeg to diseases aGGomjpanied ly fainting

3. DiaTfTima Adiposa.— After the exhibition of Castor-oil there is
frequently recognized some peculiarity in the appearance of the eva-
cuation : " sometimes it resembles caseous flakes or a soap-like scum,
floating on the more fluid part of the dejection ; occasionally it is ar-
ranged in a form not unlike bunches of grapes, or more nearly of hyda-
tids of a white color; more generally, however, it is found mixed up
with the faeces as a kind of emulsion, and in some few instances it has
been discharged under the form of solid tallow-like masses " [London
Med. Gaz. Dr. G. Bird. vol. XV. p. 225.)

Dr. Watson, after describing the nature and symptoms of that very
rare disease, which is named Diarrhma Adiposa^ from the circum-
stance of fatty matter passing from the intestinal canal, in connection
with the ordinary stools, says : '^ With respect to the treatment in such
cases, all the hints I can give -you, are such as are furnished by the
tw^o following facts: Mr. Howship, in his book on morbid anatomy, men-
tions the instance of a lady who was aff'ected with this diarrhoea adi-
posa, and parted with vast qua,ntities of fat, and who was cured upon
the principle of " Similia similihus GuranturP for she recovered after
swallowing a pint of sweet oil. And Dr. Elliotson, acting on this hint,
gave his patient, who was laboring at the same time under diabetes, a
quarter of a pint of Olive-oil; and the voiding of fat greatly diminished
from that time and soon ceased entirely." (PraGtioe of Physio., vol.
11. p. 505.)

It is known that the phenomena of the excretion of fat is not peculiar
to the action of Castor-oil, but also follows the use of Olive-oil.

Gtiprum.—CoTTBu. — 1. "Two women, who had taken a confection
prepared in a copper utensil, suffered from severe headache, constric-
tion of the throat, nausea, colic, and extreme weaJmess. Two young
men, having eaten of the confection more freely, had for some hours
excruciating colic, severe pain in the mouth and throat, impeded breath-
ing, and hurried, irregular pulse ; for twenty-four hours they suffered
from headache and prostration of si/rengtTiP (Gliristison, Treatise
on Poisons, p. 466.)

In each of these cases debility \% mentioned as a symptom. Now
the sulphate of copper is classed by medical authors as a mineral tonio.
As such it is frequently prescribed in those states of the system in
which debility is the most prominent symptom.

2. "A confectioner's daughter took two ounces of verdigris, and died
on the third day, under incessant vomiting a,nd diarrhoea, attended
towards the close with convulsions, and then with palsy of the limbs*
A lady and her daughter partook of " Sauerhraut^^ which had been

* Organon. p. 49.

350 DISEASES OF THE DIGESTIVE FUNCTION.

k^pt in a copper-pan. Soon after dinner they were attacked first with
pain in the stomach, then with nausea and anxiety, and next with eruc-
tation and vomiting of a green, bitter, sour, astringent matter. The
pain afterwards shot downwards throughout the abdomen, and was
followed by diarrhoea, afterwards by convulsions, at first transient, then
continued, and finally by insensibility. The daughter died in twelve
hours, the mother an hour later.

In these cases a conspicuous symptom is diarrhma. For this spe-
cial symptom Cuprum has long been used as a remedy.^ The sulphate
of Copper has been used with great benefit in chronic diarrhoea and
dysentery. It often succeeds when the ordinary vegetable astringents
fail." (Pereira^ Mat Med, vol. I. p. 803.) " In extreme cases," says
Watson, "the sulphate of Copper has been found to have a powerful
effect in restraining the flux. It is apt to gripe." Then let him di-
minish the dose, and he may still say with truth that " given three or
four times a day, it is frequently found successful, when previous
attempts to remove the diarrhoea have failed." {Princij>. and Pract.j
vol. II. p. 483.)

4. Serous DiarvKma, — -Fkom Debility or Relaxation. — In the
early stages, the cases connected with relaxation and debility may
generally be arrested by Mercurius-sol. I have frequently arrested it
by a single dose of the third or fourth attenuation. In persons of ad-
vanced age whose constitutions have been broken down by other dis-
eases, who are pale, sallow, feeble and subject to exhausting diarrhoea
from slight exposure, or irregularity of food, I give a dose of Mercur-
sol. in a very small pow^der on the tongue. In ten or fifteen minutes
the patient will frequently express relief These cases were all in scro-
fulous constitutions and did not appear to have been previously injured
by Mercury. T\iq Dewherry^ Bubus-cmskis^ is regarded in the southr
ern States as a specific. Prof Mettaeur, of Virginia, says, the tincture
of Diospyoros-virg. or an infusion of the unripe fruit, " meets the indi-
cations most perfectly." This remedy is peculiarly efficacious in ar-
resting diarrhoea, especially those distinguished by sero-mucous dis-
charges without pain and the protracted cases of diarrhoea following
the bilious fevers of the Mississippi. Rheum, Cinnabar, Arson., Aloes
are good remedies. {Amer. Jout,^ 1850. p. 390.)

Cojfee\^'^ often been employed with success in chronic diarrhoea of
different forms. Indeed, coffee causes' constipation in large doses, act-
ing as a cathartic, by the same process that it cures it in small ones
when it restrains diarrhoea. When the motor nerves possess their nor
mal power, large doses, by over-exciting them, exhaust that power, and
constipation results ; when they are weakened by other causes, the mo-
derate stimulus of small doses of coffee removes the paralyzed state of

* Dr. DruQimoncl, Homoeop. among the Allopaths, p. 42.

DIARRIICEA. 851

the nerves and cures the diarrhoea, as well as constipation attendant
on it.

5. Chronic Diarrhoea. — Calgaeea CAEBONioA.-r-Case by Dr. Dun-
ham. A boy, aged ten years, has had diarrhoea from the age of four.
Of good height, but emaciated till his tissues are utterly devoid of fat,
and muscles wonderfully attenuated. " My thumb and finger meet with
ease around the middle of his arm. Is active and full of fun ; appetite
prodigious — thirst very great ; distress or " grumbling pain" in epi-
gastric region before stool, partially relieved by pressing his hand upon
it. Epigastrium sensitive when touched. Abdomen greatly distended,
hard, tympanitic ; hard ovoid bodies, tangible by deep pressure on the
abdomen. Stools five to twenty in twenty-four hours, — copious, pappy,
dark greenish-brown, quite offensive, occurring chiefly between four
A. M. and noon. Though copious they do not produce faintness or
sense of weakness ; he is lively, full of mischief. Arsenicumhad failed
though fully tried. He now has. twenty stools daily.

The general dyscrasia and diathesis directed to Oaloarea-Garl).
There are diseased states of the alimentary canal and of the mesenteric
glands, depending unquestionably upon a general depressed state of
the vascular and nervous systems. The case was not merely a diar-
rhoea^ which was only a secondary symptom. The distended, pro-
minent abdomen, the indurated and enlarged glands, the excessive ap-
petite, the great thirst demanding large draughts of water, the pain in
the upper part of the abdomen just before the stool, the tender epigas-
trium, the copious long-continued diarrhoea, without corresponding ex-
haustion, correspond better with Calcarea-carb. Its aggravations are
frequently in the morning, and the pain in the abdomen relieved by
warmth. Calcarea-carb. two-hundredth dilution ; two globules were
dissolved in four ounces of water ; a teaspoonful of the solution to be
given every four hours. {Amer. Horn. Hev, 1860. p. 471.)

From the day after this visit the lad had but one stool daily ; and now
after ten months the bowels continue to act normally, and only once every
day. In one month the boy became ruddy and plump, having gained
strength and twenty-two pounds of flesh ; the rotundity of the abdomen
disappeared, and the indurated abdominal glands were no longer felt.
The two globules of the remedy were all that he received.

6. Chronic Diarrhoea of Camps and Hospitals. — See Colitis. —
Index,

Genus IX.~CH0LERA.
1. CHOLERA MORBUS.-SPORADIG CHOLERA,

Name derived from xoT^l, 'bile, pew.fiow.^ literally a flow of bile. In
general, however, there is an utter suspension of the biliary secretion

852 DISEASES OF THE DIGESTIVE FUISTCTION.

DiAGisTOSis. — -Distressing nausea and vomiting, with great fulness
and oppression at the stomach ; severe griping or colic pains in the um-
bilical region ; frequent watery stools ; twisting cramps in the abdominal
muscles and calves of the legs ; tongue slightly furred ; pulse quick
and weak ; countenance expressive of suffering and anxiety.

Causes. — Torpor of the liver ; obstruction of the biliary ducts ; eat-
ing unripe or decayed fruits, or crude esculent vegetables ; constant ex-
posure to a cold and damp atmosphere.

Causes and Pathologt. — The lungs and liver are the great decar-
bonizing organs of the body. The lungs are most active in cold
weather from the part they perform in generating animal heat; in sum-
mer the liver is stimulated by the heat to increased action, and forms
a larger quantity of bile, which is required to perform important uses in
the function of digestion. The peculiarity of the function of the liver con-
sists in its reception of the blood from the stomach and intestines, and
from this venous blood, secreting the bile. If, therefore, the liver is in
full healthy action, the blood transmitted to it through the portal veins
passes freely through all the minute vessels of the liver, the excess of
carbon with which it is laden is eliminated by the secretory apparatus,
the purified stream flows onward to the heart, while the newly-secreted
fluid, the bile, is poured through the biliary ducts to exert its power-
ful chemical influences on the contents of the alimentary canal, and
stimulate its muscular fibres to propel these contents forward to their
destination. — But, when the secretory cells of the liver are deranged
in their action, the blood furnished by the portal system of vessels ac-
cumulates in the liver, there being no other route by which it can pro-
ceed to the heart. The liver becomes congested^ engorged ; and the
spleen participates in its condition. When the spleen is full, the con-
gestion extends to the splenic vein, thence to its tributary, the inferior
mesenteric, and, still farther, to the vascular Tde that lines the colon.
" Now, we know," says a late writer, " that, whenever an obstruction to
the venous circulation exists afronte, an exudation of the serum takes
place through the walls of the distended vessels. If we apply a ligature
around the arm, so as to impede the circulation towards the heart, all
the parts beyond the ligature become oedematous from the exudation
of the serum of the blood in the distended vessels into the cellular
tissue. In the congested state of the vascular rete of the colon, this
exudation takes place into the colon and gives us diarrhoea."

When from any cause there is entire suppression of the function of
the liver, we immediately have extreme congestion of the liver, stomach,
large and small intestines. This condition directly leads to increased
sensibility, (irritability,) and an exosmose of the watery portion of the
blood of the congested part into the stomach and bowels. As it passes,
it will wash away the epithelial scales of the mucous membrane. The

CHOLEEA-MOEBUS. 353

increased sensibility in tlie stomach produces vomiting; in the bowels,
frequent stools which consist of washed off epithelial scales presenting
the appearance of rice-water. [Gayley^ A7)ier, Jour. Med. Soi, July,
1850. p. 85.)

These are the usual phenomena presented in Gholera Asiatica^ bu
they are also seen in severe sporadic cases of cholera morbus. The
hot season of almost every year furnishes occasional cases of this
kind when there is no epidemic cholera in the country. (See Conges-
tive Fever ^ Cholera form,)

Therwpeutios. — The most efficacious medicines in the treatment of
this complaint, are, Yeratrum^ Arsenicum^ Colocynthy Chamomilla^
Pulsatilla.^ IjpeGacuanha^ Mercurius.

Veratrum-aTbum, — -Countenance pale or bluish, cold and disfigured ;
eyes sunken; nose pointed; mouth parched, lips dry or cracked and
of a dark color; surface cold or hot and dry; contraction of the mus-
cles of the abdomen and extremities; pulse frequent and very weak;
cold sweats; evacuations watery, light, greenish or brownish. Severe
cutting pain in the umbilical region; violent nausea and vomiting, with
diarrhoea ; burning sensation in the stomach ; speedy rejection of food
or drinks ; stomach and abdomen tender on pressure ; cramps in the
abdomen and in the extremities; extreme prostration; great oppression
and distress at the stomach; inten3.e thirst; general uneasiness. Ex
cessive anguish; fear of death; despair of recovery; delirium.

Administration. — This medicine may be used at from the first t^*
the third dilution, a dose every half hour, in urgent cases, until the
requisite impression is produced. In slight cases, two or three doses
of the third dilution, at intervals of two to four hours, will suffice for
the cure.

The author of the treatise on epidemic diseases (smSrjiiiojv) (attri-
buted to Hippocrates — at the commencement of lib. 5.) mentions a case
of cholera morius that resisted every remedy, and which he cured by
means oi white Hellehore alone, which, however, excites cholera itself,
as witnessed by Forest, Sedelius, Reimann and many others.

Arsenicum-album. The indications for this remedy are somewhat
similar to those of Veratrum^ but it is especially useful when the dis-
ease is violent from the commencement, attended with an almost im-
mediate prostration of strength ; trembling of the limbs ; severe burn-
ing pain in the stomach ; constant nausea and vomiting ; diarrhoea ;
ringing in the ears ; vertigo ; giddiness ; great anguish and restless-
ness; skin dry or cold, and bluish; hippocratic countenance; eyes
sunken, dim and suffused ; thirst ; distress from swallowing the blandest
liquids ; tongue and lips dry, dark and cracked ; breath cold; excessive
anguish, anxiety and despair.

Vol. I.-23.

Soi DISEASES OF THE DIGESTIVE FUKCTION.

Administration. — Same as Veratrum,

ColoGyntfi will occasionally serve us in cases attended with mode-
rate nausea, vomiting and purging; violent cramp-like pains in the
region of the navel ; cramps in the extremities ; tongue loaded with a
yellow fur; bitter taste in the mouth ; great dejection and anxiety, and
general restlessness. It may be given at the third potency, every two
hours, gradually lengthening the intervals as the pains subside.

Chamomilla \i^% been highly recommended when the disease has
been "excited by a fit of passion." The symptoms which point to this
remedy are : frequent vomiting of food or of mucous, sour or bitter
substances ; great anguish and pressure at the pit of the stomach;
cramps in the calves of the legs when lying down ; tearing and cutting
pains in the abdomen.

Administration.— ■^d.mo^ as Oolocynth.

Pulsatilla is chiefly useful in cholera which has been induced by
the abuse of fat, crude and indigestible food. In cases of this descrip-
tion, it is often promptly serviceable, administered at the first or second
dilution, as circumstances require.

IpecaGuanJia is the remedy when vomiting is the most prominent
and troublesome symptom. It may be given at the third potency, every
half hour, until the symptoms abate, afterwards as the exigencies of
the case demand. {JFor Merourius^ see p. 846.)

2. CHOLERA ASIATICA.

General Remarks.— This disease, which is said to have destroyed
more than fifty millions of human beings, and has now raged in all
the four quarters of the globe, originated in India. A similar
disease is endemic in that country, and has been described in a Hindoo
work of great antiquity; it was very fatal in the time of Bontius, 16293
and has prevailed to some extent almost every year for at least one-
hundred years ; but the great epidemic now so much an object of terror^
first began in the beginning of June, 1817, in its epidemic form in Jessore,
Nuddea and other parts of the marshy districts of the Delta of the
Ganges. At that time the artificial canals employed in irrigating the
ground, being out of repair were overflowed and filled with stagnant
water. The excessive rains had destroyed much of the grain raised,
and damaged that which was saved. It was while the people in im-
mense numbers were crowded together on the banks of the Ganges,
living on limited supplies of spoiled or mildewed rice, that epidemic
cholera commenced among them in a more malignant form than in any
former year. {Dr, Fytler^ Sir Gilbert Blane^ Murray'' s British
India, VoL 2, p. 192.) The first year it extended no further than the
boundary of Bengal, but during 1818 and 1819, it difiused itself

CHOLERA- ASIATIGA. OOD

fcliroughout the whole length and breadth of India, the Burmese Empire
and other territories of Eastern Asia and entered China in 1820. In
1821 it traversed the shores of the Persian Gulf. In 1822 it spread
through parts of Arabia, Persia, Mesopotamia and Palestine ; in 1823
it invaded the Russian Territories at points to which it has several
times since returned. In 1830 cholera advanced through the southern
provinces of Russia and reached Moscow September, 28.^ It thence
proceeded through Poland, the Austrian and German dominions and
crossed the British Channel to England, to Scotland and Ireland 1831.
In 1832 the pestilence crossed the Atlantic Ocean. The first case offi-
cially recognized, occurred June 8, 1832, at Quebec. The first subjects
were emigrants, who were said to have come over in healthy vessels,
having no where been exposed to infection. The board of health reported
that they were found "in a low, unhealthy and ill-ventilated part of the
city, crowded, &c." {EnGyo. Amer. Vol. 13, 430.) It then came direct
to JSTew-York, June 27, the same year, and 2621 died.

In 1845 (September), cholera appeared at Bokhara and Samarcand.
And, soon after, at Bagdad, where 450 died daily, of a population of
80,000. It then followed the pilgrims to Mecca, advanced toward
Teheran (in Nov.), but did not reach it till June, 1846. In that city,
of a population of 130,000, nine thousand died. After an irregular
desultory march through Persia, sometimes in opposition to the pre-
vailing winds, at others passing large tracts untouched, it approached
Tauris in August, then Astrabad, and proceeded westward. In October,
1846, it appeared in the region of the Caucasus. In May, 1847, it com-
menced at Tiflis; and thence advanced to the mouths of the Don, and
to some parts of the coast of the Black Sea. In September it reached
Trebizond and Ezeroum, returning at the same time to Bagdad. In October
the official reports of the Russian officers announced the progress of
the pestilence to the northward and westward. Erom the close of
August to the middle of September, in its march through Astrakan to
Moldavia and Wallachia, of 7248 attacked, 3342 died. {Lond. Lancet^
Nov. 1847.)

The northern limit of the cholera, says Boudin, "is found in Europe
at Archangel (May, 1831, and July, 1848.). In America, it has pene-
trated as high as Canada. It has hitherto spared Iceland, Greenland
and Siberia. In the southern hemisphere it has shown itself but very
exceptionally, and has there attained its southern limit at Bourbon,
Latitude 21° south. Java was invaded by it in 1819 and 1826. Su-

* In November, 1830, the Medico- GMrurgical Review announced that the '* terrific
epidemic had reached Astrachan and even Moscow. The Emperor Nicholas, who
bad seen how powerless medical science was to combat it, had already offered a
reward of £1.100 for the best treatise on its cause, nature and cure.

856 DISEASES OF THE DIGESTIVE FUNCTION.

matra in 1853. The Cape of Good Hope and Australia have hitherto
been, spared, and Americaj south of the line, did not suffer until 1855."

Diagnosis. — Copious secretion into the stomach and bowels of a
serous fluid, albuminous in character, free from acids or alkalies ; its
color is slightly yellowish ; ^though often perfectly transparent ; it
generally resembles rice water^ containing white flakes of the size of
lentiles, is seldom bloody, and is discharged from the bowels or from
the mouth without effort. The smell is slightly albuminous, mouldy,
sperm-like; taste insipid.

Decrease or entire cessation of all the secretions, and excretions,
the tears, saliva, bile, faeces, urine, perspiration, the milk and menses
partially excepted.

The skin is cold and void of elasticity, presenting wrinkles {facies
cholerica), lead color. The mucous membranes are in a similar state,
hence the tongue and breath are cold (about 70^ or 72^ of Fahrenheit.)

The pulse is soft, the veins congested.

In the muscles, tonic, sometimes clonic spasms, particularly in the
lower extremities and abdominal muscles.

The only characteristic feature of Asiatic cholera, by which it is
distinguished from severe forms of sporadic cholera, consists in th^ fact
of ,its specific origin,

Asiatic cholera varies much in its mode of attack, violence aud du-
ration. It may seize its victim in such a manner as to produce an im-
mediate prostration of strength, together with most of those symptoms
which indicate an almost total loss of vitality, as a sunken and cada-
verous expression of countenance, small and almost imperceptible pulse,
surface of a bluish tinge and cold, cramps in the calves of the legs
and fingers, burning in the stomach and throat, extreme anguish or
stupidity, vomiting, diarrhoea, and an almost entire loss of power over
the voluntary muscles. Other cases set iri with vertigo, humming in
the ears, oppression and burning pain at the pit of the stomach, nausea,
vomiting, griping, purging of a liquid resembling "rice water," which
are soon succeeded by oppression of the chest, difiiculty of breathing,
cramp-like pains in the extremities and abdominal muscles, intense
thirst, great loss of strength, bluish color of the lips, nails and skin ;
pulse almost imperceptible, hippocratic countenance; delirium, cold,
icy skin; profuse sweats ; weak, hoarse voice, and sometimes sopor;
with eyes half open and fixed, with partial or total loss of conscious-
ness. A few or the whole of these symptoms may be present in any
given case, according to the constitutional, predisposing and exciting
cause which may exist.

In cholera as it appeared in the United States, there was such a thing
as 2. premonitory stage ; but in tropical climates its course is described
as 'one exhausting marcli from the beginning to the termination in

CHOLEKA-ASIATICA.

357

death. The flow of serum into the internal cavities, whether carried
out by vomiting or purging, or remaining in them would continue till it
drained away the powers of life, sinking the pulse and the- animal heat
as fast as a flow of blood.

In July, 1833, when cholera was sweeping the borders of the Gulf
of Mexico, the city of Oampeachy, in Yucatan, was considered safe
from infection, as it was fortified with high walls and garrisoned with
soldiers. But the cholera came; the sentinels dropped dead at their
posts and the guards at the gates ; priests fell dead in procession, while
carrying the saints whose intercession they invoked. The houses were
soon closed and the streets deserted; graves ceased to be dug; and
burials were only made by armed soldiers compelling the assistance of
the friends.

Causes. — Remote Cause.— MidXio. cholera originates in a peculiar
speeifie poison. Originally developed by a peculiar train of circum-
stances in the centre of a region which contained all the materials for
the generation and propagation of organic poisons; it has been con-
veyed by visible and invisible channels over distant continents ; in some
of the regions it has visited it has remained but for a short time ; in
others it has found "more suitable climate and other influences, which
have led to its aeGlimation and adoption, as one of the endemics of
the country. In those countries, as in the tropical regions of both
hemispheres, cholera may be aroused by a series of favoring influences.
The poison can he conveyed and planted wherever the thoroughfares
of travel may conduct it; but the disease makes only a transient stay
in places which furnish but little material for the growth and propaga-
tion of the infinitesimal fungi, which may be supposed to constitute
the agent on which the disease depends. It manifest itself as
a peculiar subtle poison, capable of being conveyed by currents of
wind from place to place, either dissolved in aqueous vapor, or in some
other unknown manner. Whether this infinitesimal, imponderable
morbific agent is generated during the prevalence of some peculiar
conditions of the atmosphere, from vegetable or animal matters , in a
state of partial or total decomposition, or from some other source, is
as yet a matter of speculation. Like most of the other more potent
agents in nature, the particles of the poison are in so minute a state
of subdivision, and so subtilel}^ diffused in the air, that in the present
imperfect condition of the sciences, we are entirely unable to investigate
or appreciate their nature. That the cause or agent is materi^alj no
one can for a moment doubt ; for it must be something or nothing ;
if it is the former, it must be composed of minute particles or atoms
of matter, which, by being absorbed, produce those specific efiects
which constitute cholera,

PROXIMATE Causes.— -Fear, sudden fright, nausea, grief, error of diet,

S58 DISEASES OF THE DIGESTIYE FUJSTCTIOK.

purgatives, taking cold, dampness, heat, low grounds, lower floors in a
dwelling, crowded dwellings, as prisons, narrow streets, negative elec-
tricity of the air. The favorable circumstances are : cold climates;
high elevation above the sea; free circulation of air. No disinfectants
have any power to arrest the spread of the disease. The manner in
which cold damp air excites cliolera morl)us may be seen under tha
head ; and all that is there said on the subject applies with equal force
to cholera Asiatica. Eut the deleterious effect of moisture is denied
by many. The Board of Health of Neio-Orleans for 1849, say: a
dry fog prevailed during its visitation, such as Humboldt noticed, on
the Andes as accompanying influenza. (Amer. Jour, Med.^ Jul. 1850.

EEEDisposiNa Causes. — Middle age, female sex, idiocy, chronic
diarrhoea, venous plethora, scrofula, intermittent fever, plica polonica.

Amongst oMldren. — Male sex, aphthae, jaundice, worms, difiicult
dentition. Persons who have once had the disease are not exempt
from future attacks. Its course may be modified by : infancy, old age,
ulcers on the feet, phthisis, influenza. The disease is generally excited
by great errors of diet ; intemperance, neglected diarrhoea, taking cold,
fear, sorrow, fright, and, above all, anger. Among the worst articles
of diet are cucumbers, melons, green corn, unripe vegetables and fruits
of all kinds. Champagne, beer, cider, &c. in process of fermentation.
(I)r, Hencke of Eiga)

Course and Progress of the Disease.-— Fir^t Stage. — After slight
premonitory symptoms, such as irritability, languor, sleepiness, imper-
fect sleep, soft slow pulse, confusion of head, pale countenance, de-
rangement of stomach, tendency to diarrhoea. In the first stage Cholera
resembles Gholerine.

This is not a premonitory stage, but the first stage of the pestilence
itself. It often begins without any pain ; and the first suspicious cir-
cumstance observed is the absence of pai7i when diarrhoea begins. In
other cases there is "pain in the epigastrium, aggravated by the touch,'-
extending to the throat and abdomen; diarrhoea, by which the contents
of the bowels are rapidly carried off*; the discharges become more light
colored as the disease progresses; as the second stage begins they
become more serous, the white flakes and the rice-water discharges
appear.

Auscultation reveals the bellows sound, first in the aorta and next
in the heart itself; pulse softer; thirst increasing in proportion to the
loss of fluids by diarrhoea.

After continuing from a few hours to a week or more, this stage
terminates in

1. In recovery, indicated by abatement of the symptoms, gentle
perspiration, sleep, increased urine, restored action of the liver, con-
sistent aivile evacuations, or

CHOLERA-ASIATIOA. 359

2. In the Second Stage, with increased violence of the symptoms,
with the true painless rice-water discharges and vomiting, and lasting
from two to forty-eight hours.

Symptoms. — Anguish in the chest ; pressure or cramp in the stomach
fear of death ; quiet position on the back or great restlessness anxiou
expression of countenances and lamentations ; indifference to the outei
world, to wounds, to relatives ; tonic spasms which contract the muscles
making them hard, round, rigid and frequently remaining after death
They commence in the lower extremities, pass to the upper, and then
to the muscles of the abdomen or thorax ; and are severe in proportion
to the venous obstruction and lividity, often causing the patient to cry
out. The cramped muscles contracted into knobs and painful ; feet
distorted by continuing contractions ; drowsiness and numbness in-
crease, though the voluntary muscles retain their power, often lax, soft,
doughy, never becoming paralyzed, but remaining rigid after death.
Pains in the sacrum.

JPtdse,-—YeYj soft, easily compressed, and disappearing during the
spasm ; in frequency varying from 110 to 120 per minute, thready,
sometimes imperceptible, equally soft at the wrist, carotids and heart
The sounds of the auricles indistinct, that of the ventricles distinctly
revealed by auscultation near the pit of the stomach.

Skin, — -Inelastic, cold, dry, smooth, pale, becoming soon of a leaden
color; and bluish gray, very thin; it forms wrinkles oh the back of the
hands, fingers, &c. ; pinched up it remains long as left. Wounds do
not gape, and no cutis anserina is formed by dashing cold water on
the'^skin, which feels like leather. General temperature 65^ to 77"^
Fahrenheit. Coldness greatest in lower extremities; skin on fingers,
hands and toes wrinkled. The patient still complains of heat on the
surface, but says he is burning up within ; mustard plasters redden the'
skin ; itch dries up, syphilis remains, hydrops disappears ; all diseases,
of the skin return with increased violence after recovery from cholera.

General Expression of Features. — Eyeballs deeply sunken, turned
upwards, indolent, glassy, pupil dilated ; sclerotica with a bluish semi-
circle ; look fixed ; upper eyelid half closed, dark blue circles round
the eyes, or lower eyelid with a blue semicircle; countenance pale,
color changing from lead to violet; skin very smooth on the lips, cheeks,
tip of the nose ; nose pointed ; cheeks sunken ; upper eyelid drawn
upward ; cartilages of the nose and ears very flexible ; coldness ex-
tending from the aim nasi to the corners of the mouth. In a later stage
cold clammy sweats.

Tongue cold^flat^ hea/vy or Hue ; mucous merribrane of the mouth
cold, feels as if tanned, uneasy, at first clean, at the transition into the
next stage, bloated, and if the danger be great, bluish; deafness.

Fit of the Stomach, — Oppressed, painful to the slightest touch, dis-

360 DISEASES OF THE DIGESTIVE FUITCTIOJSr.

tressed ; burning in the epigastrium, extending to the abdomen and
pharynx.

Thirst — At first moderate, afterwards unquenchable ; sometimes great
aversion to drinks, at others violent desire Kr water, fruits, acids,
fresh air.

The Effusion of Serum begins first into the lower portion of the
bowels, alternating with the diarrhoea, watery, having fewer white flakes,
sometimes transparent ; is discharged without effort, in gushes, or passes
involuntarily; sometimes in less violent cases, it has the consistency of
rice-water or pea-soup, or often more like brine ; m a worse form the
discharge is mixed with blood ; in full habits, and in persons of middle
age (twenty-four to forty) it is light red, dissolved in the effusion, with-
out smell ; in old people, dark, unmixed, and having a putrid smell ; ab-
domen sunken, and ribs protruding.

Seoretion-s, — These are all suppressed. (See Diagnosis) The
suspension of the action of the liver exerts the most important con-
sequences. (See Cholera Morbus.)

Breath, — Cold, inspiration deep, rather slow ; expiration short, moan-
ing; respiratory murmur distinct, somewhat ^i^^r^Z^; percussion on the
thorax before and behind, sowing emphysema.

The Blood — -is unnaturally dark and thick. In the later stages it
is black, tarry, ropy, semi-coagulated ; in the ratio of the degree of pro-
gress of the case." (Brit Army Med, Bejports, 1819 to 1822. — John-
son on Hot Climates, p. 855.

The characteristic cholera "voice is rough and hoarse ; enunciation
imperfect, owing to the want of elasticity of the mucous membrane,4^;nd
the spasmodic constriction of the larynx ; perceptible after the third or
fourth vomiting. Frequent and annoying hiccough.

Aggravation after midnight and towards morning ; patient easier
in the afternoon ; speedy exhaustion from slight exertion.

Transition, — This may be : 1. Into health by subsidence of the symp-
toms into those of cholerine ; abatement of the cold, of the dryness, the
pulselessness, the thirst and anxiety ; less vomiting ; discharges green-
ish or yellow ; sweat, cheerfulness, languor, and tranquil sleep ; later :
urine pale yellow, clear, abundant; appetite increasing; wounds heal
rapidly. Final recovery in from one to two weeks. Or

2. Transition into the Third Stage. — Symptoms. —Abatement of
vomiting ; great indifference ; consciousness remaining to the last ; ex-
treme prostration ; the patient, lying on the back, sinks down to the
foot of the bed ; some return of warmth and moisture on the skin ; more
lividity and fades cholerica) the pulse cannot be felt, later, not even
a1j the carotids or heart ; eyes dull and glassy when spoken to ; rare,
and not characteristic vomiting and diarrhoea ; later, the stools are in-

CHOLEEA-ASIATIOA. 361

voluntary, as if coming from a spout; respiration labored, rattling^
almost ceasing.

This stage lasts from one hour to two days.

Termination, 1. in J9^6^j^A, preceded by cold clammy sweats, complete
cessation of circulation and respiration ; and final paralysis of the lungs.

Or 2. in Co7ivalesGenGe^ which is manifested by bilious sto(fls ; return
of the pulse and sounds of the heart ; breathing and color more natural,
critical warm sweat. But recovery is slow, free perspiration often dimi-
nishes the strength ; and slight mental excitement, too much warmth,
drink, or food, cause anguish, palpitation, small soft pulse, vomiting or
diarrhoea, extreme debility, uneasy sleep.

Or 3. The Fourth or Gonseoutwe Stage.

Symptoms. — First Variety. — Congestive, which is soon developed
into a typhoid Fever^ which consists in the reaction following the pre-
ceding stage of depression. There is arterial pressure on the brain,
spine, and its nerves, all of which were unaffected in the cholera stage.
Inflammations subside rapidly in cholera, and wounds heal quickly in
the convalescence. The typhoid features are clearly marked in places
where the patients* are in close dwellings and the population crowded.
The symptoms are : quiet immovable position on the back, then sinking
down to the foot of the bed ; indifference, or satisfaction with his own
condition; great debility; transient delirium; fixed look; dilated pupil,
conjunctiva injected; humming in the ears; difficulty of hearing; dirty
blue color of hands and arms, of countenance ; nostrils scurfy ; tongue dry
in the middle ; slightly swollen or cedematous ; taking impressions of the
teeth; tongue, teeth and lips covered with a dirty incrustation, little
thirst; accelerated respiration, somewhat puerile ; articulation imperfect,
though not hoarse ; pulse perceptible again, sound of heart not clear,
the contraction seems difficult. Later : sleepiness, followed by stupor,
or high delirium with efforts to escape, total unconsciousness, rattling
breath, sometimes meteorism. Finally: pulse and beating of the heart
intermitting, very rapid, carotids pulsating very violently; the air only
penetrates to the upper lobes of the lungs ; the breathing becomes
slower and finally ceases: death. {Dr. Nusser of Atigsburg.)

In other cases there is abatement of the symptoms, the debility and
the delirium ; the urine increases, is clearer ; moderate sweats, tranquil
sleep ; and final recovery. This stage lasts from five to eight days.
{Johnson^ 860. — Jackson and NeilVs Rejport. Phila. 1850.)

Pathology.— Congestion of the viscera, especially the liver ; bowels
congested in some cases, the whole tube has a blanched appearance.
Vessels of the mesentery full of blood. Epithelial layer destroyed or
detached. Peyer's glands developed, also solitary glands ; villi
denuded, capillaries and proper tissue of the liver exsanguinous, but
laro-e blood-ve-ssels full.

362 DISEASES OE THE DIGESTIVE EITNOTIOISr.

Pkognosis.— Favorable, when there is gradual subsidence of the
symptoms, cessation of vomiting and purging, re-appearance of more
natural evacuations, slight warm perspiration, which is . critical in the
second stage, though not later, and does not always occur.

•Unfavorable, in those who are greatly exhausted by the rice-water
purgings; who are restless after vital warmth has returned ; relapses
generally prove fatal. Intemperate persons often die in the typhoid
stage of cerebral typhus ; consumptive patients, or those exhausted by
venereal excesses either die or recover slowly.

Treatment. — When the Asiatic cholera commenced its destructive
course amongst the millions of Europe and America, the disciples of
the ancient school of medicine stood aghast and almost powerless before
the awful scourge, their best resources often hastening rather than re-
tarding the work of the destroying angel.

Up to 1832, " Epidemic Cholera" was the prominent feature of every
Medical Journal. The different theories and modes of treatment pro-
posed have now little claim on our attention. One writer says : " Vene-
section was at one time ordered to be employed by Grovernment! Then
sweating was praised ; various ingenious contriva«ices were brought
forth for the purpose of exciting perspiration."

" Of internal remedies, Calomel and Opium were most in repute.
But they were far from successful. Hhuharb and Magnesia super-
seded them, and were in turn superseded by Sub, -nitrate of Bismuth^
This was at one time regarded in Russia, as a "specific" but was de-
nounced in England as "inert;" but hopes were still maintained in the
"Mustard Emetic." Soon, however, the conclusion was reached that
all experience "from Ceylon to Archangel, from Orenburg to Berlin,"
left the profession "as far from a rational methodus 7nedendi as they
where when it first appeared on the banks of the Ganges."

The medical theorists were all of this time wildly wandering in the
thick fogs of conjecture. M.- Andral^ then regarded as a leader in
pathology, pronounced the disease of an '' enteralgic instead of an en-
teritic character ;" and recommended " free bleeding among the young
and vigorous, external irritation, ^nd plenty of Laudanum internally."
His neighbor and equally distinguished colleague, Broussais^ declared
it to be " highly inflammatory action of the whole alimentary canal,"
and prescribed " ice internally, leeches to the epigastrium, and heat to
the extremities."

The experience of other years and of other countries was added to
that of twenty years in Asia and Europe. The amount of it all was
thus summed up by the editor of the Medico- Chirurgical Review,
''JamtS Johnson^ M.D., Physician Extraordinary to the King of Great
Britain." He said : "When cholera appeared in Hindostan, the papers
so teemed with specifics and cures, that the government put a stop to

CHOLERA- ASIATICA, 363

their further publication, on account of the mortality they caused."
"For ourselves, what shall we say? Alas ! we must own that we are
gloomy, heartless skeptics, without so much as a grain of faith, or one
saving particle of belief. Would that it were otherwise — would that
we could only so much as imagine that ch(^lera has been, is, or will be
cured by the thousand and one plans of happy memory, already
published, or to be published.

"In point of fact, we know no better 7node of treating oholera than
when it first appeared in the island ; and the really severe cases are
just as fatal as they ever have been."

The degree of mortality of cholera as it had been observed in dif-
ferent seasons and in different localities may be approximated by of-
ficial reports : The Medical Board of Bombay, in India, reported that
of 1294 cases which received no medical assistance, every individual
died ; and that no case was known to have recovered without medical
aid. In fourteen years, beginning with 1818, 4430 deaths occurred in
the British Army, out of 19,494 cases in that presidency ; these re-
sults seemed to show that medical treatment, if not the best, was better
than none. .' .

Another report of five years shows that within that period twenty-
two per-cent of the whole number attacked were carried off. In civil
life the disease has often proved much more fatal.

At Bushire, on the. Persian Gulf, in 1821, the sixth part of all the in-
habitants died. At Bassora, says Mr. Rich, 18,000 died, and of these
14,000 died within a fortnight.

In September, 1830, the epidemic invaded the Russian empire, and
entered Moscow with a step more terrifying than that of the grand
army of Napoleon eighteen years before. Up to the first of January
4385 had died, equal to fifty-four out of every hundred persons attacked
by the disease.

It was just at this time, that Andral and Broussais were speculating
about the ^'enteritid^ or the '^ enteralgid^ character of cholera; or
whether the remedies should be " antiphlogistid'^ or "" antispasmodic f^
and at the same time (1830) Samuel Hahnemann in Germany, was en-
deavoring to solve the true problem of cholera by a different method,
"Collecting," says Dr. Dake, "the symptoms given, one by one till the
image of the hideous monster stood up before him as a living reality."
Then, under the guidance of the law he had been permitted to discover,
* with a knowledge of drugs such as no other man ever possessed, he
soon arrived at Camphor^ Cupr%i7n^2.\A Yeratrum^ ^\A wrote them
down as the best remedies for cholera."'-^ The solution of Hahnemann
was not accepted by the profession ; pursuing their own theories the
results they reached are well known.

* Dr. J. P. Dake, U. States Jour. Homceop. Vol. I. p. 395.

S64 DISEASES OF THE DIGESTIVE FUl!fCTIO]^.

It is universally conceded, at the present time, that homoeopathy is
far more efficient in the treatment of cholera than any other mode of
practice. During its prevalence in Europe, from 1831 until its disap-
pearance, the average mortality of cases under this treatment was
about one in twelve, while under allopathic treatment, the average was
one in three. In Germany, Russia, France, and other European king-
doms, where our system had become known, even distinguished gentle-
men of the old school were forced to admit its vast superiority over
their own system ; and it was undoubtedly this superior efficacy and
success which caused so. many distinguished men of Europe to inves-
tigate the claims of the doctrine of '^ sumlia similibus^^ renounce the
fallacies of Hippocrates and Galen, and throw their influence on the
side of truth.

Being a disease of extreme violence, and having a tendency to run
its course with great rapidity, there was no time to apply remedies ac-
cording to the principle contraria contrariis^ nor would its severity
permit the additional waste of strength and nervous energy which ever
follow opiates, stimulants, and counter-irritants. A positive specific^ a
real antidote, could alone reach the seat of the disease, and arrest its
progress ; and to the disciples of Hahn.emann, is due the credit of bring-
ing forward these sj^ecifios, and demonstrating to the world their tre-
mendous power and efficiency over this world-wide scourge.

Dr. Lobethal, of Germany, who had charge of a large cholera hos-
pital [allopatliiG) during the prevalence of the epidemic, in 1881, and
who treated an immense number of cholera patients hommopathiGally
in the summer of 1847, and again in 1849, observes : "It has been re-
served to the " specific" healing art, generally known under the name
of homoeopathy, to stand the test of practical observation, and to de-
monstrate its superiority in combatting this fearful disease, (cholera,)
the appearance of which, followed by an immense number of well-sub-
stantiated cures, has tended in the highest degree to the spread of the
new healing art."

Dr. Buchner (" On the results of Allopathic and Homoeopathic treat-
ment according to Official Statements,") says : In nineteen different
cities 1557 patients treated homoeopathic ally, recovered, while only
ninety-three died, or nearly six per-cent. Where the spirits of Cam-
phor and the higher potencies of homoeopathic remedies were used, it
was common for only one in a hundred to die. In 1881, in the district
of Tischnowitz, under allopathic treatment, two-hundred and twenty-nine
were cured and one-hundred and two died. Homoeopathists cured
two-hundred and fifty-one, and lost twenty-seven. Dr. Baer, of Prague,
treated allopathic ally one-hundred and nineteen patients, of whom he
saved seventy-two and lost forty-seven. He then tried homoeopathy on
eighty patients, of which he did not lose any. " Count Nadasdy of

CHOLEEA-ASIATIOA. 865

Daka, in Hungary, in the absence of professional aid, treated his sub^
jects with spirits of Camphor. Of one-hundred and fifteen, who were
attacked, he only lost fifteen." {Lutze, Practioe^ p. 128.)

Treatment.— First stage. — ^When the cholera is preceded by nau-
sea, loss of appetite, constant borborygmus, violent thirst, slight febrile
symptoms, frequent thin watery discharges, absenoe of jpain in the
bowels, and other symptoms generally known under the term " clio-
lerine^^ Dr. Lobethal obtained marked benefit from PhosphoriG-aoid^
repeated every two or three hours until the symptoms are better. If
the above symptoms are attended with coated tongue, vomiting, debi-
lity and indigestion, TpeGacuanha of the third dilution is required.

Oholera, — When cholera has actually made its appearance, a re-
medy which covers the exact symptoms of the case ought to imme-
diately exhibited. Our best remedies are Verat/r,y Arsen,^ Gujpr.^
Gamphor^ Oanth.^ Carbo-veg,

In the forming stage of cholera, and in cholerine, with cramps in
the calves of the legs, give tincture of CampJior ; " and for aching or
burning in the epigastrium, Ac,-phos.^ Arsen., Oupr., Phos., Yerat/)\ ;
for rumbling in the abdomen, Acid-pTios,^ Ver., Phos. ; for diarrhoea,
Acid.-phos,, Arsen,, Ipecac, Secale, Sulph,, Veratr?^ [Nusser)

In the third stage, or collapse, Arsen., Phos., Veratr,, Carlo-veg,,
Lauro-cerat., are to be used.

During the prevalence of cholera, much may be done towards ward-
ino* off its attacks, and thus disarming it of a portion of its terrors. The
most important rule which we would inculcate, is the cultivation of pre-
sence of mind under all circumstances, cheerfulness, contempt of dan-
ger and strict temperance and regularity in all the habits of life. Other
precautions are : frequent ablutions so as to insure perfect cleanliness,
and a healthy action of the skin ; careful ventilation; frequent changes
of body linen, moderate and agreeable exercise ; good company ; and
a clear conscience.

As a prophylactic, many European authors have highly recommended
Camphor in tincture, in doses of a drop or two, once or twice in twenty-
four hours. From its extensive application as a medicinal antidote we
believe it to possess virtues of a high order as an antidote against the
poison of cholera.

Further Peophtlaotics. — Fresh pure air; the avoidance of small
close, damp apartments or streets; cheerfulness, habitual calmness of
mind ; regularity in all natural habits ; the use of such diet and drinks
only as can be certainly digested, without deranging the stomach or
bowels ; substantial healthy food ; avoid acids ; avoid all over-exertions,
grief, anger, fear.

Prophylactic MEDicmES. — 1. Cuprum, May be used during the
prevalence of cholera when the first symptoms are felt.

366 DISEASES OF THE DIGESTIVE FUNCTIOl^".

2. Camphor, — This is the specific remedy, having the power of kill-
ing or destroying the animalculse or malignant agent. In the premo-
nitory stage, when there are spasms in the calves of the legs, and pain-
less diarrhoea, — one drop of tincture (one part gum to five of Alcohol)
on sugar, every three or five minutes, with some brandy and water every
fifteen or twenty minutes. As he grows warm, give less frequently.

Phosphoric-acid, Arson., Cupr., Phos., Veratr., aching or burning in
the epigastrium, rumbling in the abdomen ; diarrhoea. Of these, Phos-
phoric-acid has been generally the most successful in cases showing a
disposition to repeated attacks.

Arsenicum, Secale, Sulph. : diarrhoea. See p. 370, 872.

Sulphur^ thirtieth, taken twice a week, six globules in the evening,
destroys the psoric diathesis, which favors the disease.

When reaction begins and he begins to perspire, a little brandy and
water will give strength. The perspiration should be kept up eight or
ten hours. During the reaction following the use of Camphor, if head-
ache indicates the beginning of congestion ; give Belladonna. If con-
stipation follows, give a cup of coffee without milk, and twenty-four
hours after give a dose of Sulphur. If dysenteric symptoms, give Mer-
curius. (PtoUe, S2d.)

Secoi^d Stage. — Verhct rest in remtmhent position / perfect com-
posure of mind, cheerfulness and confidence, both in the patient and
his attendants.

Food : weak broth only ; it is often necessary to prohibit or restrict
even this for some time.

As a drink, cold water is desired, and often does good, even when it
is constantly thrown up. In some cases it renews the vomiting and
diarrhoea after they had been checked by medicines. Beer is often
allowed to the convalescent. Medicines should be administered at short
intervals, even as short as every five minutes. Ice, in small pieces,
frequently swallowed, seems to give relief. Injections of ice-water are
recommended when the abdominal muscles are cramped. Frictions
over the abdomen may be applied at the same time.

The medicines which have been found upon the whole, most service-
able in the treatment of this malady, as it occurs in different localities,
and in its various forms, are : YeratTum^ Cuprum^ Arsenicitnhj and
Ca'mphor, Symptoms often supervene, also, which call for the exhibi-
tion of Secale-Gornutumy Wux-vomioa^ Phosphorus^ Phosphorio-acid^
Ipecacuanha^ Oa^rl^o.-veg,

Camphor: Distressing anxiety in the region of the heart ; spasms
of the muscles ; pulse small and rapid ; hands, feet and skin cold ; lividi-
ty especially of the lips ; unelastic ; facies cholerica ; anxious expres-
sion of countenance ; tongue cold, dry, livid ; epigastric pain ; thirst;
rice-water discharges ; suppression of urine ; cold breath ; hoarse, raw

CHOLERA-ASIATIOA. 367

voice ; aggravation after midniglit ; amelioration by rest ; death in a
few hours from apoplexy or sudden collapse. (Dr. Hencke, of Riga,
says, Camphor is specific in these cases. Spiritus Gamph.-fortis, in
drop-doses, every five minutes, till the heat returns.

During the prevalence of the epidemic in England and Prance, in
184:8—49, and in America, in 1849, almost every individual experienced
unusual intestinal irritation and disposition to diarrhma. In the large
cities especially, very few exceptions to this rule could be found. Even
the most strict regard to diet, and avoidance of all exposure, was no
security against this weakness and rumbling of the bowels, and a cer-
tain lassitude and uneasiness which constantly attended it. Most of
these cases subsided without any serious disturbance ; others passed
into cholerine^ which could generally be controlled when promptly
taken in hand; while those cases, which were neglected, or improperly
managed, usually terminated in cholera. In rare instances, individuals
would be attacked, suddenly and violently, without any apparent j)r6-
monitory symjptoTYis^ but cases of this description have almost invari-
ably occurred in those whose constitutions were impaired from intem-
perance, disease, or who had been deprived of proper repose, by mental
application, excitement, fear, &c.

Dr. Hencke found Omn^hor a positive specific in the spasmodic
form of cholera, '^ when the patients were suddenly taken with rigor,
and even cold in the back, which was soon followed by fain tness, and
weakness, sinking sensation in the stomach, "vertigo^ nausea^ aching^
contracting pam in the epigastrium^ g^ggi^g? vomiting, spasms in the
calves^ general tonic spasms, disappearance of the natural warmth,
therefore coldness of the hands and the whole body, depression of the
pulse^ which could hardly be felt, lividity of the lips, anxious expres-
sion of the countenance, &c., sometimes diarrhoea." Dr. H. advises
that the patient be well covered and dry heat applied to his body and
limbs, and that strong spirits of Camphor be given in drop-doses every
five minutes, until reaction occurs, warmth returns, and perspiration
sets in. Dry frictions may at the same time be employed. As soon as
we observe signs of reaction, we must either omit the remedy, or if
the' urgency of the case demands further remedial means, give the
Camphor at the first or second dilution until reaction is fully esta-
blished. It was a very common occurrence for a patient to be taken in
the night, generally after midnight, with cramps in the stomach, nau-
sea, vomiting and purging of a watery fluid, without pain or effort on the
part of the patient ; sense of exhaustion and debility, and great anxiety.
If these symptoms were not speedily arrested, there soon succeeded
extreme prostration, almost constant vomiting of rice-colored fluid ;
contractive or burning pains in the stomach; coldness of the surface;
spa«ms or cramps in the calves and other parts of the body; counte

368 DISEASES OF THE DIGESTIVE FUNOTIOK.

nance sunken, altered in expression, and indicative of extreme anxiety,
voice feeble or hoarse ; marbled appearance of the skin ; skin shrunken
and shrivelled ; cold breath; cold and pasty sweat ; burning thirst ;
marked loss of power in the circulatory and respiratory organs.

Cam^hor^ VBratrum^ Arsefiicum^ Cuprum, Acid-hydrocyanicj
Secale, Zaurooerasus, and Carho-veg^ht^YO been most successful in the
epidemic of 1848 and 1849, both in Europe and America.

Probably in no part of America did the cholera rage with more
violence in 1849 than in Cincinnati. Two physicians, Drs. Pulte and
Ehrmann, treated 1116 genuine cholera patients, in all stages of the
disease, and with a loss of only thwty-five^ — -two Americans and
thirty-three Germans. These gentlemen also treated 1850 cases of
cholerine^ and many cases of malignant dysentery, after the subsidence
of the cholera, without the loss of a single patient. Of the cases of
genuine cholera asphyxia, five-hundred and thirty-eight had voTniting^
diarrho&a and crampS' — seventy of these being in a state of collapse,
.and the balance, five-hundred and seventy-eight presented with vomiting
and rice-water discharges. These last being subjected to prompt
treatment, were speedily restored without the supervention of more
serious symptoms.

The treatment adopted by Drs. P. and E., was as follows ; in the first
stage of the malady, Tincture Camphor, one or two drops every five
minutes for one or two hours, or until profuse perspiration ensued
which should be kept up for several hours, care being taken to keep
the patient well-covered. This remedy was perfectly effectual in almos',
every case during the early part of the disease.

In the second stage, when cramps, general prostration^ and rapid
sinking of the physical energies appeared, Yeratrum, when the cramps
were in the lower extremities; Cuprum, if they were in the bowels and
breast, and SeGale-cornutum were relied upon. The latter medicine
was found of eminent service in elderly people. ^In cases of decided
collapse, Arsenicum^, and Carho-veg, were the remedies employed.
Mild frictions of the extremities with the hands alone, were the only
external means made use of.

In St. Louis, New-Orleans, and other cities of the West and South,
a similar plan of treatment was adopted by homoeopathic physicians,
and with results, which, for the most part compare favorably with those
detailed by Drs. Pulte and Ehrmann.

Cuprum. — Cardiac anguish ; spasms ; pulse soft, small, frequent ;
cold, livid, dry skin ; facies cholerica ; aching in epigastrium ; violent
thirst; rice-water discharges, both from stomach and bowels ; every
thing seems turning round ; suppression of urine ; voice hoai*se, raw ;
aggravation after midnight ; amelioration by rest. {JV^usser.)

Cuprum is suited for cramps in the muscles of the chest and great

CHOLEKA-ASIATIOA. 369

oppression of the breath. It may be given in alternation with Vera-
trum ; dissolve twelve or sixteen globules of each in four tablespoon-
fuls of water and give a teaspoonful every fifteen minutes. till the pulye
becomes less frequent, when the cramps will subside.

Ca7n^hor,—J.t is not. alone as a prophylactic that this medicine has
been advised. Hahnemann made use of it in all stages of cholera,
but he found it particularly successful in X\iQ first stages of the malady,
wdien vertigo, extreme weakness, cramps, in the calves of the legs and
muscles of the abdomen, burning and heat in the stomach, convulsive
distortion of the features, eyes sunken, face and hands bluish and cold,
and anguish, dulness, loss of consciousness and hoarseness, were pre-
sent. It has been found most useful in those cases, which have been
almost entirely unattended with nausea, vomiting and diarrhoea. It
has in some instances restored patients who were apparently, in artioulo

mortis, ^

Nux-vomiGa may by used when the principal sufferings seem to be
in the stomach, as anguish, oppression at the pit of the stomach, and
severe spasms in the stomach, also tenesmus, with an increase of the
spasms at each discharge.

In some severe cases, where the previous remedies have failed to
afford relief, the practitioner should take into consideration, Plios,,^
Phosjphorio'acid^ Ipecao.^ Gan^hO'Veg.y Ganthar,, Sul^h-ether^ Chloric-
ether^ <&G.

Y0ratrum.'--hx\gm^h. at the heart ; spasms of the extremities and
abdominal muscles ; soft, small, and frequent pulse ; skin cold ; livid,
inelastic; facies choleric a; tongue cold, livid, dry ; epigastric pain;
violent thirst; effusion serous, with white flakes, upwards and down-
wards ; suppression of urine ; cold breath ; voice hoarse, raw; aggrava-
tion after midnight or towards morning ; amelioration by rest. At St
Petersburg, (Russia,) in 1849, the success of this remedy was so great
that the pharmacies were overrun by allopaths. {Dr. Griesselioh)
Cuprum and Veratrum may be persisted in four or six hours. If the
cramps continue or stupor begins, give Secale-cornut. every half hour,
for an hour or two. If there still be much nausea or retching, increased
by motion of head or body, give Tabacum,

Veratrum,' — General coldness of the surface of the body; cold
perspiration on the face, and sometimes over the whole surface ; skin
white, or of a bluish tinge ; bluish color around the nails and of the
lips ; contraction of the muscles of the extremities ; nausea, vomiting
and purging; face pale, sunken and hippocratic ; nose cold and pointed;
breath cold ; pulse almost imperceptible: general appearance of prostra-
tion. Painful cramps in the limbs ; sensation of extreme debility and
faintness; nausea; vomiting and purging; vertigo and confusion in
the head; constrictive pain in the throat; oppressive and burning pain

Vol, L — 24.

S70 DISEASES OF THE DIGESTIYE FUNCTION.

at the pit of the stomach ; painful contraction of the abdomen : op-
pression in the chest; fulness and pressure in the region of the heart;
obstructed respiration ;, rumbling and griping in the bowels; thirst;
great restlessness. Excessive dejection, anguish and despair; constant
disposition to turn from side to side, or otherwise to change position;
sometimes loss of memory, stupidity.

Administration. — The first to the sixth dilution should be employed,
a dose every ten, fifteen or twenty minutes in urgent cases, and ex-
tending the intervals as the symptoms demand.

Arsenicuw^-alhum. — Skin of a pale or bluish color and cold; face
wan and cadaverous ; eyes sunken; nose pointed; general expression
of countenance unnatural and indicative of pain ; lips bluish or black
and dry ; trembling or stiifness in the limbs ; skin cold and covered
with a clammy sweat or dry and shrivelled ; pulse very weak, irregular
and trembling; watery discharges by vomiting and purging.

Burning pain in the stomach, worse after vomiting ; cramps in the
calves of the legs, toes and fingers ; dizziness ; nausea ; frequent in-
clination to vomit and purge ; rumbling in the bowels ; ringing in the
ears; feeling of extreme debility; very great restlessness and agita-
tion; intense thirst; for which drinking affords but slight relief;
spasmodic contraction and burning in the throa.t and oesophagus ; cramp-
like pains in the stomach and abdomen ; frequent desire to pass water^
or retention (complete surpression) of urine ; difiiculty of respiration
with hoarseness ; general sensation of coldness and loss of vitality.

Intense anguish, anxiety and discouragement ; dread of death ; con-
stant uneasiness ; confusion of ideas ; delirium.

Administration, — The lower potencies of this medicine should be
used, and in urgent cases the doses may be repeated once in fifteen or
twenty minutes until the symptoms yield, some writers extol it highly
in alternation with Veratrum^ and where either of these remedies does
not afford prompt relief by itself, by all means let them be given in
alternation.

Sym/ptoms of Arsenicum, — Anguish at the heart ; indifference ;
spasms of the extremities and abdominal muscles ; pulse soft, small
and frequent; skin inelastic, cold, livid; facies cholerica ; tongue cold,
dry, livid ; aching at the epigastrium ; violent thirst ; serous effusion
with flakeSj-upwards and downwards; suppression of urine ; cold breath;
hoarse raw voice ; aggravation after midnight ; amelioration by rest.

Previous to the first outbreak of cholera in Europe, Hufeland said^
< if there is any truth in homoeopathy. Arsenic should be the remedy
for cholera;" Arsenic is the remedy upon which homoeopaths have
very generally relied since the first experiments were made with it for
the cure of this fearful malady. They have endeavored to arrest the
attention of the public to induce them to make a trial of it with little

CHOLEEA-ASIATTCA. 871

success. During the last visitation of this disease, according to the
statistics laid before the medical board, it appeared that under homoeo-
pathic treatment more than two-thirds of the patients recovered, whilst
the returns from the allopathic cholera hospitals showed that upwards
of two-thirds died. Although this committee was commissioned by
government to examine and report the various results attending the
different modes of medication adopted during this epidemic, they with-
held those of the homoeopaths, believing that "to publish the returns
from homoeopathic practitioners would be to give an unjustifiable sanc-
tion to an empirical practice, alike opposed to the maintenance of truth
and the progress of science." And yet Dr, Mac Loughlin^ the me-
dical inspector and an aliopathist, said, " all I saw were true cases of
Asiatic cholera, in the various stages of the disease ; and I saw several
cases that did w^ell under the homoeopathic treatment, wdiich I have no
hesitation in saying would have sunk under any other. Were it the
will of Providence to afflict me with cholera, and to deprive me of
the power of prescribing for myself, I would rather be in the hands
of a homoeopathic than of an allopathic adviser." (Driimmond^
Hommop. amongst Allopaths, Lond. 1836,^. 50.)

The London Lancet for Oct. 2, 1857, contains a letter from (7. Blaohj
M, D, "On the value of Arsenic in Cholera." The author, perhaps,
did not design to advocate, homoeopathy, but his testimony is none the
less valuable on that account. lie details a severe case of cholera
treated biy the ordinary solution of Arsenic, the LiqiiOT-arseniGalis,
In conclusion he says :

"From such data, then, I maintain the specifiG action of Arsenic in
the very worst form of English cholera, and I thence infer for it a
similar power in the malignant type of the disease.

"In the East, where at the present moment the tenure of our Indian
possessions depends on the maintenance of the health of our soldiers,
this dreadful scourge is decimating the heroic band under Havelock,
and, unless speedily checked, may possibly lose us an empire which
has cost us so much blood and treasure to win. Let the surgeons of
the Indian army adopt this remedy — ^let them give it a fair and im-
partial trial — and I feel confident that with them it will maintain the
reputation of a specific for cholera, which I here accord to it." In a
second letter, published a fortnight later in the same Journal, he thus
expounds the theory of the ratio mediQudii of Arsenic in curing cholera:
" The facts connected with the history of the rise and propagation of
cholera, show that the proximate cause of the disease depends on the
presence of a certain poison in the blood which has been termed the
''choleraic poison." To the question, then, "in what respect does
Ajtienic act on the constitution in cholera ? I reply that it acts ,by
neutralizing or destroying the choleraic poison in the blood ; and when

872 DISEASES O'F THE DIGESTIYE FUNOTIOif.

it has done so, the peculiar symptoms of the disease subside. It pro^
duces its eiFect in accordance with a well-known physiological law
that no two actions of a similar nature can go on in one and the
same part at one and the same time; that in shorty the greater action
destroys the less. If, then, a greater poison be given to the blood
than the one which is already present in it, the latter must, in accor-
dance with the above law, be destroyed " If there be any such well-
known physiological law as Dr. Black refers to, it is the law first pro-
mulgated by Hahnemann in the following words :

" A weaker dynamic affection is permanently extinguished in the
living organism by a stronger one, if the latter, whilst differing in kind,
is similar to the former in its manifestations." {Organon^ Hahnemann^
§ XXVI.)

This doctrine of similia similibus curantur, as announced by Hahne-
mann, seems intelligible enough to a mind accuston;ed to look at it, but
in the mind of the learned editor of the Lancet is only a meaningless
jargon of words. When, however, the very same doctrine is announced
by a British surgeon whose orthodoxy is not suspected, the same
learned editor cordially endorses it. Dr. Black's proposal to treat
cholera with Arsenic is commende'd in the Lancet, because the editor
is too ignorant to understand that it is an endorsement of hoinoeopathy.
To test the Lancet more fully: Dr. Hitchman, a distinguished homoeo-
pathist, wrote a letter commending Dr. Black's proposal, expounding
the homoepathic law "in the very words which Hahnemann uses in ex-
plaining the peculiarities of his doctrines ; the letter was published in
the Lancet without awakening the suspicion of its vigilant editor.

PhosphoriG-aoid, — Anguish at heart; indifference; spasms of ex-
tremities and abdominal muscles ; pulse soft, small, frequent ; facies
cholerica; epigastric aching; rice-water discharges from the bowels;
hoarse, raw voice ; aggravation after midnight. It seems very success-
ful in the first stage (cholerine). After the vomiting begins it is con-
sidered useless {Dr, Griesselieh,), Also useful after the consecutive
fever stage begins in a typhoid form ; there are : stupid insensibility,
optical illusions ; confusion of the senses.

PhosphoriiS—hsiS allthe symptoms of Phosphoric-acid, with the
addition of violent thirst, and amelioration by rest.

jSeGale-eor.' — Distortion, jerking and convulsive movements of , the
limbs ; great desire to sleep ; coldness in the back, abdomen and limbs ;
cold clammy perspiration ; suppression of urine ; pains in the extremi-
ties ; vertigo on looking upwards, relieved by lying down. Secale has
all the symptoms of Phosphoric -acid, with the addition of cold, dry,
livid tongue ; violent thirst ; serous vomiting, with white flakes ; sup-
pression of urine ; amelioration by rest.

In fully developed cholera asphyxia, as it occurred at Breslau, 1848

CHOLERA- ASIATIOA. 373

and 1849, Dr. Schweikert of Breslau, found Verdtr. first, and Seoale^
first, a drop every five minutes, in alternation^ more commonly in-
dicated than any other remedies. When asphyxia took place. Dr. S.
relied upon Aoid-pJios, j either alone or in alternation with Secale ;
but in a few cases he used Tinot-^phos.y first or second dilution, with
success.

Rhus, — Anguish at heart; spasms of the muscles of the extremities
and abdomen ; pulse soft, small, frequent ; skin inelastic, cold, livid ;
facies cholerica; epigastric pain; violent thirst; serous purging; sup-
pression of urine ; cold breath; hoarse, raw voice ;• aggravation after
midnight.

In the consecutive stage, when the disease assumes the form of
typhus-fever, with delirium. The following remedies are required:

Carho-vegetabilis, — In the third stage (collapse.). No pulse, livid
countenance, hoarse voice, sunken eyes. This stage often lasts two or
three days. This remedy, thirtieth dilution, a tea-spoonful every hour,
for six hours. Arsenic may be alternated with it, if burning in the
stomach and thirst continue. They may be continued for four or six
hours and then discontinued as long ; after which they may be resumed.
Coldness of the surface often remains a long time without injury.

Lauro-cerasus, — In the typhoid stage ; torpor and stupor ; lethargy
bordering on paralysis of the brain, or entire exhaustion of the nervous
system; expression of countenance indicating great suifering, patient
weak, pulse slow, eyes half closed ; deep sighs and moaning. In that
torpor which follows a severe attack of cholera, when the patient can
not easily be aroused, is very weak, the pulse slow, yet the expression
of countenance is natural, /Spiritus-nitri^-dulcis is of the greatest
benefit. {FuUe, 327.)

A eonite. — JEsjpeeial Indications for A oonite, — Stronff excitement of
the vascular system j bitter, greenish vomitings ; passage of lumhrioi
with the evacuations. [Jahr,)

Aconite^ sd.js Ifarchesani^ \b especially indicated when the eva-
cuations are whitish, with discharges of lumbrici, excitement of the
arterial system, producing congestion, with heat, redness, full and ac-
celerated pulse, and palpitations.

In 1835 Dr. Baertl, of Venice, observed an epidemic cholera cha-
racterized by discharges of lumbrici with the evacuations. The first
period of this epidemic manifested itself by vertigo, pressive headaches,
nausea with desire to vomit, coldness, vomiting and diarrhoea. In the
Becond period, there were; vomiting of bitter and greenish matter,
vertigo, increased heat, thirst, irritable and frequent pulse, but occasion-
ally full and strong. At the third period the pulse became extinct,
with icy coldness of the hands and feet, continual agitation and ac-
celerated, short and anxious respiration. Dr. Baertl found Aconite the

871 DISEASES OF THE DiaESTIYE FU2T0TION.

best remedy for this condition. He prescribed dessert spoonful doses
of an aqueous solution of extract of Aconite every hour, joining with
it, if speedy improvement did not occur, injections of a weak w^a^tery
solution of extract of Aconite. In all stages of the malady, this treat-
ment w^as followed by speedy success, generally within forty-eight
hours. {Gazette Horn, de Leipzig^ Vol. IV., p. 161.)

Aconite has been employed with success against the first symptoms
of cholera, and is an indispensable medicine in the tumultuous reactions
which follow these attacks. A few doses are quite sufficient to combat
these reactions. [Kurnmel^ Gaz. Horn, de Lei^zig^ Vol. XXXV.,
p. 828.)

In almost all cases, says Schneider, of the vascular excitement which
accompanies the development of the first stage of simple cholera, a
few doses of Aconite will suffice to tranquilize the pulse and equalize
the circulation. {Gaz. Horn, de Leipzig^ Vol. XXXVI., p. 277;)

In the ischuria which accompanies cholera, Aconite, says Peterson,
has been employed with great benefit. Three doses of the ninth at-
tenuation afforded relief in about twelve hours* (Annales de Havtlaub
et Trincks, Vol. III., p. 75.)

In a case of sporadic cholera, in a young man, following a chill and
errors in diet, the following phenomena were present in the night :
suddenly a cramp-like pressure and tension in the stomach ; then at
the expiration of two hours, shaking chills, nausea, vomiting of acid
mucous matter, cramps in the legs, w^atery diarrhoea, cold sweats, cold-
ness of all the limbs, agitation, convulsive movements and distortions
of the limbs, face sunken and earthy, pulse weak, extreme muscular
debility, eyes dull and expressionless, prostration of all the vital
forces, inability to speak. A few minutes after a dose of Aconite,
twenty- fourth, the vital heat returned, and the pulse became stronger;
in two days the patient was cured. (Kammerer^ Hygea^ Vol. IV.,
p. 490.)

In Asiatic cholera, says Dr. Quin, Aconite is indicated when Yera-
trum^ Cujprum or Cmrvphor have arrested the evacuations, and an
inflammatory condition only remains. {TJierajp, du Gholera Asiatigue^
p. 24, 27.)

Reubel says : After the third period of cholera is happily passed
there often returns a reaction of the vascular system, in consequence
of which blood accumulates either in the liver, the lungs or the brain.
The cure then depends upon the promptness with which the physician
recognizes^ the seat of this congestion. In cases where the violence
of this reaction does not permit us to distinguish at once the organ
most threatened, we ought to make use of an aqueous solution of from
six to ten drops of Aconite. [Hygea^ vol. VII., p. 897.)

After the cessation of the actual cholera symptoms, sanguineous

ALLOPATHIC TREATMENT OF CHOLEEAa 375

congestions often occur, \Yliicli may become so violent as to result in
inflammations. In such cases says Tretzer^ Aconite is an efficacious
medicine. (Ilom, de Leipzig, Vol. XXXVII, p. 82.) In this con-
secutive stage Aconite becomes important when the reaction begins with
a full and bounding pulse, anxiety and other symptoms of fev^er.

Adj'iwaniia,—li\ the beginning of the attack the patient should be
placed in bed, well covered, and hot bottles or stones placed around
him; Camph. every five minutes, rising to higher dilutions in succession,
till warmth, perspiration, &c. return. In this state he should remain
without change for eight or ten hours ; and much longer if a tendency
to relapse remains.

In the second stage, the covering should be still warm, but left to
the patient's choice. In the cramps of the muscles, friction with the
dry hand is the best remedy. It also aids materially in restoring heat
to the extremities. If the disease has advanced to the third stage, the
same general external measures^ may be pursued. Cold drinks are
preferred by the patient and are generally proper ; but ice in small
quantities at a time, often repeated is better. External heat can not
be applied so as to produce warmth of the surface, and is most oppres-
sive. Pulte recommends wrapping the patient in a sheet wrung out of
cold water, repeating it after a few hours, if desired, and adding another
blanket when reaction begins. None of these measures have in them-
selves any power to control the violent symptoms. The spasm and
debility are only removed permanently by exciting the proper action of
the secretory cells of the liver. *^ Sanguis solvit spasma^^ was an
aphorism of Hippocrates, When the circulation is ecjualized the spasm
ceases. {Gayley^ Amer, Jour. 1850, p, 88.)

AllopathiG Treatment,

All treatment that has ever been successful in the cure of cholera
has effected it on truly homoeopathic principles. Mercurius, in some
form, has the most clearly defined power of exciting, through successive
over-stimulations, that exhaustion of vital power in the liver which
leads to inaction, cessation of the function of secretion, torpor, and
thence congestion of the organ, which forms the characteristic feature
of cholera. The size of the dose is less material in cholera asphyxia
than in any other disease known to me; the mucous membrane, with all
the fine vessels through which the medicine should be absorbed, is being
constantly loosened and washed away by the serous exudation; and
the blood vessels are already so full that the process of absorption is
almost entirely suspended. The danger then in giving Mercurials in
large doses consists, not in the poisonous povrers of the medicine, but
in the failure of the absorbing vessels to take it up^ The most we caa

876

DISEASES OF THE DIGESTIVE FUNCTION.

expect is that an infinitesimal quantity may be absorbed; and if it ^V,
the disease will be arrested. In the summer of 1834, when occupied
day and night with cholera patients, I took the disease. After the
characteristic vomiting had proceeded for some hours, I took forty
grains of Calomel every four minutes until one hundred and sixty
grains had been taken. The only effect of this was, to suspend the
vomiting immediately, and there was a gradual return to health in the
course of two days; there was no purgative effect from the Calomel;
and, so little did I then regard its powers for good or evil in cholera,
that I took nothing to carry it off. The slightest perceptible tender-
ness of the gums a few days after, reminded me that the remedy was
not entirely insignificant.

The extent to which Calomel has been carried in allopathic practice
in cholera is sufficient to show that the size of the dose has little to do
with its curative effect. It is only partially homoeopathic to the disease,
and in this imperfect degree it has shown some power in arresting
some of the alarming symptoms, whatever sized dose has been employed.

In 1832, cholera in a malignant form was prevailing at Campeachy^
Yucatan. "On the seventh day of the pestilence^ when the burials ex-
ceeded three hundred," Dr. Perrine, the American Consul, declared to
the city council, that he "had not yet seen one patient die who had
retained forty grains of Calomel in the stomach one hour, administered
while heat and pulse yet remained.'' He said: "In all cases of cholera
the first object is to arrest the flow of serum into the intestines. That
Calomel does this is not doubted. Whether we class it among the
diffusible stimulants which calm irritation, or the astringents that con-
tract the exhalent vessels, I neither know or care. Forty grains of
Calomel will arrest this intestinal effusion. In many cases within half
an hour the whole surface has become warm ; the cramps have ceased
and vomiting has not again returned. The size of the dose in this
disease is unimportant, salivation may result, but it is as liable to result
from five grains as from five hundred.'^ In Lexington, Ky,, it was com-
mon to take even a fourth of a pound in two days* All experience in
this disease, as well as others, shows, that, a remedy j^ar^^VtZZ^/ homoeo-
pathic gives only an unsatisfactory success, even when given in the
largest doses* /Whereas, a i7"i^6^^(?^;?(} produces the best results in
doses which those unacquainted with the true law of cure regard as
inefficient and inappreciablce This remark applies to all other dis-
eases as well as to cholera. (See pages 116 to 121.)

a CHOLERINE.

Cholerim^e.—K disease which often precedes and also follows Asia-
tic cholera. It is ^ diarrhoea in which the evacuations are of the ordi-
nary feciuient ^eliariueter, accompanied by rumbling of the bowels and

INTESTINAL CONCRETIONS.

377

caused by tlie epidemic constitution of the season under the chi)lera
influence. It may be excited by debilitating influences of all kinds :
fear, grief, &c. [Pulte^ 328.) I have seen it run rapidly into well-
marked cholera, on hearing the cry of fire in the street. In a cholera
season it may be regarded as the beginning of the fatal pestilence, and
should be promptly treated in whatever form it may appear. I have seen
it excited in a whole family by the use of water from a well, that had
not been used for a few days. In 1842, a choleroid disease was origi-
nated in New- York by the eating of smoke-dried beef, prepared from
diseased animals. [HosaoMs Report.)

Treatment. — ^When caused by grief: Phosphoric-acid and China in
alternation.

If caused by fear: Chamomilla, a few small doses.

If attended with bilious rheumatic symptoms, as headache, pains in
the limbs, arms and back, chilliness, or approaching to a typhoid state :
Bryonia and Rhus, in alternation, every two hours a dose, till four doses
are taken, then wait twenty-four hours. If the diarrhoea continue, China
and Phosphoric-acid in alternation.

The disposition to diarrhoea which prevails in a cholera season is re-
moved by Sulphur^ two doses on successive evenings, and avoiding all
other remedies for one or two days.

As principal remedies for the prevention and cure of cholera. Cam-
phor, Veratrum, Cuprum, and Sulphur are recommended to be kept
always at hand by persons or families liable to be invaded by cholera.
Dr. Pulte says : In 1849, these remedies with printed directions for
their use were in the hands of every homoeopathic family in the city
of Cincinnati. The disease was as severe and as generally fatal there
that year as in any other city of the same size. But under homoeo^
pathic practice 2410 patients were treated, and of these only eighty-
five died or only about 3^ per-cent.

Genus X.— INTESTINAL CONORETIONS.—ENTEROLITHUS.

1. Intestinal GoIguIus, — Substances accreted into solid masses in
some part of the alimentary canal, more frequently in the caecum or
colon, sometimes in the stomach. Bonetus found in two instances
stones in the stomach as large as a hen's egg, each weighing four
ounces. In some cases they consist chiefly of earthy deposits, in ob-
scurely crystalized layers, around a distinct nucleus; in others they
are composed of indigestible substances taken into the stomach as food.
They are often formed in concentric layers and radiated from a central
nucleus, often a gall-stone, or some foreign body. 1. The nucleus when
a gall-stone is composed chiefly of cholesterine, the yellow coloring
matter and the resin of the bile^ surrounded by layers of a mixture of the

378 DISEASES OP THE DIGESTIVE FUNCTION.

phosphate of lime, and of the ammoniac o-magnesian phosphate, with
animal ftiatter. Haller thought, the saline constituents furnished by
the pancreatic-juice, and the resinous parts derived from the bile.

2. The nuclei composed of foreign bodies. These are common in
Scotland, where the people live much on oaten bread. The beard and
fibres of the husks of the oat resist digestion, and collecting together
form a nucleus around which saline matter with successions of layers
of fibres can collect.

A case is given in Dr Cox's Medical Museum (No. 8) of a miller's
horse, which had colic and obstinate obstruction of the bowels, and
died in three days. In the caecum and colon were found one-hundred
and thirty-four stones, of which one weighed four pounds ; it was large
for this weight, as a common calcareous stone of the same size weighed
three times as much. The stones were accounted for by the existence
of the gravelly particles rubbed from the mill-stones and mixed with the
bran fed to the horse. Mr. Siebald, of Ulm, said, he had seen a stone
of this kind, that weighed seven pounds. In the collection of the Ame-
rican Philosophical Society there is a stone, taken from the duodenum
of a horse, that weighs eighteen pounds.

Concretions of a different character are formed in the intestines of
persons who have taken large quantities of magnesia or chalk, for the
purpose of correcting constipation or acidity. The concretions in these
cases consist of those earths cemented together by thick mucus. In
some persons who have long had the bowels in a costive state, concre-
tions are formed of faecal matters with earthy phosphates and inspis-
sated secretions, sometimes hardened to the consistence of calculi.

Intestinal concretions are sometimes quite large. The first Monro
found some seven or eight inches in circumference.

Diagnosis.— -When the concretion is of a large size, and the patient
begins to be emaciated, a very hard, painful, globular tumor may be
felt in the abdomen, by placing the patient on his back and relaxing
the abdominal muscles. It is found most frequently in the position of
the caecum or ascending colon, and can in but few cases be made to
change its place by careful manipulation. The digestive powers are
much impaired and the- patient becomes greatly debilitated and ema-
ciated ; pulse at first little affected; much pain and tension in different
parts of the intestines ; there are occasional attacks of nausea, vomit-
ing, tormina or purging ; pain referred to one spot, and aggravated by
taking acids or food difficult of digestion ; constant disposition to go to
stool, and sometimes dysenteric, watery, scanty evacuations, with viscid
ropy mucus or blood. Some patients have to abstain from solid food ;
others reject much of what they take.

Causes. — Sedentary occupations, inactivity, indolence ; injudicious
use of Magnesia as a purgative; swallowing of husks or beards of oats,

INTESTINAL pONCEETIONS. 879

fragments of bones, stones or seeds of fruits. Constipation oiiginating
in habitual use of purgatives.

2. Bezoar-stone. — i^Qr^id^Ti jpazaohar^ against poison) ; a concretion
or calculus, of an oval or orbicular form, found in the stomach, gall
bladder, salivary ducts, pineal gland, and especially the intestines of
various animals. On analysis the bezoar-stone is found to consis
chiefly of bile and resin. The oriental stories of their origin and of
their wonderful properties are all fabulous. So efficacious were they
once thought in counteracting the effects of poisons and as preservatives
against contagion, that they were sold at ten times their weight in gold ;
they were also hired and worn round the neck, as in Portugal, at the
rate of ten shillings per day. They are now regarded as nothing more
than common gall-stones, and no value is ascribed to them.

8. /&?/5<^fo.-— Intestinal concretions sometimes consist of fragments
of sewing-threads, paper or other substances, which have been thought-
lessly chewed and swallowed. Persons who indulge in such habits,
often become the subjects of obscure abdominal diseases, and at length
manifest tumors or accumulations in the caecum or colon. In one case,
after numerous physicians had disagreed on the nature of an abdominal
disease, a series of twelve solid masses, from the size of a filbert to that
of a walnut, were evacuated. These concretions were found to consist
of a substance resembling pasteboard, of a brown color, containing
earthy particles. On maceration they exhibited nothing but coarse
paper, partially reduced to a pulpy state, agglutinated with mucus, por-
tions of faaces, and a little phosphate of lime. The patient had, some
years before, been in the habit of chewing and swallowing pieces of
coarse gray paper. Their expulsion was followed by the disappearance
of all the symptoms.

A Form of Intestinal OonGretions is common in large cities in
which no unusual substance has been taken or passed into the
bowels ; but there is a compact mass of considerable size in the acend-
ing colon Avhich passes for a tumor. The patients are all sufierers
from d^^spepsia. They can take no food without distress ; they have
formerly been in the habit of taking purgatives frequently ; have ceased
to drink water even in the smallest quantity ; all the secretions are de-
ficient; the skin is dry, swarthy, wrinkled, mummy-like ; the countenance
devoid of animation ; constipation; perspiration, if any, is thick, clammy,
foetid; the mind gloomy, peevish, hopeless. In some of these cases
there is a solid stony or earthy concretion, as Monro found one of seven
inches circumference ; but this is rare. Much more commonly the con-
cretion is made up around some solid substances injudiciously swallowed;
as the cherry-stones, of which Helm in a fatal case found three-hundred
in the caecum and adjoining ileum. And, more frequently than any
other intestinal concretion or tumor, we meet with faecal accumulation

880 DISEASES OF THE DIGESTIYE FUNCTION.

in the enlarged csecum and colon. Such was that found by Odier in'
the case of De Saussure. After being the first to measure the crater
of ^tna, and to explore the summit of Mont Blanc, this philosopher died
of an accumulation in the distended C83cum, which better medical treat-
ment would have remedied.

In some recent cases involving chiefly the ascending colon, we no-
ticed the breath as very offensive ; tongue loaded or furred ; lips and
gums bloodless ; muscular energies much diminished ; appetite almost
extinct ; some headache ; abdomen tumid ; constant uneasiness caused
by spasmodic efforts to pass the offending matter forward, threaten-
ing dysentery ; pulse very soft and weak, but nervously rapid. The
patient inclines to crouch down forward, pressing the hand on the
tumor. Constant moaning, and short" irregular breathing ; general las-
situde ; faintness on assuming the erect posture. The worst cases were
females advanced in age. In all, the alvine evacuations were infrequent
and very small ; in one there was nothing passed for several weeks.

The treatment of intestinal concretions will readily be seen under
constipation, dyspepsia and ileus. In the cases just referred to we suc-
ceeded in all with Nux-vomica, insisting upon a gradual but speedy re-
turn to the habit of drinking plenty of pure fresh water. See p. 297. 830.

Genus XI.— HELMINTHIA.— INTESTINAL WORMS.

Species of Worms found in the Human jff6>^y.— Taenia solium ;
Taenia lata ; Tricocephalus, or trichuris ; Ascaris vermicularis ; Lum-
bricoides.

1. Tcenia or Twpe-worm, — A long tape-like worm, formed of a chain
of flat articulations united together by a membranous border, varying
in breadth or thickness ; each of the links is possessed of independent
vitality and capable of becoming a distinct worm. Brera describes one
in the cabinet of the University of Pavia, which exceeded two-hundred
and thirty feet in length. They have been seen one-hundred and fifty,
three-hundred, and even eight-hundred feet long. {Copenhagen
Transactions,')

The species called armed tape-worm is found exclusively in the
human subject and is with difficulty dislodged, as its head is armed
with two small fangs, which it insinuates into the mucous membrane of
the intestines. It is generally dislodged in joints which resemble
gourd-seed. Taenia lata is unarmed and more easily expelled.

2. Tricocephalus, — This parasite is seldom seen. Length from one
and a fourth to two inches ; external surface marked by transverse-
lines like rings. One part of the body terminates in a filamentous
elongation, as fine as a hair and coiled up in a very singular manner;
another portion ends in a broad and obtuse hook, resembling the pistil

INTESTINAL WORMS. 881

of a leguminous flower. From this extremity the worm " can put forth
a sort of tube enveloped with a sheath." Found in the ileum and
csecum. [Brera^ p. 44.) Dr. Stokes exhibited a preparation of a
c^cum containing the tricocephalus in his lectures.

3. AsGCt/ris vermieula/risy oy Asoarides. — Very common and often
discharged in incredible numbers. Round and thread like, very slender
and only from one-fourth of an inch to an inch in length. They move
with great celerity, and when touched contract to near one-half their
length. They reside in the large intestines, and are most abundant in
the rectum near its termination. But they are sometimes found in the
stomach ; and Brera says, he found them in masses in the oesophagus
of a woman.

4. i^^m5Wc<9^VZ^«9.— Resemble in shape the common earth-worm ;
white or flesh color, perfectly round and of the size of a goose-o^uill ;
abdomen yellow and transparent; length from four to twelve inches;
most common in the small intestines, but sometimes found in the
stomach, colon, and rectum ; children more subject to them than adults.
They are often discharged in great numbers, sometimes united in balls
rolled together.

DiAaNOSis.— Symptoms.— Worms in the intestinal canal may pro-
duce any of the usual spasmodic or convulsive diseases. By irritating
the nerves of the prima- via they may originate chorea, catalepsy, te-
tanus, paralysis, mania, or convulsions. To the same cause are also
attributed pleuritic and rheumatic pains, dysentery, remitting fever,
hydrocephalus, consumption, chronic spasmodic cough, &c., &c. The
presence of worms is more commonly indicated by : pale and leaden
color of the face, occasionally flushed with fever ; bluish streak under
the eyes, which are dull and heavy ; pupils dilated or much contracted ;
lower eye-lids and upper lip tumefied, especially while sleeping ; itch-
ing in the nostrils ; picking at the nose; foetid breath ; disturbed sleep,
during which the patient grinds his teeth, is disposed to lie on the ab-
domen, and suddenly start up and scream as if frightened ; tingling in
the ears ; giddiness ; interrupted speech ; palpitation of the heart, mus-
cular debility; pulse frequent, corded, or intermittent; dry spasmodic
cough; irregular and depraved appetite; abdomen swelled and hard ;
diarrhoea or constipation ; evacuations unnatural, slimy and fetid ; prick-
ing and tearing pains in the abdomen; emaciation, convulsions, para-
lysis, &c.

Signs of LumbriGoides, — Pricking and rending pain in the umbili-
cal region ; colic with rumbling noise in the abdomen, caused by this
worm irritating the mucous membrane with the sharp cutting point of
its head.

Signs of Ascarides. — Irritation and intolerable itching and prick-
ing pain with swelling at the extremity of the rectum. They some-

S82 DISEASES OF THE DiaESTIVE FUNCTION.

tinies produce infiamination of the rectum, and discharges of blood with
tenesmus, and are exceedingly difficult to remove.

Signs of Taenia, — Sense of weight and pain in the abdomen ; with
burning, and feeling of something alive in the bowels ; " prickings or
rather bitings felt in the region of the stomach ; the abdomen swells
at intervals and then subsides ; sense of cold in the abdomen ; appetite
voracious ; complexion livid ; pupils dilated; vertigo; vomiting ; the legs
vascillate and the whole body trembles convulsively; small substances
resembling gourd seeds or lemon seeds passed with the fseces, which
are found to be portions of these worms. {Brera^ p. 147.) Some
authors say, there is an uneasy feeling on hearing music. Though the
concurrence of many of the above symptoms may indicate the presence
of worms, it is also certain that any one of them may arise from other
causes.

Diseases and sympathetic Effects produced hy Worms, — Nympho-
mania in females, and seminal emissions in males : epilepsy ; hysteria ;
convulsions, dilatation of the pupils ; amaurosis, symptoms of hydro-
cephalus, and even mania. Kraus says, one man of advanced age was
effected with immoderate fits of laughter. In one case the convulsions
caused by worms were soothed by music, like those caused by the bite
of the tarantula. In a case, mentioned by Hoffmann, yellow vision was
caused by worms. Many cases of mania and aphonia were relieved by
expelling worms ; one man had spasmodic action of the muscles of the
eye, which inverted the eye-ball, causing it to present the appearance
of a globe of flesh. A case is reported by Serres, which resembled
hydrophobia ; some cases of cures are supposed to have been of this
kind. Stokes says, he saw a child which had convulsions, coma and
dilated pupils ; two eminent physicians declared the case to be one of
hydrocephalus ; treatment directed to the head had no effect ; but some
lumbrici were expelled, and in two or three hours there was improve-
ment, and a speedy recovery followed. He says, he tried to relieve a
boy of intermitting difficulty of respiration, with wheezing, loud ring-
ing, incessant cough coming on in the night ; but Calomel, Ipecac, and
Tartar-emetic made the' case worse. There being a swollen abdomen
and constipation, he gave some Castor-oil and OL-Terebinth, which
brought away some lumbrici; following this with a syrup of cowhage
(Dolchicos pruriens,) a large quantity of thread-worms were expelled
and the cough ceased. A young girl had chronic bronchitis and hepa-
tization of part of the left lung, and they gave her some cow^hage
and aloes, the cough ceased, and respiration became perfect in that
ung. Ramsay, of London, says, hsemoptysis may be caused by
worms ; Stokes says, consumption also may result from the irritation
produced by worms.

But it is quite as common to attribute too much to worms as to over-

I2;rTESTmAL WORMS. 88B

look tlieir existence; a disease may happen to exist at the same time
with worms without having been caused by them. The same remedy
which expelled the worms, may have been appropriate for the attend-
ant disease. And children are very frequently injured by treating
every species of intestinal irritation with anthelmintics and drastic pur-
gatives. Nervous and hysterical persons easily imagine the presence
of worms or other living creatures in the intestines, and can never be
satisfied with any reasoning until they see the parasite expelled. Such
fancies often exist in the minds of incurable hypochondriacs.

Dr. Morton, of Ohio, proposes to distinguish diseases,- caused by
worms, by the following additional symptoms, which, when united with
others, are "unerring." "A pearly whiteness of the sclerotica of the
eye, — a brilliant shining carmine tinge of the lips, particularly the
upper,— and a peculiar almost indescribable expression of the alee nasi,
which can be compared to nothing except the expression seen in the
same organ in the facies-hyppocratica." ( West. Med, Jo%iT,^ vol. 6. p. 82.)

Causes. — What is the origin of intestinal worms ? It has been ge^
nerally supposed that they are introduced into the stomach, either in
the egg-state or more fully developed in food or drink taken into the
stomach or in the air breathed into the lungs. But it has been shown
by Miiller, that the worms found by Linnasus in the marsh in Lap-
land, and pronounced the same as those existing in the human body,
have never been found in the body of any animal whatever. The intes-
tinal 'Worms found in the human body, exist no where in the external
world, either in any article of food, in earth, in water, or in air. Brem-
ser examined 15,000 species of worms in the cabinet of Vienna, and
could easily distinguish those belonging to the human intestines. It is
not possible that they can have originated without the body, and under-
gone a change of structure by being transplanted to a new locality ; for
no specimen has ever been seen which was in the transition state be-
tween one species and the other. And the most distinguished physi-
cians and pathologists have come to the conclusion, that they must
have originated within the body.

1, They have a peculiar structure, differing from all worms found
elsewhere.

2. The worms found in different animals have all their own pecu-
liarities.

8. Worms are found in different parts of the human body, in the cel-
lular tissue, the liver, the gall-bladder, the lungs, the trachea, the brain,
heart, kidneys, and spleen. They have been found in the air-bladder
of a fish, in the ovaries of a woman, in an aneurism of the mesenteric
artery of a horse, in the anterior chamber of the eye of the horse, of
birds that had just broken the shell ; and in the human eye ; in the
human foetus ; and there are worms peculiar to certain structures, that

884 DISEASES OF THE DiaESTIVE FFKCTIOlSr.

have neVer been found any wtere else. Though each structure has
worms no where else to be found ; and we never find any one of them
in the act of passing from one of these situations to another, or detect
it in the structure from which it might be supposed to have travelled.

Dr. Stokes thinks, that all these parasites originate in the places in
which they are found by an original generation "the result of one orga-
nization taking place within another — the production in fact of a dis-
tinct being."

The theory of Bremser and others is that intestinal worms are
formed by the presence of semi-assimilated nutritious matter in the
digestive tube. Food taken into the stomach under ordinary circum-
stances is converted into a substance fitted to supply the waste and
wear and tear of the living body; and when this process is not per-
fected, it is not taken- up by the absorbents, and is then converted into
an animal substance ; this theory explains why %orms so frequently
occur in cases where the assimilating powers are weak, in persons who
have great appetites and weak digestion, and in children with diseased
mesenteric glands. {Stores in London Med, Jour.^ May, 1834.)
Bremser says, a monk, who had lived for sixty years in good health on
animal food, suddenly changed his diet for one of milk and farinaceous
vegetables. After a few days he was troubled with flatulence, sour
eructations, colic, &c. Kemedies carried off a mass of tape-worm
The monk resumed his former habits and recoved his health.

Pathology. — Broussais taught, that worms were always asso-
ciated with a chronic inflammation of the gastric intestinal surface
But it is known that worms exist in connection with every possible con-
dition of the intestinal canal, even when it presents tbts appearance of
perfect health. Andral says, that they are almost atways enveloped
in a quantity of mucus, and he found some redness in the place where
they lay, which was caused by their presence. They are rapidly ge-
nerated in some animals in their best state of health.

Pathological Changes effected hy Worms, — -Fischer, of Vienna,
saw two circular orifices in the colon of a female which communicated
with a cavity in the peritoneum, and a lumbricus had passed half its length
from the colon into the peritoneum. A similar worm had entirely passed
into the peritoneum. Andral saw a young man, in whom a tumor
formed near the umbilicus, which afterwards gave way and discharged
a lumbricus and a large quantity of puriform matter. Worms and pus
were also found in the peritoneum on dissection. (Pathol. Anatomy^
Bremser examined a dead fish, from the abdomen of which a worm had
made its way to the outer world, had perforated the abdomen in another
place, and had returned part of the way into the body. In one well-
authenticated case a lumbricus was discharged through a tumor in the
groin of a woman ; and, during the progress of the case more than one-

INTESTINAL WOEMS. DOO

hundred more worms passed out through the opening. In another case
twenty-four worms were discharged through an opening, which was
formed by ulceration in the right hypochondrium. In some of these
cases it has been supposed, the worm that first escaped f erf orated \}a^
intestine, but in the most of them it is evident that the aperture was
formed by inflammation and subsequent %ilGeration^ first excited by the
irritation of a mass of worms. The inflamed intestine forms an adhe-
sion to the walls of the abdomen ; the different structures, in their
turn, ulcerate, and the worm and his accompanying mucus, pus, and the
contents of the bowels are conducted to the surface. In one case,
mentioned also by Stokes, a lumbricus made its way from an abscess
of the liver through the parietes of the abdomen. On dissection, the
abscess was found to have a connection with the stomach, from which
it was supposed the parasite had passed into the liver,

Oonditions in which Worms, a/re most rabidly produced,— Most
common in debilitated cachectic children under six or seven years of
age. Their digestion is imperfect ; gastro-intestinal mucous mem-
brane irritable and in a low state of vital power; food but partially
digested undergoes some other decomposition. A diet of unripe vege-
tables, containing too mujch sugar, and deficient in tonic ingredients
favors the formation of worms. By an old law of Holland, criminals
were often condemned to live on bread without salt. The effect, says
an author, "was most horrible; these wretched creatures were de-
voured by worms engendered in their own stomachs." The. want of
salt in the food of sheep originates the disease, called the " fluke" or
"rot." It oftenest commences in low and damp pastures or where sheep
are too much crowded together. Worms are said to be sometimes epi-
demic, or endemic in particular localities. It is said, that the Swiss^
who live much on vegetables, are very subject to worms.

"Worms are to the intestinal mucous membrane, what the acarus is
to the skin, and are best removed by the ordinary anthelmintics. The
general or radical treatment to prevent the morbid secretions upon
which the worms are supposed to feed is indispensible ;" but it is always
proper to preface it by the active expulsion of the parasites.

Dr. Epps says : {On Constipation, p. 171), " Worms exist alive in the
stomach and bowels. The unscientific physician gives emetics and
purgatives to expel them," but by this treatment he does not remove
the diseased condition in which they originate. John Hunter first ex-
plained the process by which the disordered stomach secretes the gas-
tric juice of a perverted character which permits the parasites to live
in the stomach.

Vol. I.—25.

386 DISEASES OF THE DIGESTIVE FUJN'OTIOK.

Diseases connected with the Presence of Worms.

VERMINOUS BIAREIKEA.

It is common during the warm seasons of spring and early summer^
and sometimes supervenes upon cholera infantum. It continues, when
not checked until the emaciation is extreme; and it often proves fatalj
The attendant fever, irritability of stomach, vomiting, thin, watery»
fetid alvine discharges, thirst, and impaired or extinct appetite corres-
pond almost entirely with cholera infantum. But the characteristic
symptoms which denote the presence of worms are, in the earlier stages,
the prominent features of the disease.

Causes. — Catarrh re trover ted upon the mucous membrane of the in-
testines ; improper use of fruit, indigestible diet. Once induced, it is
kept up by enteric verminous irritation in children in whom these en-
tozoa already exist. In many cases the disease is originally excited
by them.

TEEATMENT.~The Ordinary treatment for worms will be sufficient
to begin with ; but specific remedies for the correction of the dyscrasia
which favors the continual production of worms are necessarily, asso-
ciated with treatment proper for the diarrhoea.

Spigelia, followed 'by Cinnabar, will succeed in ordinary acute cases«

In chronic, or sub-acute cases, the difficulty is greater. The patient
is enfeebled, emaciated, and the mucous membrane of the stomach and
bowels is rapidly becoming disorganized, and effusion on the brain is
threatened. In these cases the treatment directed under follicular
enteritis will be proper.

Rheum in the form of a diluted syrup is peculiarly suited for children
in this disease. When persistently used it changes the action of the in-
flamed or irritated mucous membrane to a similar though different action,

Diospyrus or Persimmon, — A tincture diluted with water has been
highly successful in the Southern states.

Terebinth, — This remedy is specific against worms, as well as
against the mucous inflammation of the bowels. If diluted with some
syrup or emulsion it may be given in doses of one drop or less.

Piet—ln all cases permit the use of such food as is appropriate for
follicular enteritis, {which see.) Flannel should be worn next the skin,
which is usually cold and bloodless.

Treatment of Worms. — The indications are :

I. To expel the worms ; II. To prevent their reproduction.

1. Anthelmintics. — Those in popular use, which act mechanically,
are, filings of tin, Dolchicos-pruriens, pulv. Charcoal, and Crude-mer-
cury. Of these the second, Dolchicos-pruriens or cowhage is the
only one much used. The legumes are beset with stiff hairs, which.

INTESTINAL WORMS. 887

when applied to the skin, excite intolerable itching. Generally given
in form of an emulsion to expel ascarides.

We never prescribe any of these articles.

Ascarides are often removed in great numbers by injections of a de-
coction of aloes and milk ; also by injections of cold salt-water.

Among the specifics which destroy worms by some poisonous pro-
perty, are a great number of vegetables, most of which are remarkable
for a strong and peculiar odor : as Valerian, Assafoetida, Camphor,
Geoffrea-inermis, Chenopodium-anthelminticum, Artemisia-absinthium,
Tobacco, Garlic, Spigelia-marylandica, &c.

SjngeUa-marylandica or Carolina-jjin'k.—ii^ active power is in a
bitter substance and a fixed volatile oil. The bitter extract possesses
narcotic powers and produces intoxication, fulness of the head, ringing
in the ears, vertigo ; water extracts the active properties. {Bigelow^s
Med, Botany, vol. 1. p. 144:.) The whole plant is active, but the root
possesses the most power.

Spigelia, given in large doses accelerates the pulse, flushes the face,
produces drowsiness, and sensation of stifihess of the eyelids. {Dr,
Thorwpson^ Inaug. BissevL Phil. 1802.) Eberle says, he gave three
or four gills of a strong decoction of the root to a boy, six years of
age, and it produced " complete mental derangement, precisely like
that caused by Stramonium. The boy w^as affected by alternate fits
of laughing and crying ; he ran about the room, talking wildly and in-
coherently. His countenance was distorted in the most fearful man-
ner, the pupils greatly dilated ; the symptoms subsided in twenty-four
hours. In doses too large, the Spigelia often produces slight giddi-
ness, dimness of sight, and dilatation of the pupils. It is often given
allopathic ally in doses of ten grains or more to children. The decoc-
tion is more often used. Given in this way, it perpetuates the disease.

We cannot sanction the use of Spigelia in poisonous doses, but we
have long used it for the purpose of curing the drug-symptoms above
named.

Gina {Wormseed.) — Ascarides, lumbrici ; pinching colic and irri-
tating pain in the umbilical region from worms ; spasms of children
from worms ; during the intervals they partially sleep, rubbing the nose,
the eyes half closed ; epileptic spasms at night ; whooping cough with
worms ; bluish color around the mouth. Cina is the seed of the

Ohenopodium-a?ithel7ni7itiGum, or Jerusalem oak, a plant indigenous
to the United States and some parts of South America. As an anthel-
mintic the seeds are pulverized and given in doses of from twenty to
forty grains in syrup. But the essential oil is more convenient, as it is
very active. A child, two or three years old, may take from three to
eight drops of the second dilution. Dr. Morton, of Ohio, says, he cured
one-hundred successive cases of worm-disease with this article.

888 DISEASES OF THE DIGESTIVE FUIJTCTIOK.

We have not in twenty years found it necessary to use any of these
poisonous anthelmintics.

Symptoms. — Most of the symptoms appear at night. Nightly restless-
ness ; yawning, with sudden tremor and shuddering ; disposition to
w^eep or complain ; tickling cough ; Cramps ; stupefying headache ;
weariness and soreness of the eyes ; dilatation of the pupils ; paleness
of the face ; sickly appearance ; canine hunger ; diarrhoea.

jSantonine.-— This is a cry stalliz able, fusible, volatile substance se-
parable from the terminal flowers of the Artemisia, or Chenopodium-
santonica (Cina, Semen-contra). Discovered in 1830, by M. Kahler,
of Diisseldorf. It produces the pathogenetic symptoms enumerated
by Hahnemann, as peculiar to Cina : "Heat and flushed or pufly face^
bluish pallor around the nose and mouth, agitation, delirium, wakeful-
ness, and insurmountable somnolence in succession; epileptiform con-
vulsions, palpitations of the eye-brows, dysphagia, partial spasmodic
movements of the limbs, and cramps ; dilatations of the pupils, troubles
of sight ; frequent desire to urinate, &c."^ This shows, that Cina is not
merely a vermifuge, but that it exerts also a homoeopathic action against
the morbid state, which results from the presence of worms ; and we
habitually see it dissipate the symptoms for which it has been exhibited^
either in massive doses or in infinite stimals without having expelled any
worms.

Dr. Grabalda gives a case (L'Art Medical), in which all the above
symptoms were caused by Santonine. They subsided without the ex-
pulsion of worms.

M. Martini observed, that patients who had taken Santonine in full
doses, saw all objects green after the lapse of a few minutes, an effect
which with some patients lasted all day. This phenomenon is attri-
buted, not to a transient coloration of the blood-serum, but to a mole-
cular action on the retina, by which the tension and vibratory reaction,
of its nervous molecules are changed under the impression of the lumi-
nous rays. The eye thus affected generally sees objects greenish
yellow.

Asearides. — Dr. Compiret {Amer, Med. Monthly^ I860.), the best
remedy isa " simple injection of water, containing five, ten, fifteen, or
twenty drops of Sulphuric-ether, according to the age of the patient,
and repeated according to the number of the worms present. This
agent, by its subtility readily enters into and destroys the larvae ; and
by its antispasmodic powers it allays the spasmodic and nervous symp-
toms produced by them."

Oleum Terebinthinm. — ^This article has long been considered the
most certain of the anthelmintics. Turpentine, says Dr. J. Smith,

* Materia Medica Pura.

INTESTINAL WORMS. 889

seems peculiarly destructive to vegetable life ; small insects are speed-
ily destroyed by it ; indeed no other drug exerts so fatal an influence
over the majority of parasites wtiicli infest animal and vegetable life.
{Loud, Jour, Med, l?ibO,)

It should be given several times at moderate intervals, and in this
manner it seldom fails to destroy the tape-worm. It has been a com-
mon though very bad practice to give 01. Terebinth in large doses. In
this way, though it stimulates the system generally, it passes rapidly
through the bowels ; and the quantity absorbed seldom produces stran-
gury. Gastor-oil is added to it or given after it, and bland demulcent
drinks freely used. Others give 01. Terebinth in doses only of a few
drops every four, five or six hours. But such doses often produce stran-
gury. Still smaller doses have been successful in removing the follow-
ing symptoms: dull pain in the epigastrium; sickness of stomach after
eating; vertigo; dry, short cough ; foul breath; and choking sensation
in the throat. Worms expelled by it in such cases appear in a dis-
solved state. "When this course is long continued, strangury may be
produced. Camphor and large quantities of diluent drinks with mucil-
age of Gum Arabic may be given to obviate their effect.

In 1832 Dr. Bardwell of Indiana, gave 01. Terebinth to a sailor
from the Bast Indies, who was supposed to have stone in the bladder.
He discharged seventy or eighty lumbrici. He afterwards passed bloody
urine and. vast quantities of dirty white, hair like worms from the blad-
der ; about two thousa.nd were discharged. He recovered. ( W, Med,
Jour, No\. Nil,, p. 354.)

AspidiuTn-filiX'mas, — M. Eeschier of Geneva, has obtained from
this plant a fatty principle by digesting the root in Sulphuric-ether.
The preparation has an oily consistence and is used to expel the tape-
worm, in doses of one drop, made in a pill with extractive matter. Eight
pills are often siifficient to expel the tape-worm, though sometimes
thirty or more, in the course of several days are required. The tape-
worm is effectually destroyed and removed by a purgative.

SidphuriG-aeid,—!. Dr. Darrach, of Quincy, III, says : Dr. Nichols
ordered Sulphuric-acid aromatic, one ounce, water one and a half
pints. The patient to drink as often as he could. On the third day
he passed of tape-worm in fragments. The dose was repeated on
the fourth day, but there was no more of the worm. He had been
debilitated and emaciated, had severe cough. After the tape- worm was
expelled these ceased; and he gained flesh and strength.

2. Thirty years ago the same remedy was used at Cape Ann, Massa-
chusetts. A lady took a tea-spoonful of Sulph.-acid-aromaticum and
expelled the vessel half full of the animal.

3. A woman in Quincy, 111., kept her bed for two years and passed
five feet of tape-worm. Turpentine was given two days without success.

890 DISEASES OF THE DIGESTIVE FUNCTION.

The acid was given, three doses in twenty-four hours, in sweetened
water. A large worm was expelled, and health and flesh returned,
[Amer, Jom\ Med. Sciences^ Oct., 1860, p, 377.)

Principal Eemedies for Worms.— ^ot* AsoarideSy Acon.j Calcar
Chin., SidjpL- OuprL, Ferrum^ Ignat^ Cinnabar,^ Nux.-vom.^ Shigella
Sidphur,

When accompanied bj fever \—AGon.y Bell., Gina^ Ferrum, Merc,
Spigelia.

For LuTribrici. — Acon.^ Bell., Calc, Cham., Chin., Cio, Cina, Merc,^
NaiTmn-muT,, Spigelia^ Sulphur. In scrofulous children. lod.-suiph.,
Calc are a.

Worms with emaciation. — Arsen., Calcar-hyperphos., Gina^ Graph,,
Spigelia, Cinnabar, Iodine.

Worms with diarrhoea. — Aeon., Gina^ Ginnabar, Spigelia, .

Worms with convulsions. — -Giouta^ Spigelia. We have seen the
latter promptly successful when the convulsions were alarming and
had resisted several remedies, A few drops on a handkerchief and
applied to the nostrils dispelled the paroxysms of convulsions perma-
nently.

Genus XIL— PROCTIOA.— H.^MOREHOIDS.

Anatomioal Stnicture of the Hectibm. — -The veins of the rectum
are very tortuous and numerous, and form between the mucous mem-
brane and the muscular coats of the intestine quite a network of ves-
sels. The hsemorrhoidal veins unite in forming the interior mesenteric
vein, which with the superior mesenteric vein, the vein from the spleen,
and the gastric vein, compose by their union, the great portal system
vein, described as supplying the liver with blood.

As the blood is supplied to the rectum from such various sources,
and in such abundance, the reason is apparent why in diseased states,
blood is discharged from these vessels ; and also why in cases of
constipation blood often passes at the time of evacuation of the
bowels.

The external surface of the rectum has a great resemblance to the
external surface of the oesophagus. It is smooth and polished, with-
out any elevations and without longitudinal depressions which are so
evident in the colon; the only marks it presents being parallel, depen-
dent on the powerful muscular fibres which form a part of this in-
testine.

In the rectum the faeces accumulate, lose their thinner parts by ab-
sorption ; they then in the healthy state become moulded into a form
corresponding to the shape of its upper portion. When they have
■ accumulated to a certain degree they excite the rectum to contraction,

HiSMOEEHOIDAL DIATHESIS. 891

and a sensation is experienced causing a desire for their expulsion.

Their escape at any other time is prevented by two muscles, the ex-
ternal closing muscle or sphincterj and the internal closing muscle or
sphincter which is only a portion of the former. When the will sub-
mits to the internal prompting to expel the contents of the bowels,
several agencies operate together in their expulsion :

1. The m.uscular fibres of the rectum contract ; 2. the diaphragm
acts by contraction which is follow^ed by inflation of the lungs; 8. the
muscles of the wind-pipe close the epiglottis or valve at its top, which
prevents expiration ; 4. the abdominal muscles contract, in opposition
to the forcing down of the diaphragm and compress the bowels and
force them backward and downward ; 5. and last of all, the two ele-
vatores ani, press the rectum forward and upward, and aid> in the ex-
pulsion, and thus the contraction of the sphincter is overcome.

1. the'h^morhhoidal diathesis.

This predisposition to haemorrhoidal disease consists in a congestive
condition of the pelvic circulation which involve not only the rectum
but the whole digestive tube in inflammatory, spasmodic, or neuralgic
afiectionSj without taking the common form of haemorrhoids. The
patient is often treated for disease of some other name, as gastritis,
or gastro-enteralgia, flatulent colic, engorgements of the liver, obstruc-
tions of the portal system, and finally for insanity. In other cases
there are congestion, inflammation or hgemorrhage of the lungs or brain
or chronic structural disease of the bronchia, nervous headache, neu-
ralgia, asthma.

The superiority of homoeopathic treatment in hsemorrhoidal disease
is not due to the power of our remedies to operate upon the hgemor-
rhoidal circulation, but to their specific influence on the whole s^^stem,
in these cases especially the abdominal venous circulation. Even in
allopathic hands certain mineral waters and a class of remedies called
deobstruents have sometimes benefitted, if they did not thoroughly
cure, patients who suflered from diseases of the character under con-
sideration. Dr. Porges, has analysed the cases cured by the waters
of Carlsbad, and found them all referrible to what he calls ahdominal
venous ]jletlior a. He has also shown that the same waters in sufficient
doses, when taken by persons in health, produce the same diseased con-
ditions for which he recommends their use.

Case hy Dr, Escallier.^^ — A. lady aged fifty- three, tall, lean and
dark, with pimples of aene rosacea on her face ; speech feeble and
painful ; slight dry cough, palpitation very constant and distressing,

* L'Art Medical.

892 DISEASES OF THE DIGESTIVE FUNCTION.

worse after eating, and preventing sleep ; some cerebral excitement af-
fecting the hearing, causing lier to imagine that she hears the report
of cannon or exploding rockets ; some maniacal paroxysms; she has
been reduced to a milk diet ; can now hardly rise from hear seat ; faints
several times in the course of the day, and is supposed to be dying ;
flatus in the stomach or bowels increase the palpitations ; pulse small,
rather frequent, with irregular intermissions ; second sound of the heart
strong ; no bellows sound; no osdema of the ankles, but she had amenor-
rhea in youth, and then had ascites, treated by puncture, then cured
by Digitalis. Has now flatulent dyspepsia with constipation ; has had
hysteria under various forms, sometimes accompanied by gastralgia.
Rendered worse by sea-bathing. For this condition, she was directed to
take Arsenicum, twenty-four, and Platinum, twenty-four, in alternatiouj
twice a day, with good diet. ^ The constipation was partially removed
on the second day. By the third day the heart was calm ; she slept,
appetite better, digestion easier. The medicine was suspended. She
continued to improve for ten days; when, the diet disagreeing,
she took Nux-vom. one hundred. Next day she was doing well, medicine
suspended. Then she continued to improve; and the dijQSculties of the
heart and other organs returned no more.

2. HiEMOEIlHOIDS.- PILES.

Diagnosis. — This very common and troublesome complaint will pro-
bably demand the attention of the physician more frequently than any
other single malady ; nor when we consider the causes which originate
it, and their almost constant and universal prevalence, shall we be sur-
prised at this. Any cause which operates upon the rectum in such a
manner as to impair the integrity of its vascular and muscular struc-
tures, may induce the disease. The efiects in these cases are : a per-
manent dilatation or varicose condition of the veins, and a relaxation
of the mucous membrane of the part, causing tumors of various sizes,
at the verge of the anus, and within the rectum, and in some instances,
a protrusion of a portion of the rectum itself. When this last result
obtains we are presented with the disease known as prolapsus ani.

Bleeding Hmmorrhoids, — ^Many persons experience small discharges
of blood with the fseees whenever the blood vessels of the abdomen
are in a state of congestion from cold or an over-stimulating diet. The
veins of the rectum are the most dependent part of that whole system
of vessels, which should convey their contents by the vena portge
through the capillaries of the liver. Any influence then that retards
the flow of blood through the liver, causes an engorgement of the
hasmorrhoidal veins.

Symptoms of Bleeding from the Rectum. — There is a sense of

HEMORRHOIDS. 393

weiglit, lieatj fulness, and general uneasiness in the rectum wHcli in-
creases for twenty-four hours ; then when the bowels act, part of the
discharge is liquid ; this consists of blood, which seems poured out
only at the time of the evacuation ; or the passage of the faeces pro-
duces the rupture of the small vessels from which the haemorrhage
proceeds. On the next day the uneasy sensation is lessened, and it
soon ceases altogether. The patient says, he is relieved by the flow.
This transient relief often deceives him. If it happens to be suppressed
by treatment, he immediately suflers from abdominal venous plethora,
as well as from cerebral symptoms.

When the haemorrhoidal bleeding continues long it always produces
anaemia, debility and consequent nervous symptoms. In some cases
the loss of blood continues for months, reducing the strength more
obviously at first than afterwards. When the loss extends to two or
three ounces per day there is only some sensation of numbness extend-
ing down the lower limbs, paleness of the face, &c.

Case hy Sir Benjamin Brodie, — A lady, suffered from symptoms
of stricture of the oesophagus ; she could not swallow the smallest
morsel of solid food, and was compelled to subsist entirely on liquids
which she swallowed with great difiiculty; these symptoms continued
to increase for three years. A bougie was passed through the oeso-
phagus into the stomach without meeting with an;y 'mpediment. It
was then suspected that the dysphagia was only a wymptom of some
other disease ; her face was bleached as if she had suffered from re-
peated losses of blood, and the feet were oedematous. On further in-
vestigation, the whole train of symptoms were found to have originated
in the loss of blood from internal haemorrhoids. The following remedies
are proper for such cases : Podoph., Lobelia, Hamamelis, Sepia.

FluoTiG-aGid, — -Congestion of blood in the rectum.

Lobelia. — Discharge of black blood from haemorrhoids.

Elatmum. — -Blood from haemorrhoids.

Hemorrhoidal Tumors. — Piles or haemorrhoids are soft tumors,
which form either within the rectum or around the anus. In the first
place they are covered with the mucous membrane of the intestine,
and are termed inward piles. When situated without the rectum they
are covered entirely or in part with the common integument.

Haemorrhoidal tumors may be external or internal — hard or soft — >
sensible or insensible. Their general appearance in regard to color,
size, &c., will depend much upon the amount of inflammation present,
the causes which have been in operation, and the length of time which
has elapsed since the commencement of the malady.

Internal Hemorrhoids vary from the size of a pea to that of a
large walnut. Sometimes there is a single one, in other cases several.
They are found immediately within the sphincter, or at some distance

39-i DISEASES OF THE DIGESTIVE FUNOTIOK.

above it, and may be attached by a narrow pedicle, or by a broad
elongated base. In some cases they do not protrude beyond the
sphincter, in others they are forced outward by slight straining effort.

Symptoms of a fit of H^moeehoids. — It is ushered in by vertigo
dull headache, coldness of the extremities, flashes of heat, heaviness
bloating of the abdomen, flatulence, throbbing in the abdomen, consti
pation, palpitation of the heart, wearinesS, heaviness of the limbs, des
ponding and irritable mood, disposition to mela^ncholy, fulness of the
parts in the vicinity of the rectum, producing heavy pain in the neck of
the bladder and region of the prostate; strangury, pains in the loins
and back, weak digestion, loss of appetite, eructations, heartburn,
mucous coating on the tongue, burning in the abdomen and anus ; dis-
position to vomit, itching of the anus and perineum, eruption on these
parts. When these symptoms are only partially present and the veins
of the anus are swollen, we apply to these veins the designation of
'blind piles; if the turgid vessels bleed at more or less regular periods,
giving some relief to the distressing sensations, the bleeding tumors
are called fluent piles. When mucus is discharged instead of blood
they are called mucous piles.

During "a fit of piles," the tumors are usually red or purple, in-
flamed, and painful, the pain is of a severe kind, aggravated to an al-
most intolerable degree when at stool, and accompanied by tenesmus
and frequent discharges of blood. The location and character of the
pains vary much in different cases, being sometimes confined to the
tumors themselves, and at others extending upwards into the intestines
or into the perineum down the thighs, &c. The pains may be itching,
burning, aching, throbbing, darting, or shooting, constant, or only when
at stool, on sitting down.

Causes. — When the mucous membrane of the rectum is much re-
laxed, we almost always have as a complication, jpr(9Za;p5i^(5 ani. Al-
though this complaint sometimes originates independently of any
heemorrhoidal enlargements, in the majority of (severe) cases the two
diseases are conjoined, and this is ex23licable from the circumstance
that the causes of both are generally the same. The most common of
these causes is hohitucil constipation^ induced, for the most part, by
the reprehensible practice of inattention to daily alvine evacuations.
We have before observed that the protracted presence of indurated
foecal matters in the rectum, gives rise to a semi-paralytic condition,
which impairs the tone of the parts, and thus induces constipation^
piles^ and prolapsus anL The evils, then, to which this condition of
the lower bowels give rise, may be summed up as follows: first con-
stipation^ and the numerous and grave consequences which often result
from it, in the form of determinations of blood to the brain, lungs, and
intestinal canal ; also mania, hypochondria, neuralgia, dyspepsia, bowel

HiEMOEEHOIDS.

895

affections, colic, fistula in ano, &c.; second, j?iZ^^, and its train of un-
pleasant symptoms; third, prolapsus anL

OTHiiHi Causes of these affections, in addition to tlie one already
mentioned, are, abuse of cathartics, as Aloes and Sulphur, which operate
specifically upon the lower portion of the intestinal tube ; ascarides
excessive exercise on horseback, long continuance in the standing pos-
ture, or in certain other constrained positions ; protracted bowel com-
plaints, general debility, dyscrasias, sedentary habits, indulgence in
highly seasoned food, coffee, wines and liquors, tight dressing, lacing
the epigastric region of the abdomen, and all other causes by which
the regular course of the circulation is interfered with. Sleeping on
feather beds, and sitting on soft chairs are common causes.

Teeatment. — The first object with the physician in the treatment
of hemorrhoids, should be to ascertain the cause or causes upon which
the malady depends, so that immediate and efiicient measures may be
taken to remove them. In a majority of instances the disease is un-
questionably connected with constipation^ which should therefore
receive a due share of attention. Nothing can remove the torpid con-
dition of the bowel, upon which the constipation depends, unless all
indurated faecal matters be removed daily, in order that a sufficient
time may elapse, to enable the debilitated parts to recover their im-
paired tone. The first step necessary to secure this result is to adopt
suitable dietetic regulations. In many instances . this alone will
suffice to regulate the bowels, and thus to remove all traces of the
hgemorrhoidal, affection. Amongst the articles of food which we par-
ticularly commend in those cases, in Avhich the stomach is not irritated
by it, is bread -made from unbolted wheat. A liberal and daily use of
this highly nutritious substance, and of other articles of a similar
character, with an occasional indulgence in ripe and wholesome fruits,
and the habitual free use of cold water as a drink (see page 297), will
often surpass our most sanguine expectations in abolishing diseases of
the rectum. Should these simple means alone prove ineffectual after
a thorough trial, we may then call in the aid of enemata of cold vfater.
This last resource will rarely disappoint us, provided the case is recent,
and the cause has not been too long in operation. When the hsemorr-
hoidal tumors are much inflamed and very painful, great service will
frequently be derived from external applications of- cold water, and in
some instances, of ice, enclosed in a linen cloth, and applied to the
parts as long as may be deemed expedient. In troublesome cases of
prolapsus anij also these applications and injections will sometimes
afford prompt relief. Water moderately cool is often better thaln ice.

The medicines which are entitled to the highest consideration in
hsemorrhoidal affections are, JS^icx-vomica, Sulphur^ Rhus-tox.^ Sepia^

396 DISEASES OF THE DIGESTIVE FUNCTION.

JBryonia^ LyGopodium^ O^ium^ Pulsatilla^ Aloes ^ Carbo'Vegetabilis^
and Calearea-carb,

Nux-vomica is appropriate in choleric dispositions, when the disease
has been caused by inactive and sedentary habits, high living, use of
coffee or spirits, or the depressing mental emotions, and is attended by
constipation, prolapsus, and general loss of power over the muscular struc-
ture of the rectupa; stinging, burning or itching of the anus; stitches
and shocks in the small of the back, with bruising pain; frequent con-
stipation; unsuccessful urging to stool; congestion of blood to the
abdomen and head; bloating of the pit of the stomach and hypochon-
drium; heaviness of the head, inability to think; retention of urine:
discharge of blood and mucus, &c. It may be given in the second or
third attenuation, one grain every night as long as is deemed expedient.

Kali-Garionicum, — Constipation owing to inactivity of the rectum,
passage of fajces difficult, owing to their bulk; the knobs bleed and
swell during a stool, or when the urine is passed.

CalGarea'Garl)oniGa.---^2idmorv\ioi^^ which bleed profusely, are pro-
truded in knobs, and become painful in walking, relieved by sitting
down; protruding and forming a bunch externally, in evacuating the
bowels; constipation; disposition to determination to the head, when
the hsemorrhoidal flow of blood is arrested; haemorrhage in females
having the menses too early and too profuse.

J!for^(2^5^(3-(2(?^<^. — Prolapsus recti when urinating; swollen, blue,
protuberant knobs, very painful to the touch.

Phosphorus. — Haemorrhoids appear simultaneously with chronic
diarrhoea in which the sphincter ani is relaxed ; the stools mucous,
liquid, and passed involuntarily.

Nitrid-acid,- — Old haemorrhoids, particularly after the abuse of
Mercury with remains of condylomata and syphilis.

^/w^*(^.-— Excrescences on the skin, or syc otic affection, remaining
after the local symptoms have disappeared spontaneously, or been
driven away by local means. Symptoms: Feeling of pressure on the
hasmorrhoids, with compression; swollen knobs, protruding much:
tenesmus; itching, burning in the anus.

Garbo-veg. — Constant bleeding at every stool with burniDg and
itching in the anus; great swelling of the tumors, and lancinating pain
in the thighs.

CfetM'^'z'c^'iy^m.— Constipation with ineffectual efforts of defecation, when
the knobs impede the passage of the faeces ; the pains are aggravated
by walking, and especially by mental labor.

Graphites. — Feeling of weight in the abdomen; chronic constipa-
tion, with hardness in the region of the liver; hard knotty stools with
discharge of mucus and blood ; pains in the haemorrhoidal knobs ; pro-
lapsus ani without straining, as if the sphincter were paralyzed, (see

HiEMOERHOIDS. 397

its use in constipation, page 331) ; watery leucorrhoea at tlie time of
menstruation.

Sepia. — Its special sphere of action is the portal circulation. Its
effect is to retard the circulation, and cause an over-loading of the
portal vascular system with venous blood. The condition it produces,
and which it specially cures, is 2. jplethoria "oenosa^ with a correspond-
ing state of depression. (See Meyer^ in IIo7)%Ge,0']p, Vieri.j &g)

SuljyhuT. — Irritable disposition, tenesmus, vomiting, griping; the
power of Sulphur to produce these symptoms enables it to cure similar
symptoms in cases of dysentery, haemorrhoidal diseases attended with
tenesmus.

Sulphur is well adapted to cases occurring in individuals tainted
with syphilis, scrofula, psora, or mercury. If the piles bleed frequently
and profusely, and there exists considerable inflammation of the sur-
rounding mucous membrane, with darting pains up the bowel, tenesmus,
discharges of mucus or of fsecal matters, mixed with blood and mucus,
this medicine will generally prove effective. It should be given at the
third attenuation—one grain morning and evening, until the desired
effect is produced. In some psoric constitutions Sulphur is effectual
when given in high attenuation and permitted to have a long-continued
action.

Mhus-tox.j in alternation with /S^'t^Z^A'WT' or Nux^ has been eminently
useful in piles and prolapsus conjoined, which appeared to be connected
with some latent impurity of the blood. We are accustomed to use the
first or second attenuations in these cases— giving a dose daily, and
changing the medicine every other week.

When the haemorrhoidal tumors protrude, and are inflamed, red, and
painful, with profuse haemorrhage during each evacuation, we may con^
BidiQ^Y Acid-nitr,, Acid-mur,, Aloes, Calcarea-carh.y and Sepia,

If the disease arises during pregnancy, and constipation is unusually
obstinate, we advise Pulsatilla^ Opium, Bryonia and Platina,

Administratioit. — This malady responds more satisfactorily ttj the
first, second and third trituration — given in grain or drop dosei^, once
or twice in twenty-four hours.

Case by Dr. H. C. Preston. Hamamelis-virginica is Ucjed empiri-
cally and with success in varicosis of the haemorrhoidal veins, except
when coagulation has reduced the veins to hard cords.

A woman, mother of six children, middle age, had at xma time vari^
cosis of all the veins of the legs up to the groin, crampj pains in the
legs, preventing sleep. Bandaging the legs, and use of Hamamelis
cured for the time. At one time after delivery, when haemorrhoids
were in the worst state, she took Hamamelis, six drops to the tumbler
full of water, a table spoonful every hour. This, with external use of

o9o DISEASES OF THE DIGESTIVE FUNCTION.

a tinctuiie of tlie remedy, applied with linen clothSj gave entire relief
in twenty-four liours. It did not return.

Aloes, — In large doses it excites griping heat at the lower part of
the rectum and haemorrhoids ; frequent small evacuations, chiefly of
mucus, attended with tenesmus; abdomen at the same time distended
and tender; the patient complains that the "bowels feel as if scraped;"
pulse quickened; sensation of constriction of the head. Under long-
continued use of Aloes we observe emaciation; the purgative action
becomes more uncertain ; mucus and portions of lymph, and sometimes
matter resen-pbling fat, being passed off with much tenesmus, enteritis,
stricture of the rectum; some degree of diuresis where squills and
other diuretics have failed. In appreciable doses it aggravates dys-
menorrhoea, monorrhagia, organic disease of the uterus, haemorr-
hoids, &c.

3. PROLAPSUS ANI.— PROTRUSION OF THE RECTUM,— FALLING OF

THE INTESTINE.

This affection has often been described, as consisting in an extrusion
of the mucous and sub-mucous coats alone through the expulsive
power of the muscular coat of the rectum. But it is really an inver-
sion of all the coats of the intestine. The protrusion and eversion of
the rectum is effected by the weight and pressure of the bowels above,
aided by the contraction of the abdominal muscles in the act of reliev-
ing the bowels. At ordinary times, when the sphincter is contracted,
its strength is sufficient to resist the bearing-down forces above; but
when the bowels act, the sphincter is necessarily relaxed, and the
strain is allowed to tell on its lateral adhesions. The rectum is indeed,
as well as the oesophagus and colon, provided with a strong coat of
longitudinal fibres; but its power is rendered inadequate to its object,
and when the bowels are long constipated, the passage of a mass of
solid fseces will carry through the rectum an everted fold. This
generally returns spontaneously, but its frequent repetition renders a
spontaneous replacement less and less. perfect.

Causes. — Habitual constipation and frequent efforts to relieve it by
purgatives; the tenesmus attending diarrhoea or dysentery; certain
purgatives which operate specifically upon the rectum, as Aloes, Podo-
phyllum, Sulphur. Calomel and Blue-mass often cause it. These ar-
ticles, therefore, are remedies for certain cases. The protrusion of the
rectum is also often caused by straining, as from the irritation of a
stone in the bladder, which causes involuntary bearing down. In
children this effect is peculiarly liable to occur; and if the stone be
removed by an operation, and the cause of the straining is removed,
the prolapsus ceases to take place. It is more common in persons de-
bilitated by disease, or by inherited discrasias.

:derattgemeiv[ts of the liver. 399

Prolapsus is common in children, not otherwise much diseased, and
is usually not serious, though if neglected, it may terminate in inflam-
mation or ulceration of the part.

Treatment.— The tumor is easily returned; place the child for two
or three minutes in a warm hath; anoint the protruded part with olive
oil, and then apply gentle and uniform pressure. If the protruded
bowel is already inflamed, it maybe relieved by- the aid of the fol-
lowing remedies :

Wux-voQuioa; when there is constipation and hard straining. It
has a specific influence on this disease, as w^ell as the constipation and
hssmorrhoids often associated with it.

Jferourius.— When there is diarrhoea or dysentery.

Ignatia.—An'dlogous in its action to Nux-vomica.

Sulphu7\ — -In psoric constitutions, in which there has been diarrhoea
or dysentery, followed by costiveness, and an evident tendency to
relapse.

ORDER II.-FUNCTIONAL DERANGEMENTS OF THE
OOLLATITIOUS VISCERA.

1. THE LIVER.

The Minute Anatomy of the Liver is thus* described by Dr. Hel-
muth.^ "Bach lobe of the liver constitutes in itself an epitome of
the hepatic structure^ and there are two sets of veins, one artery, and
one duct in each lobule. Of these two varieties of hepatic veins,
the first is the intra-lobular, which occupies the centre of each lobule
and receives the blood from a plexus, formed in each lobule by the
radicals of the portal vein ; the second variety being those veins con-
tained in canals, formed by the bases of the lobules, applied gide by
side, and which veins for the most part receive the intra-lobular veins ;
or in other words, in each of the minute lobules of the liver we have
first an artery (as usual in all organs) to supply the requisite suste-
nance to the part; 2d, a vein to carry oiF the efi'ete blood; then, Sdly,
we have blood from which the bile is extracted, contained in the portal
vein, the secretion being carried away, or received 4thly into the ul-
timate ducts of the acini, and following these channels to the larger
biliary canals.

1. FuNCTioisrAL Derangement' OF the Liver. — The lungs and liver
are the great decarbonizing organs of the body, and the activity of one
of them is always in an inverse ratio to that of the other. "In the
lungs, carbon undergoes slow combustion, accompanied by a disengage-
ment of heat for keeping up the animal temperature and is thrown off

* N. Jo^r. Homoeop. vol. XI. p. 480.

400 DlriEASES OF THE DIGESTIVE FU1TCTIOJ57.

as carbonic acid. In the liver, it unites witli hydrogen, and small por-
tions of hydrogen and nitrogen, and forms bile." In summer, when the
temperature of the air is high, there is less demand on the oxygen of
the air, therefore the decarbonization by the lungs is less, and the
extra labor of getting rid of the carbon which the lungs do not throw
off with sufficient rapidity, devolves upon the liver. This increased
secretion, which the liver is required to perform, demands increased
activity in the circulation of the portal system; and all the radicles
of the veins which unite to form the vena portarum must partake of
the acceleration. The circulation, supplying the digestive organs
must then be more active in warm weather and in warm climates, as it
also is after taking food.

Besides the lungs and liver, the skin also participates in the work
of eliminating carbon and other effete waste materials of the body.
As the product of its secretory function we have a sebaceous matter
for keeping the skin soft and in a healthy condition, also the perspira-
tion furnished by the sudoriferous glands, and a large quantity of fluid
passing off by simple evaporation. And a further duty performed by the
skin is a partially respiratory function, by which it aids the lungs and
liver in the function more especially assigned to them.

The evaporation from the skin, kept up by perspiration, keeps the
temperature of the body at the proper point for health, at the same
time that the respiratory power of the skin is directed in aid of the
liver in the decarbonization of the blood. When the dew-point is low^
these processes go on satisfactorily, when it is high, the decarboniza-
tion is less effectually performed. This relation of the skin to the
liver in eliminating disease-causing materials from the system, is the
ground of that sympathy between them explained by Johnson.=^ When
increased heat is temporarily applied to the skin, it is stimulated to
over-action for a time ; but this increased excitement is followed by a
corresponding depression and diminution of the natural function of the
over-worked organ, with increased susceptibility to the action of any
deleterious influence. When the skin and liver have been for some
time over-excited by heat, exercise or other undue stimulant influences,
and are in a state of consequent exhaustion, the depressing influence
of cold is liable to produce disease by repelling the blood from the
surface, and causing internal congestion of the internal viscera; and,
of these, the liver, being the most exhausted organ, will naturally
suffer most. When the over-excitement and subsequent depression have
been great, the result m^^j he ^^MKous fever f' otherwise the tonicity
of the system is repaired by sleep and rest, and the equilibrium is
restored. If, however, the liver has been too much or too frequently

* On Tropical Climates, p. 19—242.

DEEANOEMENT OF THE LITER. 401

congested, it may not be able, by the re-acting powers of its vessels, to
press out the excess of blood thrown upon it ; and some portions of the
organ may remain in a state of partial congestion. If the causes
which produced this condition continue to operate, the morbid condi-
tions they produce continue to increase. The functions of the liver
become obviously deranged; the stomach, the large and small intestines
become involved. The patient now complains of a bitter taste in the
mouth on waking in the morning, furred tongue, constipated bowels,
languor, yellow adnata, and a heavy feeling over the eyes; and the
skin, participating in the deranged condition of the liver through the
" cutaneo-hepatic sympathy,'^ referred to above, becomes pale, dry and
sallow. If the patient continues to be exposed to the same deleterious
influences, especially if the atmosphere be charged with marsh miasm
or malaria, the resisting power of the system becomes progressively
less, till a stronger determination of blood takes place to the liver,
spleen and portal vessels, and we have the phenomena of a chill, fol-
lowed by the consequent re-action, called fever.

2. ICTERUS— JAUNDICE.

This disease was so named by the ancients, from its likeness to the
plumage of the golden thrush, of which Pliny relates, that, if a jaun
diced person looks on one, the bird dies and the patient recovers.

General Characteristics. — ^Yellowness of the skin and eyes
fgeces white, and urine of a high saffron color. The yellow color of
the skin characteristic in jaundice, is oftexx^only a symptom of some
chronic structural disease of the liver. In this place we shall treat of
jaundice as a specific disease as connected chiefly with functional de-
rangement of that organ.

biliary jaundice,— i^rom Sudden Suppression of the Biliary Secretion.

Under this title Allison and Bright have given cases of a formidable
character. In Allison's case there was "pain and heat in the abdomen
with thirst and chilliness for seven weeks ; then jaundice followed in
two days by delirium — occasional singultus, stools bilious, coma, pur-
puric spots on the skin, death ten days from the occurrence of jaundice.
Liver smaller than natural — flabby — light yellow— mucous membrane
of the ducts unnaturally white." {J^dini, Med. Jour,)

Dr. Bright gives two cases characterized by : " Abdominal pain —
jaundice— tenderness of the epigastrium — occasional sickness. — Three
weeks after the appearance of jaundice, indistinct utterance, loss of
power in the left hand, coma and death. Liver very small, soft or flac-
cid, and of a reddish color. No inflammation on the capsule or in the
ducts, which were not even stained with bile — brain congested." {Guy^s
Hospital Jieports)

Vol. I.-26.

402 DISEASES OF THE DIGESTIVE FUNCTION.

Diagnosis.— Kokitansky says, " it is distinguislied during life by its
acute course, extreme pain in the liver, (not a constant or even frequent
symptom,) nervous symptoms and jaundice ; finally a fatal issue after
fever, symptoms of blood poisoning, irritation of the brain, and its mem-
branes, hydrocephalic softening of the brain, exudation and softening
processes generally, and especially of the mucous membranes, pneumo-
nia, &c. The blood in the larger vessels of the liver is thin, fluid and
of a dirty brown color."

Causes. — ^A serious lesion of the proper hepatic nucleated cells,
"which are, perhaps, sometimes entirely destroyed. The attack has
sometimes the features of a fever accompanied by an apparent "acute
paralysis" of the biliary functions. The subsequent head affection re-
sembles that which may follow any organic lesion of the hepatic struc-
ture. The excessive drowsiness, or any other symptom denoting cere-
bral irritation or oppression should be promptly treated.

Among the causes of jaundice from suppressed secretion of bile,
deep grief or other strong mental emotion may be mentioned, also the
bite of serpents or poisonous insects, the miasm of certain fevers ; the
noxious products of depraved digestion, and certain vegetable or mineral
poisons. In some, cases it is impossible to discover any probable cause.
Abercrombie says, in one case, which he calls " black ramolissement
of the liver," there was a sudden occurrence of deep jaundice, followed
by frequent vomiting of black matter, and great prostration ; death oc-
curred at the end of three weeks without any cerebral symptoms. On
dissection the liver was much diminished in size, was of black color,
soft and disorganized throughout, like a mass of coagulated blood. The
gall-bladder was empty and collapsed. This case was allied to. gan-
grene. (See Gangrene of the Liver)

Treatment. — The usual allopathic measures for serious structural
diseases of the liver, — active purgatives, and moderate bleeding have
never been successful. Mercurials, Nitro-muriatic-acid, Sanguinariaj,
&c., have done better.

Sanguinaria.^ — This remedy alone is capable of curing many of
the common cases, particularly in young persons and in the spring-
season. In those more serious cases, in which all the vital powers are
in a state of extreme depression, other remedies may be preferred.
Sanguinaria acts on the liver and stomach, improving digestion, increas-
ing all the secretions, and, when long continued, improving the condi-
tion of the pulse and skin. In cases of jaundice, dependent on ab-
scesses and induration of portions of the liver, intestinal accumulations,
torpor of all the secreting viscera, it should be employed for a long
period in sensible doses.

* Sanguinaria was first noticed by Jacob Gornuti, 1635.

JAUNDICE, 4:03

Mercury. — In no form of diseases liave physicians, who deny the truth
of Hahnemann's principles, so nearly approximated to both his theory
and his practice as in the inflammatory diseases in which their great
reliance has been alterant remedies. Of these Mercury is the most
important ; and when we come to employ it according to the homceo-
pathic law of cure, avoiding the fearful medicinal aggravations or,drug-
diseases that it has so often caused, we shall find it an agent of the
highest value.

Diseases caused hy MeTCury, — 1. Increased secretions of the liver
intestinal mucous membrane, &c., causing increased evacuations from
the alimentary canal.

2. In smaller doses it produces excitement of the salivary glands
and glandular system generally, excited circulation, nervous irritability,
and quickened circulation of every tissue of the body.

3. An insensible tranquil, alterative action, which may subvert dis-
eased action without greatly deranging the operations of health; there
is no perceptible quickening of the circulation, no increased vital force^
or subversion of the accustomed action of life.

Mercury acts in causing as well as curing disease :

1. In a manner almost homoeopathic to certain well-known diseases,
as " iritis, hepatitis, or hepatization of the lungs," which ends in the
deposition of coagulable lymph. It has been common in pushing it to
the extent of sensibly producing these results to cause a strumous
or angemic condition which ends m phthisis or scrofula. More recently
this action of Mercury has been called sul)stitutive^ and is relied upon
in obstinate fevers and acute inflammations, threatening the destruction
of vital organs by suppurative or ulcerative disorganization. The drug
disease commonly produced in the effort to cure acute or chronic in-
flammations with Mercury is called ptyalisTn, It is manifested by
tenderness, redness and swelling of the gums, increased secretion from
the salivary glands, often progressing to ulceration of some of the
affected parts. See p. 248.

3. More molent Effects of Mercury, — In large doses it excites
violent irritation of the stomach ; in smaller doses often repeated it
soon produces excessive action of the salivary glands, or destructive
ulceration of the mucous membrane of the mouth and fauces ; this in-
flammation is of an erysipelatous character, is spreading, ulcerating,
and commonly without suppuration. In other cases the mercurial action
displaces the diseased action, when the fever remits its violence ; but
it yields to the superior power of the fever in every febrile exacerba-
tion, and Mercury, therefore, is not entitled to be regarded as a true
specific for fever.

Mercurialism is a disease produced by the constitutional influence
of Mercury, and presents itself under various aspects. Under mercu-

404 DISEASES OF THE DIGESTIVE FUNCTION.

rial action, the whole glandular and absorbent system is more active;
the patient becomes emaciated; all accumulations of fat are taken up
and thrown into the general mass of blood ; disintegration of the old
materials of the body goes on more rapidly than the new supply fur*
nished by recently digested food is deposited.

Mercurial Anmmia, — Dr. Farr says, that Mercury as rapidly and
effectually destroys the red blood as venesection. A lady was attacked
with haematemesis ; the stomach and liver were engorged with blood, and
her complexion was composed of the tints of the rose and the violet.
Under a course of Mercury, " she was blanched in six weeks as wiiite
as a lily." {Watson^ s Lectitres,) It is this power of destroying the
red blood which has given this poison its immense popularity in the
treatment of inflammatory diseases. It being supposed that it has the
power of suspending that kind of inflammatory action which results in
the effusion of coagulable lymph either in serous or cellular tissues; it
has long been the sheet-anchor of the energetic physician. By this
power of " defibrinizing the blood" it suspends inflammatory action and
substitutes its own action. But, even here, it is never effectual in
stYon g\ J jfhlogistic cases; and, in all the forms of inflammatory action
in which some general dysorasia disposes to erysipelatous, gangrenous
or scrofulous disease, its action in minute crude doses, is just the oppo-
site of that which is desired. Allopathic mercurialization deepens and
aggravates all forms of disease in debilitated, irritable or nervous con-
stitutions. Having itself the power to produce these, very conditions
in the strongest persons,' and being capctble of curing theTn^ when used
in accordance with the homoeopathic law^ it always reduces the vital
disease-resisting powers in persons predisposed to any of the above
conditions.

Mercury in Hepatic Derange7nents, — When mercurials are pre-
scribed for temporary bilious derangements with some apparently be-
neficial effect, this "cure," so-called, is generally of transient duration.
The same patient, whatever the precise degree of his derangement of
the liver may be, is almost certain to need that kind of curing very
frequently in the course of a few years ; and the oftener he is com-
pelled to resort to the inevitable blue-pill to rouse up his torpid liver,
the shorter are the intervals between the occasions that call for it. In
the tropical and malarial parts of America, as well as in the Eastern
hemisphere, we can point out in any community the persons who have
most frequently undergone hot climates. Dr. Morehead* thus sums up
the results of his observations on the mercurial treatment of the diseases
most common in hot climates. " To all who have within the last twenty
years had the opportunity of extensively observing disease in India in

* Clinical Eesearches on the Diseases of India, Vol. 2, p. 206. 1857.

jAtmDicE. 405

all classes of the European community, the a*sthenic state, the dys-
peptic symptoms, the injured teeth, the pains in the sides and loins,
the habitual foul tongue, the constipated bowels, the pale alvine eva-
cuations, the depressed spirits, and the sense of sinking at the epi-
gastrium— all clearly traceahle to the aiuse of Mercury — must be
familiar facts." We seldom find in medical literature as much truth in
one page as is embodied in the above comprehensive sentence. These
symptoms, every one of which embodies a volume written over, within
and without with human miseries are now all known to be the common
effects of Mercury. And it is also known that they have been caused,
not always by a reckless heroic administration of Calomel or Blue-pill
in dangerous diseases, but quite frequently by the most minute doses
spoken of in standard works. But they have been generally regarded
as orginal diseases, or as the relics of diseases imperfectly subdued.
The patient who suffers from any or all of them does not say he has
been poisoned, and does not charge his physician with mal-practice.
For further remedies see Treatm,ent of Jaundice in general,

3. JAUNDICE WITHOUT OBVIOUS ORGANIC DISEASE OF THJl LIVER.

Diagnosis. — ^Yellow color of the skin and conjunctiva; sometimes
itching of the skin, yellow tint from bile in the urine, readily distin-
guished by the eye, and also by the chemical test of Sulphuric-acid, by
the addition of which the urine containing bile assumes a dark-green
and afterwards a purple color; urine in jaundice sometimes appears in a
deep vessel dark, almost black.

The stools are generally, though not always, pale or whitish from
deficiency of bile ; and have a sour and very offensive smell.

In most cases the bowels are constipated, as the bile has an impor-
tant use in exciting the natural peristaltic action; though in exception-
al cases there is chronic diarrhoea associated with the yellow color
of the skin.

The perspiration is also bilious and stains the linen yellow. Saliva
sometimes yelloWj^ with a distinctly bitter taste.

The mucous membranes and their secretions do not participate with
the skin in this change of color ; the tongue, inside of the lips, and
the mucus of the stomach are not tinged with bile, and that of the
intestines is not stained except where bile continues to flow into the
duodenum. The milk of nursing women is said to be sometimes, if not
generally, entirely unchanged.

The color of objects, seen by persons in this disease, is sometimes
changed to yellow, as in the cases of Dr. J. Mason Good and some
others. It has been often remarked that "to the jaundiced eye all
things look yellow." It is supposed that the ophthalmic vessels in their

406 DISEASES OF THE DIGESTIVE FFIirCTIOJSr.

natural state do not permit the coloring matter of the bile to pass
through them; but that when they become enlarged by disease, so as
to admit the coloring particles of the blood, they may also give a pas-
sage to the yellow coloring matter, which tinges the humors of the
eye, thus coloring the rays of light as if they had passed through a
piece of stained glass.

The color of the skin varies in different in persons, being in som
bright lemon yellow, orange or of a greenish olive hue.

Dr. Schmidt of New-Orleans, in a memoir to be published by the
Smithsonian Institution, proposes to prove 1. the existence of a network
of capillary vessels, previously discovered and described by him as
"biliary tubules," from which start the smallest hepatic ducts. This
network is independent of that in which the smallest branches of the
portal hepatic artery, and veins arise.

2. The discovery of minute lymphatics of the liver, and their origin
in the network of biliary tubules, by which a communication between
the hepatic vessels and the lymphatics is effected.

8, The discovery of lymphatic vessels directly joining small hepatic
ducts, by which a second communication between these vessels is
established.

4. A minute description of a system of small follicular and racemose
glands, the ducts of which form extensive plexuses throughout the
liver ; and their relationship to the other constituents of the organ.

5. The discovery of a communication of the lymphatics, directly
with these glands. As many .of these glands also join the hepatic
duct, a third communication between the lymphatic and hepatic ducts
is thus indirectly established.

The discovery of a natural communication between the hepatic ducts
and the lymphatics of the liver enables us to give a natural physiologi-
cal explanation of the ^'hOiXiomend, oi jaundice^ which never appears
as a symptom of any disease where the secretion of bile is arrested,
but often, nearly always is present where there is an abnormal or
excessive secretion of bile through the bile-ducts, or the common bile-
duct, into the intestine, is closed or obstructed by concretions or
otherwise. These discoveries also explain why the lymphatics of the
skin, or near the surface .of the eye-ball are loaded with bile, giving a
yellow or green tinge to the derma and the sclerotica, even within a
very few hours, when the flow of bile through the gall-duct has been
arrested by biliary calculi ; they also explain why the large lymphatics
on the surface of the liver are frequently found filled with bik gft/^r
death.^

* See Freirich's Memoir on the Liver. TransL by Dr. Murchinson

JAUNDICE. 407

4. JAUNDICE EEOiM: OBSTRUCTION OF THE EXCRETORY DUCTS OF THE
LIVER.— CHOLOLITHUS.—aALL-STONE.

1. Any pressure, made upon the excretory ducts of tlie liver, will pro
duce jaundice; such pressure may be made by tumors, seated in the
liver itself; scirrhous pylorus; disease of the pancreas; diseased con-
dition of the duodenum. 2. The bile-ducts may be obstructed by mu-
cus within, or by biliary calculi in the ductus" choledochus, the cystic,
or the hepatic duct.

A Gall-stone consists of a solid concretion from a bile, usually
formed in the gall-bladder, and occasionally in the hepatic ducts. The
latter are darker and more irregular on the surface, in consequence of
the absence of an investing deposit of cholesterine.
• Gail-stones are very light considering their size. When fresh from
the gall-bladder they usually sink in water; but, when they have been
kept long and are quite dry, they generally float in water till they be-
come saturated with it, and then sink slowly. Their characteristic con-
stituent, cholesterine is lighter than water. The coloring matters of
the bile are heavier. The lightest are those which contain the largest
proportion of cholesterine. Some of these stones are composed al-
most entirely of it. These are white, have a crystalline appearance, a
soapy feel, and burn with a bright flame in a candle.

Diagnosis.- — In the 'case of a gall-stone obstructing the bile duct,
the pain is very severe; as a stone, a half-inch or more in diameter,
may be forcing its way through a tube no larger 'than a goose-quilL
The pain is not constant, but comes and goes; there is nausea and
vomiting of sour matters, sometimes hiccough, flatulency; the patient
is dyspeptic, languid and gloomy. If the concretion passes into the
intestines, the pain suddenly ceases; but such attacks, having once
occurred, are liable to be repeated.

The pain is distinguished from that of inflammation by the absence
of tenderness and of fever. Pressure, instead of increasing the pain,
generally mitigates it At the beginning of the attack the patient keeps
his hand firmly applied to the epigastrium or leans forward, resting the
weight of his body on some hard substance. After there has been
much retching the straining and vomiting produce some tenderness of
the abdominal muscles. The pulse is not quickened by the pain, but
is in some cases even rendered slower ; the skin is cold.

Prout, Watson and others direct when gall-stones are suspected,
to mix the faeces with water, on the surface of which the stones, if they
exist, will be found floating; but Watson acknowledges that he never
but once detected a gall-stone in this way.

The symptoms of the passage of the gall-stones through the ducts-
into the duodenum are ; " Sudden pain in the region of the gall-bladder

408 DISEASES OF THE DIGESTIVE FUNCTIOlir.

commencing two or three hours after eating, resembling colic " The
pain continues the whole time of a dull, aching character, and is oc-
casionally interrupted by paroxysms so excruciating, that the patient
bends himself double, or rolls himself on the floor, pressing his hands
firmly against the pit of the Stomach, or lower part of the chest, where a
great constriction is felt, which sometimes eases the pain. These
paroxysms cause great exhaustion; the pulse becomes weak or slow,
the face pallid, whole body covered with a cold sweat. There is also
distressing nausea and frequent vomiting of very acid matters, which,
in all cases of repeated vomiting, when the duct is not closed, are bit-
ter. In some cases these symptoms cease after an hour or two, and
generally suddenly^ as the stone escapes into the duodenum. In some
other cases in which the stone is larger, or the passage is less free, or
where several stones pass in succession, the symptoms may continue,,
with intervals of comparative ease, for several days ; sometimes, when
the stomach has been completely emptied of food, enormous quantities
of acid are thrown up. It is secreted from the surface of the stomach
and shown by Prout to be muriatic-acid. {Budd on the Liver^ p. 288.)
When the paroxysm continues long the patient becomes more or less
jaundiced; there are frequent rigors occurring at irregular intervals as
in stricture of the urethra, or when a calculus from the kidney de-
scends into the bladder through the ureter.

The prognosis is generally favorable, though some cases have ter-
minated fatally. In these cases ileus has ensued, or the gall-bladder
or ducts have been ruptured, and the bile has been effused into the ab-
dominal cavity. In some cases the stones are very numerous and their
occasional passage gives constant pain and anxiety. In one severe case
a lady passed two hundred of various sizes in two weeks. Mackin-
tosh found two hundred and forty in one gall-bladder, others have
found 2000 or more ; sometimes a single concretion nearly fills the
gall-bladder.

Pathology. — The mechanical irritation of the stone in passing
through the gall-duct causes vomiting by nervous influence reflected on
the muscles that perform the act of emesis, and also causes untimely
secretion of acid in the stomach by nervous influence reflected on the
mucous coat of the secreting apparatus. The muriatic-acid is derived
from the decomposition of common salt in the secreting vessels of the
stomach by a process that seems to be merely chemicah In some oases
the vomiting takes place when there is no pain produced by the gall-
stone; as a worm in the intestine may cause spasmodic disorder with-
out exciting pain in the. point "where it happens to lie, and an old ab-
scess of the liver, painless in itself, may occasion frequent vomiting.

TreatTneni of Jaundice from Gall-stones.— T\\q following method
of treatment was directed, N. A. Journal of Homoeop., vol. VIL, p.

JAUNDICE. 409

395: As soon as the pains have declared themselves, give six ounces
of tepid olive-oil, and follow it with Aconite and Nux in alternation,
every half hour; apply hot water fomentations and an occasional
warm bath till the pain subsides. The oil softens the concretions,
relaxes and dilates the duct, and thus great numbers of the stones are
enabled to pass into the bowels and pass off with but a trifling amount
of pain. Olive-oil dissolves the stones placed in it in a short time
out of the body. We have treated several severe cases by this
method and found it successful. If the stones be large and numerous
it may be necessary to repeat the oil several times. It dissolves the
stone, relaxes and dilates the gall-duct, and gently moves off all the
contents of the bowels. Our object here is to remove not a disease^
but to carry off an extraneous mechanical substance.

Professor Hale gives the following case: A young lady suffered
several years from paroxysms of supposed gastralgia, or neuralgia of
the stomach, and was treated with Mercury, Opium, and Chloroform
without benefit. She became "emaciated, jaundiced (her skin of the
hue of bronze). The tongue was coated white; no appetite; headache
most of the time ; pulse quick and hard, but small; urine very scanty,
of yellowish brown color and containing bile; pain in the epigastrium,
extending to the region of the gall-bladder; constant, but at times ag-
gravated in paroxysms of extreme intensity; excessive nausea, when
the pain became severe; constipation, alternated with diarrhoea; eva-
cuations for several weeks, destitute of bile."

Dr. Hale having decided the symptoms to depend upon obstruction of
the bile-ducts by gall-stones, after some other trials, " gave one grain
of Podophyllin in the evening. She was allowed chloroform during the
night. In the morning she swallowed three ounces of olive-oil, at 6
o'clock. At 9 o'clock she vomited bile, after which all pain ceased;
at noon she had a free evacuation of the bowels, of a bilious appearance.
At 3 P. M., another bilious stool, and with it a discharge of several
gall-stones. The concretions were round, about the size of cherry,
rough externally, yellowish, and when broken, showing a radiating ap-
pearance from a common centre. In a few days, under the use of
Aconite and Nux, the jaundice had nearly disappeared, the appetite
returned;" in two weeks she rode into the country, and afterwards en-
joyed good health. [N. A, Jour. Horn., Nov. 1863, p. 261.)

Jaundice is often met with, associated with conditions of general ill-
health, with mental depression and anxiety in persons in whom no struc-
tural disease or obstruction of the ducts of the liver can be supposed to
exist. It has been caused by fits of anger, fear, or alarm; by the pain
of a severe surgical operation or the dread which preceded it; grief,
mortification, and extreme anxiety. It is observed, says Watson, that
these cases "are often fatal, with head symptoms: convulsions, deliri-

410 DISEASES OF THE DIGESTIVE FUNCTIOJSr.

urn, or coma, supervening upon the jaundice." In the cases that prove
fatal with such symptoms, it is supposed "that some peculiarly poisonous
matter is evolved in the system, most probably from the decomposition
of the retained elements of the bile." [Mayo^ Budd^ Watson^

Jaundice sometimes succeeds violent and long-continued vomiting
it is a symptom of both acute and chronic inflammation of the liver
it is often caused by the depressing influence on the skin and liver in
hot climates, and hot weather ; it often accompanies pregnancy, from
the pressure of the enlarged uterus on the liver and its ducts.

There is a form of jaundice which is common among newly-born
children. This is called icterus neonatorum^ and is ordinarily of
little importance, being curable by the remedies given below.
. Prognosis. — Jaundice may be expected to ievmmdi<iQ favorably when
it is obviously connected with functional derangement of the liver;
when it proceeds from some knoAvn cause of a temporary nature, and
which can be avoided in future. When the patient is of previous good
health, and not far advanced in life. The prognosis is unfavorable
when the disease depends on structural hepatic disease; when it has
arisen upon some great mental or physical shock, in a constitution pre-
viously broken by serious disease ; or when there is no visible cause
for the jaundice in an aged p-erson, and the color of the skin is green
ish, approaching to black.

Treatment of Jaundice, — The Chief Remedies are :

Aconite^ Arnica, Aurum,'Bell., Bry., Calc, Canth., Cham,^ China
Cocculus, Crotalus, Hepar^ lod.-mer., Lach.^ Merc.^ Nux-v., Phos.
Rhus, Sidph.^ Phos.-ac.^ Digits Sanguin.^ Podojp.^ Berberis^ Canth

Jaundice^ after anger and chagrin, or keen disappointment : — Aeon.,
Chamuy China,, Nux-v.^ Puis., Sulph., Taraxacum.

After abuse of Cinchona : — Bell., Calc, Merc.^ Nux-v.

Jaundice after abuse of Mercury : — China^ Hepar^ Lachj Sulph,^
Nitric-acid, The last is also a remedy for prolapsus ani.

Phosphoric-acid, — Pain in the liver during menstruation : feeling
of heaviness in the liver ; stitches in the region of the liver and spleen ;
burning at one spot in the region of the liver ; deficiency of bile in the
stools; whitish-gray, red evacuations; very light yellow stools. In
jaundiced subjects it increases the action of the kidneys, diminishing
the bile in the urine ; inflammation of the duodenum ; jaundice in scro-
fulous children ; languor of body, inactivity of mind ; bad effects of
grief, chagrin, care, and anxiety; itching eruptions or reddish spots on
the skin.

Aconite, — Dark-yellow skin ; yellowness of the sclerotica ; loss of
appetite ; disgust for meat ; bitter taste in the mouth ; pain under the
short ribs. Malaise after eating ; eructations with sourish taste ; vo-
miting of green bile, or of watery fluid ; pressing in the stomach as from

MEL^JSTA. 411

a weiglit ; violent colic, or pressing pain in the hypochondria ; inflation
of the bowels by wind ; respiration embarrassed as if from enlargement
of the liver ; achmg in the umbilical region ; squeezing pain in the
region of the gall-bladder, when sitting ; alvine evacuations white, thin
watery ; rumbling in the abdomen with faint feeling ; urine reddish or
brown in the morning, depositing a sediment; constipation several
days ; nights very restless, sleepless, full of fearful and vexatious dreams.
Head feels confused and vacant in the morning on waking. Pain all
over as if beaten. Unusual weariness. Pulse slow, unequally full,
soft. {Meyer)

The following concentrated remedies have been successfully used in
the cure of jaundice : Apocynin, Chelonin, Myricin, Podophyllin, Po-
pulin, Veratrin, Leptandrin, Ehein, Colocynthin. They have hitherto
been too indiscriminately used.^

MelcBua, — Two forms of this disease was described by Hippocrates :
1. The Blaoh Disease^ Morhus Niger^ Blaoh or Green Jaundice.

Diagnosis. — ^Vomiting of blackish-red concrete blood, mixed with a
large quantity of insipid acid, or viscid phlegm. The evacuation is
generally preceded by a pungent, tensive pain in both the hypochon-
dria ; and its commencement is accompanied by anxiety, compressive
pain in the prascordia, and fainting. As the disease progresses the
blood evacuated becomes foetid and putrid and the prostration becomes
extreme. The disease has been supposed to depend on diseased con-
dition of the spleen ; but it is probably always associated with some
dyscrasia or depraved constitutional condition. Dr. Nunez, of Madrid,
thought it to depend on repelled herpes or other inveterate psoric dis-
ease. (See Psora. — Index) He gives the following case : The
Marquis of 0. had formerly suffered from chronic eruptions on the legs
and at the anus, which were expelled by Sulphur-baths. He had after-
wards disturbed digestion, and vomited black coagulated blood. Suc-
cessive attacks of the same character followed at intervals, accompanied
with black alvine discharges and prostration. The patient became
feeble, emaciated and unable to turn in bed. Dr. Nunez found him
powerless and motionless ; the least movement or cough caused nausea
and vomiting, tongue brown, clay-colpred; intense thirst; mouth and
throat dry ; aching pain in the epigastric and hepatic regions, with
constant anxiety ; obstinate constipation; pulse thready, frequent faint-
ings ; sight obscured by a veil. He took Ipec, twelfth, in repeated
doses, which diminished the cough and nausea. The appetite improved.
Veratrula-alb., twelfth, removed the constipation, faintings and cold
sweats, producing first melanotic, and on the next day natural evacua-
tions. The patient recovered in a few days under Arsenicum, twelfth,
and Sulphur, twelfth.

* Concentrated Organic Remedies. By Dr. Ooe.

412 DISEASES OF THE DIGESTIVE FUNCTION.

TREATMENT. Chief remedies : Aconite, Aur.-c, Ant., Nux-v., Phos..
Secale-cor., Ipecac, Arsenicum, Chin., Veratr. -alb., Sulph.

Aconite, — See symptoms of this remedy under jaundice, p. l-iO.
2. Melcena Cruenta, — Black Vomit — See Yellow Femr,

Genus IV. — VISCERAL VENOUS PLETHOEA.

1. VENOUS PLETHORA OF THE PORTAL CIRCLE.

There is a condition of retarded circulation, with overloading of the
vascular system, with venous blood or blood resembling venous, called by
Cullen physconia, and by Dr. Good parabysma, or visceral turgescence.
The pathological state is marked by depression ; debility of the physical
and mental powers ; the muscles are feeble, and the nerves manifest
exhaustion.

Treatment. — Se^ia, — The homoeopathicity of Sepia to venous ple-
thora of the portal circle has been demonstrated by Dr. V. Meyer.*
He proposes to show : —

1. That Sepia, by primarily aifectlng the splanchnic nervous system,
induces an over-loaded condition of the portal system.

2. That all further morbid conditions are but secondary, and are
natural results of the further development of the primary disease.

^^ Action of Sepia on the Portal System, When the blood corpuscles
lose the power of separation and of becoming reddened by oxygen, the
quantity of the blood becomes increased and its quality deteriorated
by the useless and defunct corpuscles which remain behind. The
whole of the blood assumes a dark, blackish-red color, similar to venous
blood, which has been called by Schultz melanotic blood. At first
this abnormal blood is collected in the portal system, and subsequently
gives a melanotic appearance to the entire mass. Various chronic
diseases gradually appear."

Symptoms. — Feeling of fulness in the region of the liver ; pain under
the last rib caused by jolting motion on a rough road. Pain and
soreness in the liver ; flatulency ; yawning ; feeling of weight in the
limbs ; shooting pain in the region of the liver and kidneys ; constipa-
tion, paleness of the face ; sickly, pale countenance ; eyes red ; face
and conjunctiva yellow ; . yellowness extending over the nose and
around the mouth. Icy cold feet in the afternoon and evening when
sitting. Feet remaining a long time cold in bed; cold hands and
knees. Sweating of the feet. Ebullition of the blood, with deter
mination of the blood to the head and chest. Feels the pulse beat
in the head and limbs ; aching of parts of the body or limbs on
which one lies or sits. Legs feel weak, and ache on slight exertion :

* Homoeopathische Vierteljahrschrift.

H^METEMESTS. 413

faintness in the morning, loss of thought, constant chill with shivering,
goose-skin and yawning for an hour. Blackness before the eyes ; nau-
sea ; heat of skin, but pulse slow; dejection of spirits ; timidity ; intes-
tinal flatulence ; headache with dulness and heaviness in the forehead,
preceded by scintillations before the eyes. Profuse sweat in walking
morning sweat over the whole body. Absence of thirst, or thirst with
bitter taste in the mouth. Drowsiness during the day, falling asleep
late in the evening ; uneasy dreams. Nerves sensitive to the least
noise. Despondency, weariness' of life; indifference to everything;
without sympathy ; apathetic ; mental indolence, dejection of spirits ;
anxiety, timidity, involuntary laughing and crying. Fever charac-
terized by slowness of the pulse, slight shivering, drowsiness, and
absence of thirst; pressure and weight in the head. As the venous
plethora extends there arise various disorders of the digestive organs;
hsemorrhoids, disordered respiration, spasmodic twitchings or paralysis.
The formation of the blood is incomplete ; there arise gouty or rheu-
matic complaints, and finally dropsy.

Oarbo-animalis. — When excess of venous blood is denoted by blue-
ness of the lips ; also, in elderly people there is blueness of the cheeks.

2. H^MBTEMESIS.— Vomiting of Blood.

The mucous membranes consist of a layer of epithelium spread like
a pavement over a thin and structureless membrane, which serves to
support it ; and the blood-vessels run and ramify in the cellular tissue
behind. It is observed that however the congestion may be induced,
whether by impediment to the return of blood from the stomach or not,
it is only on the open surface of the mucous membrane that the blood
issues in any considerable quantity. The stomach may also be injected
with colored size in the dead body, and it oozes forth from the open
surface of the mucous membrane. It is further remarked that though
the mucous membranes allow blood to issue upon their surfaces they
never allow the serum of the blood or the watery fluid to escape with-
out the red corpuscles. In dropsical cases resulting from the gin-
drinker's liver disease, though the peritoneal sac is enormously dis-
tended with watery fluid there is no flow of serum, no drain of fluids
from the intestine itself, beyond the slight oozing of blood already
mentioned. When the passive congestion of the intestines from the
obstruction to the portal circulation has continued long, the nutrition
of the digestive organs is slower than in health. The solvent juices are
sparingly secreted, digestion is slower and more feeble, and the bowels
are constipated.

The impediment to the passage of blood through the liver or chest,
if it be created rapidly, usually causes haemorrhage from the stomach

414 DISEASES OF THE DIGESTIVE FUNCTIOIT.

before it causes ascites ; an equal impediment created slowly cause-s
ascites before it causes hsemorrbage.

The mucous membranes compose the only tissues from wbicb tisemor-
rliage occurs readily and from mere congestion. It hardly ever occurs
from this cause in the brain or liver, and never in the serous or synovia]
membranes. In the mucous membranes the liability to haemorrhage is
great in proportion to the more active function of the membrane. The
oesophagus, urethra and urinary bladder are lined with a membrane
which acts as a mere lining and is little disposed to bleed. The mem-
branes lining the stomach, the intestines and uterus, being designed
to furnish large secretions to perform important fujactions in the body,
are more vascular, and readily bleed from passive congestion of their
vessels. Blood effused within the. stomach is thrown up by vomiting.

Diagnosis. — Previous to the vomiting there is experienced a sense
of weight, fulness, pressure and disturbance in the stomach, nausea,
faintness, debility, general uneasiness, giddiness and confusion in the
head, roaring in the ears, anxiety, bitter or saltish taste in the mouth,
loss of appetite, occasional chills and sometimes pains in the stomach,
side or chest. The pulse is for the most part small and contracted,
though now and then full and bounding.

" The haemorrhage," says Dewees, " no doubt generally occurs from
the mucous membrane of the stomach, but it is thought also to proceed
in some cases from the liver or spleen.'. When the blood comes from
the former organ, it passes along the common bile-duct into the duo-
denum, and thence regurgitates into the stomach. When the spleen
is the source of the haemorrhage, if this be ever the case, the blood,
it is supposed, gains admission into the stomach through the vasa
brevia."

The appearance of the blood which is thrown up, varies, being in some
instances liquid and bright red, at other times black or coagulated. If
the haemorrhage proceeds directly from the rupture of a blood-vessel
in the stomach, it will be red and liquid; but if it has been conveyed
from the liver or spleen into this organ, it will be black and perhaps
coagulated.

The quantity of blood which is sometimes vomited from the stomach
is very great. I have in several instances witnessed the loss of two,
three or even four quarts from this organ without any very serious in-
convenience, and that too in persons whose constitutions had been im-
paired from long- continued intemperance. A not uncommon result of
these profuse evacuations is, however, the supervention of dropsy.

Causes.— -Intemperance, suppression of accustomed discharges, as
hemorrhoids, catamenia, &c. ; congestions and engorgements of the
liver, spleen and pancreas, scirrhous and other ulcerations of the gastro-

H^MATEMESIS. 415

mucous membrane, violent inflammations, whether caused by active
drugs or mechanical injuries.

Causes. — 1. Strangulation, — Dr. Yellowly described the effects of
strangulation in the case of a criminal executed by hanging in 1813.
The body which had been much convulsed in the death struggles in the
act of dying, was opened the next day ; and the stomach and its ap-
pendages were found deeply congested with dark colored blood. The
external vessels of the stomach were turgid, and its inner surface
coated by dark, coagulated blood ; and when this was washed off, the
whole surface of the mucous coat was red.

All the minute capillaries had been injected with blood and it had
escaped by exhalation from every part of the surface of the membrane.

2. Epileptic Convxilsions, — In some severe cases, during the terrible
spasmodic contractions of the muscles of the whole body, the face
and neck are highly congested, and frothy saliva is forced from the
mouth. The profound stertor that often follows the spasmodic parox-
ysm may be succeeded by vomiting of a dark coffee-ground looking
matter, which is shown by the microscope to consist of altered blood.
The discharges from the bowels after such paroxysms are often black
like pitch, which receive their color from altered blood.

3. Organic Disease of the Liver, — In that state of altered structure
called "hob-nail" or gin-drinker's liver the .current of blood is impeded;
and the stomach and intestines, which should be constantly relieved
from excess of blood passing from all their veins through the vena
portarum to the liver, are left in a state of congestion. In some cases
this leads to a frequent oozing of blood from the mucous membrane,
and in many others to a freer haemorrhage, in which case the blood is
brought up by vomiting. When the quantity of blood is large its loss
diminishes vital power rapidly, and this is one of the most common of
the modes in which death is brought about ; and when death occurs,
post-mortem examination shows that the blood has exhaled from an
unbroken mucous membrane.

More generally the congestion is slowly induced and the minute
vessels accommodate themselves to the increased quantity of blood
they are compelled to retain; or a small oozing of blood takes place
from the membrane. The patient has constant pain in the epigastrium,
and may vomit daily a small quantity of blackened blood, which is
generally mixed with mucus. The stools are sometimes stained with
altered blood.

4. Organic Disease of the Heart — -Pericarditis, with disease of the
lungs may produce impediment to the onward course of the blood, keep*
ing the stomach in a state of congestion. The quantity of blood effused
on the mucous surface is small and is seldom noticed. In some cases
the obstruction is so great as to cause vomiting of blood.

416 DISEASES OF THE DiaESTIYE FUlSrCTION.

Congestion from Change in the Relative Proj>ortion of the Con-
stituents of the Blood. — Such change, by altering the consistence of
the blood, and thus "rendering its propulsion more difficult, or by modi-
fying the chemical relation which naturally exists between the blood
and the tissues, may cause blood to pass less freely than natural through
the capillaries." When from any cause the condition of the blood is
changed and plethora of the organ results, the secretion of the gastric
fluid is lessened, and the mucous membrane is more disposed to be
inflamed by the irritation of the undigested or unwholesome food; if
this congestion proceeds far, a certain oozing of blood takes place
from the open surface of the membrane.

Diagnosis.— Vomiting of blood, especially in small blackish coagula
showing that the blood has escaped by oozing, and that it was coa-
gulated before it had time to collect in a mass.

Treatment of HcBmatemesis in General, — The following remedies
will be found useful in all cases in which there is no fatal organic dis-
ease.— Aeon., China, Puis., Nux-v., Ipec, Ars., Sulph., Arn., Ham.,Millef.

5. Amenorrhea, — Haemorrhage from suppressed menstruation may
occur from one of the mucous membranes, from which blood easily
flows, and is more common from the stomach than any of them. Dr.
Latham says in one case, Hsematemesis occurred monthly in a young
female who never menstruated. After her marriage it ceased during
pregnancy and lactation and then returned. No uterine menstruation
ever occurred. Haemorrhage of the stomach from this cause usually
occurs at or near the menstrual period ; while it lasts the stomach is
painful and tender. Cullen remarked that it was scarcely ever fatal, as
.the plethora of the system is relieved by it. We have seen one fatal
case, but it was one in which there was long-continued congestion and
structural disease of the liver. The patient was mother of a large
family, and was fifty-eight years old when the vomiting of blood com
menced. Up to that time regular menstruation had continued. She
lived in an atmosphere strongly malarious, and had sufiered from many
attacks of remittent and intermittent fevers. Her liver had been tor-
pid for years, was in a state of habitual congestion, had often been in-
flamed, and remained in. parts of its structure permanently indurated.
The skin was yellow, wrinkled, shrivelled, somewhat resembling the
skin of a yellow peach, withered and dried upon the stone. The
vomiting of blood commenced at a period when menstruation first
failed. The quantity of blood ejected from the stomach- by vomiting
was usually about two quarts, which always relieved for the time the
gastric distress, but left the patient in a state of extreme prostration.
The paroxysms were at first periodical and approximating the men-
strual periods, but they ultimately became much more frequent.
Though temporarily relieved by medical treatment, this patient, in the

COKGESTIOK OF THE STOMACH. 417

course of a year and a half, sank into extreme anaemia with permanent
enlargement of the liver and spleen, and total failure of physical and
intellectual power.

Diagnosis. — Hsematemesis from deranged menstruation is known by
its occurrence at or near the time when menstruation was expected,
and when ordinary causes of haematemesis, as extraordinary obstruc-
tions in the liver or chest, or enlargement of the spleen are absent;
there is in this case no reason to suspect an ulcer or other organic
disease in the stomach, and the derangement of the stomach is not of
long continuance. For treatment see Anaemia.

The Treatment of Hmmatenhesis from sujpjpressed menst/ruation
consists chiefly in slightly acidulated drinks, complete abstinence from
solid food. The remedies usually indicated are : Ipecac, and Hamamelis
in alternation. Other remedies are : Gallic-acid, Millefolium, Arnica,
Collinsonia, Iodine, Secale, Sabina, Macrotin.

6. Hcemorrhage from ulcer of the stomach. — In this case the hae-
morrhage issues not from any large vessel laid open by ulceration, but
from the minute vessels of the tender surface.

In the treatment of diseases that cause impediment to the passage
of the blood through the liver or chest, the congestion of the stomach
and the feebleness of digestion must be borne in mind. Though the
congestion is secondary and can only be relieved by the means that
can relieve the primary disease.

Sparing diet of articles easily digested; total abstinence from in-
toxicating drinks, except in cases where stimulants in a dilute form are
necessary to promote the strength and caji be used without irritating
the stomach or quickening the action of the pulse. Mercury can only
be given with safety in a form highly attenuated ; stimulating diuretics
can not be used safely. It is only in their attenuated form that they
may not do injury to the stomach as well as to the kidneys. A per-
sistent congestion of the stomach improperly treated always leads to
gastritis, as continued congestion of the lung leads to bronchitis.

When the stomach is kept in a state of congestion by obstruction of
the blood in the liver or chest, the secretion of the gastric juice is
diminished, and the stomach, which in full health should secrete about
four pounds of the digestive fluid in one day, secretes far less; it can
digest less food than in health and requires longer intervals of rest.
(See Remedies. — Argen.-nitr., Kal.-bi., p. 217.)

PnoPHYLAGTic TREATMENT. — Such a rcgimcn as shall regulate the
bowels, and the portal circulation, and thus prevent the engorgement
of the stomach. All such measures as promote the general health,
Nitro-muriatic-acid, in drop-doses, diluted in large quantities of water;
Sepia and other remedies that promote menstruation.

Vol. I.— 27.

418 DISEASES OF THE EESPIBATOET FUNCTION.

CLASS II. -DISEASES OF THE EESPIRATORY

FUNCTION.

There is a sympathetic relation between the organs of respiration, cir-
culation and digestion ; and this relation is kept up through the nervous
system. The connection between these functions is seen in the case
of a person apparently drowned. He is taken out of the water, with-
out action of the parts concerned in breathing, without pulse ; the mere
dilatation of the lung, its repeated action will bring on the action of
the heart. Were it not so there would be no possibility of resuscita-
tion. This first action of the heart does not cause decarbonization of
the blood, nor does it send arterial blood from the heart through the
body. It only first restores sympathy between the actions of the heart
and lungs. Inflation and compression of the lung being repeated for a
certain time the pulse returns. {Charles Bell)

If a frog be rendered apparently insensible and motionless on being
immersed in a non-respiratory gas, the heaft being pricked with the
point of a needle, begins to act, and according to its nature, acts two or
three times, when being pricked again, it renews its action; and pre-
sently after it has acted the breath returns, and respiration becomes
established. And when the animal has breathed once or twice it turns
from its back and leaps about. Here we see the action of the lungs
drawing after it the action of the heart, and then again, the action of
the heart drawing after it th,e action of the lungs.

The experiments of Mr. Colman showed, that if a narcotic were intro-
duced into the stomach in the attempt to perform such experiments, it
would not succeed. The explanation is this : These three organs are
connected together, not only by proximity of situation ; but by being sup-
plied with branches from the par vagum, which lies by the side of the
pharynx, giving off the pharyngeal branches; coming to the larynx, it
gives off the laryngeal branches ; coming down to the thorax, it gives
off the recurrent nerve under the arch of the thorax; which course re-
moves the particular interest attached to it, because, so long as it con-
tinues to run from its source, distributing its branches, there is no in-
tricacy about it, nor is there any call for its minute study. But we next
find the nerve taking a circuitous route, the branches running up to-
gether, and it now becomes a fair subject for close investigation and
inference. It is observed, that the trapezius muscle acts in the pro-
cess of respiration, but only when stimulated by the same nervous in- =
fiuence by which it is connected with other parts. The nerve through
which this influence is conveyed is seen running down to the root of the
lungs, about to expand on the lungs, but not before it sends circuitous

DISEASES OF THE BESPIKATOEY OEGANS. 419

brandies back to supply tbose parts, which are necessarily drawn in
the regular act of breathing. The frame, were these parts not so drawn
in, (one branch being kept irregularly or imperfectly excited,) would
suffer spasm or suffocation as the result.

Now the nerve comes down into the chest, one branch passes to the
lungs, where it throws out little branches, which unite again, and so are
distributed to the heart. It was formerly said, that the lungs and heart
were void of sensibility. They are not very sensible. When Harvey put
his hand to the heart of a young gentleman, which had been laid bare
by an injury, the youth did not know, that the organ was touched ; he
did not know they were handling him, except when the external inte-
guments were touched.

But with all this insensibility, as commonly expressed, we can not
rise from a seat without a certain increase of the pulsating artery ; we
can not walk faster without quickening the action of the heart.

DISEASES OF THE RESPIRATORY ORGANS.

GENERAL OBSERVATIONS.

In-^all of our investigations touching affections of the lungs and their
appendages, whether acute or chronic, a few preliminary inquiries are
essential, in order that we may be able to arrive at accurate opinions
respecting the seat, nature, treatment and probable termination of each
particular case. Although we are to be governed, as a general rule,
by symptoms^ J ei certain constitutional or accidental peculiarities con-
nected with a given train of symptoms, might induce us to select one
specific in preference to another, which was equally homoeopathic to
the disease. Thus cough, copious expectorations, pains in the chest,
tickling in the throat, &c., which had followed immediately upon
the suppression of some chronic eruption, might be completely covered
by Bryonia^ IpeGaGuanha^V\\oB^\oY\xB^ Phosphoric-acid, Staphysagria,
Silicea, &c., so far as the mere symptoms are concerned; but who
would not prefer, in cases of this description, Sulphur^ or some other
specific, which would have a tendency to reproduce the eruption, while
at the same time, it would be perfectly homoeopathic to these indica-
tions? So in regard to temperament, habits of life, occupa.tion, medi-
cinal symptoms, age, sex, climate, &c., our remedies should always be
selected in such a manner as to bear upon any occult miasm, or other
latent cause, which may be operating upon the organism, and thus,
either directly or indirectly aggravating and complicating the apparent
symptoms. See p. 152.

When called to treat lung-affections, therefore, let the physician
inquire, first, is there any hereditary predisposition on the part of the
patient to scrofula, consumption, dropsy, erysipelas, nettle-rash, syphi-

420 DISEASES OF THE EESPIEATOEY FTJNCTIOK".

lis, &c. ? Second, is tlie chest well developed and symmetrical, so that
the lungs can have ample room to perform their functions ? Third, is
the subject, during health, put out of breath by slight exertion ? Fourth,
has the malady supervened on, or shortly after the disappearance of an
eruption? Fifth, do all parts of the chest dilate equally and properly
during inspiration, and is the respiration natural during health?

Kespecting this last question, it is proper to observe, that a difference
of opinion exists amongst authors. Laennec, considering respiration
natural, Svhen the anterior and lateral parts of the chest dilate equally
distinctly, yet moderately, during inspiration, and when the number of
inspirations, in a state of repose is from twelve to fifteen in the minute ;"
which Andral, Broussais, Miiller, Forbes and others suppose, that Laen-
nec has placed the mean number of inspirations too low. These gentle-
men assure us, that the " mean average of respirations is more than
sixteen or eighteen in the minute, in the healthy adult, and that most
persons in health breathe from eighteen to twenty- four times in a
minute." From much observation in reference to this subject we are
disposed to adopt the opinion of Laennec, rather than that of Andral,
&c., and, therefore, estimate the mean number of respirations in a
healthy adult at fifteen or sixteen in a minute*

DIAGNOSIS OF DISEASES OF THE CHEST.

ABDOMINAL BESPIEATIOK.

On simple inspection of the chest and abdomen, it is seen that the
ribs scarcely move at all, while the belly rises and falls alternately
with the descent and ascent of the diaphragm ; we infer that there must
be painful condition of the intercostal muscles, of the pleurse, render-
ing the patient unwilling to elevate his ribs, or that there may be dis-
ease of the spinal cord, between the origins of the phrenic nerve and
the intercostal nerves, rendering the patient 'U^aSZ^ to raise them; or
that this inability may arise frctm some disease of the lungs them-
selves.

ThoTctciG Breathing, — When the breathing is entirely performed by
the thorax, no motion of the abdomen being perceptible, there may be .
affection of the diaphragm, or of the pleura, reflected over it ; or dis-
ease and tenderness within the abdomen ; or peritonitis, or mere dis-
tention of the abdomen.

Auscultation and Percussion.

One side of the chest may be seen to expand, while the other remains
motionless, it may appear of the natural size ; it may be contracted or
rounded and bulging. From all of which appearances important con«
elusions may be deduced.

AUSCULTATIOK AND PERCUSSION. 421

Auscultation is a term, used to express the investigation of disease
through the sense of hearing, and is generally employed in the inves-
tigation of diseases of the thorax. It is employed to express all that
can be learned by listening to a cough or the sounds of the respiration,
or the sounds made by striking the chest. Percussion is the term
used to express the mode of eliciting new sounds by striking the sur-
face of the chest. More exactly, the term auscultation denotes the art
of distinguishing internal conditions by listening to internal sounds, by
means of the application of the ear to the naked or thinly covered sur-
face of the body ; or by means of some conductor of sound interposed
between the ear and the person of the patient ; when this only is ap-
plied the operation is called immediate auscultation ; when an instru-
ment is interposed the process is called mediate. Both modes are em-
ployed to ascertain the qualities and modifications of the voice, as re-
flected through the chest; the peculiarities of the breathing ; and the
sounds of the heart. To Laennec we owe the discovery of auscultation
and nearly all that is known of it, though gradual improvement is still
being made in it.

By percussion, which was invented by Avenbrugger, a German, a
hundred years ago, we ascertain the degree of resonance, or want of
resonance of the part struck. As different substances, when struck,
give out different sounds, an experienced ear soon learns to detect by
the sound the nature of the substance struck. Bodies that are solid or
inelastic, give the sound dull in proportion to their thickness, or their
want of elasticity. On the other hand, hollow vessels, those containing
air, with thin, firm, elastic boundaries, give out a sound more or less
approaching in its qualities to that of a drum ; this is called a hollow
sound. A wooden cask containing air only, resounds when struck ; if
half full of water, the lower half, when struck, gives a flat sound, the
upper half a hollow sound, less hollow however than a vessel entirely
empty ; fill it up with water and the whole is dull on percussion ; take
out the water and fill it loosely with wool, and it will give a sound on
percussion, though less clear than when filled with air alone.

When we make a similar experiment on the human chest, we find it
a- large cavity bounded by firm, thin, tense and elastic walls. Within
it we find the lungs of a spongy texture when full of air, with other
solider parts of which the heart is the principal. If a slight hnoch is
made against the chest, over a portion of a healthy lung, it produces a
resonant or hollow sound. If the lung be not there, but is pushed
aside by something more solid which occupies the space, or by fluid,
we hear a dead sound. If the lung be there, but has become more
solid by disease, we also hear the dull sound. But still there are
liabilities to mistake which render practice necessary before percussion
may be depended on in auscultation. When we percuss the chest over

422 DISEASES OF THE EESPIKATORY 1? UKCTIOlSr.

the heart, we get a positively dull sound. Avenbrugger, who invented
percussion, and Corvisart, who brought it into public notice, employed
only direct percussion with the ends of the fingers. More recently
M. Piorry showed the advantage of an intermediate solid substance
which he calls a plexi-metre or "stroke measurer." A ro-und,
thin, flat plate of ivory was first used by him; other substances have
since been used ; at present it is quite common to use the fingers of
the left hand.

Method of employing Percttssion. — Place the patient, if convenient,
in a sitting position on a firm chair in the middle of the room ; at least
in some position in which the parts to be struck be as firm as possible.

When the front of the chest is to be percussed let the patient per-
mit his arms to hang loosely down, while he throws the head back„
To explore the side of the chest, let him place the hand of that side
upon his head and lean a little to the opposite side. To try the pos-
terior part of the chest, let the patient lean forward, the arms hanging
loosely between his knees, the head bent downward.

Mode of Perou^ng.' — Bring the ends of the fingers of the right
hand together in such a way that the ends may stand as if of equal
length, no one projecting beyond the other. If we employ no inter-
mediate substance, we merely strike the surface with the evenly project-
ing ends of the fingers. To test the relative condition of the two sideSj
always try the corresponding point of the opposite side. Always
strike on one side, and then, immediately, on the exact corresponding
point on the opposite side, thus constantly comparing the two sides.
If we have tried one side at the moment of inspiration, we must choose
the moment of another inspiration to strike the other side. The fin-
gers should be held in the same manner, and the ends forming a line
which makes the same angle with the ribs of both sides ; the same de-
gree of force should be exerted for each, the blow not being hard
enough to give pain, but smart and quick, the ends of the fingers being
instantly withdrawn. When the patient can not bear it without being
pained and distressed, it is better to omit it, as the case can always be
made plain enough by other means of diagnosis.

Mediate percussion ^yoSlVlGQ^ less pain, can be employed on a spot
precisely indicated even through the clothes ; it gives a more decided
sound though the force of the stroke is broken by the pleximeter.
It may be also employed over oedematous or parts covered by very
great thickness of fat, where immediate percussion would reveal noth-
ing; though the ivory plate, employed by Piorry, gives a louder
and clearer sound, the fingers of the left hand answer well enough in
general. Press them closely to the surface, and strike on the backs
of the fingers.

The sound given out on percussion during inspiration is more reso-

CORYZA. 423

nant than during expiration; in cliildhood and youtli than in middle
age ; it is still less so' in old age ; . less in females than in males ; in
thin persons than in fat.

We beg leave in this place to recommend, in strong terms, the use
of ausaidtation and percussion in the investigation of chest-diseases
if for no other rea,son than to form an accurate diagnosis and prognosis
In order to acquire skill in the use of the stethoscope, percussion, &c
a patient and careful course of study and practice upon both healthy
and diseased is indispensable. By this means, the physician will be
able to pronounce with certainty the seat and nature of the malaHy,
and its probable termination. As we advance in our descriptions of
the different affections of the respiratory organs, we shall point out the
peculiar sound elicited by percussion and auscultation, in the several
varieties of disease.

OKr>ER I.-FXJNOTIONAI. DISEASES OF THE RESPIRA-
TORY MUCOUS MEMBRANE.

Genus I.— CORYZA.— Simple Oataerh.— Defluxion, or Cold.

Diagnosis. — CharaGteristiG symptoms,- — Sneezing, watery discharge '
from the nostrils ; increased secretion from the lachrymal glands ; slight
headache; heavy feeling in the head; occasional chilliness, slight
evening fever ; in severer cases, sore throat, hoarseness and cough.
It appears in different forms and with varying degrees of severity.
Thus : 1. Coryza sinnplex^ as fully described by Celsus, which is
chiefly confined to the schneiderian membrane. 2. Gra/vedoyOY ca-
tarrhal cephalalgia, in which the affection is chiefly seated in the
frontal sinuses. 3. Cold in the head, involving both the sinuses and
the mucous membrane. 4. Catarrhal sore throat, involving chiefly the
fauces. 5. Catarrhal cough with hoarseness, the disease extending to
the glottis and pharynx. 6. Catarrhal bronchitis, in which the bronchia
are implicated. 7. Catarrhal ophthalmia. 8. Catarrh of the stomach.

The nature of catarrh is influenced by the constitution of the pa-
tient. In many persons it presents many of the features of rheuma-
tism ; in others, there is an inflammatory state which is more charac-
teristic of erysipelas. As each of these diseases is entirely distinct
from inflammation, they each require a specific treatment.

Symptoms of Coryza, — Chilliness or coldness, commencing one, two
or more days after exposure or atmospheric change ; lassitude, heavi-
ness of the head, followed by dryness, fulness or stuffing of the nasa
passages ; frequent sneezing ; dull pain and sense of weight in the
forehead; stiffness or uneasiness of the eyes; increased secretion of a
watery fluid from the nose and eyes ; slight redness and tumefaction
of the mucous surfaces of these parts. The defluxion from the eyesu

424 DISEASES OF THE RESPIRATOEY FUNCTION.

and nostrils is somewhat acrid and saline, sometimes producing slight
excoriation of the parts over which it passes. If the disease proceeds
in its course only a day or two after these symptoms are developed, we
have in the evening chilliness, shiverings, followed by increased heat ;
the posterior nares, fauces, nose and eyes are affected. The patient
complains of a sense of roughness or soreness of the throat ; loss of
sense of smell ; sometimes dullness of .hearing ; soreness or pain ex-
tending along the eustachian tube to the ear, with slight redness of
the fauces and mouth; hoarseness ; tickling cough; mucous fluid
secreted from the posterior nares, fauces, pharynx and trachea. The
voice becomes partially or entirely suppressed from oedematous fulness
about the glottis. There are pains resembling those of rheumatism in
the neck, head and limbs ; loss of appetite, slight thirst and bowels
constipated. The patient is unusually sensitive to the influence of
cold, though the skin is warmer than natural, he is continually liable
to contract fresh cold. Thus he is liable to prolong the disease or ag-
gravate it until it assumes a more serious form. See Oata/irrhal Fmer^
BronC'hitis^ Pneumonia^ Ozoena, c&c.

Pathology. — This disease consists in a specific irritation of the mu-
cous surface of the nostrils, extending to the frontal sinuses and eyes,
to the posterior nares, fauces, throat, and occasionally also to the
pharynx, oesophagus, glottis and trachea, thus terminating in catarrhal
bronchitis. It is believed that the morbific influences which originate
catarrh, affect, primarily the organic nerves which supply the surface
principally disordered, and through them, the system generally. Ow-
ing to this change in the condition of the diseased texture, the func-
tions of secretion and circulation in the part are specially deranged.
The chief modifications of the disease arise from the degree in which
the constitutional actions are disturbed, the extent of surface involved,
and the grade of irritation produced in the capillaries of the part

Pkognosis. — -Catarrh is generally a mild ailment, attended with no
danger. It is more serious in aged persons, in those predisposed to
pulmonary disease, who have already tubercles developed in the lungs ;
in those who have had haemoptysis, who are asthmatic or have suffered
from bronchitis, pneumonia, pleurisy, or chronic catarrh in the form of
ozoena. Unfavorable, obstinate and difficult cases are characterized
by continued irritation, slight redness of the posterior nares and fauces,
abundant muco-puriform discharge, or persistent progress towards
chronic bronchitis. Aged persons ; children of lymphatic temperament,
in which the muco-purulent secretion obstructs the breathing ; infants^
becoming irritable, and showing evidence of disturbance of the cir-
culation in the brain or chest, or obstructed croupy breathing or eough^
or in whom the disease assumes the aspect of ozosnaj are sometimesf
difficult to cure permanently.

COEYZA. 425

TREATMENT. — Tartar Er)ietiG exercises a specific influence upon
tlie mucous membrane of the air-passages, producing among other
effects, sneezing, violent coryza, chilliness, loss of taste and smell, and
irritation of the Schneiderian membrane. It has been used with success
in influenzas and ordinary catarrhs, also in herpetic pustular and other
eruptions about the nostrils. It is efficient in the first, second and third
attenuations.

Aconite. — Almost always proper in the beginning of a cold, even
if the appearance of fever is very slight. Also when on an increase
of the cold, the discharge from the nose is suppressed and is followed
by headache.

Arsenicum, — Not much fever, heat or thirst, the patient restless,
particularly at night ; drinks often, but little at a time ; is very weak
and easily agitated; discharge acrid and corrosive ; excessive soreness
of the nostrils and violent burning of the nose, internally and ex-
ternally. Exercise and warmth are agreeable, and exposure does not
aggravate the disease.

NuX'V07niGa. When Arsenicum has failed to relieve ; catarrh fluid
during the day and dry at night ; mouth dry and parched, without much
thirst; lightness of the chest, constipation; fever and chills alternate
in the evening ; great heat of the head and face.

Merciorius, — Epidemic catarrh or influenza when many persons
are affected with it a time ; there is constant sneezing; soreness of the
nose, with constant watery discharge ; offensive smell ; profuse per-
spiration at night; catarrh worse in the morning; there is fever, thirst;
heat is uncomfortable, but he can not bear cold air. See Influenza.

Hepar, — Catarrhs caused by suppressed perspiration, in persons who
have taken much Calomel; fever with pains in the limbs; catarrh
renewed by every breath of wind; headache increased by motion.

Lachesis. — Catarrhs of great severity, profuse watery running from
the nose ; with great soreness and swelling.

Didcamara. — Patient better when in motion than at rest ; slight
exposure renews the obstruction.

Pulsatilla, — Loss of appetite and of smell; the mucus discharged
is thick and yellowish, sometimes green and offensive.

EujpJirasia. — Catarrhs with discharge of white mucus from the
nose ; eyes watery, sore and running. Cepa has the same symptoms.

CJiainorrhilla, — Catarrh, with ulcerated nose, chapped lips ; one cheek
pale and the other red; chills and thirst.

Ipecacuanha. — Difficulty of breathing.

Sulphur. — Psoric cases, protracted and resisting other remedies.

Ifitric-acid. — Dr. Helmuth had operated on a child, eight months
old, for hare-lip. The case was doing well, but about the second day
a violent coryza set in, the discharge being very profuse and quite

±26 DISEASES OF THE EESPIEATORY FUNCTION.

acrid; Laving seen a similar case in which the acrid discharge pre-
vented union of the lips of the wound, the termination of which was
unfavorable, Nitric-acid and Arsenicum were prescribed. In a day the
corjza was arrested, and the cure, in the usual time was complete. In
such cases several coatings of Collodion should be applied over the
whole surface of the upper lips, jaws and ligatures to prevent the
injurious influence of any nasal discharges.

Genus II.^POLYPUS.

Polypus is a tumor, generally originating from a small pedicle, which
was formerly supposed to consist of several roots or feet, like the
zoophyte polypus. In some cases a polypus of the nose commences
from a small swelling of the pituitary membrane and gradually en-
larges until it fills up one nostril and entirely obstructs the other.
Others commence on a carious point of some of the bones which form
the internal surface of the nostrils. Some are so soft that they bleed
on the slightest touch, others are hard, compact, even scirrhous. They
always produce disturbance of the breathing, compelling the patient
to breathe through the mouth. A large one presses upon the spongy
bones, forcing them down on the upper maxillary, thus obstructing
the lachrymal duct, and forcing the tears to flow out over the eyes and
cheek. Le Dran descrihed polypi so large as to force the ossa palati,
and protrude the fleshy palate to a position parallel with the third
molar teeth. The most common form bears in consistence, shape, color
and size some resemblance to a common oyster. When both nostrils
are occupied by polypi, the patient breathes with difficulty, and with a
peculiar rattling noise.

Pathology. — Polypus is believed to originate in a constitutional
dyscrasia, further views of which we will give in the article on Sycosis,
As the polypus always appears protruding from the mucous membrane
which is always kept moist by the proper secretion flowing over it, and
not exposed to the drying effect of the air, it is always softer in texture
than the syc otic tumors or excrescences which grow from those points
of the mucous membrane at which it unites with or is continued into
the skin. The polypi either hang by a narrow pedicle, or present
a bloated, wrinkled appearance, and are attached at no great distance
from the external orifice where the access of air is still possible. They
are highly vascular and often bleed largely when removed by surgical
operations.

Treatment. — Before Hahnemann's time no treatment was relied
upon except excision. The publication of his work on chronic diseases
led to new efforts to discover specific remedies for the diseases pro-

POLYPUS.

427

duced by tlie constitutional miasms wliicli had hitherto baffled medical
skill.

The remedies which have been most successful are: GalGarea^ JPhos-
phorus, Staphysagria, Teucrium, Sepia, Silicea, Sanguinaria and
Thuja.

Mucous Polypus^ .TeuGrium-marmn produces the principal symp-
toms of polypi of the nasal fossae ;=^ irritating formication in the right
nostril, with running of tears from the right eye ; the right nostril feels
half stopped up and cannot be relieved by blowing or sneezing. Tear-
ing, shooting at the summit of the right nostril ; nose runs for several
days, whenever exposed to the air; frequent obstruction of both
nostrils.

, Puffy swelling of the nasal mucous membrane after a facial erysipe-
las, was cured in six days by the use of the powder of Marum leaves.

A recent polypus of the nose was cured by Marum in a short time.

A nasal polypus already thrice torn away, has not again appeared
after the use of Teucrium Marum, 3d, taken internally, a drop every
evening for several months. The loss of smell of twenty years stand-
ing was cured at the same time.

A mucous polypus which entirely filled one nostril disappeared under
this drug in a few weeks. ( Veith, JSygea, Vol. V., p. 450.)

Dr. Ilermel gives a case. A lady aged twenty-five had a polypus
in the left nostril. Within three years it was twice torn away and .
returned. Six months later it began to reappear after a cold, and was
visibly closing the upper part of the left nostril ; there were painful
formications and shootings at the root of the nose, in the frontal sinus
of that side ; the eye ran tears, and mucus flowed copiously from that
nostril ; blowing the nose caused acute pain and bleeding ; breathing
through that side impossible. Teucrium 6th was used for a fortnight
made no impression, the first and third were tried. At the end of
another week there was sensible diminution, a little flow of mucus, and
the air could traverse the nostril. In three weeks more the polypus
had entirely disappeared, and the breathing was nearly free. A year
after she continued well. But four years later her nose was stopped
with a cold; she feared return of polypus, took Teucrium, and was
relieved by the first dose.

Case hy Dr. (xa'balda,—K man aged 42, had mucous polypi of the
left nasal fossa; had long felt increasing difficulty of respiration in
both sides, worse on the right. Ordered to snuff a few drops of water
containing Thuja tincture. No change in a fortnight. Ca-lcar. 30th
substituted. In a fortnight more the respiration, was freer, right nostril

* Koth's Materia Medica Pura. — Dr. Hermel, in L' Art Medical, 1859. Augsburg
Horn. Gaz. Vol. I., p. 59.

4:28 DISEASES OF THE KESPIRATORt FUNCTION.

less embarrassed than the left, in which a small polypus is visible, re-
duced in size. Teucrium-marum 12th every morning. A month later
rapid improvement, cure under Teucrium 80th. Kleeman, {Musfs^ Ma-
gazine^ Vol. 18.) A mucous polypus which hung down almost to the
orifice of the nostril was reduced by the snuffing of powdered Teucrium
in two months till the air could pass up the nostril.

C. Mayer, {Merat and HeUn^ Diet, univ. Mat Med) had polypus
from his fourteenth year; often extirpated and cauterized, but it still
returned. Advised to snuff Teucrium he was permanently cured.

J. Mayer gives in HufelanW s Journal (Vol. 64) a case of polypus
in a child aged eleven years, cured by snuffing Teucrium, three to
five times a day. In twelve days there was no trace of polypus left.
During the use of the remedy there were heaviness of the head, ver-
tigo, and bleeding from the nose. Some months later another coryza
developed another polypus. The same powder produced more violent
pain in the head. On the third day it was detached by sneezing. It
did not reappear.

Roth gives a case of a uterine polypus three inches in length, pyri-
form, smooth and polished. Tincture of Teucrium was applied locally
for several weeks, when the polypus withered and came away at the
touch of a ligature.

Nenning and Roth report each a case of failure with Teucrium.

Drs. Hermel, Roth, and others report numerous cures.

Symptoms. — " Violent titillation in the right nostril, with weeping of
the right eye." Titillation in the nose soon after taking the medicine,
recurring frequently. The right nostril feels as if half closed ; obstruc-
tion cannot be removed by ordinary efforts. Brief lancinations in
the upper part of the right nasal cavity. Fluent coryza in the open
air. The nose is much obstructed several times during the day and
particularly in the evening while reading aloud. {Archiv, V.) A
thickening of the mucous membrane of the nose, the sequence of an
erysipelas of the face, was removed in six days by the use of powdered
leaves of Teucrium. {ArcMvyXX.) A recent nasal polypus, which
had been three times removed by the operation did not reappear after
Teucrium had been administered, in the dose of one drop every evening
for several months. At the same time the sense of smell returned,
which the patient had been deprived of for twenty years. {]Vusse7'^s
Allgemeine Zeitung^ I.^) A mucous polypus which entirely filled one
nostril was cured in a few weeks by the use of Teucrium. {Jlygeia^ V.)

The effect of this remedy is seen in the case of a lady, who had po-
lypus in the right nostril. In the course of three years it had twice

* Allg. Horn. Zeitung. Tr. by Dr. J. M. Rhees. Am. Horn. Kev. Sep., 1859,
p,556

POLYPUS. 429

been extracted but still returned. A new coryza developed it again ;
it fills the upper part of the nostril ; there are titillations and painful
prickings in the root of the nose, and in the left frontal protuberance.
The eye weeps much, the affected nostril discharges much mucus ;
blowing the nose gives pain, sometimes haemorrhage ; breathing through
that nostril impossible. July 14th, Teucrium 6th, two drops in two
hundred grammes of water, a spoonful morning and evening. After
fourteen days tried the first, then after a week the third. In three
weeks the size of the tumor had diminished. On the eighth of Septem-
ber nothing could be seen of the tumor ; some inconvenience in that
nostril in respiration. In 1858, May 7th, the lady feared a new coryza
would reproduce the polypus. She took Teucrium, 6th, as before* Im-
mediately after the first dose the symptoms that gave uneasiness
vanished.

Polypus of the iTc^^.— Dr. Richards, of N.- Jer., gives the follow-
ing case : Sarah , aged twenty-eight, bilious temperament, has. po-
lypus of the right nostril, which commenced five years ago; two years
'ago had it extracted ; about a month ago it began to return.

The polypus is of a soft gray color, and obstructs the nostril so as
to almost wholly prevent breathing through it. Calc.-carb., 6, Staphys.,
1, given Aug. 31, 1860. Sept. 14th. Ko better, Teucrium, 1, three times
a day. Improvement commenced in a week. Nov. 18th, polypus has
disappeared, patient breathes freely through the nostril. March 5th,
1861, continues well.

Thuja, — Dr. Petroz, in 1852, read before the congress of homoeopa-
thists of Paris, some cases of polypus and other sycotic diseases cured
by this remedy. One of these was that of a lady, aged forty, who had
been treated with Sulphur for scabies when young. At thirty-four, she
had attacks of asthma ; afterwards, her face was pale ; there was con-
stant sense of fulness in the brain, diminution of memory ; melancholy,
flushes of heat to the face ; head too full ; throbbing of the temples ;
dyspepsia; then followed metrorrhagia, and the development of a large
uterine polypus. She was cured by Thuja, 18, a dose every two days.
The polypus was detached on the eleventh day. Bell., Secale and
Siiicea completed the cure.

Sanguina/ria. — Some cases have been cured by the local application
of this remedy. One was a youth, in whom the polypus projected from
the nostril. It was first extracted by force, causing profuse haemor-
rhage. It again grew as large as ever, and extended beyond the ate
nasi. Dr. Price, of New-Jersey, applied the pulverized root of Sangui-
naria, and the tumor soon assumed a paler shrunken appearance. He
entirely recovered. A case of a little girl and one of a man advanced
■n life, were cured in the same manner. {Loidsville Med, Jotor, 1840.)

Sanguinuria has been often used successfully as an errhine for the

i30 DISEASES OF THE EESPIEATOET FUNCTION.

cure of polypus. Dr. Wolf directs it in the 200th potency for a severe,
one-sided headache, which extends into the frontal sinus. Mercur.-
corros. relieves it temporarily only. Nitric-acid is one of the best
remedies for that condition of the pituitary membrane that predisposes
to polypus. There are bleeding from the nose ; scorbutic state of the
gums ; swelling of the lining membrane of the throat, which often
proceeds to laryngeal phthisis. These cases often occur in persons
of sycotic or psoric constitution. They have been cured with Nitric-
acid, Apis, and Fluoric-acid, each at the 80th potency or higher.

Minor Operations on the Nasal Passages. — The extraction of nasal
polypi, whether by forceps or ligature, requires a knowledge of the posi-
tion and relations of the turbinated bones, and the direction of the meati
of the nose. These abnormal growths may attain such proportions
that the whole contour of the face is disfigured. Fergussen gives a
case in which "the tumor extended from, the ethnoid bone to the con-
dyles of the occipital, and was also detached to both sides of the sep-
tum. Two large pendulous bodies hung down into the pharynx."^

HcBmorrhage from the No8e,—h\ obstinate haemorrhage from tha
nose, when the ordinary medicines have failed to arrest the bleeding,
the posterior nares must he plugged^ wadi a correct idea of the canals
and cavities to be operated on is absolutely requisite before the instru-
ment can be applied, whether the instrument be the canula of Bel-
locque, the hog's intestine used by Frank, or the gum-elastic bag
of Martin St. Agne.f

Eustachian Tube. — Gatheterism.- — This operation is' a simple one;
but it is necessary for the operator to bear in mind that the position of
the floor of the nares is horizontal, and that the internal opening
of tiie canal is on a level with the inferior turbinated bones.X

Genus m.—ROKOHUS.— RATTLING RESPIRATION.

1. Stertor. — A noisy kind of respiration, such as is observed in apo-
plexy.—Snoring, it is more properly a symptom of certain patholo-
gical conditions, which will be illustrated under cornaj apoplexy^ So,

2. Wheeling. — An imperfectly-developed form of asthma, called in
some GouiitYies phthisic. We meet it in children of psoric constitu-
tions, and elderly persons predisposed to phthisis. It is sometimes in-
duced in horses by driving them too fast and compelling over-exertion
of the lungs. Such horses are said to be " wind broken." The most
effectual remedy we have known tried is Nitric-acid, — a few drops in a
pail of water. See Asthma,

* Practical Surgery, p. 491. t Bernard and Ruette, Manual, &c. p. 192
t Dr. Helmuth.

EATTLIN-a EESPIEATION.

431

3. Ohsi/ncGtion to Eespiration fo'oon Foreign Bodies in the Larynx
or Trachea, — In tlie act of talking or laughing at the same moment
that something is swallowed, sometimes a portion of the food is drawn
in with the breath and starts down "the wrong way;" thus instead of
passing into the oesophagus it goes into the glottis, and instantaneously
produces alarming symptoms, in some cases immediate death.

The foreign bodies, which find their way into the larynx, are fre-
quently much larger than the size of the glottis would seem capable of
permitting to pass ; morsels of food, coins, grains of corn, seeds, nuts,
teeth, bullets, nails, &c., have found their way through this narrow
aperture ; how they got through it has been regarded as a mystery. But
it has been fully shown that dilatation and contraction of the space at
the glottis occur in regular alternation during the respiratory act^, the
first in inspiration and the contraction during expiration. When dilated
during inspiration, the size of the rima-glottidis is nearly double what
it is in a state of rest. Then in the act of inspiration, if the epiglottis
fails to protect the laryngeal opening, a foreign body passing toward
,the oesophagus may be drawn into the larynx. After its entrance, the
vocal chords contract forcibly from its irritation and thus prevent its
being thrown out again, hence so often a surgical operation becomes
necessary for its removal.^

Symptoms caused hy a foreign Substance in the Trachea, — " The
pain caused by its presence is towards the front of the throat, before
the oesophagus ; when in the throat the pain is further back ; there is
difficulty of breathing and of swallowing in both cases ; but, when the
wind-pipe is obstructed, the breathing is particularly difficult, the face
is bloated and purple, the eyes protrude ; the voice is more affected, be-
comes hoarse, or is lost altogether ; the cough is whistling or rattling,
and threatens to terminate in suffocation. These symptoms are slight
at first, but they gradually increase, sometimes subsiding almost entirely
for a time and then returning with greater violence ; obstruction to the
passage of air, often producing fatal asphyxia. Some cases of this
kind have been treated for croup, for laryngitis, or spasm of the glottis ;
these may also be mistaken for a foreign body in the trachea, &c.
When it exists, it may be lodged in the trachea, larynx, or one of the bron-
chi, being more frequently found in one of the latter. Dr. Gross found,
that they had been more common in the right one. In one case it was
transferred from the right one to the left.

If the foreign substance is not located m but helow the glottis, and
respiration is not impeded by it, the patient may seem to be in good
health for days and even for weeks, without experiencing any cough or

* Foreign Bodies in the air-passages, by Prof. S. D. Gross, of Louisville Univer-
sitj. 1854..

432 DISEASES OF THE BESPIRATORY FUNCTIOISr.

other symptoms. " Suddenly, however, he will be taken with violent
spells of coughing, almost to suffocation, the attacks resembling those
of croup. In such cases, if TartaT-emet or Silioea do not afibrd im-
mediate relief, there is little hope remaining. Neither will an incision
avail, if, between the attacks of coughing, the respiration becomes more
and more difficult and heaving. By this time the lungs have become
hepatized, and the sufferer must die, whether an opening be made into
the larynx or not.""^

DiAQZsrosis. — Auscultation may reveal the fact of the existence of the
foreign bpdy, indicate something of its size and locality. Chloroform
has been advised as an aid in the performance of a satisfactory ex-
ploration.

A dry rale, sonorous or sibilant, may be heard at the point of lodg-
ment. It is described as whizzing, whistling, cooing, whiffing, puffing,
snoring, any of which may indicate the fact of the existence of the
body and its locality. A boy in Dublin was whistling through a plum-
stone, perforated on each side, the kernel removed ; by a strong inspira-
tion he drew the stone into the largynx, where it became fixed trans-
versely, producing a sound as when the stone was held across the lips ;
for hours he continued this new mode of whistling, being much pleased
with it, and it gave little inconvenience for several days ; when it was
removed by an operation. {Stokes on the Chesty p, 262.) When the
body is lodged in one of the ventricles of the larynx the rale is heard
on that side. If it remain long in one position il; produces inflamma-
tion and ulceration, and a moist rale is produced. When the body is
drawn up and down by the current of air, passing in and out, a valvular
flapping sound is the result. It has even been felt to be projected by
the current of air against the vocal chords in the act coughing. In
one case a pebble was thus felt in the trachea of a boy, and was ex-
tracted by an operation. The symptoms are :

"Feebleness or suppression of the vesicular murmur equally on both
sides, if the foreign body be situated in a bronchus, the vesicular mur-
mur on the corresponding side enfeebled or suspended, the percussion-
resonance remaining clear, except collapse of the lung be induced.
Feebleness or suppression of the murmur sometimes suddenly giving
place to a well-evolved and normal respiratory sound, after an act of
coughing, which dislodges the foreign body, and carries it upward into
the trachea. Occasionally feebleness or suppression of the vesicular
murmur transferred from one side to the other, indicating a removal of
the foreign body from the bronchus of one side to that of the other
side. Exaggerated vesicular respiration on the side opposite to that
on which the murmur is found to be diminished or suppressed. Dry
and moist, bronchial rales, after a time, more or less diffused over the

* Hering.

LOSS OF YOICE. . 433

side corresponding to the bronclius in which the foreign body is
lodged."^ .

Treatment.— The first efforts to give relief in these cases generally
consist in "beating with the flat of the open hand on the back, blowing
snuff in the nose to induce him to sneeze, or tickling the throat with a
feather to excite vomiting, may throw it out. But if it be firmly fixed
in the wind-pipe, it will not be brought up by any such efforts ; and, if
the symptoms become alarming, if there be danger of suffocation, the
patient must be relieved by the operation of tracheotomy.

Medical Treatment.! — Ipecac, may be given whenever it is ascer-
tained that a foreign body is lodged in the wind-pipe. Free use of
demulcent drinks.

Belladonna. — The distress is paroxysmal, showing irritability of
nerves and disposition. By controlling the spasmodic effort the pa-
tient sometimes sleeps and becomes relieved by the ejection of the
substance during sleep.

Dust, feathers or hair, having been inhaled, cause violent cough.
.Hepar may follow Belladonna. Sugar-water or Gum-arabic water
used freely as drink.

Hepar for after-symptoms during recovery.

TartaT-emetic. — Danger of immediate suffocation, symptoms resem-
bling those of croup. Suffocative paroxysms in children who have got
something in the throat pressing on the larynx.

Opiitm. — Suffocative paroxysms of distressed breathing. The pa.-
tient becomes purple in the face.

Silicea, — ^When after trying Tartar-emetic the attacks return con-
tinually, or, if there is a cough attended with an offensive smell. Con-
tinue, morning and evening, until the obstruction is removed by cough-
ing. In tedious cases, Hepar'may be alterated with Silicea.

Genus IV.— APHONIA.— LOSS OF VOICE.

Dumbness or loss of voice may arise from various causes, none of
which need be treated of at length in this place. The different species
described by authors are: 1. Aphonia from absence of the tongue,
2. Aphonia from tumor of the fauces or near the glottis. 3. Aphonia
from disease of the trachea. 4. Aphonia atonica from paralysis or
loss of nervous energy.

1. Aphonia from defect of the Organs of Speech.— -T^^o hundred
years ago it was supposed that dumbness was always dependent on &C'
ganic defect of the organs of speech. It is now known that persons

* Flint's Diseases of the Respiratory Organs, p. 626.
t Hering.
Vol. I.-28.

434 DISEASES OF THE KESPIEATOET FUNCTIOIT.

who are deaf and dumb are almost exclusively capable of producing
vocal sounds, and indeed of sp.eaking and reading, and that they are
only dumb, because they are deaf; they cannot imitate, because they
cannot hear the articulate sounds made by others. There are a few
cases of malformation or defects of the organs of speech from injury.
In the states of North Africa cutting out the tongue has been often
inflicted as a punishment. The subjects of this cruel operation retain
the sense of taste for ordinary sa,pid substances, but acids and bitter
articles cause intense suffering.

2. Aphonia from Disease,— The diseases which cause loss of voice
are generally of an inflammatory character, and will be sufiiciently
referred to under their respective names. On curing the accompany-
ing disease the voice is restored.

3. Aphonia from breathing caustio vapors.

Ammonia, — A young lady lost her voice entirely from exposure to
cold. Numerous remedies were tried in vain for three months ; she at
last-regained it in three days by inhaling ammoniacal vapor, disengaged
from a mixture of a solution of the hydrochlorate of Ammonia and
carbonate of Potash. See JBromine, Iodine, — Index.

4. Aphonia ^-u^-do^vm.,— Deaf -dumbness. See Deafness. Index.

Genus Y.—DYSPHONI A.— DISSONANT VOICE.
1. HOARSENESS. -RAUCITAS.

Nature of the Disorder, — A peculiar condition of the mucous
membrane which lines the larynx or trachea* The affection may be
"acute or chronic.

Symptoms.— Rough and indistinct voice and cough, sometimes ac-
€ompanied by pain ; asthma, and rattling in the throat. When caused
by a chill, the disorder is mostly associated with a hard dry cough, or
with expectoration of a watery saline fluid ; after a few days, much
viscid white mucus is discharged. Other catarrhal symptoms often
occur. The hoarseness is observed only when the patient coughs or
speaks, or when the lungs contract, and not during inspiration.^

Causes. — A chili ; congestion of blood in the neighborhood of the
throat. Relaxation or partial destruction of the tissues of the larynx
or throat.

Prognosis. — Hoarseness is generally temporary and soon yields to
judicious treatment; in rare cases it continues for years, even for life,
^Treatment. — Aconite when there is any fever beginning or antici-
pated ; when the disease has been recently excited by cold ; heat of
face and hands with cold feet ; shivering.

Hartlaub.

IIOAPvSEj^^ESS. ^60

Arnica may" be diluted with water and used as a gargle wlieu the
affection seems to depend on a relaxed state of the lining membrane
of the phar^mXj tonsils and adjacent parts.

C/ia/mo'niillaj'-— Suited especially for children ; there is hoarseness
with catarrh, tough mucus in the throat, dryness, burning and thirst;
the temper irritable ; easily vexed, morose, taciturn.=^

jVux-vomica, — Persons of quarrelsome, obstinate,, headstrong and
sulky disposition. There is a rough, deep, dry cough, arising from
dryness, tension, and soreness of the throat; the mucus not loose;
heat and chills alternating, causing cough, with pain in the throat ;
voice, hoarse, weak^ deep and dry ; obstruction of the nose ; slight pain
while breathing ; sleeplessness at night ; cold feet and hands in the
afternoon, followed by fever and thirst ; confusion of the head in the
morning ; peevishness ; aversion to labor ; irritable, fretful disposition ;
obstinacy.

I\clsatiUa.'--RovL^ii(ie&Sy hoarseness and pain at the back of the
throat ; roughness in the palate, with dryness of the mouth ; tenderness
of the throat, during deglutition ; cold in the head, with discharge of
bloody mucus from the nose; cough, with expectoration and pain in
the chest; tickling of the throat, which excites coughing, and which is
worse in the evening; shivering with drawing pain in the limbs; fever
towards evening, followed by external coldness, fatigue and depression,
dry heat at night; disturbed sleep, troubled with dreams; silent, tear-
ful, irresolute disposition ; fickleness.

Mercur-vwios. — The voice is hoarse and rough ; burning and tick-
ling in the larynx; disposition to perspire, but the sweat giving no
relief; exposure to the air aggravates.

/.Capsicum.' — -Hoarseness with itching and obstruction of the nose;
cough, producing pain in different places.

Oa^lstiGUln.—Oh%im^tQ hoarseness, with catarrh; soreness of the
chest and throat. In obstinate cases a psorie influence in the consti-
tution may be suspected and Cinnahar will give the patient the benefit
of its valuable anti-psoric powers.

S'ulphitr.~K dose of the fnirtieth attenuation^ once a week, will often
remove obstinate hoarseness. Acid-niur, is one of the best remedies.

Genus VI.— PSELLISMUS.— DISSONANT SPEECH.

1. Bambalia, — Stammering. — Hesitation of speech consists in an
interrupted articulation, accompanied generally with more or less of
straining and distortion of the features. When owing to serious mal-
formation of the tongue or other organs of speech it may be incurahle,

* Ilering.

4:36 DISEASES OF THE KESPIEATOBY FUNCTION.

But in all tlie cases we have seen, tlie disease was of a spasmodic cha-
racter; the cure is generally possible and sometimes easy. It generally
arises from the effort to speak while drawing in the breath, which can
be avoided by an exertion of the will. Let the patient begin by filling
the chest well before he tries to articulate the first word, and then
slowly enunciate one word after another. Let him avoid fhe usual
hurried repetition of the same syllable; and, when one oral position
threatens to become spasmodically permanent, let him simply open the
mouth, allowing simple sound to escape. A still more specific direc-
tion is the follovang: Let the stammerer begin at once to beat time for
every word he utters^ either in talking or reading, just as if singing
the words. If this does not stop the hesitancy, then try beating time
for every syllable, and afterwards gradually run into beating for words,
and then for sentences. The beating can be done with the foot, or
with a hand, or one finger. Thus: "When [beat] in [beat] the [beat]
course [beat] of [beat] hu- [beat] man [beat] e- [beat] vents," [beat] &c.
A persistent course of measuring the words until the stammerer can
read and talk straight forward, though slowly, for an hour at a time,
will overcome the habit of stammering in very many, if not all ex-
treme cases.

Internal Medicinal Treatment must be directed to the cure of ner-
vous peculiarities of the patient's constitution. MerGurius-soL^ Ignatia^
Aconite^ Belladonna and Pulsatilla are the most important remedies.

ORDER II.-DISEASES OF THE RESPIRATION AFFECT-
INO THE LUNGS.

Genus I.-— COUGH.

1. IDIOPATHIC COUaH.

In most instances cough is one of the symjptoms of inflammatory
action, either of the parenchyma of the lungs, or of some membrane
connected with the respiratory organs; but coughs occasionally arise
and reduce the patient to a very low state of hectic fever, without the
presence of any inflammatory action, except that which is produced
by the act of coughing, from an elongation and relaxation of the uvula,
from the pressure of tumors and swellings in the throat, trachea or
thorax, from hypertrophy and other organic affections of the heart, and
from accumulations of serum or pus within the thorax. The process
by which this symptom of disease is produced consists in closing the
glottis, and then making a sudden or strong expiration. Its purpose is
the dislodgement of mucus, which may have collected in excess in the
air passages, or it requires the admission of a certain quantity of air^
and the possession of a certain degree of muscular strength. Patients
often die from want of strength to expel the accumulating mucus and

COUGH.

437

plilegm. A case is given of a boy who was dying of croup, being
about to suffocate from the accumulated mucus in the trachea which
he could not expel, because he could not draw in air enough to inflate
the lungs heyond the collected mucus. An opening was made into the
trachea ; he drew in a long breath and coughed up the mucus through
the rima-glottidis. {Med, Ghir, Transactions)

Cough may also be excited by other causes besides the accumulation
of mucus in the air-passages. The sensation that prompts to cough
may be caused by : slight irritation about the glottis ; a long trailing,
tickling uvula ; inspiration of irritating vapors ; pressure upon the re-
spiratory organs.

SympcuthetiG C^^i^A.— -Irritation of the nerves of the stomach may
excite a sympathetic cough. (See Catarrh of the Stomach) We see
therefore that mere cough is not a diagnostic symptom, which by itself
can reveal to us the nature of the disease of which it is but a symptom.

We have in several instances speedily succeeded in removing trouble-
some coughs, and of restoring patients to health, who were apparently
in the last stages of pulmonary consumption, by clipping off a portion
of an elongated uvula. It is not uncommon that protracted and trou-
blesome coughs are promptly cured by the removal of tumors in the
neck, by the puncturing of abscesses in the -^ throat or chest, or by
evacuating from the thorax an effused fluid. It behooves us, therefore,
in all cases of cough, where the cause is not perfectly apparent, to
make our investigations with reference to the above enumerated com-
plications, in order that surgical measures may be resorted to on all
suitable occasions.

It is to be feared that errors are sometimes committed by gentlemen
of our school, in underrating the value and importance of surgery, as
a means of curing disease. When the cause is of such a nature that
our remedies are at best slow and uncertain, while speedy and safe
removal may be affected by a surgical operation, we should never
hesitate in our choice. Even in cases like paracentesis abdominalis, or
paracentesis thoracis, where only a troublesome symptom is removed,
we often accomplish much good by placing the patient in the best
possible condition for the favorable operation of remedial agents. But
in the examples of obstinate tumors and abscesses, pressing unduly
upon some part of the respiratory apparatus, the aid of the surgeon is
often indispensible.

Many individuals are troubled with coughs in temperate latitudes
from an inherent debility of the lungs, and a want of vigor to resist
the stimulating influence of cold air. Such persons often succumb
eventually from phthisis without having experienced any actual in-
flammation of the pulmonary structure.

488 DISEASES OF THE EESPIEATOKY EUNCTlOIf.

Otliers, from excesses of various Idncls acquire a predisposition to
coughs from tlie most trivial exciting causes.

Teeatment.—- Appropriate remedies for all ordinary kinds of cough,
may be selected from those elsewhere referred to, when treating of
the different affections of the respiratory organs.

CliToniG Cough. — Case hy Dr, Dry s dale. — Arsenioum.—A patient
had suffered for a year with a cough which came on in paroxysms ; it
was worse on lying down at night, with dyspnoea, and was relieved after
an hour's coughing by the expectoration of tough mucus ; the appe-
tite bad ; gnawing pain at the epigastrium an hour or two after meals ;
diarrhoea for the last month. Urine scanty, clear, but passed frequently
and with difficulty. Cured by Arsenicum in two weeks.

&ingm'}iaria,—ln dry and humid coughs of almost every form, and
chronic coughs following inflammations, acute or chronic, Sanguinaria
is one of the best remedies. In these cases there is irritation of the
bronchial membrane. In many cases the cough is kept up by irrita-
tion of the stomach, torpor of the liver, tendencies to headache; and
in females spinal irritation. In all of these cases Sanguinaria is pe-
culiarly appropriate ; and in none of them is its success to be attributed
to its power of exciting expectoration. It is most useful in the pre-
tubercular stage of phthisis, the follicular inflammation of the throat ;
chronic catarrh. In phthisis it helps to prolong life, even in the
later stages.

2. PERTUSSIS.-HOOPING-COUGH.

Diagnosis. — Most writers recognize three destinct stages in hoop«
ing-cough, viz : first, the forming stage, presenting symptoms like
ordinary catarrh, as sneezing, watery eyes, dry cough, headache, con-
striction and oppression at the chest, feverish nights, &c,, which con
tinue for two or three weeks, when the second or convulsive stage sets
in. At this period of the malady, there are violent paroxysms of cough
of a convulsive and suffocative character. This cough is distinguished
from others by a peculiar stridulous or whooping sound, which occurs
during inspiration, while the expirations are interrupted by frequent
fits of coughing. This whooping sound is owing to a spasmodic con-
traction ef the glottis, which renders respiration very difficult, and
gives rise to a sense of obstruction and impending suffocation. This
spasm and contraction, together with a tickling in the throat come on
previous to the paroxysms and subside somewhat after the coughing
has ceased. The duration of the paroxysms varies from one to five
minutes, at the termination of which there is often vomiting or ex-
pectoration of mucus. This stage usually acquires its greatest degree
of violence in from one to two weeks, and its continuance is from five
to six weeks, when the third, or stage of declension commences. At

couaiL

439

this period all of the symptoms gradually become milder ; the parox-
ysms are less frequent,^ — the cough less urgent ; the contraction and
obstruction less strongly marked, until at the end of two or four weeks
more, under favorable circumstances, all of the symptoms have dis-
appeared.

Causes.— -Pertussis is unquestionably attributable to the absorption
into the organism of a miasm of a specific nature. We know nothing
of its chemical or physical character; but in this, like other maladies,
the system must be rendered susceptible by previous preparation, or
predisposition, to enable the miasm to exercise its specific eiFects and
induce the phenomena of hooping-cough.

Whether this specific miasm operates primarily upon the mucous
membrane of the air passages, the stomach, the diaphragm, the lungs,
or the eighth pair of nerves, we are unable to decide in a satisfactory
manner. It would seem that the advocates of each particular opinion
in regard to its primary location, have found in their autopsical ex-
aminations, appearances which indicated that there had been inflamma-
tion in each of the structures alluded to. That the pneumogastric and
other nerves, as well as the membrane of the glottis, larynx, &c., are
involved either as a primary or secondary effect of the contagion, there
can be no question.

The causes w^hich act upon the organism in such a manner as to
render it susceptible to the action 0/ the miasm, are, atmospheric
vicissitudes, colds, debility and chronic diseases of the respiratory
organs, inhalation of irritating substances, fatigue and exhaustion of
the physical or nervous system.

Dr. Wolf, in his work on Psoric Diseases, says: "hooping-cough has
beconie a stationary disease, in consequence of the universal practice
of vaccination. It often appears after vaccination or re-vaccination, or
vaccination exerts a salutary influence upon it."

Tii^ATMEi^T.—TaHar-emetiG. — -When the paroxysms of coughing are
accompanied by vomiting, diarrhoea, great weakness, rapid and feeble
pulse, cold and clammy skin, great tenderness, and irritability of the
larynx, and trachea; flushed face. Tartar-emetic about the second
or third trituration meets all the symptoms. It is often proper to altmv-
nate it with Belladonna. ^

Trifolitmi'infmncL — Common Clover. — This remedy has, says Dr.
Foster, " a wonderful effect in relieving hooping-cough,

a rpj^Q remedy is jpv/rely emj^irical^ but it nevertheless ouresmost;
cases in a few days." On this subject Dr. Hale remarks :

Instead of " empirioaV^ the doctor should have writteni "'hom<i)eopa
thic" for it certainly is indicated by the law of Similia, Tb^. so
called "hay asthma" is due to the influence of the medicinal principle
of clover, which escapes partially during the process.; of, curing)-. It

i-iO DISEASES OF THE KESPIRATOEY FTJl^CTIOK.

seems to reside principally in the impalpable dust whicli arises from
the clover. It has been supposed that this dust produced its effects by
its meGhanical action alone., The same has been asserted of Ipecac,
yet we know that Ipecac, in small doses relieves many forms of asthma,
and various spasmodic coughs. The Trifolium deserves a trial in
many affections of the bronchia and lungs. It is homoeopathic to spas ■■■
modic asthma. It causes a similar disease in man ; and horses who eat
clover, get the " heaves," which is but a form. of asthma. Dr. Hale
says, it causes spasmodic cough in horses ; a cough which much re-
sembles hooping-cough, and the cough arising from spasmodic croup.

Cwpsicuin, — Dr. Morgan, of 111., says, he cured promptly a severe
case of hooping-cough with three pellets of Capsicum, 3^ centesimal,
every three hours. , Having seen the result in this case, he gave it to
a half dozen or more other patients. in whom the disease had not, any
more than in the first one. In every case in which it was faithfully
used, it was successful in immediate" suspension of the disease; and the
improvement was permanent.

Coffea. — Coffee, " Cafe I'eau" hot and well sugared, a tea-spoonful for
a child, two years old : allow a good diet of minced meats, moderate
quantity of milk and farinaceous food. Prohibiting confectionaries.

In one case, a child had alarming paroxysms of coughing, which
threatened suffocation and fainting, till relieved by vomiting ; the coffee
mitigated all the symptoms. We have often used it with success in
severe cases. Coffee acts both on the stomach and on the nerves.

The chief remedies for pertussis are: Bell.^ see Exanthemata,'—
Index. * Drosera^ — pertussis after measles, with haemorrhage from the
nose or mouth. Mephitis-jputorius,—The most effectual in all common
cases. Other remedies are : Acid-mur., Cup.-suL, Cup.-met., Acid-nitr.^
Ammon.-mur., Veratr.-alb., Aeon., Canth., Allium-sat., Senega.

CrBNUs II.— DYSPNOEA. —EMBARRASSED OR LABORIOUS BREATHING,

In a healthy adult under ordinary circumstances, the act of respira»
tion is performed, unconsciously almost, about eighteen times in a
minute, nearly equal to one act of respiration for about every four
beats of the heart. In certain diseased conditions the frequency of
inspirations and expirations may be increased or diminished. Dys-
pnoea is applied to that deviation from the natural manner of alternately
expanding the thorax and permitting it to collapse, in which this act of
breathing is performed with labor, usually in a hurried bat imperfect
manner. This irregularity and difficulty depend on an altered proper-
tion between the quantity of air that reaches the lungs, and the quan-
tity of blood that is sent into them from the right ventricle of the heart
40 be converted into arterial blood.

DTSPNCEA. 441

Respiration is a movement, that is carried on unconsciously during
sleep, but which is also subject to the occasional control of the will. It
is supposed, that the presence of venous blood in the capillary vessels
of the lungs excites the pulmonary branches of the par-vagum ; this ex-
citement is transmitted to the brain and reflected on the motor branches
of the nerves, which supply the muscles of respiration ; by these muscles
more powerful efforts to alternately expand and eontract the chest are
made in an excited irregular manner; and their failure to completely ac-
complish their object is accompanied with a feeling of distress. In oi*-
dinary health the sensation indicating the " want of breath" is so slight
and so exactly apportioned to the need of the individual, that it is
scarcely felt and is not attended to, and is at once appeased by the im-
mediate aeration of the blood. It is only, when it is not relieved by the ad-
mission of air that the sensation of "want of breath" becomes ex-
tremely painful ; then all the voluntary muscles of respiration are
forcibly called into action to assist in the mechanical process of pro
pelling and aerating the blood.

In various forms of disease dyspnoea becomes a prominent and alarm-
ing feature. Thus In croup and laryngitis, tKe Inlet for the air Is nar-
rowed at its entrance to the lungs ; more blood then passes to the lungs
than can be supplied with oxygen, and instinctive efforts are aroused
to make up by numerous short inspirations the work which should be
better performed by a few full ones. If the obstruction to the passage
of air increases, the bad effects of the half-decarbonized blood circulat-
ing in the arteries begin to be perceptible. It begins to linger and
stagnate in the lungs; the lips become livid, the skin grows dusky,
showing the accumulation of carbon in the blood.

In any condition in which the quantity of blood flowing to the lungs
continues the same as in health, while the air inspired, is dispropor-
tionately small, dyspnoea will be produced. "When a portion of the
lung loses its spongy texture and becomes rapidly solid, so no air can
penetra.te it, though hlood also ceases to penetrate it ; the same quan-
tity of blood flows towards it from the right side of the heart into the
pulmonary artery, and the portions of the lungs still pervious receive
an excessive quantity; therefore there is great deficiency of oxygen for
this excess of blood and dyspnoea. The same effect may arise from
obliteration of the pulmonary vessels in one part by pressure of fluid in
the pleura ; enlargement of the heart ; dropsy or tumors of any kind
within the chest ; or pressure upward against the diaphragm by en-
largement of organs within the abdomen, from tumors, ascites, obesity,
pregnancy or full stomach. Dyspnoea may also be caused by disease
of the walls of the chest, or by restricted capacity of the chest 'by dis-
ease, rigidity or pain preventing its expansion, or by palsy of the
muscles depended on to expand it.

442 DISEASES OF THE EESPIEATOKY EUISrCTION.

DygpnmafTom increased Flow of Blood to the Lungs. — Under ac-
tive exercise tlie pressure of the muscles upon the veins propels the
blood with greater velocity to the right side of the heart; the heart
contracts more frequently in proportion as it is more rapidly filled with
blood ; an increased quantity is sent to the pulmonary artery ; and the
brea,thing must be more rapid to supply this excess of blood with air
the individual is out of breath, he is in a state of dyspnoea, though tem-
porarily so. We also see dyspnoea in some states of fever, and in all
other cases in which the equilibrium between the blood sent to the lungs
and the air supplied for its oxygenation. Such disordered conditions
show, how intimately the functions of the heart and those of the lungs
are dependent on each other; and also that dyspnoea considered in it-
self is not a diagnostic symptom revealing what organ is suffering or
how it is affected, whether the fault is in the heart or the luiigs, or
whether neither or both of them are in fault. For treatment see Asthma,

Genus III.— ASTHMA.

DiAaNOSis.— For a week or two previous to an attack of asthma, the
patient will often be troubled with sneezing every morning, itching in
the inner canthi of the eyes, irritation of the throat, with constant dis-
position to hem or hack, lassitude, dull pains in the head, back, and
limbs, loss of appetite, dry hacking cough, and great depression of spirits.

The attack most commonly commences during the night, with tight-
ness and constriction about the chest ; urgent and distressing dyspnoea,
aggravated by the slightest movement ; inspirations short and strong,
while the expirations are long, labored and vvheezing ; great and rapid
movement of the nostrils ; countenance bloated and livid, and indica-
tive of intense distress and anxiety ; inclination to retain the erect po-
sition ; even during the forming stage there is inability to lie upon the
right side or back ; more or less pricking or burning heat after the
attack commences, aggravated by scratching ; sometimes aggravated
by eating even bread ; respiration very difficult, as if from want of air,
yet the wind from a fan or the draught from a door or windov/, stops
the breath, and can not be borne ; face and forehead livid, or pale ;
sharp pain through the temples; inability to lie upon a feather bed
from the first ; during the paroxysm must constantly retain the erect
posture ; the dyspnoea, &c., worse in the night, and remitting during
the day ; dry cough in the first instance, sometimes, but not always,
followed in a few hours by expectoration of a viscid mucus ; perfume
of flowers, hay, &c., increases the symptoms, and almost puts a stop to
the breath during the paroxysms ; extremities cold ; respiration through
the mouth ; attacks brought on from excitement, particularly grief and
fear ; also certain odors or irritating substances inhaled ; palpitation
during the attack; the attack occurs for the most part during the

ASTHMA. 443

season of flowers ; tongue foul ; breath offensive ; eructations ; flatu-
lency ; urgent desire for cool, fresh air ; pulse variable.

Causes. — First^ the causes of the paroxysms; and second^ the
causes of the disease. The former are usually easily ascertained ; but
it is often very difficult to point out the latter, or those influences
which have disposed him to fall into the asthmatic state on the occur-
rence of the ordinary irritations are divided. The authors between
those who say that asthma has at the root of it some organic disease
within the chest, and those who deny that genuine spasmodic asthma
ever depends on organic lung-disease, and maintain that it is always a
pure neurosis.

It was observed by Hahnemann that asthma always occurs in
individuals who are suffering from some chronic miasm. In numerous
instances we have been able to trace a direct connection between
asthma and an attack of urticaria, but partially developed, and then
suddenly suppressed. Indeed it may be safely asserted that a majority
of the cases of true asthma, are attributable to this or to some other
miasm, which has been thrown, from some exciting cause, upon some
portion of the respiratory a-pparatus. We are confirmed in this opin-
ion, from the fact that in several instances where an attack of asthma
has been seriously threatened, and even commenced, we have been able
to cut it short by administering a remedy like Puis., Bry., and Citpr-
aoet, which had the effect to develop the nettle-rash, and thus relieve
the air-passages. See page 449, Causes^ c&e.

Other causes which are, properly speaking, exciting causes, may be
enumerated:, as humid easterly Avinds, atmospheric vicissitudes, and
electricitv in the air ; inhalation of certain medicinal and other irritat-
ing substances, like IpecaCj the odors of certain plants, the inhalation
of the imponderable particles of which often causes severe paroxysms
of the malady ; also indigestible food, anger, fear, the irritation of preg-
nancy, spinal disease, sedentary habits, &c.

PBoaNOSis.^ — "Asthma," says Dr. Salter, " never kills," at least he has
never seen a case in which a paroxysm proved fatal. When a patient
dies from the contingencies "of the disorder, he does so from the organic
changes in the heart and lungs which have gradually progressed. An
unfavorable prognosis must be made when there is obstinate persist-
ence of expectoration, and chronic cough, as both of these symptoms
show that the lining membrane of the air-passages is the seat of or-
ganic change.

"If the patient is young, the chest sound, the attacks short, the in-
tervals long ; if there is no permanent shortness of breath, no cough
or expectoration ; if the attacks are getting milder or rarer, and -if the
exciting cause is clear and such as may be obviated, then a favorable
prognosis may be given. If the patient is old, the lungs damaged, the

44:4 DISEASES OF THE EESPIRATOEY EUNCTION".

attacks frequent and severe, tlie breathing never quite free, cougliing
and spitting constant, the disease apparently gaining ground, and the
exciting cause occult, or irremediable, then, in view of all or any of these
cii mmstances, there is no alternative, but to give an unfavorable
prognosis " {Dr. Salter on Asthma)

Treatment. — Pulsatilla^ Ipecacuanha^ Arsenicu'm^ Bryonia.^
jSfux-vo'inica^ Belladonna, China^ Sulphur^ Lohelia-inflata, Gaffe a^
Digitalis^ and Acid-hydrocyanic^ and Moschus are the principal
remedies in this complaint.

Pulsatilla is indicated in cases occurring in persons* of a mild tem-
per, light complexion, hair and eyes, from suppressed or confined urti-
caria or other rash, cessation or other derangement of the menses, and
inhalation of the vapor of Sulphur, The external indications are :
Short, suifocating and extremely difficult respiration, as if from want
of suificient air, or choked by some irritating substance ; the patient
is obliged to retain the erect posture; his movements are rapid and
his whole appearance indicates great distress and anxiety ; tongue
loaded with a thick coating; breath offensive; frequent eructations;
hiccough; countenance pale, sometimes alternating with redness;
attacks usually coming on in the night during sleep.

Cramp-like and constrictive tension of the chest or larynx ; respira-
tion impeded and distressing, increased by motion, walking in the open
air, or by eating; short spasmodic cough, nausea; palpitation of the
heart ; sensation of fulness and distention in the stomach ; throbbing
pain in the forehead ; bad taste in the mouth ; cramp-like pains in the
abdomen; itching, burning or prickling sensation in the skin, in the
evening or during the night; pains in the limbs ; nausea and vomiting;
smarting or burning pain in the canthi, and pressure in the eyeballs.

Very great depression of spirits, and melancholy from the onset of
the symptoms ; intense anxiety ; agitation and dread of suffocation
during the paroxysms.

Administration, — From the third to the sixth dilution may be used
- — a dose every half hour in urgent cases — until aggravation or amend-
ment occurs.

Ipecacuanha,— In asthma, caused by the suppression of miliaria,
urticaria, and by the inhalation of irritating vapors. Ipecacuanha at
the first to the third attenuation, may be exhibited. The signs which
particularly indicate this medicine, are : Spasmodic contraction of the
larynx and chest ; anxious sighing or panting respiration ; palpitation
of the heart ; air seems full of dust ; face pale ; extremities cold ;
nausea; vomiting; coated tongue; insipid or bitter taste; dry, spas-
modic cough ; irritability ; impatience and fear of death.

Arsenicunn-aTbum^ is a valuable remedy in bad cases, occurring
from suppressed eruptions or catarrh, also in persons of feeble or im-

ASTHMA. 445

paired constitutions, wliether from excesses, previous sickness or old
age. The following symptoms point especially to tliis medicine, viz :
feeling of extreme lassitude and debility; difficult, stifling dyspnoea,
with attacks of suffocation; spasmodic constriction of the larynx and
chest; respiration short, anxious and v^heezing; irregular throbbings
of the heart; sufferings aggravated at night by lying down, movement,
eating, mental excitements, or exposure to the cool fresh air; disten-
tion and cramp-like pains in,^he abdomen; frequent eructations; nau-
sea; vomiting; burning sensation at the stomach; foetid breath; smart-
ing or burning sensation in the throat; oppressive burning pains in the
eyes; face pale or bluish; anxious aud desponding. The first to the
third trituration may be employed, regulating the repetition according
to the urgency of the symptoms.

"It is a common practice in China, for asthmatics to smoke Arsenic,
and with the greatest relief to the disease. A very interesting case is
related, in which a French lady did the same, in consequence of hear-
ing the above. She commenced with a quarter of a grain, swallowing
the smoke. From being in a state of constant breathlessness and
suffering, unable to lie down or make the slightest exertion, she is
now aMe to go abroad, and is rarely threatened with an attack oftener
than once in three or four months, and that is at once checked by
smoking Arsenic."

The Liquor Arsenicalis is said to be much more efficacious than the
Ars.-alb, It seems to be more prompt and energetic when Arsenicum
is indicated. It should be prepared with distilled water instead of
Alcohol. The most efficacious and satisfactory method of treating
asthma, is with the Arsenical solution — first dil. and Kaii-hyd., first
trit. (dec.) in alternation, every hour or two, or three times a day, as cir-
cumstances demand.

Bryonia is applicable in cases arising from suppressed eruptions,
or rashes but partially developed. It is also appropriate in cases com-
plicated with catarrhal and pulmonary disorder.

The paroxysm usually occurs in the night ; the respiration is diffi-
cult, short, sighing, impeded by stingings in the chest, and aggravated
by exercise; there are oppressive, tensive or contractive pain in the
chest ; cramp-like pains, cuttings or shootings in the abdomen ; bitter
or acid eructations ; throbbing or pressive pains in the head, increased
by movement ; pressure and burning pain in the eyes on motion. It
may be exhibited in the same manner as Pulsatilla,

Asthma, which has been caused by derangement of the disgestive
functions, excessive study and watching, sedentary habits, abuse of
drugs, liquors, coffee, &c., may often be cured by the use of N%ix,

The ^'^^(^a^-symptoms are, weight and constriction at the chest; great
difficulty of breathing; aggravation of the symptoms in the night, on

416 DISEASES OF THE KESPIHATOrvY FUNCTION.

walking, eating or lying down in tlie evening ; heat and burning in the
chest; bitter and acid eructations; pressure and contractive pains in
the stomach and epigastrium ; palpitation of the heart ; short, dry,
spasmodic cough, sometimes attended with a scraping in the throat ;
foetid breath ; loaded tongue ; heartburn ; distention of the abdomen
after eating ; heaviness or tearing, throbbing, drawing or jerking pains
in the head ; frequent sneezing, with coryza ; hypochondrica, anxiety
and irritability. It may be employed in ^the same manner as Ptclsa'

Belladonna has been especially recommended in cases occurring in
females of an irritable constitution, also in cases where there exists a
tendency to spasms, or any organic lesion. Hartmann asserts that it
*' often proves radically curative after the exhibition of some inter-
current remedy, particularly in cases which have not become too
chronic by repeated relapses, under which circumstances we must have
recourse to Sulphur^ Caloarea^ or some other antipsoric."

It is particularly called for when the paroxysms come on in fits of
short, difficult, irregular and suffocating respiration, accompanied by
dry cough; pressure on the chest; violent beatings of the heart;
vertigo, swimming or darting pains in the head ; pains in the small of
the back and limbs ; cramps in different parts of the body ; anxiety,
irritability, and fretfulness.

A dose of the second or third dilution every hour or two until an
impression is produced.

Charnonhilla is an important remedy in the flatulent asthma of
children, also in that following a suppressed catarrh. It is likewise
specific in those attacks which are caused by anger, grief, fear, &c.,
in adults. Among the symptoms which point to it may be mentioned
distention and sense of fulness of the stomach and bowels ; pressure,
anxiety, and fulness in the region of the heart, short, wheezing respira-
tion ; great restlessness ; dry irritating cough ; bad taste ; tainted
breath.

Administ/ration, — Same as Belladonna.

Lobelia-infiata, — Dr. M. Cutler says : he had been an asthmatic
for ten years, during which time he tried all known modes of treat-
ment, getting better results from Ictodes-foetida (skunk- cabbage) than
any thing else. When an attack, the most severe he ever had, came
on, he took a table- spoonful of tincture of Lobelia, the fresh plant, fully
saturated, — at a time when the difficulty of breathing was extreme
In three or four minutes the breathing was as free as it ever was ; there
was no nausea. In ten minutes took another spoonful, which occasioned
sickness. In ten minutes more he took a third, which produced
moderate vomiting and a prickling sensation through the whole systemy
even to the extremities of the fingers and toes. The urinary passages

. ASTHMA. 447

were affected with smarting in passing urine. These symptoms soon
subsided, and a vigor was restored to the constitution which he had
not experienced for years. He had no attack afterwards, and had only
on a few occasions a few of the symptoms. Before taking the Lobelia
he scarcely passed a night without more or less of them ; and often
was unable to lie in bed. In other cases he found it to give relief, but
it affected different persons in different ways. A tea-spoonful produced
emesis in some. Nausea in some degree was thought necessary. He
thought his own case one of '^ convulsive asthma from pulmonic irrita-
tion of effused serum. Dr. W. P. Barton gave it to lady who had nar-
row and compressed thorax, subject for years to asthma. The above
excessive and dangerous doses only cured because the remedy is
capahle of causing asthma.

The Lobelia-longiflora, which grows in the West Indies, spreads
such deleterious exhalations around it that an asthmatic oppression of
the chest is felt on approaching within many feet of it as it stands in
the corner of a room. [Ingenhouz) Darwin thus alludes to it :

" And fell Lobelia's suffocating breath

Loads the damp pinions of the gale with death."

Botanic Garden.

Lobelia-injlaia is a remedy of great value in cases of spasmodic
asthma induced by humidity, and certain other conditions of the at-
mosphere. It is indicated when the attack is preceded or accompanied
by a kind of " prickly sensation through the whole system, even to the
extremities of the fingers and toes," constriction across the chest ; short,
anxious and wheezing respiration; nausea; vomiting; sense of pros-
tration ; trembling of the limbs ; giddiness and headache, spasmodic
cough ; burning sensation in passing urine; intermittent pulse ; cramp-
like pains in the abdomen ; cold sweats.

Ad'ministration.- — Potencies from the third to the sixth,~a dose
every two to four hours, as the symptoms require.

There are other remedies, like Ooffea^ Ignatia^ Str ammonium y China^
Arnica^ c&o., which should always be borne in mind by the prac-
titioner; for instances may occur where one or more of them will
be required.

In cases of asthma of long standing, and which appear to be con-
nected with some chronic miasm lurking in the organism, SulpJiitr^
Digitalis^ Acid-hydrocyanic, Galcarea, &C.5 are worthy of consideration,
and will sometimes effect cures when the other medicines enumerated
have disappointed our expectations.

Thuja,' — Dr. Wolf says of this rem_edy that it corresponds to all forms
of asthma; and in the course of the cure by Thuja it is not uncom-
mon to see the sycotic gonorrhoea appear and re-appear in its primitive
form, and with apparent relief of all other morbid symptoms^ Often

448 DISEASES OF THE RESPTBATOEY FUJSTCTIOIsr.

also, we find the above described affections appear as the immediate
consequence of vaccination. (See 449, Causes^ &c.)

Bromine, — Dr. Douglas says a dyspnoea of ten years standing in a
girl sixteen years of age, which, had remained after measles, and was
so violent that the girl was sometimes not able to walk fast or go up-
stairs without feeling very much exhausted, disappeared after taking
five doses of Bromine 80*^ of five pellets each. It is one of the few
drugs that produce the croupous false membrane in the air-passages.

Calcarea, — ^Dr. Luther reported a case of a girl aged seven years,
who presented all the appearances of permeability of the ductus ar
teriosus^ namely dyspnoea, irregularity of circulation, blue discoloration
of the skin, &c. Calcarea 80^ effected a radical cure in six weeks.

Genus IV.— LARYNGISMUS. — Laryngio Suffocation,

I. ASTHMA THYMICUM.—ASTHMA MILLAKII.-SPASMUS GLOTTIDIS -LARYN-
aiSMUS STRIDULUS.— CROWING DISEASE OP CHILDREN.

This disease was first described by Dr. John Clarke, and then by
Dr. Simson, 1761, Dr. John Millar in 1769, Dr. Davies, 1826, It
consists essentially of a constriction of the glottis, which impedes the
passage of the air into the chest, even in the mildest cases, and some-
times suspends altogether for a time the respiratory function.

Diagnosis. — The child has an interruption of the breathing, and
after vehement struggles at length succeeds in drawing in its breath
with a shrill sound like the peculiar inspiration of croup and hooping-
cough. These attacks are paroxysmal, and vary in frequency, severity
and duration. The intervals become shorter as the disease advances.
In the earlier stages the attack is often slight, and soon stops with
a fit of crying, which is succeeded by a refreshing sleep. The severity
increases in violence and becomes unyielding. In the early stages the
attacks begin generally in the night, but afterwards they come on at
any time from trifling causes. It is evident that there is an unusual
approximation of the sides of the glottis as in hooping-cough or
croup. When the closure is not perfect, the child breathes, but hur-
riedly, and the countenance is bluish, eyes staring, and each inspiration
is attended with a crowing noise. Where more complete, respiration
is entirely suspended for a while; the child makes vehement struggles,
termed convulsive, to recover its breath ; at various intervals, from a
few seconds up to a minute or in some to two minutes, air is admitted,
and this rush of air, passing through a narrow chink produces this
peculiar sound. A fit of coughing or crying follows and the paroxysm
ends ; or, if the glottis does not open at the end of two or three minutes,
the child dies of asphyxia ; pallid and exhausted, it falls lifeless on the
nurse's arm, and is said to have died in a fit.

LARYNGISMUS. 449

During tlic struggles for the recovery of breath all the muscles sup-
plied by the respiratory system of nerves are in violent action ; the
face is pale and cadaverous, and the external veins turgid with highly
carbonized blood. When it ends in death, sometimes we have true
convulsions, but generally slight.

Contraction of the flexors of the thumb, fingers, wrists, ankles and
toes has been considered as characteristic.

The sound of mucus in the trachea, as the child wakes from sleep^
breathing for some moments unusually hard, is caused by the increased
secretion of mucus ; the sound is more observable just before a parox-
ysm. In some cases it is one of the most striking symptoms, lasting
for weeks or even months without interruption, and so resembling
hooping-cough as not to be distinguished from it. It has been con-
founded with catarrh with increased secretion, but in the crowing dis-
ease the lining membrane of the fauces, nares and frontal sinuses are
free from disease.*

The convulsions are common, but the disease may exist without them,
convulsions do not always indicate cerebral congestion. Dr. Merriman
gives two cases of children who died in the fits, in which no trace of
cerebral congestion could be found after death ; he only found a collec-
tion of small glandular swellings on the neck, pressing upon the par-
vagum.

It is also noticed that when the crowing is caused by dentition, the
symptoms do not vanish instantly upon cutting the gum and the starting
of the tooth through it, but they pass off gradually ; some time being
required for the irritation and tumid state of the cervical glands to
subside.

Catjses.— -Laryngeal suffocative asthma is perhaps in all cases de-
pendent on the presence in the system of some one of those constitu-
tional miasms which Hahnemann has shown to lie at the foundation of
nearly all chronic diseases. In his great work on that subject he gives
many cases gleaned from various authors, in which asthmatic suffocative
diseases originated in repelled cutaneous eruptions, as itch, herpes,
&c. Scrofula is one of the most widely-diffused miasms. See Scrofula^
Psora^ and Bloody Diseased states of.

Causes of the Paroxysm, — They consist in all influences which can
close the glottis involuntarily. The breathlessness which commonly pre-
cedes the sonorous inspiration cannot arise from the closing of the rima
glottidis, which in such cases is perfectly normal, but must depend on
defective power in those agents whose office it is to open that narrow
aperture. The " crowing inspiration which is nature's imperfect cure
of the temporary suspension of breathing, arises from the glottis being

* Laryngismus Stridulus, by Hugh Ley, M. D., London, p. 480
Vol. I.-29.

450 DISEASES OF THE RESPIRATORY FUISTCTION.

partially open for tlie admission of air, and remaining so until some
expalsive expiration, such as screaming crying, coughing, or belching
shall mechanically burst open the flood-gates and perfect the recovery
from the paroxysm."

Pathology.— The symptoms of this disease seem to show its spas-
modic character ; but it has been rendered more probable by observation
" that the glottis is closed by the usual exertion of some of the ordi-
nary functions, as swallowing, &c.," and that it remains "partially or
totally closed from some want of vigor in those antagonistio powers
which should again sufficiently open the glottis for the purpose of re-
spiration." It is proved that children of strumous constitutions are
almost the only ones affected with it ; and whatever be the remote
cause of the malady, the only pathological fact which exists in all the
cases is an enlargement of the thoracic or cermcal ahsorl)ent glands.

Relation hetween the Pathology of the Disease and its Symfto'ins,
Charles Bell says : " the knowledge of the nerves of respiration dis-
tributed in the neck, throat, and thorax will enlighten the physician
in distinguishing the symptoms of disease." In the present case we
notice that the two clusters of glands subject to this enlargement or
induration during infancy are in the neighborhood of vital orga-ns ;
and when enlarged they must exert a pernicious influence on the parts
with which they are in contact. In children the absorbent glands are
seldom enlarged so as to press much upon the trachea, but may obstruct
the lymphatics or interrupt the functions of the nerves, and there may
be much enlargement of the glands at the root of the lungs before
and behind the bronchia, blending with others on the arch of the aorta,
and frequently between the origin of the carotids, which are but con-
tinuations of those that follow the course of the trachea downward„
It is therefore probable that the recurrent nerve at its origin may be
subjected to its injurious influence, as this nerve upon the right side
turns round upon the subclavian artery as it emerges from the innomi-
nata, behind which the nerve passes close to the origin of the carotid
upon the side ; whilst the left recurrent nerve winds round the arch
itself of the aorta, generally between the carotid and subclavian ar-
teries, upon and about which these glands are situated.

If the deeper-seated chain of glands be enlarged, they may eifect
the recurrent in its course ; for they lie in the cellular tissue and form
a cushion for that nerve. Now what would be the precise effect of
such pressure upon the recurrent? This much seems proved, "that this
disease, the spasmodic character of which has been conceded without
examination is more allied to paralysis than to a compulsive move-
mentr The symptoms are not those of excitement either of the par-
vagum or of the recurrents, but resemble those which are proved by
physiologists to result from an annihilation of the powers and attributes

LAEYNGISMUS. i51

of those nerves, as where they have been tied or divided, or the portion
of a nerve excised.

Treatment. — 1. Of the constitutional state -which predisposes to
laryngismus. This must be attempted by the antipsoric remedies best
suited for each special case. See Scrofula^ AsthTna^ Sycosis^ Psora,

2. Treatment of the Par oxy son, — Pemedies, Aconite, Bell., Ipecac,
Sambucus, Arsenicum, Barj^ta-carb., Cham., Coffea, Cuprum, Moschus,
Bry., Nux-vom., Puis., Sulph., lod.-sul., Calc.-carb., Ammon-carb.

SaQubibGUS. — -Slumber with half open eyes and mouth ; on awaking
from it he could not draw a breath, and was compelled to sit up, where-
upon respiration was very hurried, with wheezing in the chest, as if
he should suflbcate ; he lashed about with his hands ; the head and
face were bloated and bluish; he was hot without thirst; weeping at
the approacb of a paroxysm; without cough ; manifestations especially
at night, from twelve to four o'clock.

Chlorine, — Dr. Carroll Dunham says, that chlorine gas in cold water
produced in his own case the following symptoms : 'Pnspiration un-
impeded and could be eflected in the natural manner, but expiration
was absolutely impossible, and the impossibility arose, not from any
inability of the muscles of expiration, but from a closure of the rima
glottidis, expiration being felt to be impossible, inspiration was again
attempted, and was accomplished, fully and easily, although the act
was attended by a slight Growing noise. Expiration which was again
attempted, was impossible as before. By these successive operations
the lungs became inflated to a most painful degree, but so firmly did
the glottis appear to be closed, that it seemed as though air might
pass through any part of the thoracic walls more readily than by the
way of the larynx. This arrest of respiration having endured for
about a minute, the face becoming turbid and livid, partial com^ super-
vened, the spasm relaxed, and respiration became free again."

These symptoms had been excited by only washing the mouth with
"a weak solution of chlorine gas in cold water." On another occasion
he saw the same train of symptoms produced by inhalation of chlorine
gas. In a proving of chlorine a similar effect is indicated. Pereira
says : the attempt to inhale it " produces spasm of the glottisP

Dr. Dunham gives the following case:"^ "An infant seven months
old, well developed and large; fourth child of healthy parents ; was
seized three weeks ago, with spasmodic affection of the respiratory
organs ; would suddenly, without warning, make a long inspiration with
a slight crowing noise ; attempt to exhale would fail ; another crowing
inspiration followed by forcible ineffectual effort to exhale. This suc-
cession of spasmodic efforts would follow each other till the child be-

* American Horn. Review, Vol. II., p. 2p.

452 DISEASES OF THE RESPIEATOEY FUNCTION.

came blue around tlie mouth, and sank into partial unconsciousness ;
free respiration would then followj and then a deep sleep. Sometimes
convulsive movements appeared as the paroxysm was subsiding. Attacks
came on after excitement, frequently during sleep, most common after
midnight, as many as thirty or forty attacks in twenty-four hours.
Emaciation progressing rapidly, losing appetite, strength and playful-
ness ; face pale and bloated; eyes dull und glassy. Homoeopathic
treatment and change of air had failed ; an older cMld of the same
family had died during the past year with the same affection, terminat-
ing in four weeks in convulsions. In that case autopsy revealed no
organic lesion; simply emaciation and atrophy. The disease had
evidently advanced almost to the second or convulsive stage in which
the prognosis is decidedly unfavorable.

A saturated solution of chlorine gas in water at 60^ Fahrenheit was
prepared ; of this was made the first centesimal dilution, retaining still
the odor of chlorine. Of this twenty drops were dissolved in four table-
spoonfuls of water; a tea-spoonful to be given in a porcelain spoon?
every two hours. A few drops to be placed in the mouth at the be-
ginning of each paroxysm. Beginning at four, p. m., June 24:th, when
the child had had forty paroxysms within the last twenty-four hours.

" During the succeeding twenty-four hours there occurred but four
paroxysms ; only one of which began with any severity, and this one
was instantly arrested midway by a few drops of the solution placed
upon the child's tongue. During the night of the 26th not a single
paroxysm. Appetite and playfulness returned, the bloated aspect of
the face and dulness of the eye disappeared."

Genus Y.—EPHIALTES.— ONEIRODYNIA.
L ONEIRODYNIA GE A V ANS.- INCUBUS . — NIGHTMARE,

Ephialtes was so called from the belief of the ancients, that a demon
leaped upon the breast and prevented its expansion to draw in the
breath.

Some nervous or indisposed persons are oppressed during sleep with
a heavy pressing sensation on the chest, by which respiration is im-
peded, or the circulation of the blood intercepted to such a degree as
to threaten suffocation. <.Prightful ideas are recollected on waking,
which have occupied the dreaming mind. Frequent attempts are made
to cry out^ but often without effect, and the horrors and agitations felt
by the patient are inexpressibly frightful. In the more severe cases,
the patient seems at the commencement of the paroxysm in a profound
sleep and suffering imaginary troubles in an unpleasant dream.

The uneasiness of the dream increases and ends with the conscious*

EPHIALTES. 453

ness of being in bed and asleep ; he feels oppressed with some weight
that bears down and prevents breathing, and feels sensations the most
painful that can be conceived. As he becomes partially awake, he
makes violent efforts to move the limbs ; but no muscle obeys the will ;
and every exertion exhausts the remaining strength, and appears to be
the last ; the heart beats rapidly, sometimes with palpitation ; the coun-
tenance is ghastly ; the eyes half-open. If let alone the sufferer re-
mains a minute or two, and then recovers all at once the power of voli-
tion ; he jumps out of bed or turns in it till quite awake. If this is not
done, another paroxysm may be expected as the propensity to sleep is
irresistible ; and immediate sleep is surely followed by another par-
oxysm. Some hear singing in the ears and see spectres before the
eyes ; some acceleration of the pulse and palpitation of the heart re-
main; and if the patient does not fully awake, he may retain some re-
membrance of his horrible imaginings as of some fearful supernatural
visitation. It is said, that the most intelligent persons have been de-
ceived in this way, and could only avoid it by rousing themselves fully
to a full consciousness of their condition. The amiable poet Cowper
thought, he "was hunted by spiritual hounds every night;" and could
not tell whether it arose from his state of health or the divine displea-
sure. When the digestive organs are in certainstates of disease, there
may be preternatural pulsations from one end of the alimentary canal
to the other. A man of Cowper's morbid sensibilities might easily
combine from his sensations and his dreams, a vision of spiritual hounds.
Forestus thought himself pressed by a black dog, so that he could not
move. Night-mare and its accompaniments may be expected by con-
templative, hypochondriacal persons, subject to nervous diseases, when
the stomach is over-loaded by indigestible substances.

Virgil, if not a sufferer from night-mare, was acquainted with it. He
Bays: (Book 12, line 1218, ^neid,)

" And as when heavy sleep has closed the sight,
And sickly fancy labors in the night,
We seem to run ; and destitute of force,
Our sinking limbs forsake us in our course ;
In vain we heave for breath ; in vain we cry ;
The nerves unbraced their usual strength deny ;
And on the tongue the faultering accents die."

Walter Scott also knew something of night-mare, which he thus de-
cribes in the "Lady of the Lake :"

'* In broken dreams the image rose
Of various perils pains and woes :
His steed now founders in the brake ;
Now sinks his barge upon the lake ;
Now leader of a broken host,
His standards fall, his honor lost.

454 DISEASES OE THE EESPIRATOEY FUNCTION.

Then from his couch may heavenly light
Ohase this dread phantom of the night."

CATJSES.---The distressing sensations of the patient in some cases
originate in a large quantity of wind, or indigestible material in the
stomach, which is oppressed with a full supper taken at a late hour
The stomach expanded with acid-gas, presses against the diaphragn,
preventing its descent, and thus impeding respiration. The stomach is
generally acid in persons subject to this disease. Inflation of the intes-
tines also produces disturbed respiration or mental perturbations.
Sleeping on the back seems to have some influence in causing this
disease. The patient seems to himself to be on his back, and to be kept
down by some external power. The above are the causes which most
commonly operate ; but neither any one of these, nor yet the stopping
of the circulation in the heart or of any particular part ; neither a full
stomach nor an empty one can always be charged with causing it.

Treatment.— Persons subject to it, should eat but little in the eve-
ning, and take light food at all times ; drink no wine, beer, nor coifee.
Weak black tea may be taken, but the free drinking of water is better.
Milk and soup are both heavier for some dyspeptics than solids of pro-
per quality and quantity. (See Dysjjejjsia,) The patient should bathe
the head and neck in cold water in the evening in summer, or rub the
face, neck and back of the head, throat, chest, &c., with a wet cloth or
sponge, and drink cold water on going to bed.

Remedies. — Nux-vomica, — Disorder of digestion caused by spirit
tuous liquors, strong-beer, too high livingj sedentary habits. Take it
every night.

Aconite,- — When the disease occurs in children and women, and is
accompanied by much heat, thirst, palpitation of heart, determination
of blood to the head or chest ; oppressed breathing, nervousness, un-
easiness ; also for headache, febrile excitement following the attacks.

(9^^^^m.— Paroxysms violent ; patient lying with his eyes half closedj
snoring, the mouth open, rattling in the throat, the breathing irregular^
face much distorted, and covered with cold perspiration, extremities
convulsed.

Pulsatilla. — Considerable derangement of the digestive apparatus
from high living.

Sulphur and Silicea. — In occasional doses, when the attacks con-
tinue to recur after having taken the above remedies.

2. EPHIALTES APNCEATICA.— Ephialtes feom Suspended Respieation.

Diagnosis.- — This form of ephialtes occurs in persons of nervous tem-
perament, who inherit certain psoric or other constitutional maladies,
or have been broken down in health by the influences of malaria oi

EPHIALTES APNCEATICA. 455

Mercury. There is generally derangement of digestion manifesting it»
self in a depraved appetite, craving for indigestible articles ; disposi-
tion to chew paper, rags, or charcoal, &c. The sleep becomes at first
disturbed, and then occasionally too sound, attended with troubled
dreams. In the worst cases the patient after being somewhat weariedj
or eaten a supper only a little heavier than usual, retires to rest in ap-
parent health. Immediately after he becomes fully asleep, he begins
to breathe gradually less and less deeply. The amount of air taken in
at each expansion of the lungs is successively smaller, till he lies as in
a profound stupor, breathing so faintly that the respirations can not be
heard or counted. During the same time the beatings of the heart also
have been becoming gradually fainter; and the pulse, which on going
to sleep was full and strong, has diminished in force till the beats have
become almost insensible. For the length of time that breathing can
be dispensed with the patient seems in a profound trance, insensible to
all ordinary noises or even to efforts of others to wake him. At length a
struggle within to renew the act of breathing manifests the return of
consciousness. Breathing is at first impossible, the face becomes
darker under spasmodic, fruitless efforts to "catch the breath."
The features are distorted and the whole frame convulsed with agony
some seconds, which seem to observers very long ones ; at last the first
spasmodic expulsion of air is announced in a fearful seremn^ which
thrills and rouses every body near, whilst the patient through convul-
sive and protracted efforts is succeeding in the restoration of ordinary
respiration. The first paroxysm on going to sleep is ordinarily the
most severe ; but he is liable to others during the night, and at other
times on falling asleep.

PATHOLoaY.— Sir Charles Bell* has sufficiently demonstrated the im-
portance of the Respiratory System of Nerves in securing "a wide-
spreading means of connexion between parts that are remote, to pro-
vide for freedom in the simple act of breathing."! He has also ex-
plained the process by which the act of respiration, which "proceeds
so equally during sleep, is uninterrupted in the insensibility of apo-
plexy ; and how it continues when the head of an animal is crushed,
the brain deeply injured, or the head altogether removed." It is
through the respiratory system of nerves that the processes of x^espira-
tion and the other involuntary vital actions are carried on ; and in
health, they proceed as regularly during sleep as at any other time.
But there are some diseased conditions in which the suspension of the
voluntary actions is accompanied by the cessation of action in the
involuntary nerves also.J

* British and Foreign Medico-Chir. Review, April, 1852, p. 396,

t Nervous System of the Human Body, pages 71, 72.

X Appendix, p 214.

456 DISEASES OE THE EESPIBATOEY EU:NCTI0N.

A surgeon from the West Indies, who had suffered from a nalignant
fever with erysipelas, and had taken large quantities of Calomel, con-
sulted Mr. Bell for the following spasmodic affection : " On falling
asleep, just at the moment when volition and sensibility cease, the in-
volicntary motions also stop, with a sensation of death, under which
he awakes, generally convulsed.

" His medical friends have sat by him and watched him, and they
have found that when sleep is overpowering him, the breathing becomes
slower and weaker, the heart and pulse also fall low, and cease to beat
as sleep comes on, and after a short time he awakes in tremor. This
gentleman is very naturally in much apprehension that some of these
attacks may terminate existence. But he is young, and I think the
attack is essentially different from the case of angina pectoris. The
case presents us a lively idea of what would result were the invohm-
iary nerves subjected to the same law of the nerves of sense and voli-
tion ; for then sleep, by overpowering both, would be death !"

We have met with a few cases of this character, in all of which the
pathological condition corresponded in general with the case given by
Mr. Bell. These patients all (but one) had resided in a malarious
region ; they had taken considerable quantities of Mercury and Sulph.-
quinine to cure intermittent or remittent fevers; and the respiratory
phenomena were nearly the same in all. The spasms came on at first
exclusively during sleep, producing the greatest imaginable distress
and terror. One of these cases was peculiarly severe, and caused the
patient and friends extreme suffering and anxiety for several years.

This patient was a boy belonging to an intellectual and nervous
family; he had had ague occasionally, and been cured under different
modes of treatment. At the age of ten years he became subject to spas-
modic attacks, commencing always in sleep. The whole progress and
pathology of the case corresponded entirely with that given by Mr.
Bell. It resisted all treatment for six-and-a-half years, and the boy
ultimately died of another disease. The other cases referred to were
cured by ISTux-vomica and regulations of diet.

DISEASES OF THE SANaumOTIS FUNCTION.

457

CLASS III.— DISEASES OF THE SANGUINOUS
FUNCTION.

The "heart is the most remarkable muscle of the body, lying ob-
liquely in the chest between the two lungs, its base pointing upwards
in the direction of the right shoulder, the apex pointing to the space
between the fifth and sixth ribs. It is inclosed in a peculiar capsule,
called the pericardium, consisting in a fibrous layer without, and a
serous membrane within ; the cavity between the heart and pericar-
dium generally contains more or less fluid which lubricates the heart
on the outside and renders its local motions easy.

The heart comprises four cavities, consisting of one auricle and ven-
tricle on each side ; the right pair of cavities being devoted to the cir-
culation of the venous blood, the left pair to that of the arterial blood.
The upper cavities, called the auricles, constitute the base of the heart,
the ventricles which are much stronger than the auricles, form the apex.

The heart thus constructed is the prime-mover of the circulation of
the blood. When this indispensable function is perfectly performed,
the physician generally feels that, though something else majy he
wrong^ the centre of the hlood-syste'in remains well balanced, and
something may be done towards restoring the normal functions of other
portions of the machinery. When the blood, which contains the ele-
ments of life, growth and reparation starts on its circuit to the remote
portion of the organism, it sets out from the heart, beginning its jour-
ney at the left ventriole. By the contraction of that cavity the living
fluid is forced into the aorta, from which it is to be distributed into all
the high-ways and by-ways of the body. After ramifying through the
remotest and finest capillary branches of the arteries, it finds its way
into the minute corresponding tubules which constitute the beginnings
of the veins ; these, uniting with each other as they proceed towards
the centre, pour all their contents into the two great trunks, called the
venae cavae ; and they unload themselves, moment by moment, into the
right auricle. Though the blood has already reached the heart, it is
not yet at the point from which it started, to reach which, another jour-
ney must be performed. The right auricle contracts on the blood and
forces it into the right ventricle by which it is sent off through the
pulmonary artery, to the lungs ; and there it ramifies through the many
.minute branches of this artery, till it enters the finest vessels of the
pulmonary veins. These collect it from all portions of the blood, and
concentrate it in the four large venous trunks which pour it back into
the left auricle of the heart ; and this cavity at once contracts upon it
and drives it through the opening valve into the left ventricle from

4:58 DISEASES OF THE SANGUINOUS FUNCTION.

which the circuit was commenced. Such is a brief outline of the cir-
culation of the blood in health. We proceed to treat in regular order
of its principal accident^, modifications, and derangements generally
spoken of as Febrile and Inflammatory Diseases,

ORDER I.-PYREOTICA.-FEVERS.

It has been estimated by good observers that one-half of all the
human family have died from febrile diseases ; and yet a clear and
faultless definition of Fever has never been written. The acutest in-
tellects in every age have been employed on the subject, but nothing
important has been added to the analysis of its phenomena made by
Hippocrates. The word signifying fever, in nearly all languages, sig-
nifies to hum or to ioil^ but heat alone does not constitute fever.
Boerhaave endeavored to ascertain the essential characteristics of fever
by collecting from all authors the symptoms of all the different fevers,
and then throwing out all symptoms that did not appear in every fever.
In this way he reduced the essential symptoms to three only, — sliiveT-
ing, frequent pulseyheat But no one of these symptoms is always
present. Shivering only occurs in cases that progress rapidly, the
pulse may be slow instead of quick, even as low as thirty or forty beats
per minute ; the heat is often below that of health. Cullen added to
Boerhaave's definition, "languor, lassitude, and other signs of debility,
together with derangement of the functions, particularly a want of
vigor in the limbs without any primary local affection." None of these
symptoms are present in all cases. Wilson Philip {On Fevers j p. 10)
endeavors to correct Cullen's definition, and gives the essential symp-
toms of fever in "languor, lassitude, and other signs of debility," all
of which occur in other diseases as well as in fever. In our own day
the following definition has been given by Dr. Wood of Philadelphia :
"Fever is an acute affection of the system, in which all the functions
are more or less deranged ; the most striking phenomena being sen-
sorial or nervous irregularity, increased frequency of pulse, increased
heat, and disinclination for food. The essence of the affection is uni-
versal derangement of the functions." {Practice of Medicine.) Per-
haps no definition yet given is more radically defective. Fever can
not be defined in few words. We must take all the symptoms given
by all the above authors, and admit that any one or more of them may
be absent in an individual case. We must also distinguish between
the phenomena usually expressed by the termy^^^r, and those diseases
called "fevers," in which this state occurs as the leading phenomenon.
"Fever," says Dr. Smith of London, "is not an entity, it is a series of
events, and our object in investigating it is not to discover what consti-
tutes its essence; but what events invariably occur in the series, and in

FEYEKS. 459

what order they constantly occur. These will include all that we
shall ever know of what is termed the nature of fever." "VVe do not
look for the events which constitute fever in "the external symptoms
of internal and generally invisible conditions." We must look for
them in the state of the organs. [On Fevers^ p. 56.)

Functions deranged in Fe^ver.—Dr, Smith says (p. 60) : " The evi-
dence is as complete as observation during life and inspection after
death can make it that a morbid change does take place in a certain
number of organs. These organs are : 1. the nervous system ; 2. the
circulating; 3. those organs that constitute the systems of secretion
and excretion. The chain of diseased organs consists of the brain
and spinal cord ; the heart and arteries, especially their capillary ex-
tremities ; the secreting and excreting organs, which in fact are com-
posed essentially of the capillary extremities of the arteries; the
secreting and excreting extremities of these arteries, especially as
they terminate in the external skin and in the mucous membranes
•which form the internal skin." This is the circle of diseased actions.
"There never was a case of fever in which all these organs and func-
tions were not more or less in a disordered state; and this complete
circle of organs were never in this morbid state without fever. A de
viation from a healthy state in one or in two circles will not produce
fever; there must be deviation in the three circles before fever can exist.

" Such are the common phenomena of fever, not only invaricMy in
their occurrence, but in their concurrence in a particular order.
Derangement of secretions and excretions is never first in the series,
derangement of the nerves and sensorial functions never comes last ;
derangement of the circulatory system is never first, or last, but is
always the second in the order of succession." [Smith on Fevers^
London, p. 60.)

A majority of the profession at the present day, however, suppose
with Cullen, that the prime causes which produce fevers, act directly
upon the nervons system^ and thus produce their pernicious results.

Our own opinion is, that fever is a eonibination of symptoms that
may arise from a disturbance of any one or more parts of the body ;
that the primary impression is made upon the extreme nerves of the
part acted on; and that the whole system is affected to a greater or
less extent, secondarily, thus giving rise to that congeries of symptoms
which constitute fever.

The skin, the nervous system, the circulation, the respiration, the
secretions, and indeed the whole body partake more or less in the
general disturbance.

We suppose that the causes which produce fevers, are sjoeoiJiG agents
which operate by being absorbed into the circulation, and conveyed to

i60 DISEASES OF THE SAJ^GUINOUS FUNCTION.

those structures for wliicli they have an affinity or attraction, thus im*
parting thgse peculiar and specific actions which induce fevers.

Diagnosis. — -The external signs of the pathological condition which
constitutes fever are variable in the different forms in which it appears.
Though life and death depend on our correct discrimination between
conditions which may require measures of treatment entirely opposite ;
though certain states of the vital organs, if allowed to remain long,
must terminate in fatal changes of structure, and we know that certain
l-emedies, if applied in due season, are capable of removing these con-
ditions ; a most intricate problem is presented to the mind of the prac-
titioner in every case of fever. The external characters and the in-
ternal states exhibited to the mind in individual cases, demand for their
analysis the clearest exercise of the intellect and the most extensive
knowledge of the resources of science. "Fevers differ in different
countries, in different seasons, and in different individuals. The cir-
cumstances which excite and develop these varieties of fevers are of
the utmost importance, as they are often intimately connected with
those causes which may render the disease mild in its character or
fearfully mortal." The methods of distinguishing between the different
febrile maladies will be given under the respective diseases.

Distinction between I^ever and Inflammation, — Fever differs from
inflammation in being an affection of the whole nervous and vascular
systems ; in inflammation there is an affection of those systems in some
one organ; fever is an affection of the heart and large arteries, while
inflammation is more an affection of the capillaries. In inflammation
there is an enlargement of the diameter of the capillary vessels, with
sloAver movement of the globules of the blood, and in this state the
old practice of bleeding from the large veins was seen to reduce the
action of the heart and arteries while the capillaries were but little
influenced.

PATHOLoaY. — The question of the relations necessarily existing be-
tween fever and inflammation was first brought prominently before the
medical profession by Broussais. This great pathologist, having found
inflammation a more frequent attendant on fever than had been pre-
viously suspected, endeavored to prove that these two pathological
states were so intimately related that the one must be, necessarily, the
outgrowth of the other. The general experience of the profession has
sanctioned a part without confirming the whole of the doctrines of
Broussais. It is now believed that fever may sometimes be essential^
or idiopathic, and sometimes symptomatic.

The probability is, that some causes act locally on one organ exclu-
sively, others act generally on several organs, some universally on all.
But when an essential fever arises from a cause acting upon a particu*
lar part, the first impression, after setting the febrile movement a-

FEYEES. 461

going, is no longer absolutely necessary to it, and may cease altogether
otherwise the fever would be symptomatic of the local affection.

Causes of Fever. — The causes of fever are either predisposing, or
exciting. Any thing which debilitates the organism, or impairs the
tone and resisting power of the nervous or muscular system may be de-
nominated do predis2:)0sing cause of disease. Under this head may be
ranked excessive physical or mental exertion, protracted grief, anxiety,
fear, chagrin, and disappointment, deprivation of well-ventilated dwell-
ings, proper food, clothing and exercise, over-indulgence in the plea-
sures of the table, stimulating drinks, licentiousness, w^ant of cleanliness,
and finally congenital causes, and those connected with some hereditary
predisposition.

Those causes which induce fever by a direct impression are termed
exciting causes. Miasmata, contagious and epidemic effluvia, noxious
gases, extreme and protracted heat or cold, and sudden changes of tem-
perature; local injuries and inflammations, however excited; vicissi-
tudes of temperature ; exposure to great heats, cold, or damp air ; too
free use of stimulating food ; electrical influences ; atmospheric impuri-
ties; epidemic influence; miasmata.

All of the causes, however, which we have ranked under the head
of predisposing, may, and often do become, under favorable circum-
stances, actual exciting causes of fever. See Observations on the
Causes of Disease, p. 182.

It is equally true, also, as we have before observed, that what are
called exciting causes, do not usually operate so as to produce fever,
unless the system is prepared or rendered susceptible to their influence
by debility, or some other predisposing cause.

The powers of the body may be taxed up to a certain point, by
moral or physical, morbific or remedial agencies without exciting actual
disease ; but if the influence be carried beyond this point, an im-
paired condition of the capillaries acted on, will ensue, with the usual
concomitants, inflammation and fever. Even the natural maladies,
scarlet fever, measles, small-pox, chicken-pox, and hooping-cough,
seldom make their attacks unless the system is predisposed to receive
their impressions. Therefore, these disorders will often attack one
member of a family, while all of the rest, who are equally exposed to
the contagion, will escape.

The same rule holds good in regard to the operation of morbific, as
of remedial agents, viz, : in proportion to the departure of the organs
and tissues from their healthy standard, so will be the acquired suscep-
tibilities of these structures to the influence of morbific agents.

The importance, then, of a constant and regular system of physical
culture, and a rigid avoidance of all those things, which can in any way
impair the normal integrity of the organism, will be recognized. In-^

i62 DISEASES OF THE SAKGUIJSrOIJS FUNCTIOJST.

deed, we believe, that STich a course might be pursued, as would secure
an individual against dis,ease until his system should succumb from
old age. Such a course would involve a herculean task in our pre-
sent state of physical degeneracy, yet it is not beyond the bounds of
possibility.

A few of the means which we would recommend to accomplish this
object would be

1. A proper system of physical education.

The first and most essential condition for the enjoyment of perfect
health consists in a symmetrical and w^ell-developed organization. In
looking around upon the world, how few do we behold who can boast
of unexceptionable physical conformations — how^ few who have not
some imperfection, which might have been avoided by an early and
proper attention to physical culture !

But how shall this bodily perfection be attained?

We reply, by the universal establishment of free, public gymnasiums,
where those athletic exercises can be pursued which shall systematically
develop and strengthen every part of the body ; athletic sports, games,
&c., should be established suitable for all ages and conditions ; where
the man of mature years may occupy agreeably an occasional leisure
hour with physical and mental benefit ; where the growing youth can
correct all incipient bodily defects, and acquire that development and
expansion in every part which will enable all of the organs to act in a
free and healthy manner. Let us abolish " infant schools" for the
education of infant intellects^ and establish in their place infant gym-
nasiums for the culture of their infant iodies. Let is see no more in*
tellectual " infant prodigies," with their pale, sickly faces, and their
feeble and half developed forms, but show us in their ^iQ2idi^ physical
prodigies with their rosy cheeks, their plump, firm, and well-grown
muscles, and with elasticity and buoyancy, reminding us constantly of
perfect health. Show us your, children of six, eight, or ten years of
age wild, bouncing, and overflowing with animal spirits, rather than
your prim, well-mannered, delicate, sickly, hot-house and band-box
specimens.

All physiologists agree as to the vast importance to the young, of a
great amount of exercise — free, spontaneous, and unrestrained. It is
a principle of their natures, absolutely essential to their well-being,
and we must not permit the artificial customs or restraints of society
to prevent it.

Our remarks apply with more force to cities than to the country, for in
the former every thing is forced and unnatural; children are born into
hot-houses, heated with anthracite coal to the temperature of seventy-
five or eighty degrees of Fahrenheit. Here do these unfortunates pass
the best part of their existence, encompassed by every thing which is

FEYEKS. 463

unnatural and artificial, and inhaling an atmosphere deprived of a por-
tion of its oxygen, and impregnated with carbonic and other noxious
gases, until, while yet young in years, they arrive at conditions of old
age, satiated with the displays and luxuries of life, and reduced to a
miserable state of physical inefficiency.

It has been well remarked by physiologists, that if the large cities
were not constantly supplied with healthy recruits from the country, they
would soon become desert wastes. This remark is, beyond question,
true, and it is only necessary to look into any of our large towns and be-
hold the numerous worn-out and impotent wrecks of the wealthy fami-
lies, who have been inhabitants for two or three generations, to be con-
vinced of the fact.

The second means, which we would advise to secure health, would
be a correct system of dietetics. The use of all kinds of animal and
vegetable substances, which are not perfectly pure, digestible, and
healthy, should be rigidly prohibited. In order to accomplish this ob-
ject, we do not believe that better rules could be adopted, than those
instituted and commanded by Moses for the Jews. Amongst the articles
forbidden in the dietetic regulations of the great Hebrew law-giver, we
find pork excluded, from the supposition that the swine is unclean and
unhealthy. When we consider how frequently that animal is affected
with that dreadful malady, scrofula, and also how filthy and disgusting
are its habits, it is not surprising that any person who is at all particu-
lar as to the quality of food he consumes, and who possesses ordinary
powers of observation, should denounce this offensive and diseased ani-
mal as unfit for food. But this abominable stuff in all its different
forms is consumed by Christians everywhere. Lard constitutes the
culinary expletive which serves to connect the ingredients of almost
every dish in one greasy union.

Whether the uses of pork and its preparations have any agency- in
causing scrofula we leave for others to determine. An argument, how-
ever, which tends to establish the affirmative is in the fact, that amongst
the strict Jews, and all of those nations where this animal is not used
as food, this malady is scarcely known, while in every country where it
constitutes an article of diet, scrofula abounds.

In brief, care in regard to the selection of proper articles of food,
suitable methods of cookery, avoidance of fat and condiments, stimu-
lant, narcotic, and hot drinks, and regularity in partaking of meals, will
enable mankind to preserve the integrity and health of those organs,
which are concerned in digestion and assimilation, and thus avoid the
numerous evils which accrue from errors in diet. See Semarlcs on
Pitrity of Food at pages 285, 286.

Finally, we would recommend the establishment of such a state of
society as would recognize no pursuit or custom as legal or respectable,

4:64 DISEASES OF THE SANQUmOUS FUNCTION.

except such as should conduce directly to the health, morals and general
welfare of the community.

COLD.-CHILL.

INFLUENCE OF CHILL FROM SUDDEN EXPOSURE.

When a person becomes chilled from sudden exposure to cold and
wet, he loses a large share of vital warmth and animal or vital gal-
vanism. A common accident is a fall through the ice, followed by
protracted exposure to cold air in the wet clothes. In such cases the
clothes should be changed for dry ones, when possible, and when this is
not, as much water should be squeezed out as may be done by the hands,
and heat developed by active exercise.

The advantage to be gained by exercise consists in the free, full
respiration and accelerated circulation of the blood. In extreme cold
weather the wet clothes freeze on the outer surface, while the internal
warmth generated by the exercise and rapid respiration produce per-
spiration, which has the effect of a vapor-bath ; and injury from cold
is prevented, if care be taken in a final change of clothing.

The m^r^ change of clothing after exposure to cold and wet is not
sufficient for safety, even if a warm room can be soon reached. If free
circulation of the blood, and respiration and perspiration be not brought
about by active exercise, there will be a sense of chilliness, alternating
with flashes of fever, and these chills indicating congestions of some
internal organs, liable to become established into more permanent local
inflammation with fever may return at irregular intervals for several
days or merge themselves in some more serious disease.

This condition of the blood-vessels is considered by some writers as
a primary affection ; by others, as by Dr. Wood, it is believed to be
"always an effect of some pre-existing morbid state or action; and it
is a partial view which is directed to this effect alone, without embra-
cing the other elements that enter into the complex-phenomena pre-
sented by the part congested." There is probably no form of conges-
tion which may not be traced to some one of the morbid effects already
described, and its varieties have consequently been treated of along
with the other phenomena or effects of these states respectively.

Sources of Active Congestion, — 1. Irritation or inflammation ; 2.
depression; 3. physical agency. In every case of excessive capillary
excitement there is an increased flow of blood to the part affected, and
an accumulation in the vessels of that part; and any excessive or un-
healthy excitement constitutes either irritation or inflammation, the
latter beginning where the former ends. "Congestion, therefore, is
nothing more than a phenomenon of one of these latter affections."
But the term congestion should be restricted to "that condition in

COLD. CHILL 465

which the vessels are merely engorged, and the peculiar features of
congestion have not yet made their appearance." In this sense, con-
gestion is simply a phenomenon of irritation. It is not the disease
itself^ but is merely the sign of a disease. The real seat of the mor
bid action is not in the blood; it must be in the vessels themselves
"The disease is, in fact, some peculiar modification, not well under
stood, of the solid tissues, of w^hich a change in the innervation al
ways, probably, constitutes an essential part, and which is induced by
the operation of some excitant, unhealthy either in its nature or de-
gree. In other words it is an irritation." ( Wood.)

Passive 'Congestion, —hi this abnormal condition the blood accumu-
lates in the vessels of a part, because it is not carried forward so
rapidly as it enters by the ordinary movement of the circulation.

Causes. — 1. Want of due degree of that action which is necessary
to its transmission, that is from depression. 2. Physical diflSculty or
obstruction.

The depression which gives rise to congestion may be general, or
confined to a particular organ. It is common in diseases attended with
great and sudden prostration. , The heart, participating in this pros-
tration, is unable to transmit the blood so rapidly as it is conveyed
towards it by the continued action of the capillaries, and by the forces
w^hich move the blood in the veins. . This fluid, therefore, necessarily
accumulates in the right side of the heart, and the great venous trunks
and consequently in those organs with which these trunks more imme
diately communicate, viz : in the brain, liver, and through this latter
organ, in the abdominal viscera generally. Thus : a blow upon the
head, or any severe shock, temporarily paralyzing the cerebral actions;
certain mental emotions tend to produce syncope; the chill of fevers,
especially those of a typhous or malignant character, and the prostra-
tion of violent internal spasm of the stomach, all occasion internal
congestions consequent upon depression in the movements of the heart.
The alarming phenomena which attend these aifections, the feeble
pulse, the cold extremities, the pale and shrunken skin, and the fre-
quently suspended or impaired intellectual functions are not caused by
the congestion, for it "is a mere effect of the prostration, and ceases
when the heart resumes its usual energy." The error of ascribing
.these alarming phenomena to the internal sanguinous engorgements,
and directing the treatment accordingly has led many practitioners to
overlook the collapse of the nervous system, and the feeble movement
pf the heart, though they are both overwhelmed by some powerfully
depressing influence. The title of " Congestive^^ generally applied to^
those affections, in which that condition forms a prominent feature is'
objected to by Dr. Wood; but the nomenclature of diseases can-
scarcely be reformed in a satisfactory manner * and we still employ

Vol. L— 30.

^6Q DISEASES OF THE SAISTGTJINOUS FUNOTIOH.

this term, as well as all others, as they are universally known and
understood.

BATHS.-COLD SHOWER-BATHS AFTER HOT-AIR-BATHS.

1. Pure experimentation proves that the primary action of the hot
air-bath, of the temperature of from 110° to 140° Fahrenheit is to ex-
cite and stimulate the system ; to raise the temperature of the body,
to accelerate the pulse, and to produce a copious excretion from the
pores of the skin. A sensation of oppression is for a moment felt, and
disappears as soon as the perspiration begins to break out. This con-
dition is soon superseded by the opposite group of phenomena, viz. :
The prover experiences a chill, or cold sensation all over the body; he
looks pale; the pulse is much reduced, is. feeble and slow. He feels
weak and depressed. He shivers, and collapse soon takes place. This
condition constitutes the secondary action of the hot air-bath, or the
reaction of the organism, which m,ay terminate in death.

2d. That the primary action of a cold water-shower-bath, at the
temperature of from 82° to 60°, or 80° produces a general sensation
of frigidity all over the body; takes the pulse down; shortens the
breath, when the shock is sudden; the face becomes pale; and the
prover experiences more or less chills and shivering. An opposite
group of symptoms occurs, which constitute its secondary action, viz. :
a gradual restoration of the equilibrium of vital action, followed by an
agreeable sensation of warmth all over the body. The pulse rises ;
the face becomes florid ; the breath is free ; and a copious discharge
of urine ensues. These being the pathogenetic effects of heat and
cold in the forms already expressed, it follows that the therapeutic
properties of the latter are evidently manifested, when used im-
mediately after the former; because, our therapeutic law teaches us,
to treat pathological conditions, in their primary state, by administer-
ing a remedy whose secondary action is similar to \he primary action
of the case, and mce "oersa. The proof of this kind of action and
reaction, which is a principle universal in nature, equally operative in
therapeutics as in physics, will be found in the hundreds of remedies
contained in our materia medica.

The eflects of long-continued exposure to cold and moisture are quite
diiferent from those of sudden exposure. The powers of the body are
at first diminished by the depressing powers of the cold; and many
iraportant functions are immediately deranged, diminished or com-
pletely arrested. At the same time, if some vital force is not ex-
pended in the processes of secretion and depuration, the system will
become loaded with matters that should be thrown off; the accumula-
tions of effete matters that the perfect performance of the secretory func«

CLASSIFICATION OF FEYEES. 467

tions would liave carried ofF, now interfere with all tlie vital functions ;
and this too at a time when the powers of life are debilitated and de-
pressed by cold or its consequent reactions.

The removal of the person who has been thus exposed to a room,
warm enough to restore the animal heat, is far from being all he needs.
The restoration of the heat itself is dangerous, if it be not slowly and
carefully done. The diffusible stimulants commonly resorted to to restore
the warmth of health, very often go beyond the mission entrusted to
them and excite fever or inflammation which demand judicious treat-
ment.

Classification of Fevers.

We shall arrange the various /^SWZ^ diseases under the following
general divisions or genera : I. Ephemeral fevers ; those which arise
from slight temporary causes ; and which terminate spontaneously when
their exciting cause is withdrawn.

II. Malarial or Autumnal Fever. Originating in malaria or marsh-
miasm ; a specific form of disease, whether resembling other diseases in
external symptoms or not. It subdivides in two species as commonly
observed, though in their origin they are essentially the same.

III. Intermittent Fevers.

IV. Remittent Fevers,
V. Continued Fevers.

VI. Exanthemata. — Eruptive Fevers.

The different specific forms of fever will be- treated of under one or
another of these general heads.

In each of these fevers there are certain peculiar characteristics
which serve to distino-uish them from it and from all other maladies. Not-

withstanding this, however, we scarcely ever find two cases of the same
type, running precisely the same course, or presenting precisely the
same symptoms. So many circumstances connected with the exciting
cause, as climate age, sex, temperament, predispositions, habits, &c.,
tend to modify the character of each particular case, that all instances
of the same malady must necessarily present different trains of symp-
toms. It will readily be perceived, therefore, how impossible it is to
prescribe for the name of a disease instead of symptoms. It is there-
fore scarcely necessary to express our opinion, that any classification
of diseases whatever, is valuable as an aid in diagnosis rather than in
the exhibition of remedies.

•The course of a fever sometimes varies during its progress from its
commencement to its termxination, and on this account divisions are
made:

1. The forming stage.

4:68 DISEASES OF THE SANaUINOUS FUNCTION".

2. The cold stage.
8. The hot stage.

4. The sweating stage,

5. Collapse.

This is a mere arbitrary division, which can by no means be relied
"apon, for many fevers run their course without the supervention of
these stages. Lqt it ever be impressed upon the mind, then, that these
classifications and divisions are entirely arbitrary and artificial, and can
only be used for the purpose of facilitating diagnostic examinations.

Genus II.— MALARIOUS OE AUTUMNAL FEYER.

Of all fevers, those which have pervaded the world most extensively
in all ages and countries have been attributed to one cause, now usu-
ally designated as Miasm or Malaria. This mysterious agency, which
in ancient ages was regarded as a demon of darkness, continues to be
developed under all the conditions that could bring it into being three
thousand years ago ; and it has no where been destroyed, except in
small territories that have happened to come under a higher civilization
than the nations have yet reached. If it be sometimes losing ground
in one place it is always gaining elsewhere. In all the places where
Febris, the goddess who anciently presided over fevers, was ever
worshipped, the blighting influence of Mal-aria or iad <^^V, continues
to preside as the tutelary genius that human science has not yet been
able to expeL From the Appenines in Italy to the sea shore, and for
a distance of two hundred miles north and south her power is as great
as when her temples were most honored ; and, instead of improving
under the influence of modern civilization, it has been gradually grow-
ing worse. Eome which in ancient times was uninhabitable for two
months in every year is more noted for malignant intermittents than
it was in the time of the Republic. From the Pontine marshes, fifty
miles south of the city to the Tiber the intensity of the malaria has
been long increasing. For two hundred years the Ague has resisted
all the resources of science ; and has held possession of the Palatine
Hill, the Circus Maximus, the Forum and nearly the whole of the an-
cient city. It has outlived the throne of the Caesars, and the Iron
Crown of the Lombards, claims joint sovereignty in the Vatican, and
promises well to outlive the Eternal City itself.

Malarious Fever in its various forms of Autumnal Intermittent,
Remittent or Bilious Fevers, is extensively prevalent in all parts of the
American Continent. In the United States it is seen annually in all
the Territories between the Gulf of Mexico and the Rio Grande and
the forty-fourth degree of North latitude. South of thirty-three degrees
it extends from the Mountains to the Atlantic Ocean ; farther north it

MALAEIOUS FEVEE. 469

is less known east of the Alleghanies. In tlie south- west it is found
in all the valleys on both sides of the Cordilleras of Mexico. In the
Northern Territories of the United States, malarious diseases exist on
all the fertile plains and forests of the Mississippi Valley, and on all
the tributaries of the Missouri as far west as the western parts of
Dacota, Nebraska, and the middle of Colorado, six-hundred miles above
St. Louis.

In considering the conditions that impose geographical limits and
give prevalence to autumnal fever, it is, says Dr. Drake "a safe gene-
ralization to affirm, that, all other circumstances being equal, autumnal
fever prevails most where the amount of organic matter is greatest, and
least where it is ieast."^

Conditions necessary to develop Malarioios Fever, — These are:

1. Decaying organic matter for supplying the material for the ge-
neration of the poisonous agent, whatever that agent may be.

2. Surface water^ which, by impregnating the air with water, gives
a high dew jpoint^ promotes those chemical actions in certain soils sup-
posed to generate malarious exhalations ; favors the growth and decom-
position of a luxurious vegetation, produces animalcule and micros-
copic plants ; and, through evaporation and condensation, produces
electrical changes ; all of which effects of surface water have been sup-
posed to cause malarious fever.

8. Elevated Temperature, — These diseases prevail extensively and
virulently in warm climates, and become milder and less general as we
pass from the tropics towards the poles.

These conditions which combine to originate malarious diseases, and
the phenomena by which they are characterized, are essentially the
same in all ages and countries. All observers have remarked the same
general features of these diseases, wherever observed, differing only in
the degree of condensation 'm which the marsh poison exists in the
various localities. All observers have remarked the general vital
degeneration produced on all the inhabitants of the malarious districts ;
and it has often been noticed that the most disastrous results may
follow a residence in a marshy region in persons who have never suf-
fered from intermittent fever in a regular form. The description given
by Montfalcon, of the inhabitants of La Bresse, in France, is appli-
cable to the residents in many portions of the American Republic.
He says :

" Each child languishes and grows thin ; a yellow tint tinges his skin
and eyes ; the viscera become engorged ; and he probably dies before
he has attained his seventh year ; or if he reaches this age he does not
live but vegetates, he continues cachectic, oedematous, subject to putrid

* Diseases of the Mississippi YaUey.

470 DISEASES OF THE SANGUINOUS FFNCTIOK.

and malignant fevers, to endless autumnal remittents, and to passive
hemorrhages, to " ulcers of the extremities, which heal with great diffi-
culty; and the miserable being is scarcely able to fi.ght against the
diseases which convert his life into a prolonged dying. The inhabi-
tant of the Bresse, having perhaps arrived at his twentieth or thirtieth
year, the disorganization commences, his faculties become enfeebled ;
and, generally, the age of fifty years is the limit of his life."

When a resident of the Pontine Marshes was asked how it was pos-
sible to live in so unhealthy a place, he replied : — " "We do not live —
we die !"

In localities where the marsh poison exists in a concentrated form
we remark : an imperfection of physical development ; engorgment of
the abdominal viscera, especially of the spleen; general inertia, and tor-
por of intelligence ; an appearance of apathy passing in some cases into
idiocy ; atony, and diminished power of reaction of the nervous centres ;
in .short, all the physical, intellectual and emotional faculties are de-
pressed, and the duration of life is diminished.

GharaGteristiG Features of Malarious Femrs, — These vary in dif-
ferent seasons and in difierent localities. Besides the usual ensemble
of symptoms commonly included under the iQim fever ^ the disease may
simulate almost any other disease. We may have the external symp-
toms of cholera morbus, Asiatic cholera, dysentery, bilious diarrhoea,
monorrhagia, enteritis, inflammation of the brainj or of any other organ.
Even tetanus may be the only outward expression of a paroxysm of
autumnal fever.

In those sudden and violent attacks properly called congestive^ there
is a collapse, a sinking of the dynamic powers similar to that seen in
malignant cholera ; though there is not the same exhaustion of the cir-
culating fluids. In the congestive form of malarious fever the collapse
is in the nervous and cerebral symptoms. "The cerebral and nervous
influence is prostrated as a primary effect of the specific poison that
causes the disease."

The diagnosis of autumnal fever does not rest on any generally ob-
served assemblage of symptoms, but on the attendant circumstances
which may accompany the accession of the disease in its origin. We
may consider the locality in which the patient resides, his recent his-
tory, the season, the epidemic constitution of the atmosphere, and the
exciting causes to which the attack may be attributed ; and from these,
with the concurring evidences of the existence of malaria presented by
the case before us, the true nature of the disease may be determined.

Forms and Varieties of Malarious Fever,— In the United States,
and especially throughout the Mississippi Valley, two great varieties
of these fevers may be distinguished:

1. Fevers of open excitement.- — 2. Congestive Fever.

MALAEIOUS FEVEE. 471

These forms of fever are not distinct diseases ; they are only diiferent
manifestations of the same disease, operating in a diiFerent way, on dif-
ferent persons, according to their individual states of general health*
It is observed by Dr. Monette, of Mississippi,^ that "the tone of fibre,
and degree of tension in the Northern constitution, resists the febrile
influences, especially those of a debilitating- or relaxing nature; whilst
the natives of the South, whose systems are already relaxed and ener-
vated by the climate, are obliged to take greater precautions to escape
the endemic of the country. Strangers arriving from the North, are
usually only attacked by the fever in its simplest form, with open ex-
citementj which is easily subdued. But if the same person remains to
be attacked after spending a second or third summer in the country,
depletion will not be well borne ; and, at a later period, after migration
from the North, he will be more likely to be attacked by the fever in
its congestive form."

Farther Northward, and in the region bordering on the North-
Western lakes, we only observe that the effects of malaria are mani-
fested in different degrees somewhat proportioned to the powers of the
constitution to resist its influence.

When the atmosphere holds a large quantity of the specific poison,
a few days, or even a few hours may be sufficient to develop the dis-
ease in some form. When the amount of poison in the air is smaller,
it might require a year or two to bring the system so far under its in-
fluence that the common proximate causes of disease will excite mala-
rious fever.

This fever, when established, may assume any one of the various
types usually observed, thus :

1. When the atmosphere is strongly saturated with marsh-poison the
most trifling exposure to vicissitudes of temperature or exhausting
exercise will develop true intermittent fever, or " shaking ague."

2. When there is less malaria in the air, but other causes combine
with it to derange the ordinary operations of the different organs, the
disease produced is characterized by less gMU^ but this is followed by
fever of longer duration. The intermission, if complete, is still very
short ; the chill and fever run more into each other; and we have the
form of disease known in the West as " chill fever."

3. When the amount of malaria in the air is still smaller than in the
locality where the last form is most prevalent, but the miasm is assisted
by great exposure, extreme heat of the weather, or excessive bodily
fatigue, the disease resulting is called " remitting fever," there being
only a remission^ no interinission of the fever.

4. When malaria, existing in a greater or less degree, is aided by e^x

* Fevers of Mississippi. Western Med. Journal, 1850

i72 DISEASES OF THE SANGUINOUS FUNOTIOl^-.

posure to cold air long continued, or other strong causes of disease,
the effect of the marsh-poison is almost obliterated by the strength of
the exciting causes of the attack, or some epidemic influence. The re-
mission in this case is scarcely perceptible, and the case is called
one of continued fever.

5. Any of the preceding forms of malarious fever, inefficiently treated,
may terminate at the end of the first, or of the second week in a lower
form called, though improperly, typhoid fever. The remission is not
perceptible, or scarcely so.

6. An attack of fever in any of the foregoing types, occurring in an
individual already greatly prostrated or exhausted by previous ill
health is liable to assume the form much dreaded in the newer territo-
ries and known as congestive fever.

Sinking Chills^ or Malignant intermittent Fever,~Thh form of
disease is always mortal when not arrested by medical treatment ; and
it is a common remark that "none survive the third paroxysm." In
some localities beyond the range of enlightened medical practice, it
constitutes in autumn the principal outlet of human life.

1811 was a season of unusual sickness near the banks of the Mis-
sissippi and Missouri. The Missouri rose to an unusual height in
June ; the waters of the small rivers were backed far up in their chan-
nels, flooding their banks and covering quantities of luxuriant vegeta-
tion* This was succeeded by very dry hot weather. Bilious and in-
termittent fevers then commenced in a form of unusual severity.

In the years 1819, 1820, 1821, all the region bordering on the Mis-
sissippi, Illinois, and Missouri suffered much from malarious fever. Im-
migrants in immense numbers had recently arrived in the countries
then being rapidly settled. Multitudes were living in new and open
cabins of green timber ; they were drinking the stagnant water from
creeks and ponds ; a luxuriant vegetation was growing and decay-
ing around them ; and they were suffering all the other evils attendant
on the settlement of a new country. Of these people large numbers
died. The summer of 1820 was the hottest and dryest ever known in
the Western States. For weeks in succession the thermometer was
at 96^ in the shade, for hours in the day ; not a cloud came over the
sun. Fevers were unusually violent, malignant and unmanageable ; ii.
many cases at St. Louis and the adjoining country were seen every mark
;of yellow fever. Bilious fever appeared in its most malignant form.
The contents of the stomach thrown up by vomiting were black and
foetid. Lake Creve Coeur, (seventeen miles from St. Louis and near
the Missouri river, several miles long,) was entirely stagnant, covered
with thick scum, sending forth a disgusting smell, and the fish died in it
The same general sickness prevailed in the South beyond Cape Girar-

INTERMITTENT FEVEE. 473

deau, (150 miles distant, and along the Missouri above to the highest
inhabited points, sixty miles above St. Louis.

At Vincennes and other points in Indiana, disease triumphed. A
gentleman, who lived through those times says, " nothing was so dis-
heartening as the cloudless sky and burning sun, which continued un-
changed for weeks in succession. The small town of Hindostan, thirty-
eight miles East of Vincennes, begun in 1819, contained seventy or
eighty families at the beginning of 1820. The heavy beech, poplar
and oak timber was cut down ; the logs were left on the ground ; the
bark became loose, and intolerable stench proceeded from the timber.
Fever was rapidly developed and about two-thirds of the people died,
though there was no visible local cause for disease.

The summer of 1821 was a sickly one throughout the United States
and in foreign countries. In the West it was less severe. St. Louis
had a population of 5000, of which 136 died. The place had no police
regulations ; the people were crowded into poor and small dwellings,
and filth accumulated. No such season has been known since. {liev.
J. M, Peck of Illinois)

In 1820 and 1821, bilious fever was prevalent \h. all parts of the
Union, even in the hilly and mountainous districts of Pennsylvaniaj
Virginia, and the Green Mountains of Vermont.

INTERMITTENT FEVER.

Intermittent Fever,— ^q have observed, that each type of fever is
marked by certain symptoms, which distinguish it from all other varie-
ties. The type under consideration presents its chief features in a
very characteristic manner. Indeed, so great is the difference between
intermittent and other fevers, that some writers have withdra.wn ii from
the list of febrile diseases, and ranked it with those connected with de-
rangement of the cerebro-spinal system. The regularity and distinct-
ness of the paroxysms, and the complete state of apyrexia between the
periods of attack, certainly offer some reason for this course ; but, on
the other hand, as the combination of symptoms termed fever, is uni-
versally present during the paroxysms and since upon the whole it
bears a closer resemblance to febrile than neuralgic or ganglionic
affections, we will continue to employ the old classification.

In the different forms of intermittent fever, the interval which elapses
between the commencement of one paroxysm and another, varies ;
some cases having an interval of twenty-four, forty-eight, and others
seventy-two hours from one attack to another. From this circumstance
the different types have been designated — guoditian, or twenty-four
hour type ; tertian, or forty-eight hour type, quartan, or seventy-two

474 DISEASES OF THE SANGUmOUS FUKOTION.

hour type. These have also been subdivided into dovhle quarian^
double tertian, &c.

Diagnosis.-— A paroxysm of intermittent fever is composed of three
stageSj viz. : first, the cold ; second, the hot ; third, the sweat stages.

Preceding the cold stage, there usually occur general feelings of
lassitude; debility, uneasiness, and pains in the head, back or loins, and
sometimes slight sensations of external and internal cold. There is
also a loss of appetite, disinclination to bodily or mental exertion, and
a constant disposition to stretch or yawn.

As i\iQ cold stage actually commences the extremities feel cold and
contracted ; the surface becomes pale, shrunken, rough, "vvith diminished
sensibility; a sensation of cold along the spine, extending into the tho-
rax and abdomen; the coldness soon diffuses itself throughout the
whole -body ; universal tremors, external and internal ; chattering of the
teeth ; respiration laborious, rapid, and imperfect ; oppression at the
prsecordia; counten,ance pale, leaden, earthy, or livid, shrunken, and
expressive of anguish ; eyes dull and sunken ; lips livid ; general sense
of physical and mental prostration.

The pulse is variable ; it may be slow, rapid, weak, oppressed, of in-
termitting.

The temperature of the body is usually natural, with the exception
of the extremities.

The duration of this stage is exceedingly various ; sometimes ter-
minating in ten minutes, at other times, lasting four or five hours.
' Paroxysms occasionally occur without any well-marked cold stage*,
a slight trembling only being experienced previous to the hot stage ;
at other times neuralgic or rheumatic pains, or coma, precede the
second stage.

Hot Stage,— Kf^ soon as the chills begin to abate, flushes of heat
commence passing over the body, until in a short time, the hot stage is
fully developed.

This stage is cha.racterized by hot and dry skin ; countenance flushed
and full; mouth dry ; tongue parched ; urgent thirst ; headache ; respi-
ration rapid and anxious ; general restlessness ; pains in difierent parts
of the body ; more or less disturbance of the mind; pulse usually rapid,
sharp and bounding. This stage also varies very much in duration, it
rarely terminating in less than four, and often continuing twelve, and
sixteen hours. In some instances the hot stage even continues several
days, when it becomes a continued fever ; or it may assume the re-
mittent form.

Sweating Stage,— MiQv the hot stage has run its course, a per-
spiration makes its appearance upon the forehead and extremities,
which is soon difl*used over the whole body. As the sweating becomes
more and more profuse, the febrile symptoms, with the pains and un-

INTERMITTENT FEVEE. 475

easj^ sensations gradually subside, until the paroxysm terminates in a
perfect state of apyrexia^ or convalescenGe.

The above is a general description of the ordinary course of a parox
ysm of intermittent ; but in some instances these stages are reversed, o_
one or more of them may be absentj or if present, only a few of the
symptoms enumerated will be recognized.

Writers have divided intermittents into four varieties, viz.: first, the
infiammatory ; second, the congestive ; third, the gastric ; fovLVih, the
r/ialignant intermittents.

! This division is made from the fact, that the different types, under
certain circumstances, partake of the general character which these
terms indicate. Thus, the inflammatory variety generally occurs
during the winter and spring. Quoditians are more prone to partake
of this modification than tertians or quartans. Patients laboring under
this variety rarely enjoy perfect intermissions between the paroxysms,
and they are often left with permanent disorders of the liver, lungs, &c.

The congestive variety is very uncommon. It seldom attacks any
except persons of feeble, relaxed, and exhausted constitutions, in whom
there is not suflBcient vigor to accomplish a perfect reaction. The
brain is the organ which usually suffers most, and coma often -super-
venes during the cold stage, which ends in death.

The ^(2'S?/Hc variety presents prominent symptoms of gastric derange-
ment from the first, a superabundance of the biliary secretion, furred
and bitter tongue, with nausea and vomiting. It is peculiar to tem-
perate latitudes, and usually occurs in the autumn. In this variety the
liver is much affected, and therefore, we find chronic enlargements of
this organ often remaining after the paroxysms have been subdued.

The mMignant intermittents are common in hot latitudes. They
are attended with extreme debility from the onset ; respiration is feebly
and imperfectly performed, and the blood is only partially oxygenated,
diarrhoea now and then ensues, and a rapid prostration of the powers
of the system usually occurs, which in many instances speedily proves
fatal. It has been noticed that chronic enlargements and indurations of
the liver and spleen, affections of the lungs, dyspepsia, scirrhous indu-
rations, &c., often succeed fever and ague. These affections have been
looked upon as secondary consequences of fever, while in point of fact
they are often medicinal diseases, superinduced by the abuse of Mer-
cury and Bark. .

*' These drugs are empirically employed by the allopath for the cure
of this malady in all its various forms ; whether inflammatory symp-
toms predominate, whether there is congestion of the brain, lungs, or
liver, or whether the system is exhausted by previous debilitating
causes. Quinine and Calomel in large doses are the grand, and we might
almost say, the only remedies of allopathy. But do these violent drugs

4:76 DISEASES OF THE SANGUHSTOUS FUNCTIOK.

actually eu7'e the malady ? When tlie paroxysms are arrested by the
use of these herculean doses, are the seeds of the disease eradicated,
and is there no danger of a relapse ? Let the candid practitioner of
the old school answer.

It is the opinion of some eminent allopaths that large doses of Qui-
nine often suspend chills and fever, by superinducing in the liver or
some other important viscus, a serious medicinal inflammation or con-
gestion, which usurps temporarily, the place of the intermittent. The
eifect of this truly allopathic measure is, however, only of short dura-
tion, for the paroxysms return again as soon as the artificial disease
has somewhat abated, or from some slight exciting cause. Thus will
the paroxysms repeatedly return, and be as often temporarily suspended,
until finally some permanent chronic malady will become fastened upon
the system and thus supersede the original affection.

Critical Days, — Many accurate observers have noticed certain
epochs of decline or determination of diseases, especially those of the
febrile character. The most marked of these changes occur on the 8d,
7th, 11th, 14th and 21st days. Several partial crises are observed in
the progress of the same case, each leaving it changed by the some-
what sudden depression or mitigation of some of the symptoms. ISTow,
if under the current treatment each of these changes is, on t'he%oliole^
a favorable one, and the final result happy, the several improvements
and the final cure are not attributable merely to nature ; and on the
other hand, not merely to medicines given immediately before the
access of the several changes. If others have been previously ad-
ministered, they may have equal claims as the cause of the improve-
ment or cure. If the physicia,n neglects the observation of the critical
days he may draw erroneous conclusions in regard to the curative in-
fluence of the drug. The quotidian changes are generally appreciated;
the before mentioned critical days are also in regard to some symp-
toms and in some degrees, the days of exacerbation ; and their neglect
might vitiate the pathogenetic confirmation, though usually less than
the therapeutic. {Minor on Fe^er^ p. 213.)

Every regular continued fever has one or more quotidian exacerbations
and remissions; and besides this, certain other uniform and stated
revolutions. It does in fact pay regard to certain or definite periods
at which there is more or less effort, and at which likewise the disease
inclines to terminate either in the heginning of convalescence or in the
sinking of the patient. Of these periods the 7th, 14th and 20th 'br
21st seem of primary importance, while the 5th and 9th are only of
secondary importance. There is some effort on the 8d and 11th, but
less likely to be successful. Crisis on the 4th day is very rare.

Those of the shorter periods are more important in fevers of only
seven days duration than on those of fourteen days ; and generally the

INTEEMITTENT FEYEE.

477

longer the duration of the fever is the more permanent are the critical
efforts. The mildest continued fever seldom terminates, except at one
of these periods, and the worst cases seldom end in sinking, except at
one of these times.

A seven-days' case generally terminates on the 8d, 5th, or 9th
day, and a fourteen-days' case on the 3d, 5th, 7th or 9th. Bad
treatment is generally not obviously injurious, except at one of these
periods; and good treatment leaves the patient to begin to convalesce
at a critical period. At one of them the case is decided. Death waits
for the crisis, except in malignant congestive intermittents, typhoid
pneumonia, or dysentery, cholera, &c. The exhaustion in the first con-
gestion may not leave vital power for reaction.

In a regular case of continued fever the crisis is not before the
seventh day,* nor after the fourteenth day. Accidental circumstances
may extend it beyond or shorten it within it, or may change a fourteen-
days case to three, or more rarely, four weeks ; bad management still
farther.

After the seventh they incline to go on to the 11th. "What is called
going beyond this is generally an irritation, depending on debility and
morbid excitability. Eut acute cases, by proper .treatment, should be
made to follow the laws of acute fevers ; bad treatment degenerates
them into chronic diseases ; as sub-acute disease of the lungs is fol-
lowed by hectic ; which, like an intermittent, has defined laws, but no
definite period of duration.

By obtaining a perfect crisis we decide upon life and death ; by par-
tial crises, we decide upon the duration, but not on the event. The an-
cients describe complete crisis as occurring suddenly upon a striking
exacerbation of the most essential symptoms: as sweating, ptyalism,
vomiting, purging, haemorrhage from the nose, rectum or uterus, thick
sediment in the urine, eruptions, tumors, &c., with or without treat-
ment. Inert treatment permits diseases to follow their natural laws.
Bad treatment may exhaust the vital powers and render the system too
feeble to go through with it. Good treatment conducts the patient
through the danger, moderating the force of the disease and saving the
vital energies.

Causes.-— The common, if not the only cause of intermittent fever
is a peculiar miasm which arises during the progress of vegetable de-
composition, and which some authors have termed Tcoino miaswMa.
The term marsh-mias'in is often used, but we deem it improper, as the
miasms generated in elevated locations, are a,s capable of causing the
disease as those formed in low marshy ground. The decompositition
of vegetable matters by the aid of solar heat and moisture, is the only
condition requisite to develop the morbific principle.

Other exciting causes occasionally give rise to fever and ague^ as

4-78 DISEASES OF THE SAJSTGUIKOUS FUNOTIOK.

intestinal irritation from indigestible foodj as worms, sudden suppression
of old discharges and atmospheric vicissitudes ; but these causes sel-
dom if ever produce a genuine, periodically recurring ague^ except in
persons fully imbued with the specific malarial poison.

The pernicious form of intermittent fever shows itself in its m^ost
violent and dangerous aspects in swampy countries, during hot and dry
summers, in places where large quantities of vegetables decay. The
poison displays itself in the humid air of marshy places, spreading
rapidly after sunset, and accompanied by large numbers of flies and
other insects. The danger of taking the disease is greater during
sleep, especially after sunset, and windows should be shut from sunset
to sunrise. The bed should never be near a wall. The dress should-
be warm, silk should be worn next the skin.

"Paludal fevers," says Boudin {Geog, et Stat Med, Carte phys,
'meteoTol. du globe terre) "extend in the northern hemisphere from the
equator to a boreal limit which, at least on the old continent would
correspond with the isothermal curve of 53 (Fahrenheit), but which in
the Atlantic Ocean, might be represented by a line passing from Que-
bec, in Canada, to the coast of Norway, towards the 59th parallel.
This line excludes Scotland, the Hebrides, the Orcades, the Shetlands,
Faroe, and Seeland. In the Southern hemisphere, the domain is much
more circumscribed, and its Southern limit does not even reach the
isotherm of 59°. Paludal fevers extend high in Sweden, but are rare
in Norway. South America, beyond the tropics, is very little affected
by them, even where stagnant waters and marshes abound, and where
the mean annual temperature is higher considerably than that of
Southern Europe or Algeria. Corrientes, Montevideo, and the isles of
the Uruguay river, where lagoons and pools of water are left after the
overflow of the country, have been especially remarked for their ex-
emption from fevers. (Saurel, Theses de MontjpeUier^ 1851 and 1858.)

Malaria is most rapidly developed when the weather is hot, the wet
surface of the marsh much exposed to light, covered with a rapidly
growing vegetation, which upon the drying up of the water dies and
becomes the food of a new race of cryptogamic fungi. These grow
rapidly, but are extremely minute and of poisonous quality. Persons
exposed during the night to the damp and chilly air, contaminated with
malaria, or who drink inipure water, soon lose their healthy color, look
care-worn, exhausted and dyspeptic. The skin is now of a brownish-
yellow color, the aspect of the countenance is that of a patient in col-
lapse, and in detached places, bloated. Dropsy soon follows ; the eyes
are^ sunk in their orbits, the muscles are flabby and lose their motive
power. Sometimes there are slight febrile symptoms ; scurvy accom-
panies or follows dropsy; the mind becomes obtuse and even idiotic.

The doctrine of the Correlation of Forces has been applied to the

INTERMITTENT FEYEE. 479

explanation of tlie theory of the origin of intermittents by Dr. Lord
of Chicago. We can only here give a summary of his conclusions.^^

*^ 1. All physical changes, pathological, physiological or chemical are
the result of force.

"2. Force manifests itself only through the vibration of molecules.

'^ 3. Molecules aggregate only when compelled by extraneous force.

"4. Every mass of matter may have a force specific and peculiar to
itself, or common to many other material bodies. Hence the force of
one body may differ from that of another, or of all others.

" 5. A dissimilar force will produce differing vibrations or oscillations,
and of course produce different results.

"6. The human organism is subject to the same laws as %th.eT matter,
in its every organ, tissue, ganglion and cell.

"7. The force of one mass may neutralize, modify or correllate that
of any others. Thus the resident force of a ganglion may modify or
correllate any passing force.

"8. Normal nerve force oscillates only through the axis cylinder of
the nerve. Toxical forces, or those of the poisons proper, and zymo-
tic, probably are confined to the same track.

"Imponderables seem to pass along the periphery. They may act
mechanically, however, when in excess. Mechanical force pervades
the entire cord, and has no specific or peculiar character, but may dis-
order different organs or tissues equally or unequally, alike or unlike,
while the effects of electricity and the vegetable and mineral and ani-
mal poisons are each, under the same circumstances, uniform and specific,
differing only in intensity until disorganization commences.

"All these forces when not correllated to nerve-force are disturbers
of the economy ; disease-producers; and essentially, though not tech-
nically, toxical.

"In this sense, however, I shall hereafter use the word toxical.

"9. Each of the ganglia has a resident and peculiar type-force, which
modifies the character of the vibration passing through it. Thus the
cardiac ganglion or plexus, that which goes to the heart, the semi-lunar,,
that to the stomach, &c., &c.

" 10. Though the principal changes take place in the ganglia, doubt-
less the plexuses of each tissue have a general or common modifying
power; while the connecting recti-linear nerve-trunks must pass the
vibration almost or altogether unchanged.

"11. Several differing vibrations may obviously pass down the axis
cylinder of a nerve at the same time with little or no interference.

"12. Differential or modified vibration, probably, depends for the most
part on differential cell-form or molecular arrangement of its tissues,
and the status of its connective or interstitial matter."

* 111. State Med. Asso. Transact N. A. Jour. Homoeop., Aug. 1863, p. 117.

480 DISEASES OF THE SAKGUnTOUS FUNCTION.

PROGNOSIS. — When the constitution is good, intermittent fever should
be always regarded as curable in every case. When there is a cachectic
state, the case is more difficult; it is more stubborn in cases in which
the paroxysm anticipates the hour of return, and such are inclining
toward the severer or remittent type. Strong and lasting chills are
symptoms of malignity; when the duration of the fever is long, the
intermission is short, and the tendency is, first to remittent and then to
typhoid continued fever; when perspiration is deficient, the tendency
is to assume a worse form of the disease. Nursing babes suffering
with this disease and dentition at the same time are liable to hydro-
cephalus; aged persons are in danger of the congestive or sinking
chills, and pregnant females to abortion and its consequences. The
disease neglected or inefficiently treated is likely to continue for many
months, and relapses a.re more common than in almost any other disease,

"A simple intermittent fever, even when left to take its course, rarely,
perhaps never, proves directly fatal; but it may derange the structure
of some organ, or generate a kind of cachexia, or spansemia, from
which, as pathological causes, other, and, at last, fatal consequences
may follow." Inflammatory intermittents, left to themselves, are not
generally immediately fatal ; but, by establishing a permanent inflam-
mation in some vital organ they may end in the total derangement of
health, and, finally, in death.

Inflammatory remittents are much 'more dangerous. Though not
directly fatal, they are liable to run into a typhoid form, which, if it
does not result in death immediately, must always be regarded as a
serious form of disease, demanding immediate and proper treatment. ^

"Malignant intermittent fever is always fatal when not arrested by
prompt and efficient treatment; and many die of it every autumn, its
true character not being perceived in time, or the patient residing
beyond the range of enlightened medical practice. Where this variety
prevails, therefore, it constitutes in autumn the chief outlet of human
life. Malignant remittents are not so common as intermittents, but
more difficult of cure and, therefore, much oftener fatal."

ACCLIMATION.

ProphylaotiG Measures and Precautions, — The atmosphere in
which man lives, besides the gases fitted for respiration, contains other
emanations and deleterious agents which exert a disturbing influence
on health. The human body is endowed with a power of reaction and
resistance to these influences ; and, in every act of resistance, increased
energy and vigor are developed by the effort. "A man plunges into
cold water, which disturbs the vital force ; it recedes from the surface.
If the impression is not too violent, it reacts. If the plunge is repeated

ACCLIMATION. 481

this impression is not so great, the resistance being greater. With
every plunge the impression lessens, and resistance increases, until no
disturbance is created. This increased power of resistance is the
principle of acclimation." (Bayard) s Address^ 1853.) When we have
long been accustomed to the atmosphere, and all the vicissitudes of
temperature, and the endemic influences of a certain climate, the system)
habituated to their impressions, has become so far invigorated by its
reactive eiforts that the deleterious agents without cease to produce
any perceptible effect. If we now remove to a different climate we
come in contact with a new series of subtle and deleterious influences
which make new impressions on the sensitive organism, and provoke
new resisting and reactive powers. When the powers of resistance are
so far cultivated that the causes of disease peculiar to the new locality
make no impression, beyond what they make on a native of the place,
acGlimation is said to be complete.

To enable emigrants to pass safely through the process of accli-
mation, many rules and systems of management have been proposed.
In passing to a warmer and more unhealthy climate, attention should
be paid to

1. Diet. — This should be of a lighter character than that formerly
used ; it should be plain, unirritating, and consisting chiefly of vege-
tables, particularly during the first summer. The old system of diet
which prescribed salt meats in hot weather in the South, has cost
thousands of lives. During the second summer, more freedom may be
allowed; after full acclimation a generous diet is recommended, as it
gives tone to the system and enables it to resist morbific influences.

2. Drinks. All stimulants are highly injurious. The whole gastric
system is already in a state of high stimulation. All direct stimulants
retard acclimation and increase its dangers, aggravating all the dele-
terious effects of the hot climate.

Dr. Barton, of New Orleans, says that of 1226 deaths which occurred
in the Charity House of that city in 1835, only nine had completed the
process of acclimation. He says, he knows of no circumstance in which
stimulating drinks are necessary in that climate for health, "whether in
exposure to wet, heat, or fatigue," and believed them a " counterfeit
good" in ail cases. [Address, Med, CoL Louisiana)

3. Clothikg. — This should always be adapted to existing circum-
stances. In all climates, whatever malarious poisons may exist in the
atmosphere, the influence of changes of temperature on the skin is the
principal exoiting cause of disease ; and, in adapting the thickness of
clothing to the state of the weather, the error most commonly committed
is in dressing too light. In hot weather, when not exposed to direct
action of the sun, light clothing is appropriate. But, when the external
heat is greater than that of the human body, clothing, too light, should

Tor. L~3t

482 DISEASES OF THE SANGUINOUS FUNCTION.

be a bad conductor of caloric. Flannel should be worn next the skin
in every climate, not only when the weather becomes suddenly colder,
but before the change occurs^ and in anticipation of it, by all who are
liable to the diseases of an unhealthy climate. Clothing sicfficiently
warm is indispensible.

4. All habits of life which invigorate and promote health, are im*
portant.

General ProjphylactiG Measures. — 1. Avoid all depressing passions.
Fear, grief and anxiety cause the blood to recede from the surface,
producing ashy paleness of the skin. 2. Avoid over-indulgence in food
of any kind ; over-distention of the alimentary canal produces congestk)n
of the portal system {Carpenter^ Physiol, p. 543.) All rich food con-
taining fatty matter predisposes to fever. Fat contains 80 per cent, of
carbon, peas and beans 87 per cent., potatoes 12, and bread 30. An
excess of rich animal diet throws increased labor on the liver to^carry
off the excess of carbon. 3. Avoid the hot sun by day and the cold
damp air of the night. When the dampness of the air is precipitated
by frost, the danger of exposure is less. The air then becomes a bad
conductor of electricity and heat, and has a bracing effect. Put on an
extra amount of warm clothing as soon as the air begins to be colder.
Prudent officers sailing in tropical climates always command their men
to put on their fiannel jackets at or before sunset. Those who do not
obey are liable to be attacked with fever. Wherever malaria exists its
baneful effects are always heightened by sudden changes of temperature ;
where the daily range of the thermometer is great these effects are
most visible. By wearing flannel next the skin the system is shielded
from the influence of these viscissitudes of temperature. 4. A warm
fire made every evening in the apartment occupied is indispensible to
health, whether it be needed for comfort or not. Pliny refers to the
more ancient authorities of Empedocles and Hippocrates to prove its
utility. Lascisci made the same observation at Rome. Sir J, Clarke
says, " A person may sleep with perfect safety in the centre of the
Pontine marshes, by having his room well heated by a fire during the
night." {Sanative influence of Climate, p. 117.) Napoleon I. relied
much upon the protective influence of fires when his armies were en-
camped in the worst districts of Italy. McCulloch says, "In Africa, a
superintendent engaged in directing the cutting of wood erected thirty
ea.rthen furnaces on the spot where his men were at work, iightiiig
them every day. Before this he had always from forty to forty-eight
of his workmen sick; when in a short time they were reduced to twelve,
then to four, and finally to one." {On Malaria, p. 285.) This fact
with all others bearing upon the same point are easily explained on
the cryptogamic theory of the origin of malarious fever. We also see
how cooks, engineers and others who work near the fire, were exempt

ACCLIMATIOiq-. 483

from tlie sweating epidemic ; and can explain tlie " danger of sleeping
in mouldy sheets, and tlie sternutation excited by turning over old books*
and papers. No known poison but that of organic living fungi is ca-
pable of being disarmed of its virulence by dryness and great heat.
Hot weather only promotes the growth of the poison. 5. In choosing
a location, for a residence or temporary encampment, avoid all stagnant
pon<ls of water, particularly those that are in process of drying up. In
June, 1809, the British army marching through a dry, rocky and ele-
vated country on the borders of Portugal, found the mountain streams
dried up from long-continued hot weather, some of the regiments en-
camped near the stagnant pools yet remaining in the bed of the stream.
Some of the men were attacked with remittent fever the next morning ;
and that type of fever continued exclusively among the troops that had
bivouacked near those stagnant pools. After the battle of Talavera the
army retreated to the plains of Estramadura and encamped along the
banks of the Guadiana river, which ^'as then so nearly dried up as to
consist only of "lines of detached pools in the courses that had
formerly been rivers." Here they were attacked by ^remittent fevers
of such destructive malignity that the enemy and all Europe believed
that the British host was extirpated. . This fact, to which any desired
number of the same character can be added, is given by Mr. Ferguson,
of the British army, to prove the truth of a theory of his own. {On
Marsh Poison^ p. 5.) It at least illustrates the danger of exposure to
an atmosphere saturated with malaria; and also that the dried bed of
a nearly obsolete river furnishes the best possible ground for its rapid
development.^'' (See Yellow Fever — Causes)

Infl%ienGe of Local Causes on the Health of Armies. — Camp dis-
eases most abound near the muddy banks of large rivers, near sw^amps
and ponds, and on grounds from which the timber has been recently
removed. The distance to which the malaria of a swamp or of the mar-
gin of a river can be borne by currents of air, may not always be posi-
fivei^r determined ; but it is generally possible to either remove a camp
out of the reach of the poison or to apply some remedies that may
"weaken the force of its pernicious impressions."

"The remedies," says Dr. Robert Johnson, Inspector General of
Hospitals of the English army,| " consist in the interposition of rising
grounds, woods, or such other impediments as serve to break the cur-
rent in its progress from the noxious source. It is an obvious fact that
the noxious cause, or the exhalation in which it is enveloped, ascends as i
traverses the adjacent plain, and that its impression is augmented by the
adventitious force with which it strikes upon the subject of its action.

" It is thus that a position of 300 paces from the margin of a swamp,

* See Amer. Homoeop. Review, Nov. 1859, p. 50. f Report for the year 1846.

484 DISEASES OF THE SANGUINOUS EUNCTION.

on a level with the swamp itself, or but moderately elevated, is less un-
healthy than one at 600 paces on the same line of direction on an ex-
posed height. The cause here strikes fully in its ascent; and as the
atmosphere has a more varied temperature, and the succussions of the
air are more irregular on the height than on the plain, the impression
is more forcible, and the noxious effect more strongly marked. In ac-
cordance with this principle, it is almost uniformly true, cwteris paribus ^
that diseases are more common, at least more violent, in broken, irre-
gular, and hilly countries, where the temperature is liable to sudden
changes, and where blasts descend with fury from the mountains, than
in large and extensive inclined plains under the action of equal and
gentle breezes only.

" From this fact, it becomes an object of the first consideration, in
selecting ground for encampment, to guard against the impression of
strong winds on their own account, independently of their proceeding
from swamps, and noxious soils.

" It is proved by experience, in armies as in civil life, that injury
does not often result from simple wetting with rain when the person is
fairly exposed in the open air, and habitually inured to the contin-
gencies of weather. Irregular troops, which act in the advanced line
of armies, and which -have no other shelter from weather than a hedge
or tree, rarely experience sickness — never, at least, the sickness which
proceeds from contagion ; hence it is inferred that the shelter of tents
is not necessary for the preservation of health. Irregular troops, with
contingent shelter only, are comparatively healthy, while sickness often
rages with violence in the same scense, among those who have all the
protection against the inclemencies of weather which can be furnished
by canvas. The fact is verified by experience, and the cause of it is
not difficult of explanation. When the earth is damp, the action of
heat on its surface occasions the interior moisture to ascend. The heat
of the bodies of a given number of men, confined within a tent of a
given dimension, raises the temperature within the tent beyond the
temperature of the common air outside the tent. The ascent of moisture
is thus encouraged, generally by a change of temperature of the tent,
and more particularly by the immediate or near contact of the heated
bodies of men with the surface of the earth. Moisture, as exhaled from
the earth, is considered by observers of fact to be a cause which acts
injuriously on health. Produced artificially by the accumulation of
individuals in close tents, it may reasonably be supposed to produce its
usual effects on armies. A cause of contagious influence, of fatal effect,
is thus generated by accumulating soldiers in close and crowded tents,
under the pretext of defending them from the inclemencies of the
weather ; and hence it is, that the means which are provided for the
preservation of health, are actually the causes of destruction of life.

TREATMENT OF IHTEEMITTENT FEVER. 485

" There are two causes which more evidently act upon the health of
troops in the field than any other, namely, moisture exhaled direct from
the surface of the earth in undue quantity, and emanations of a pecu-
liar character arising from diseased action in the animal system in a
mass of men crowded together. These are the principal, and they are
important."

The following remedy is proposed : A carpet of painted canvas
spread on the floor of the tent, prevents the exhalations of moisture
from the surface of- the earth; it is convenient, is always ready, it is
less expensive than straw, and requires to be fresh painted only once a
year. A light roof is a defense against the vertical sun, or rain falling
perpendicularly ; while side walls of moderate height are only employed
as a protection against driving rains.

Treatment of Intermittent Fever, — Remove the patient, if the cir-
cumstances permit it, to a dry habitation in a healthy place, free from
malaria. The rooms should be off the ground, the air pure, and ren-
dered dry by fires ; it should also have the benefit of the sun. The
clothing should be warm, diet moderate, easy of digestion ; alcoholic
drinks and all intemperance in eating should be strictly forbidden. Be-
fore the expected paroxysm but little nourishment should be taken.
During the chill the patient may have more covering and some warm
teas, but no stimulants. The heat of the fire only increases the chill
and the subsequent fever.

During the fever remove some of the covering to be put on again
during the sweating stage, but regulating it with care, that unnecessary
perspiration be not excited by excess of heat.

Selection of the Proper Remedy, — Dr. Baertl* says: A fever
remedy must not only cover the cause of the fever, as it may now pre-
sent itself, already complicated with artificial medicinal effects; but it
must also reach the organic, the symptomatic and vital condition corres-
ponding to the character and speciality of the fever in its physiological
effects. Every fever remedy must act on the nervous system, and
especially on the vaso-motor part of it ; and it is only then, when such
a remedy, although well chosen, does not effect a cure, that the anti-
psorics are indicated, as entering more deeply into the vegetative
sphere of life, and thus enabling them to remove cachexias. The type
of the fever gives no indication here ; but we have to consider the re-
lations between the chills, heat, sweating, thirst, and the other accom-
panying ailments ; as also the time of the return and termination of the
paroxysm. The whole disease, paroxysm and apyrexia, must be taken
a^ a unit, for frequently the paroxysm itself is void of characteristic
symptoms.

* Homoeopathic Views and Experiences in the Treatment of Intermittent Fevers.
By Dr. Joseph Baertl. Sondershausen, 1859.

486 DISEASES OF THE SANGUINOUS MIJ^CTIOlir.

Time of giving the Remedy,— T\iq best time is at tlie expiration
of the paroxjT-sm, and when the interval is short, begin giving as soon
as the perspiration commences; repeating it several hours before the
next chill is expected. Or it may be given at regular intervals.

After the disease is broken, it is advisable to keep up the action of
the remedy in lengthened intervals, to prevent a return of the disease
If the remedy has failed to keep off the expected paroxysm, it must le
repeated or another remedy chosen. Sometimes the proper remedy is
followed by* an aggravation of the paroxysm, and frequently a latent
psora is aroused by the fever.

The remedies most commonly made use of in this malady, are China
and Arsenicum. The following will also be found appropriate in many
instances : Tpecacitanha^ Bryonia^ Exipajtoriumj-jperfoliatum^ Ntix-
vomica^ YeTatTum-alb.^ Belladonna^ Carbo-veg., Pulsatilla^ Anti-
'inor)%i%i7rh-GTuduin^ Ignatia^ CocGulus^ Lachesis^ Sahadilla, Suljjhur^
Cina^ NatTum-muriatiGum^ Capsicum^ Ajpis. Cornine^ Salicine,

China. — Yellowish color of the skin and fa-ce ; during the chill and
heat, redness of the face, and distention of the veins of the face and
head. "During the chill, bilious vomiting; palpitation of the heart;
short cough." {Sartlaub.) During the intermission, yellowish, clay-
colored countenance; weak eyes; fulness of the abdomen; cough;
anasarca. In tertian fever, with thick, brown, yellow-coated tongue;
countenance palish-yellow during the paroxysm and intermission; swell-
ing in the region of the spleen; eyes red and sensitive." [Knorre.)
Quotidian fevers with pale countenance; cold and pale hands and feet;
and retching up of mucus during the chill; while during the fever
there are red face, full, quick pulse, dry spasmodic cough. Paroxysm
preceded by palpitation of the heart, sneezing, anguish, nausea, thirstj
bulimia, headache, and colic. Thirst hefore and after the shiverings,
or during the sweating^ stage* coldness in the region of the liver;
easy perspiration during sleep, or when moving; short cough; for the
most part no thirst during the cold or hot stages. Hartlaub has cured
chills, external or internal, without thirst, followed by heat with thirst;
and followed or not by sweat; or chills in some parts of the body, with
shuddering and heat in the head, terminating in fever, intermingled
with chills, attended with thirst and followed by sweat; or no chills,
but fever with urgent thirst, and afterwards with perspiration. Hart-
mann advises China^ when we have during the paroxysm throbbing
pain in the head, extending to the orbits; vertigo; nausea; pain in the
region of the liver; sharp pain in the chest; short cough; aching pain
in the abdomen during the chill; pains in the loins and legs. During
the intermission, confusion of the head ; transient vertigo ; variable ap-
petite; thirst; drowsiness after meals; uneasy sensation in the pit of
the stomach; nausea; constipation; general debility. Knorre has

TREATMENT OF INTEEMITTENT FEVEE. 487

cured the quotidiaQi type, attended with vertigo; pale and cold hands
and feet, and retching of mucus, during the chill ; and pains in the
head, both sides, and pit of the stomach; dry and jarring cough, and
drowsiness durhig the fever, which is protracted and violent. Also,
tertian fever with violent chills, heat and thirst, followed by perspira-
tion. During the paroxysm and intermission, there were bitter taste
eructations, and vomiting; aching pains in the pit of the stomach, and
in the region of the spleen; yellow and sickly aspect. Also in tertian
fever, when the chill is short and slight, but followed by violent aching
pain in the forehead, in the right temple, and around the right eye;
general heat; intense thirst; 'eyes hot, painful and sensitive to the
light; paroxysm commences in the forenoon, lasts until evening, and is
succeeded by perspiration during the night.

Confusion of ideas and drowsiness during the paroxysm and inter-
mission; anxiety; discouragement; great activity of the mind; some-
times delirium.

Intermittent with want of strength, debility, and ansemia, deep affec-
tion of the blood-life, and super-irritation of the nervous system, (irri-
tation of the spinal marrow, pressure on the spine between the shoul-
der-blades, painful, especially during the chill) ; great weakness also in
the apyrexia, quick development of dropsy and axaemia, decomposition
of the blood from urinary crystals and deposits, swelling of the spleen
and liver, China is especially curative where a long-lasting impres-
sion of the paludal miasma acts depressingly upon the vegetative
life and the preparation of the blood, over-irritating the nerves, pro-
ducing swelling of the liver and spleen, sallow complexion, general
cachexia, anseniia and hydrssmia. {Arsenicum^ Ferrum) All the
stages clearly defined^ severe and long-lasting, Apyrexia, in the
beginning without symptoms, or only symptoms of injured digestion,
similar to the apyrexia of Natrum-'innriatiGum, Sweat predominant.
Thirst between the chill and heat, or after the heat ; sweat even in the
apyrexia. Paludal intermittents, if not cured by a few doses of China,
need always for their removal a few doses of the antipsorics. Inter-
mittents appearing as pure neuroses, the so-called febris intermittens
larvata, as paroxysmal cough, convulsions, paralysis, epilepsy, sopor or
mania, if no other remedy corresponds better to the totality of the
symptoms.

Symptoms produced hy Cinchona^ according to the old authors. —
Oppression of the stomach; vomiting; diarrhoea; syncope; great debi-
lity, a form of jaundice; bitterness of the mouth; tension of the ab-
domen. It was for precisely these evils in cases of intermittents
other authors recommend the Cinchona alone. Its power of curing
exhaustion, indigestion and loss of appetite, resulting from acute fevers,
(particularly when the fevers have been treated by venesection, eva-

i88 DISEASES OF THE SAKGUINOUS FUlSTOTIOK.

cuants, and debilitants), depends on the faculty it possesses of de*
pQ^essing excessively the vital powers, jprodtwing mental and bodily
exhaustion^ indigestion and loss of appetite, {Hahnemann, Mater.
Med III.)

Administkation. — ^^One drop of the third dilution in a teaspoonfui of
water, may be given previous to the chill, and during the forming stage.
Should this prove insufficient to remove the symptoms, the dose may be
repeated every four hours during the intermissions.

Siilphate of Quinine, — The importance of this article in the hands
of men of every school in the treatment of many forms of disease
justifies an analysis of the researches hitherto made in view of ascer-
taining its true physiological action.

Quinine has a powerful affinity for the nervous system. It is a law
of the animal economy that no function can be performed without loss
of substance. Muscular motion implies the loss of fibrine; and any
activity of the brain and nervous system involves a corresponding meta-
morphoses of this tissue. The waste of nervous tissue, or in other
words, the activity of the function of innervation is usually accelerated,
being in a direct ratio to the sum of the phosphates found in the urine. "^^

It has been proved by experiments that Quinine given in a state of
health augments the amount of phosphates, and consequently, increases
nervous action. Dr. Ranke {Med, Times and Gazette, May 80, 1857,)
ascertained by experiment that the paroxysm of fever greatly increased
the amount of phosphoric-acid ; showing most clearly that the nervous
system plays an important part in the paroxysm of ague. Dr. Ham-
mond {Amer, Jour, Med, Sciences) found while experimenting on him-
self during an attack of intermittent fever, that on the day of the first
paroxysm the amount of phosphoric-acid found in the urine was 69.18;
next day, that of the intermission, 52.95* Third day (paroxysm) 72.95«
Fourth day (intermission) 55.27. On this, fourth day. Quinine was
taken. Next day, being the day for the paroxysm, and when the.
amount of phosphoric-acid, calculating from the average, would have
been 71.06, it fell to 56.22, but a trifle above that excreted on the days
of intermission.

Eut rapid disintegration of nervous tissue is not confined to inter-
mittents. It is a permanent elepaent in nearly all severer forms of
fever. General debility, and non-performance of function are doubt-
less due to this case. Continued experiment led Dr. Hammond to the
conclusion that "Quinine has the power to prevent much of this great
waste of nerve-material." It not only prevents destruction of nerve-
tissue, but, by its well-known efiects on the function of nutrition, con-
tributes greatly to the reparative '^roQe^s, It may therefore be

* Dr. Nevison, Amer. Jour. Med. Sciences, 1861, p. 51,

TEEATMENT OF INTERMITTENT EEVER. 489

regarded as the great conservator of the nervous system in conditions
of febrile excitement or nervous prostration.

Its Action on the Circulation. — It has the power of giving con-
tractile action to the capillaries in every part of the system. Dr. Cor-
rigan, physician in ordinary to the Queen in Ireland, says : It has the
same power "in giving contractility to the capillaries in the lungs
which we know it to possess in so marked a degree over the capillaries
and venous radicles in the spleen."

This power gives control over nearly all forms of venous and capil-
lary congestion which it is impossible to obtain^by any other known
agent. It approximates the pulsations to the healthy standard, render-
ing them slower when too quick, and quicker when too slow\ It enters the
blood-vessels and goes the round of the circulation. Tiedemann and
Gmelin long ago found it in the blood of a patient to whom it had
been administered; and in from three to twelve hours after it was taken,
it appears in the urine, as shown by Dr. Bence Jones, M. Brignet and
others.

Quinine diminishes the amount of uric -acid in the blood. Dr.
Ranke tried it in three individuals in health, and found that under the
influence of the Quinine the uric-acid was diminished nearly one-half.
Dr. Hammond made a series of observations during an attack of inter-
mittent fever, where, as in all fevers, the amount of uric-acid is always
greatly increased. He found in this case the quantity promptly reduced
more than one-half by the action of the Quinine.

But Quinine defibrinates the blood, rendering it fluid and uncoagu-
lable. Dr. Samuel Garden shows this in the Dublin Quarterly for Au-
gust, 1856. It is further proved by the experiments of Baldwin, Melier,
Brignet and others, which may throw light on its power of subduing
many forms of inflammation, arising under the influence of malaria.

The diseases to which Quinine is especially adapted contain an im-
portant neuropathic element. The innervation may be either deficient,
irregular or excessive ; all, however, imply the existence of, or ul-
timately produce debility. Many derangements of the circulation,
nutrition, secretion, sensation and muscular motion are included as
sequelae. (Dr. Nevison.)

An example of excessive innervation is manifest in precocious chil-
dren. The vivacity, intellectual and moral development indicate a de-
gree of nervous activity altogether disproportioned to the restorative
or nutritive function ; early decay is the result. The diseases accom-
panied with derangement of the circulation are attended with general
or local congestion, conspicuous among them are intermittent, remittent,
continued and pernicious fevers, and many diseases usually regarded as
inflammatory. Derangements of secretion, excretion and calorification

490 DISEASES OF THE SANGUINOUS FUNCTIOK.

follow in the train of disordered circulation, and imply disturbance of
the ganglionic system.

Sulphate of Quinine is in any dose in some way homoeopathic to ma-
larious bilious fever, of every grade in which there is merely irritation
without local inflammation. It is adapted to the treatment of ojpen
fever where the high phlogistic symptoms have been subdued by other
measures, or before local inflammation is established. But it is injuri-
ous in a high degree in the doses commonly employed in bilious fever,
with gastro-intestinal irritation. In these cases the head sufiers in-
tensely from full doses of Quinine ; and, where there is tendency to intes-
tinal irritation, the Quinine speedily causes dryness of the mouth, dry
and red tongue, with general irritation. It is safer in the early stages
before the local irritation is established than after its has become fixed
in local inflammation. The Callissaya-bark is superior to Quinine in
all the bilious fevers, possessing powers very different.

Quinine in ordinary doses is injurious in cases of an asthenic cha-
racter; in an impaired condition of the general system where there is
an atonic state of the general circulation, and symptoms of adynamia,
Quinine diminishes still farther the force of the circulation, and in-
creases the frequency of the pulse with all signs of irritable debility.
It is certainly wrong to call it a stimulant in such cases. It is injuri-
ous in all cases attended with pale skin, sallow complexion, feeble and
quick, or weak and sluggish pulse ; irregular biliary secretion, and in
cases of extreme debility in which there is a tendency to syncope in
the erect posture ; throbbing in the head ; tinnitus aurium; palpitation
and vertigo. It is highly injurious in violent congestive fever with cere-
bral congestion ; or the collapse stage of common remittent, malignant
and typhus. In all of these cases Quinine never fails to induce a
quicker and more irritable pulse, thirst and cerebral congestion ; and
whilst each dose of it increases the danger, Wine and Camphor sustain
the failing powers.

In fevers of an opposite or phlogistic character, Quinine produces the
ordinary eflects of a stimulant, more decidedly than the Bark itself.
Dr. Monette says : " A full dose is followed by increase of temperature
of the surface and fulness of the vessels of the head. When full and
frequent doses are taken, the countenance generally becomes flushed
and the vessels of the head very full; there is confusion and heaviness
of the head and ringing in the ears." In a few cases these effects go so
far as to cause a singular form of delirium resembling that produced
by an overdose of Stramonium.

MM. Itard and Piorry say, they have often known permanent and
complete deafness follow the use of Quinine in large doses. All prac-
titioners of large experience have seen the same thing.

M. Guersant says, a physician in France believed that Quinine onlj

TEEATMENT OF INTERMITTENT FEVEE. 491

failed to cure ague when the dose was too small. Such was the state
of mind of our colleague when his wife was attacked with ague. He
gave her sixteen grammes (92.604 grs.) of Sulph. Quinine in a very
short space of time. The patient soon fell into a state of stupor with
weight in the head, dazzling, and then blindness and deafness. M.
Bazire, conceiving that these new symptoms were due to the approach
of a new paroxysm of pernicious ague, gave his wife twenty-five
grammes more of the drug. After the taking of this considerable dose
the symptoms increased with frightful rapidity. The patient became
more completely deaf and blind, her respiration embarrassed ; pulse
very bad, skin cold. At this time the physician was greatly alarmed
by the great number of bad agues abounding in the province, and the
failures he had experienced had thrown him into despair ; he now saw
in dismay the malady again triumphant ; and the remedy he had thought
invincible was utterly powerless ; fortunately for the wife he took the
disease himself; dosed himself as effectually as he had her, and ended
the disease and his own life together. [Diet, de Med.)

ProphylaotiG Powers of Quinine, — In the years 1840 — 41 the
English government sent an expedition into Africa to explore the
sources of the Niger river. Two ships carried the party with all the
materials that could promote the comfort of the men with extra contri
vances to purify the air on board ; and they were expected to make a
protracted stay in that malarious region. Of these two ships' crews
none escaped the African fever; and, after two years' struggle
with malaria, a few returned alive to England. In 1854 — 55 the
same government sent out another expedition of two ships designed
to remain in the Niger two years. The men generally escaped the
fever by taking Quinine. Each man was ordered to take five grains
of Quinine every morning before exposure on the decks of the vessels,
while in the river. After repeated trials it was found, that after leav-
ing the river for the ocean it was necessary to continue the Quinine for
fifteen days after leaving the river. This practice was continued for
five months annually for two years. In December, 1858, the crew had
been encamped twelve months on the Niger, and the men maintained
robust health. In the malarious regions of the United States the use
of Quinine has been tested as a prophylactic. Dr. de Saussure, of
Charleston, S. C.,* mentions many cases of persons who took it regu-
larly for many years, visiting the sickliest locations, as the rice-fields,
every day. They all escaped the fever. When they became careless
and omitted the antidote they had attacks of it. A rail-road contrac-
tor on the Charleston and Savannah R. R. had one hundred and fifty
unacclimatcd North Carolina negroes at work in a notoriously unheal-

* Medical Intelligencer. Feb. 1860.

4:92 DISEASES OF THE SANGUESrOUS FUNCTION".

tliy region. He carried with him some pounds of Quinine, took it
daily, and compelled all his laborers to take it. He reported at the
end of the season, that not one of the men had the fever. Dr. Living-
stone says, by the aid of Quinine his p-arty in Africa were able to
" ward off the pernicious fevers of the country." Half grain doses
have always in our hands proved effectual.

Modus ojjerandi of Quinine in anticipating the Paroxysm of
Ague, — Dr. Wood^ says: "Every consideration in connection with the
peculiarities of intermittent fever diseases leads to the conclusion that
the paroxysms are produced by an influence acting through the cerebral
centres ; and if these can be preoccupied by a strong impression from some
other source, they may be rendered insensible to the morbid influence,
and the paroxysm is therefore set aside. Quinine is characterized by
its disposition to act energetically on certain nervous centres, which
are probably the same as those through which the cause on the dis-
ease operates. Quinine therefore interrupts the succession of parox-
ysms." The theory given by Hahnemann {Organon of Medicine^
Fourth Am. Edition^ 1860, Sect. 43, p. 115, &c.) is much more clear
and satisfactory. Dr. Holcombe considers that the malaria and the
Quinine act on the same tissue, in a more or less similar manner, and
the stronger excludes the weaker. By inducing the Quinine disease
within the interval, the ague disease can not act upon the pre-occupied
tissue. He thinks the disease can be still more perfectly met by some
additions to the Quinine ; and that to render it certainly effectual the
dose must be appreciable and the remedy thoroughly horaoeopathic.f

We prefer to correct the system first by other proper treatment, and
then the case will be curable by this or some other remedy.

Arsenicum, — The, internal use of Arsenic in the treatment of skin-
diseases has often developed ague. M. Biet says, he has often ob-
served "a cevtsim periodicity in the symptoms following the use of it.
It is well known that it frequently cures ague neuralgia and other
intermittent diseases."

Symptoms. — Face puffed and earthy, or countenance anxious, sunken,
and of a yellow tint; pendiculations and drawing in the limbs during
the cold stage ; pungent and burning feel of the skin during the fever ;
dropsical swelling ; trembling of the limbs during the sweating stage ;
pulse irregular, or quick, weak, small, and frequent, or suppressed and
trembling ; tongue bluish, white, or bright red ; diminished urine ;
night-sweats ; face red during the fever, but pale and sunken during
the intermission. — Aggravation of the existing symptoms just pre-
vious to, or during the attack ; paroxysms imperfectly developed ;
chills and heat alternating ; periods of attack regular, and generally

* Therapeutics. Vol. I. p. 261. f North Amer. Jour. Homoeop. 1861. p. 10.

TREATMENT OF INTERMITTENT FEVEK. 493

in the morning or evening ; burning thirst, or adypsia ; fever of either
type ; burning in the stomach, sharp pains in the limbs, chest, back
and head, during the heat, with diJB5culty of breathing; during the
sweating stage, heaviness of the head, buzzing and ringing in the ears
between the cold and hot stage, drowsiness, languor, thirst, nausea
vomiting and hiccough ; sweats during sleep, or on waking in the morning.
Dr. Watzke has cured chills and thirst, followed by high fever, urgent
thirst, dizziness, confusion in the head, and finally profuse perspiration
without thirst. During the apyrexia, pains in the chest and head ;
weakness and faintness ; small appetite ; abdomen swollen, and affected
with occasional colic pains. Dr. Hartlaub has cured chills without
thirst, followed by fever with or without thirst, and then by perspira-
tion ; before the chill, vertigo ; fainting ; pains in the side, chest, ab-
domen and back ; stretching and yawning ; during the chilly anxiety ;
pains in the head, back, limbs, and pit of the stomach; stretching and
yawning; prostration; nausea; vomiting; coldness of the abdomen;
oppression of the chest ; during the fever^ delirium ; pain in the
head; vertigo on rising; nausea; bitter taste ; aching pain in the
region of the liver ; aching a,nd burning, extending from the pit of
the stomach to the left hypochondrium ; oppression of the chest;
during the intermission^ pale countenance ; white tongue ; swelling
of the hypochondrium and abdomen; cold clammy sweat; throbbing
pain in the forehead ; thirst ; no appetite ; nausea ; extreme debility ;
pains in the head, chest, back, and limbs. Depression of spirits, and
irritability previous to the attack; anxiety, uneasiness, confusion of
ideas, which gradually increase until the sweating commences; oc-
casionally delirium during the hot stage.

Arsenicum has been found efficient in the cure of intermittent fever,
which has lasted already some time, and withstood remedies seemingly
indicated. In fevers with short chills, but protracted heat, or where
the sweating did not occur ; malarious paludal fevers accompanied by
mucous and bilious vomiting, watery diarrhoea, burning sensations,
especially in the pit of the stomach, syncope, great anxiety, remarkable
collapse of the vital power, inquietude and great thirst, especially
during the day and burning heat. Arsenicum is most appropriate when
the whole vascular and nervous systems are deeply implicated, caused
by malignant endemic or climatic influences, especially malaria, and
producing disorganizations of the liver and spleen. The fever having
already lasted some time, and, perhaps been maltreated with Quinine,
has produced a general cachexia, especially a dropsical or putrid state.
The paroxysms are long continued and severe, especially the heat ; the
apyrexia never complete. Arsenicum produces no perfectly formed
fe^er J all the stages of the paroxysm are either ill-defined or one

i94 DISEASE OF THE SANGIJIKOUS FUJSTCTIOJST.

of them is wanting ; rapid sinking of the vital power ; debility of a
a torpid character.

M. Bodin, physician general of the French army in Algeria, says,
he often foiled to cure the agues of that country with Quinine, though
he succeeded with Arsenic. With " a single dose that did not exceed
rhr of a grain" he " radically cured fevers contracted in Algeria or
Senegal, and which had resisted various means of cure, including
Sulph.-quinine, &c. He often succeeded in a short time inputting an
end to the quotidian, tertian, and quartan agues contracted in latitudes
the most various, often complicated with chronic engorgements of the
abdominal viscera. {Traite de Fiev, Intermit, p. 280.) Of two
hundred and sixty-six cases one hundred and eighty-one were cured
by Arsenic, of these fifty-seven had resisted Quinine.

jidrrdnistration, — Two drops of the sixth dilution in an ounce of
water, — -a dessert-spoonful once in six hours during the apyrexia, until
the symptoms have disappeared. One dose of this remedy will often
prove successful where allopathic doses of crude Cinchona and other
articles, have produced no effect. We have, in two instances, succeeded
in curing cases which have resisted the old school method for months,
with a single drop of the thirtieth attenuation.

Remaeks. — Arsenicum is appropriate in any type of intermittent,
or fever and ague, provided the symptoms correspond, although several
authors especially commend it in the tertian and quaHan forms.

IpeoaGuanha. — At the heginning of Inter mittents^ where the sub-
jective difficulties of digestion and breathing have not yet got seated.
Intermittents caused hy errors in diet Intermittents complicated
with gastricismus, and in relapses, after abuse of China. It suits sen-
sitive juvenile persons. Thirst totally wanting, or only trifling, during
the chill. Chills predominant, with special irritation of the upper part
of the spine {China and iV^wa^.), therefore with occipital pains and .ten-
sive pressure of the neck, spasmodic dyspnoea, spasmodic cough. Heat
trifling, more external, often with cold hands and feet, or only heat in
the face. Sweating entirely missing (Arsenicum), or only appearing,
sour smelling, about midnight. Reduced secretion of urine. Apyrexia
with gastric symptoms.

Sallow Skii^. — Before the shiverings, uneasiness, stretching and
lassitude, with cold sweat on the forehead; tongue clean or loaded;
during the apyrexia^ countenance pale or yellowish. Slight chills,
followed by much heat ; or, severe chills with little heat ; aggravation
of the rigors from external heat ; thirst only during the chill ; nausea,
vomiting, and other signs of gastfric disturbance^ manifest during the
heat ; also, constriction of the chest. Watzke advises Ipecac, when
chills are attended wdth thirst, confusion of ideas, and dull pains in the
head ; the hot stage^ with thirst and sharp pains in the head ; the

TREATMENT OF INTERMITTENT EEVEE. 495

sweating stage, with little or no thirst; the apyrexia, with want of
appetite, bitter taste, oppression at the stomach, and pale face. Hart-
laub has cured slight and short chills, without thirst, followed with
violent fever, with thirst, and succeeded by profuse perspiration, or
without perspiration.

Before the chill, pain in the back ; during the ^{S^'r6)a?2/'^m, headache,
dulness of intellect, gastric derangement, nausea and vomiting, oppres-
sion, contraction, pain in the chest, and cough ; dxtring the inter-
mission, bitter taste of food, much saliva, loss of appetite, vomiting
after eating, lassitude, sleeplessness.

Before the chill, dulness of intellect and sleeplessness ; during the
chill confusion of ideas, irritability, impatience and indisposition to
mental eifort.

Administration. — Same as China.

Remarks. — This remedy has been most frequently used in fevers of
the qywtidian and tertian types. Lobethal, Hartmann, Boenninghausen,
Schmidt, Fleischmann, Watzke, Madden, Trinks, Elwert and Rumel have
expressed themselves strongly in favor of the low dilutions of Ipecac,
in this disease. Others have succeeded with higher potencies but in
peculiar cases.

Apis-mellijlGa, — ^Wolf and Hering recommend Apis as the speoifio
against every sort of intermittent fever, no matter how complicated
the case. As intermittent fever-poison acts as an alterative on the
whole sanguification, and on all the nerves, spinal as well as ganglionic.
Apis-mellifica does the same. Its action is direct, whereas other fever
remedies correspond only to certain individualities.

^^y6>m<^.— Simultaneous affections of the organs of the chest and
abdomen ; chill and heat moderate ; sweating predominant and lasting ;
thirst strong during the chill and heat ; excruciating, dry, racking cough
during the chill, with stitches in the chest; bilious symptoms; rheu-
matic pains in the extremities.

Pleuralgia. — D%iring the shiverings, trembling and redness of the
face ; during the heat, nauseaj and tendency to keep the recumbent
posture ; during the sweating period, frequent sighing and cough.

Pleuritic AauE. — ^Preceding the cold stage, vertigo, headache,
and lassitude ; first stage, ushered in with severe chills and trembling,
with heat in the head ; chilly stage, more violent than the hot or slight
but protracted cliills, and some thirst ; second stage ushered in with
flushes of heat and slight chills, in alternation in the first instance,
afterwards burning heat and thirst ; universal dry heat, external and
internal; spasmodic cough ; vertigo and headache during the fever;
shooting pains in the side and abdomen ; after the heat, profuse sweat ;
oppression in the chest, with dry cough ; tendency to sweat night and
morning ; during the apyrexia, constipation, thirst, unhealthy, yellowish

496 DISEASES OF THE SAJN'GUmOUS FUNCTION.

complexioiij and night sweats. Irascibility and disposition to look on
the dark side of affairs.

Administration.— Two drops of the third dilution in an ounce of
water, — a dessert spoonful two or three times during the apyrexia.

Eupatormmrjperfoliatum, — This is a remedy which we have found
highly serviceable in many cases which have been complicated by the
abuse of Calomel and Quinine. It is particularly indicated when the
liver is much implicated. An intelligent homoeopathist who resides in
a fever and ague district at the West, informs us that he has for many
years past made use of a small quantity of an exceedingly weak infu-
sion of this agent as a prophylactic against this disease, in his own
family, and with complete success. He also assures me that he has
often cured, with astonishing facility, cases which had baffled for
months, the ordinary treatment, with a dose or two of an infusion very
slightly bitter. We have often used it with success.

Yellow tinge of the skin and eyes ; eyes dull, heavy and sunken ;
lips pale or bluish, dry and cracked.

Peinoipal Symptoms. — Irregular development of the paroxysms ;
frequent slight chills previous to the commencement of the first stage ;
partial chills in the back and extremities ; dizziness, heaviness and
ringing in the head, during the cold stage ; hot stage ushered in with
slight chills, alternating with flushes of heat, until in a short time the
heat becomes general, attended with headache, nausea, vomiting, pains
in the chest and stomach; pains in the bones; tenderness of the ab-
domen on pressure ; loss of appetite ; sensation of fatigue, languor, and
debility; constant inclination to sleep; nocturnal sweats.

Dr. Williamson advises Etcjpatoriuwh in the quotidian and tertian
types, when the following symptoms are present: paroxysm com-
mencing in the morning ; thirst several hours before the chill, con-
tinuing during the chill and heat ; stiffness of the fingers during the
chill ; soreness in the bones ; aching pain with moaning throughout
the cold stage ; a greater amount of shivering during the chill than is
warranted by the degree of coldness; retching and vomiting at the
conclusion of the chill; distressing pain in the scrobiculus cordis
throughout the chill and heat ; chill beginning at nine o'clock in the
morning ; throbbing headache during the chill and heat ; violent pain
in the head and back before the chill ; inconsiderable perspiration,
or none at all ; fever in the forenoon, preceded by thirst early in the
morning, but no chill ; attended by fatiguing cough and not followed by
sweat ; loose cough in the intermission ; cough in the night previous
to the paroxysm ; yellowness of the skin. During the paroxysm, con-
fusion of ideas and ringing in the ears ; discouragement ; indifference
to life ; dullness of conception, and discontent during the apyrexia.

AdministfvAtion. — One drop of the first dilution in a spoonful of

TREATMENT OF INTEEMITTENT FEVEK. 4^ /

water during tlie apyrexia. As a prophylactic against miermittents.
one drop of the tincture two or three times a week.

JVicX'Vomiea.—DuYmg the chills, skin, hands, feet, face, and nails
are cold and bluish ; redness of one or both cheeks ; spasmodic con-
tractions in the limbs ; yawnings and stretchings. Sweat profuse, some-
times with a disagreeable acid smell; partial or one-sided sweat; pulse
hard, full and frequent, or small, quick and feeble, or intermittent ; dry-
ness of the lips ; tongue coated white or yellow. First stage preceded
by external and internal cold and yawning ; chills usually at night, or
in the morning * aggravated by motion, drinking, or excitement ; pain
and heat in the head ; thirst for beer ; pains in the back and loins ;
during the hot stage, headache, vertigo, thirst, nausea, pains in the
chest ; shivering on motion ; debility ; during the sweating stage the
symptoms are mitigated ; sweat and chills come alternately.

"Watzke gives us the following indications : Chills with thirst ; head-
ache, loss of consciousness or delirium, painful and inflexible limbs, con-
tracted feel of the muscles. Chills last four or five hours, and not
followed by heat or perspiration. After the chill exhaustion ; pains in
the hypochondria from distention ; thirst and want of appetite ; tongue
white; feet swollen; sensation of heaviness when walking. Or, chills
followed by heat and sweats with thirst ; anxiety ; headache ; slight
cough, with burning sensation in the chest, worse during the chills and
heat ; constipated bowels ; loss of appetite ; craving for beer ; weak-
ness and faintness. Hartlaub has cured chills with or without external
coldness, and without thirst; followed by fever with thirst, and succeeded
or not by perspiration. The chill maybe slight and short, or violent
and protracted, with shaking and chattering of the teeth, and blue
nails ; fever attended with perspiration about the head and neck. Or,
shaking chills with thirst, followed by fever with thirst, and by per-
spiration; chill preceded by thirst, coldness increased by drinking.
Or, alternating chill and fever ; motion during the fever or sweat causes
chills ; during the chill, pain in the back (sacrum) ; during thefe^er,
headache, vertigo, red face, pain in the chest, vomiting of water, bile,
slime and food ; red urine ; during the interinissiony headache ; ver-
tigo ; trembling of the head on motion ; pain in the forehead ; acid
eructations ; bad taste in the mouth, loss of appetite, disgust for food ;
much thirst; pain in the pit of the stomach after eating; distention
and pain in the belly ; constipation ; pressing at the neck of the bladder
after .urinating ; drawing in the limbs ; weakness. Hartmann employs
it when, at the commencement of the paroxysm, there are, paralytic,
weakness of the limbs ; disordered stomach ; vertigo, and sudden pros-
tration of strength.

During the chills, stupid or delirious; during the fever, anxious^

Vol. L— 32.

4y8 DISExVSES OF THE SANGUINOUS FUNOTIOK.

melanclioly, sad, timid, apprehensive of death. Occasionally monoma
nia during the progress of the disease.

The sphere of action of Nux-vomica is such that it is specific in
prima-ry affections of the spinal or the ganglionic system; gastric
troubles with nervous origin, where the stomach, bowels and liver are
so morbidly affected, that the apyrexia shows considerable evidences
of deranged digestion, even to vomiting and constipation. Intermittents
caused by taking cold, errors in diet in hot-headed irritiable males, who
easily get angry; also indicated in fevers with ^rim-ary affections of
the spinal nerves or the ganglionic system ; when during the paroxysm,
twitchings, tetanus, trembling, sacral pains, sensitiveness of the spine
to pressure, paralytic feelings in the extremities, sleep between the
chill and heat (Ignatia). Yellow skin, the person thin, dark colored,
of choleric, sanguine temperament. After Arsenicum, Nux is one of
the best remedies, even in paludal fevers. Also in malarial fevers with
symptoms similar to those of Cina, constipation being a prominent
symptom.

In the usual Nux-paroxysm the chill is predominant; every little
motion, even drinking, aggravates the chill, with severe pressing head-
ache and congestion. Hands and feet ice cold; blue nails; no thirst;
then continuous heat, with pressive frontal headache; redness of the
face and thirst, followed by sweating; apyrexia, vertigo, heaviness and
dullness of the head ; pressive throbbing headache in the sinciput and
temples. Waxy paleness of the face; toothache ; tongue clean or
covered with a brown thick mucus; taste bitter, sour, or lost; malaise
and bitter vomiting; stitches in the liver and in the right side of the
chest; sensitiveness and painfulness of the stomach to the touch;
bloating, pressive contractive pain iii the stomach; painfulness and
bloatedness of the left hypochondrium; enlargement of the spleen,
bearing no touch, impossibility of lying on the left side. Constipation,
stitches in the anus, dry cough at night, general ailments, loss of flesh;
debility, anxiety, inconsolability, with bitter crying ; touchiness, being
easily excited to anger. Intermittent, with nervous symptoms, emanat-
ing from the spinal cord and reflecting themselves in other organs.
Apoplectic intermittent with vertigo, anxiety, febrile shivering, delirium
with lively visions and tension in the stomach.

Administration. — Two drops of the twelfth dilution in an ounce of
water, a dessert-spoonful each night. If a cure is not effected at the
end of a w^eek, give a drop of the first dilution once in six hours,*until
the symptoms disappear.

Eemakks. — NiLX is particularly applicable to the quotidian and ter-
tian types. If the individual has been an intemperate drinker or luxu-
rious and sedentary in his habits, the indications are still stronger.

^?^m(3<x.-— Inclination to remain quiet.

TREATMENT OE INTEEMITTENT EEYEK. 499

Peijstoipal Symptoms. — Chills occur in the evening; thirst; con-
traction of the features. In the hot stage, pain in the back and limbs;
shiverings, from the slightest exposure ; the hot and sweating stages
are of short duration. In the apyrexia, pain in the stomach ; loss of
appetite and general appearance of wretchedness and debility. Ob-
stinate ; reckless ; quarrelsome.

ADMmiSTEATioN. — Dr. Shue has been accustomed to exhibit this
remedy in alternation with IpeGacuanha with marked benefit. It may
be given at the first attenuation, a few drops every four hours during
the apyrexia.

Veratrum-albu7n.— One of the best remedies. Severe chills with
feeling of internal heat or both together ; cold sweat of the body, or
only cold frontal sweat ; great thirst, especially during the chill and
sweating ; paralytic debility ; anxiety ; quick collapse of the strength ;
slow pulse which seems to fade away ; wa,tery vomiting and diarrhoea;
cadaveric color of the face ; delirium; cramps. Most of the symp-
toms also in the apyrexia : decomposition of the blood with sugillations.
In such dangerous cases, also in asphyctic intermittents, Veratrum is
far preferable to Arsenicum.

Cholekine Ague — Cold and clammy perspiration on the forehead ;
shuddering. In the hot stage, coma and red or purplish cheeks ; pulse
slow and almost extinct, or small, quick and intermittent; tongue red
and dry; general coldness of the whole body; cold stage of short
duration, and attended with shivering ; vertigo ; nausea ; pains in the
back and loins ; thirst for cold water. The second stage more pro-
tracted, and accompanied with headache ; short, dry cough; fever with
external coldness ; urine dark colored ; diarrhoea or constipation ; coma.
In the third stage, profuse perspiration with thirst and drowsiness.

Hermann prescribes Yeratrufn when the chills are followed by sweat
and afterwards coldness. Or, chills followed by fever with thirst;
vertigo ; nausea, and pain in the back, succeeded by fever with de-
lirium; flushed face, and tendency to sleep. After the paroxysm, mor-
bid appetite. Or, cold stage, without the hot or sweating stage.

In the cold stage, confusion of ideas ; in the hot stage, coma; during
the apyrexia, restlessness and sometimes mental alienation.

Administration. — One drop of the first dilution in an ounce of
water — a table-spoonful two or three times between the paroxysms.

BelladonncL-—'¥d.Q>Q pale and bloated during the cold fit ; eyes red
and injected; face red; pulsations of the carotids; veins of the fore-
head swollen, and some perspiration during the heat ; shiverings alter-
nating; rigors, followed by heat; during the fever, burning thirst;
headache ; shootings m the temples ; great sensibility to impressions ;
delirium ; sweat only of the parts covered ; stitches in the chest ; dim-
ness of sight ; quarrelsome and passionate during the paroxysm, or great

500 DISEASES OF THE SANGUmOUS FTJNOTIOW.

agitation ; mistrustful ; constant dread of evil ; visions of friglitful or
ludicrous objects ; delirium. Predominant affection of the vascular
system; fevers simulating nervous fever, or phrenitis ; congestions to
the brain during the fever ; vertigo ; redness of the face ; heat of the
head ; delirium ; sopor ; dreams and phantasies ; palpitation ; pulsation
of the arteries of the neck, heat predominating ; spleen swollen and
painful, especially during the chill ; swelling of the whole abdomen, of
the eyelids, and of the lower extremities ; sallow face ; nearly total
prostration of the digestive and reproductive sphere ; great irritability
and crossness in persons usually very patient.

Administration.— A drop of the third dilution in water, every four
hours between the paroxysms.

Pulsatilla. — Intermittent with chlorotic quality of the blood, and
corresponding imperfection of nutrition, with nervous debility com-
bined with irritability ; dyspepsia and amenorrhoea, paroxysms begin-
ning at night or in the evening: Characteristics of Pulsatilla are, a
long chilly little heat ^ and ahsenee of thirst ^* the different stages, ex-
cept the chills, have no great power; they run into one-another. During
the chill, paleness of the- face, heaviness of head, and cephalalgia ;
anxiety; sometimes mucous vomiting, and oppression of the chest.
During the heat, moderate thirst, headache, redness of the face, and
bloated appearance; painfulness, sighing, and complaining, anxious
breathing; chilliness in uncovering; nausea; diarrhoea, followed by
sweat; vertigo; oppression of the chest; palpitation; pains in the
sacrum and extremities ; fainting spells ; and in women, amenorrhoea.
During the apyrexia, headache ; seething of the blood ; palpitations ;
different disorders of digestion ; moist cough, and disposition to weep ;
urine plenty and pale ; shivering during the apyrexia. Suitable in
new cases, where the whole picture resembles chlorosis ; paroxysms
weakly developed and therefore easily overlooked. Dropsical swellings
are cured by Pulsatilla only in the beginning of intermittents, but not
when they are the sequels of the deeply-affected energy of the vascu-
lar life ; sweating only on one side of the body. — Face pale during the
hot stage ; face red and bloated in the hot stage, sometimes with sweat
on the face ; swelling of the veins ; anxious and rapid respiration ;
eyes dull and cloudy ; inclination to remain in the recumbent posture ;
pulse quick and small, or full and slow, or feeble and suppressed ;
tongue coated, whitish, grayish, or yellowish ; chills in the evening or
afternoon ; vertigo ; pain and heaviness in the head ; sensation of cold
from slight exposure ; irregular diffusion of heat, chiefly in the face, or
on one side ; absence of thirst ; after the paroxysm, headache, oppres-
sion of the chest, moist cough, bitter taste. Or, chills without thirst,
fever with thirst, and dull headache ; sweating very slight. Or, chills
(jommencing with vomiting, with slight thirst during the cold, hot and

TREATMENT OF INTERMITTENT FEYER. 501

sweating stages ; diarrhoea; loss of appetite. During the paroxysm,
anxiety ; sadness ; taciturnity ; apprehension ; dread of sudden death ;
great depression of spirits during the apyrexia.

Administration. — Two drops of the first dilution in an ounce of
water, — a dessert-spoonful three or four times during the apyrexia.

Remarks. — When the attacks have been incited by abuse of fat and
indigestible food, or are connected with any derangement of the men-
strual function, Pulsatilla is appropriate. It has been most frequently
employed in the quartan type.

Case by Dv. Pearson^ Iowa.— ''In the months of August, September
and October, 1859, I frequently prescribed for as many as thirty cases
of chills and fever daily, and found no remedies equal to Pulsatilla and
Cedron, at from the sixth to the thirtieth attenuations." And "when
ague has been suppressed by Quinine, or more particularly with
Ohinoidine, and has again returned, there is no remedy so likely to
effect a cure as Pulsatilla." In one violent case where Pulsatilla 6° w^as
given, after a long allopathic course had failed, the chill returned with
augmented severity. The same remedy 3° permitted it to return two
hours sooner, the chill being extremely violent, and lasting three hours
before reaction appeared. It was then prescribed at the thirtieth di-
lution, every three hours, and there was no other attack. ( ZT, K lour.
^om., vol. I., p. 480.)

Tgnatia. — Purely nervous intermittent, especially if caused by fright
or terror ; apyrexia of the intermission complete ; paroxysms short,
changing, irregular, or the various stages running into each other;
chilis and heat occurring simultaneously in different parts of the body,
most of the symptoms obscure or lightly displayed to outward appear-
a,nce ; sudden attacks ; suitable for females. The fever begins often in
the afternoon and lasts the whole night; the patient irascible, can not
describe his sufferings, which are augmented by every noise. ' Compare
with Cina.

During the chill, pale or sunken face ; bilious vomiting ; during
the second stage, pale face, or one cheek red and the other pale;
during the intermission, lips dry and cracked ; countenance pale ;
hard, dry stools; nettle-rash; pulse variable; tongue white. Rigors^
with thirst for cold water; nausea and vomiting; pain in the back
and limbs ; oppression at the chest ; loos^, short cough ; coldness re-
lieved by external heat ; heat general during the second stage ; ver-
tigo; headache; pain in the back and limbs; drowsy; absence of
thirst during the hot and sweating period ; during the intermission,
pressing and shooting pains in the head, back, and limbs ; loss of
appetite

Occasionally delirious during the fever ; suppressed grief, with sigh-
ing ; timid, sad, irresolute, and inclined to weep during the apyrexia.

502 DISEASES OF THE SANaTJINOIJS FUNCTIOJST.

Admi7iist?xition, — Same as Belladonna.

Ooceiihis,' — Trembling during the first stage ; redness of the cheeks
during the heat ; pulse full, hard, . and frequent ; tongue clean or
loaded.

Transient chills ; skin hot to the touch, in the first stage ; burning
heat in the cheeks ; cramps in the loins and stomach, and but slight;
fever in the second stage ; apyrexia, accompanied with vertigo ; dull
pain in the head, and general debility.

Apprehension of approaching evil ; fear of death, during the parox-
ysm ; sadness and discouragement during the apyrexia.

Administraiion, — Two drops of the third dilution in an ounce of
of water — -a tablespoonful every four hours between the paroxysms.

Lachesis, — Face pale, or leaden, discolored or yellowish, during
the cold stage and the intermission ; red spots on the cheeks, while the
fever is on ; blue circle round the eyes ; red swelling of the face ; agi-
tation and tossing in the cold and hot stages ; pulse intermittent, or
feeble and frequent jr.stongue dry in the second stage. Most of the
time icy coldness of the limbs ; rigors only partial ; pains in the limbs ;
fever at night or in the evening, with headache.

Garho-vegetahilis. — Thirst only during the chill, or diminishing
during the heat ; offensive-smelling perspiration ; anxiety, despondency
and despair ; weak, scarcely perceptible pulse ; cachexia, with in-
creased irritability ; burning pains ; flatulency ; abuse of Quinine ;
venous abdominal affections ; oppression of the chest ; rheumatic affec-
tions of the joints and bones ; cold feet.

Before the chill, pale face ; cold feet and hands ; during the fever, red
face ; during the intermission, nocturnal sweat; cold sweat on the face
and limbs.

Tertian type, kept up by awakened psora; rigors, preceded by throb-
bing of the temples ; rending in the teeth and bones; and attended with
thirst and sense of prostration ; hot stage, attended with thirst or
without thirst; headache ; vertigo ; impaired vision ; nausea; pains
in the stomach and chest; acid sweats in the morning; in the inter-
mission, paleness ; emaciation ; distention of the stomach ; headache ;
loss of appetite ; lassitude and disturbed sleep. Anxiety and fear in
in the evening ; intellect dull.

Administration. — One grain of the third trituration in two ounces
of water, a tablespoonful once in four hours during the apyrexia.

Remarks. — This remedy was supposed by Hahnemann to be of es-
pecial^ service, in those old and obstinate cases of intermittent fever^
which appeared to be connected with a psoric miasm lurking in the
system. Hartlaub has found it curative in similar cases. It is adapted
to the tertian type. In the apyrexia, melancholy, violent jealousy j

TREATMENT OF USTTERMITXENT FEVER. 503

Weakness of memory ; during the paroxysm, delirium ; loquacity ; irri-
tability.

Administration,— One grain of the third trituration in two ounces
of water-— a dessert-spoonful every twelve hours until the desired effec
is obstained.

Saiadilla,-—-Th.G coldness . predominates ; affections of the spina
marrow and digestive organs, with pains in the bones of extremities
stretching, bloatedness of the stomach, oppression of the chest, spas-
modic cough. During the apyrexia, bruised feeling all over. In the
cold stage, trembling of the limbs, spasmodic cough ; in the hot stage,
yawning and stretching ; pulse variable ; tongue natural.

The different stages imperfectly developed ; external coldness with
shivering; dry cough, pains in the chest, limbs and bones in the first
stage; during the apyrexia, dull pains, with sense of fatigue.

During the paroxysm, inability to collect or arrange- the thoughts ;
delusions of the imagination with respect to ones self; delirium.

Remarks. — This remedy is useful when the malady has been pre-
ceded for some time by gastric derangement, or in cases complicated
by abuse of Quinine.

Administration. — -Same as Veratrum.

Sulphur, — Intermittent, coming on in the evening or night, with
more or less chills; then thirst during the heat and sweating, head-
ache, congestions of the chest, with dyspnoea, delirium, stitches and
swelling of the spleen.

Intermittent with itching urticaria, appearing during the paroxysm ;
thirst before or during the chill; heat and sweating in persons who have
had the itch; complexion sallow, yellow albuginea ; pain, swelling and
hardness of the spleen ; white-coated tongue. Whenever the remedy
seemingly well-indicated fails to break the fever, and psora may be
justly suspected, and where the symptoms lead us to Sulphtirj the use
of this remedy, especially in the lower triturations, will hardly disap-
point us.

Symptoms. — Countenance pale or hot during the first stage; circum-
scribed redness of the cheeks during the second stage; sweat upon
the head, face, and hands ; eruptions or scabs upon the face, hands,
or limbs; pulse hard, full and quick ; tongue natural.

Previous to the first stage, thirst and lassitude ; chilMness in the
evening or at nighty and sometimes in the afternoon; shiverings in
the back, chest and arms, with coldness of the hands, feet and nose
heat attended with thirst ; burning sensation in the hands and feet
bruised and tired feelings in the limbs ; palpitation of the heart ; per
spiration easily excited in the head, neck, hands, &c.

In the apyrexia, sadness, with frequent inclination to weep ; during

504 DISEASES OF THE SANGUINOUS EUNCTION.

the paroxysm, irritable and peevish ; thoughts incline to religi^ us
subjects.

Administration, — One grain of the first trituration in four parts —
a powder every twelve or twenty-four hours, until decided amendment
or aggravation of symptoms ensue.

Remaeks. — Sulphur has most often been employed in the quotidian
type. In many cases of fever and ague occurring in psoric subjects,
it will also prove eminently serviceable.

MatrtcTn-niuriatiGum.—OiiQ of the best antipsorics. After abuse
of China, even in malarious agues, if connected with psora, in tedious
cases, but where the disorganization of the assimilative organs is not
too far advanced. Terrible stitching headache, especially during the
Jbeat. Disturbances in the digestive organs, disorganization of the
spleen. Thirst in all the stages of the fever; vomiting, continual
chilliness even in the apyrexia. Twitchings of the extremities, ulcera-
tion round the lips, yawning, stretching, sleepiness, debility, sallow
complexion.

Hartlaub commends this remedy in chills with little or no thirst;
sharp pains in the forehead, back, and bones ; short breath ; yawning
and sleepiness, followed by fever, with great thirst ; severe rending or
throbbing pains in the head and forehead; in the intermission, yellowish
face ; white tongue ; hard and scanty stools ; swollen stomach ; head-
ache; weak eyes ; bitter taste; no appetite; great thirst; pit of the
stomach painful to the touch ; sleepy in the daytime, but sleepless at
night ; lassitude and debility. It also cures tertian and quotidian
types with chills only.

Administration,— A drop of the first dilution once in four hours
between the paroxysms.

AntiTnonium-crudum, — Face and eyes of a yellowish hue ; yellow
or whitish fur upon the tongue ; pulse quick or slow.

Tertian type ; short chills, followed by fever, with pain in the chest
and pit of the stomach; predominance of gastric or bilious symptoms ;
frequent nausea and vomiting ; bitter taste in the mouth ; thirst ; diar-
rhoea ; distention of the stomach,'

During the apyrexia, indifference to life ; during the paroxysm
peevish ; dread of misfortune ; out of humor.

Administration. — Two drops of the third dilution in an ounce of
water, — a table-spoonful once in six hours during the intermission.

Cina. — Malarial intermittents with cholera symptoms. The dilated

•pupil and \k^ perfectly clean tongue are characteristics. Intermittents

with pale face and the predominating nervous affections similar to worm-

. attacks ; itching in the nose ; spasms combined with some choleraic

symptoms; paroxysm in the afternoon, after meals. Before the chill,

•malaise; nausea; drawing in the extremities : sometimes vomiting of a

TREATMENT OF ^TEKMITTENT FEVER. 505

little fluid. During the cliillj paleness and coldness of tlie face; chills
all over the body; shortness of breath; stitches in the side; cold
hands and feet; nausea; vomiting of food, bile and mucus. During
the heat, delirium; headache; paleness of the face; vomiting; severe
thirst for cold drinks ; colic and watery serous diarrhoea, following one
another quickly, and debilitating the patient. The sweating stage,
either entirely wanting, or general sweat over the whole body ; or
partial on the face ; or cold sweat on the hands and the feet. During the
apyrexia, the collapsed state continues, but the tongue is clean, and the
patient ravenous for food. Sometimes dry cough.

Hermann Gross, and others have found Oina curative when during
the paroxysm there are, pale countenance; canine appetite; headache;
nausea; foul breath; during the intermission, cold face; morbid appe-
tite; lassitude; occasional sweats.

Cfc^^^(3'i<^??^.— Phlegmatic temperament; flabby mucous constitution;
pleuritic pains, not relieved by Bryonia; chill predominant; thirst in
the chill, or during the chill and heat.

Dr. Morgan of 111.^ says : "Even when insufficient to cure, Capsicum
8d, in frequent doses, will often ameliorate the paroxysm of ague."
Dr. Curtis published a "cured of soporose ague, evidently of a malignant
character," with one drop doses of the mother tincture of Capsicum.
(i\^. A, Jour, Horn)

Symptoms. — Hartlaub advises it in chills with thirst; headache,
mucous vomiting; flow of saliva; great and painful swelling of the
spleen; rending pains in the back, loins and knees; yawning and
stretching ; fever, with or without thirst ; headache ; bad taste ; cutting
pains in the belly; pains in the chest, back, and legs ; after the fever,
slight or profuse sweat ; in the intermission, ash-colored countenance ;
swelling of the spleen and the feet ; constant chilliness and coldness ;
drawing pains in different parts when in the air ; useful in relapses
after abuses of Quinine.

Oedron, — Feverish paroxysm every day (quotidian) in some provers,
and every other day (tertian) in others, towards 8 o'clock, p. m., pre-
ceded by depressed spirits, dulness of senses, and pressive headache
at noon ; cramps, then contracting and tearing pains in the upper and
lower extremities, with a cold sensation in the hands and feet ; mouth
dry, great thirst, and desire for cold water; chills and shivering;
sometimes very strong shuddering of the whole body ; palpitation of
the heart and hurried respiration ; pulse weak and oppressed. These
s^^mptoms lasted from one to two hours, and varied much in intensity ;
they were followed by a sensation of dry heat, and then of a profuse
perspiration, full and quick pulse with animated red face ; cold and
pale in the apyrexia ; thirst and desire for warm drinks.

Hundreds of cases of intermittent fever, of different types, have

506 DISEASES OF THE SANGUINOUS FUNCTION'.

been successfully treated with Geclron^ in different countries since
1847 many of which had resisted the action of other drugs, previously
administered by physicians of both schools. Cedron was given im-
mediately after the heat, and as soon as the sweat had commenced ;
and, again, from two to three hours before the usual time of return of
the next paroxysm. It is homoeopathic to agues, endemic to warm,
damp, and low marshy regions, being capable of effecting the healthy
organism precisely as the natura] disease does. [Casanova^ Petro2.)
f Cedron is an efficient prophylactic to those forms of fever produced
by malaria of warm seasons, in low marshy regions; when taken oppor-
tunely and in suitable doses, it prevents their development, as has often
been demonstrated in Spain, Africa, and South America. This sort
of antagonism certainly gives immunity to those constantly exposed
to the deleterious disease-producing agents of those regions, whilst
under the influence of the drug. But in using it as a prophylactic,
care should be taken not to repeat the dose too frequently, otherwise
pathogenetic effects will be produced by it.

/S'^^m— Greneral cold feeling, with pressure on the temples and over
the eyes ; during the heat, vertigo, even to insensibility; sweating over
the whole body, with anxiety, without thirst, but with dryness in the
throat ; nightly perspiration ; cold sweat on the chest, back and thighs
at night; sour night-sweats ; offensively-smelling sweat; urine brown
and acridly smelling; perfect absence of thirst. See p. 412.

Staphysagria. — Evening chills without heat. Scurvy.

Taraxaoitm, — Quotidian intermittent with much perspiration.
Nightly sweat, restless sleep, great thirst, loss of strength. Chills in
the fresh air.

TJmya-OGGidentalis. — ^^Ghills and sweat without fever.

Opium. — Intermittent caused by fright, with cerebral symptoms
prominent; sopor, coma, or convulsions. Congestive chills.

HhuS'toxioodendron. — Intermittent caused by getting wet, with
great nervous depression and exhaustion ; spinal irritability; digestive
derangements, especially in the mucous membranes; therefore bad
assimilation; catarrhs, coryza, gastric troubles, thirst, pains in the back
and extremities; spasms; tearing pains in the head; sleeplessness,
formication and sensation of paralysis in the extremities; general de-
bility; urticaria; colic; diarrhoea; jaundice; sleeplessness, with tossing
about ; thirst at night ; palpitations, with anxiety and pressure in the
pit or the stomach.

Symptoms.-— The character of the eruptions and the fever produced
by Rhus are peculiar. Tractile feeling of the scalp as though one
was pulled by the hair ; disfigured and distorted face, the left side ap-
peared contracted and the right elongated ; black, inflamed, itching
pustules covering the whole body ; yellowish saliva.

TPwEATMENT OF I^-TEKMITTENT FEVEE. 507

Sydriodate of Potash, — Intermittent in a scrofidous constitution.
Paroxysms severe ; chill not mitigated by external heat ; dryness in
the mouth; thirst during the chill , heat and then sweat; ascites fol
lowed by general dropsy.

Laurocerasus. — [Agi.-a'jnydalus-amarar) , Purely nervoiis inter
termittentj great thirst iefore the chill ; chill relieved by externa
warmth. [Ignatia), Dry cough with tickling in the throat during the
chill ; general heat with headache, but without thirst or cough. General
sweat; urine pale. During the apyrexia, .tongue clean; appetite good^
bowels and sleep regular ; spine not sensitive ; general debility.

LycopodiuTYh, — Malaise ; sour vomiting ; severe chills ; hardly any
heat, followed by dreamy sleep and sour-smelling sweat. Severe thirst
after sweat ; bloatedness of the face and hands after the chill ; inter-
mittent with anasarca.

Mezereurnj,--—Q\yrmg the chill, dyspnoea, with constrictive feeling in
the chest, front and back ; dryness in part of the mouth ; accumulation
of saliva in the front part of the mouth, without thirst; sleepiness in
a warm room during the chill ; intermittents, consisting only of chills
with thirst.

Ooffea. — Chills and heat changing quickly; horripilations ; restless-
ness ; colic.

i^^rr'i^m.— Appropriate in cases similar to those suited with Arseni
cum and China. Interniittent fever with pure debility ; anaemia ; decay
of nutrition ; congestions to the head and chest, with watery decompo-
sition of the blood, especially after abuse of China, or long-lasting in-
termittent ; paroxysm not severe, but long-lasting, especially the sweat-
ing; change of type; large infarctus abdominis*^ liver and spleen
swollen; tnuscular power visibly decreasing * eyes red, lids swollen,
with mucous secretion of meibomian glands ; sweet taste in the mouth ;
black or dark-violet spots on the skin, sharply circumscribed ; some-
times black discoloration of a whole extremity ; debility, even to para-
lysis ; general dropsy.

Ferri-percyanidum, — Prussian-hlue^ is the best of the preparation
of iron for intermittent fever.

Ilepar-sulphuris'Calc,' — Urticaria, with itching over the whole
body ; then chill, followed by heat and thirst ; fluid evacuations from
the boAvels ; borborygmi, slight bilious vomiting ; bitter taste ; sensation
of formication in the arms ; urine dark colored, with sediments,

Hyoscyamus. — Quartan and quotidian fevers, with spasms in the
calves and stomach ; insensibility, delirium, and during the apyrexia
fiery wheels before the eyes and hiccough ; intermittent with dry noc-
turnal cough ; afternoon chills, with spinal pains ; epilepsy.

SamhuG'US. — Profuse weakening perspiration^ even in the apyrexia,
esnecially at night ; chilly horripilations over the whole^body, with fine

608 DISEASES OF THE SANaUi:tirOUS FUNCTIOl^.

stitching formication; icy cold hands and feet, especially from the
knee downward ; burning hot feeling in the face, with moderately warm
body and icy-cold feet, without thirst ; a good many hours after dry
heat has left, there is perspiration in the face ; profuse sweat without
thirst in the night ; on awaking from sleep, perspiration all over.

CalGared'CaThonica. — Swelling of the abdominal glands; hard
bloated abdomen ; inclination to diarrhoea, alternating wdth obstruction;
thirst, especially during the chill, with tearing pains in the lower ex-
^tremities ; spleen sw^ollen and painful ; headache during the fever ;
urine plentiful.

CampJiOT, — In doses of one drop only, given on the first appearance
of the symptoms foreboding a chill, this remedy often arrests the
paroxysm, and it does not return.=^

It is admitted by all homoeopathists, that, among the vast number of
remedies known to be sometimes successful in the cure of intermittent
fever, it is often difficult to select the true specific^ which, in the finest
dose, will be promptly effectual in a given case. It is still true, how-
ever, that there are many remedies which come near enough to almost
every case of uncomplicated ague to overcome its worst features, and
then either cure entirely by being repeated, or render the case promptly
curable by the next remedy. It is true that " simple cases are essen-
tially alike ; and China^ I^iix-vomica^ Bryonia^ Ipecac,^ Arsenicum^
Tartar,-ein,^ Oelseoninum and Cam/phor are efficient remedies." Of
these it is known that Ohina^ Quinine^ ArseniGum or Nux-vomica^
in some attenuation and in a certain dose will cure, perhaps, every
simple case.

Veratrum-mride.-— General Local Effects, — Locally applied it is
capable of producing irritation, rubefaction and even vesic cation of the
surface. Snuffed into the nostrils the powder is a strong errhine and
sternutatory ; it produces an acrid impression on the mouth and fauces
when chewed; when swallowed it causes uneasiness in the epigastrium,
then nausea and vomiting; the latter effect often persists long, is
attended with much retching, sometimes hiccough. Dr. Osgood says,
the vomiting in his case was affected by spasmodic affection of the
stomach itself, without help from the diaphragm or abdominal muscles ;
sensation of a ball rising to the throat, the result of spasmodic con-
traction of the tube ; nausea not severe, but the prostration very strik-
ing; vomiting occurs only three-fourths of an hour after taking it.
(Much longer than after Veratrum-album ;) it seldom if ever purges.

General Symptoms. — Doses insufficient to vomit cause epigastric
uneasiness ; sometimes chilliness ; diminution of the frequency of the
pulse ; sense of weakness in certain muscles, or want of due command

* Dr. Morgan, U. States Jour. Hom., vol. II., p. 500.

TREATMENT OF INTEEMITTENT FEYEE. 509

of them, through direct sedative influence upon the nerve-centres.
The pulse has been reduced by this agent as low as thirty-five per
minute without the least nausea or vomiting ; feeling of numbness, ting-
ling felt about the joints, previous to vomiting, during the process and
after it. The farmers of New England formerly soaked corn with it
and scattered it to poison the crows. After a short time the crows
that had eaten it became incapable of rapid motion or flight and were
readily caught. If left long undisturbed they recovered.

Effects on the CirGidation. — When carried far enough to cause
nausea and vomiting, the pulse falls from seventy-five or eighty to
thirty-five or forty, becomes more small and feeble, occasionally al-
most imperceptible ; surface pale, covered with cold sweat; sensation
of chilliness, or tingling or numbness ; headache ; vertigo ; dimness
of vision ; dilated pupils ; faintness, feeling as of stifihess of certain
muscles, want of command of them; prostration sometimes becomes
alarming ; though no fatal case is reported. These depressing effects
on the nervous system are accompanied with stimulation of the se-
cretory functions. Salivary, pulmonary, biliary, and urinary secretions
are increased, when nausea and vomiting are excited, and that of the skin
also during the continuance of the nausea. It does not appear to be
a specific against plastic inflammation, but against vascular irritation
and congestion.

Maerotin, — Macrotrys, Gimifuga, or Squaw-root, has ma.ny symptoms
in which it resembles Quinine, both being given in large doses. When
given freely it operates largely on the brain and nervous centres ; it
causes vertigo; dimness of vision; unpleasant feeling, even pain in
the head ; flushed face.

It has a decided and well-marked influence over the capillary system
of vessels, moderately increasing all the secretions, particularly those
of the skin, kidneys and bronchial mucous membrane.

It increases the amount of solids in the urine, without largely increas-
ing the quantity of water.

As a parturifacient it was in general use among the Indians ; it was
early employed in New England to accelerate the parturient process,
and for this it is recommended by Bigelow; it is now much used in
place of Ergot.

Dr. Tully says in many instances it produced abortion when it had
been prescribed for cough. All of the a,bove effects are commonly known
to result from Quinine.

In morbid heat and dryness of skin from irritative fever, it abates the
irritation and is followed by relaxation and gentle moisture, its action
in these cases corresponds well with Quinine, which in alternation with
Opium is regarded by many practitioners as the most certain diapho-
retic ever used.

510 DISEASES OF THE SANGUmOUS FUKOTION.

CONGESTIVE INTERMITTENT FEVER.
SINKING CHILL. — MALIGNANT INTERMITTENT.

The name Congestive Fever is usually employed, not under the idea
that congestion exists in this fever alone, but because the congestion,
though only a symptom, is such 2^ jprominent one in this form of fever,
that it constitutes its most striking feature.

By congestive fever is understood that form of autumnal disease in
which the vital force is depressed by the influence of the miasmatic
poison below the point of successful reaction. The heart, in conse-
quence of this depression of vital force^ is unable to give due circula-
tion to the blood, which consequently becomes congested in the internal
organs and large venous trunks. If the vital energies do not utterly
fail in the first paroxysm, they become still more depressed in each
succeeding one ; the venous congestion becomes greater and more
perilous, the struggles of the heart become fainter, till they cease al-
together in the second or third paroxysm. In some cases the patient
dies in the first paroxysm, without any fever supervening ; in others
the chill is followed by little or no febrile reaction, and this stage is
succeeded by a fatal cold stage.

Congestive Intermittent is not a new disease, specifically distinct
from ordinary intermittent, but a severe form of the same disease, oc-
curring in a patient whose general health is already greatly prostrated
and deranged. It is little more than the cold stage of an ordinary ague,
deepened and prolonged in consequence of constitutional exhaustion of
the vital powers from the effects of previous disease. Dr. Drake says :
<* The innervation is scathed, the circulation is enfeebled ; the blood,
largely withdrawn from the more external parts, circulates with diffi-
culty through the internal or visceral system, which is rendered ple-
thoric, and the great organs, as the stomach, spleen, liver, lungs, heart,
and brain, are, respectively liable to pernicious engorgements or ob-
structions greatly increasing the danger. A failure in the function of
respiration, in the co-operative action of the brain, and in the projectile
power of the heart, combine to diminish the aeration of the blood, which,
deteriorated in its constitution, contributes still further to sink the
powers of life. This condition of the respiratory function diminishes
the heat of the body, which is moreover reduced by the failure of the
calorific function of the skin, from the combined lesions of the nervous
and circulatory systems, while the ready transudation, which the re-
laxed integument permits, of the serous portion of the blood, and the
copious exhalation which takes place, accelerates the cooling. The
patient dies under the combined influence of depression of the vital
forces, and that consequential engorgement of. some important organ,

CONGESTIYE INTEEMITTENT EEYEE. 511

vvliicli lias procured for this fever the epithet congestive. Or, should
a partial reaction occur — should he survive two or three paroxysms to
expire in a fourth or fifth, as occasionally happens, a low infl.ammation
may be superadded to passive hyperaamia."

Symptoms.— The patient has the usual premonitions of ague, but
feels peculiarly languid, restless and feeble ; these warnings are per-
ceptible in most cases for a day or two. The disease then more clearly
announces itself with a chill ; the patient feels restless and much op-
pressed ; the skin is pale and shrivelled ; the extremities become very
cold ; features contracted ; lips purple ; tongue pointed and of a leaden
hue, or pale, cold and clammy ; pulse feeble, quick, frequent, irregular,
intermitting ; tendons corded ; occasional rigors, and sometimes shaking
chills, though the patient rarely complains of coldness. There is no
acute pain, but a dull, heavy aching in the head, back and limbs. There
is generally great thirst with nausea and vomiting. The skin continues
to grow colder and is bedewed with cold, unnatural perspiration ;. there
are indescribable restlessness, oppression and disposition to throw the
limbs about ; if the patient rises he is giddy, st,^ggerSj perhaps falls.
He feels oppressed with excessive heat, calls for ice, for cold water in
his face and breast, and while his skin is cold and wet, wishes to be
constantly fanned. A copious sweat suddenly breaks out, and as sudden-
ly disappears ; the skin becomes motley and bluish, its sensibility is
impaired, the impress of the fingers remains some seconds after pres-
sure is removed ; sometimes there is ecchymosis in dependent parts ;
respiration is irregular, with frequent sighing, great anxiety, the coun-
tenance haggard; eyes suffused; harassing hiccough. In some cases
there is a watery purging resembling Asiatic cholera, which sinks the
partient rapidly. He always complains of a distressing sense of sinh-
ing, incubus of the chest or feeling of suffocation ; he lies without
breathing for a minute, and then gasps for breath ; respires again in a
hurried manner, says he "will die for want of breath ;" rises and rushes
towards the window, staggers and throws himself on another bed or on
the floor ; the pulse which had been a mere flutter, now ceases at th^
wrist ; there is a moment of unusual anguish, then a gasp or two for
breath ; and the heart ceases to beat, the case terminating in death, six
or eight hours from the access, the sufferer retaining his senses to the
last. In other cases the patient lies unconsciously in a state of deep
comatose sleep for some hours before death.

In those cases in which reaction is excited by the free use of stimu-
lants, the fatal termination is delayed for some hours, at the end of
which the patient dies comatose. When a partial reaction takes place
from the natural efforts, the skin becomes warm, though the extremities
are still cold. The pulse is 150 per minute, and may fall, to 120.
There is some mitigation of the patient's distress ; he passes into a

512 DISEASES OF THE SANGtJIISrOUS FCTKCTIOIT.

iseries of uneasy, interrupted slumbers, until near twenty-four hours
from the first attack ; when another paroxysm comes on which only
terminates in fatal collapse.

Diagnosis and Pathology. — The seat of the congestion is indicated
by the severity of the symptoms pointing to the organ suffering most
. intensely. In many cases the sjpleen becomes engorged in a few hours
to such an extent as to be found double the natural size. The same is
partially true of the liver. Congestion of the lungs to some extent is
always present, and is generally a fatal complication. It is known by
great oppression, laborious breathing, heaving of the chest, sense of
suffocation, and rapidly sinking into fatal collapse. Congestion of the
Irain is the most alarming of all local congestions. It is marked by
deep coma ; low muttering delirium ; rolling of the head from side to
side, and drawing it backwards ; dilatation of the pupils, optical illu-
sions ; and raging delirium in the cases in which reaction is brought
about by stimulants.

Consequences of a Protracted Hot Stage in a Severe Case. — 1. A
subsidence of the general fever is not always accompanied by a return
of the congested viscera to a state approaching to health. It may
happen that some one or more of the organs " will remain in a state
of hyperaemia, and pass into inflammation. These are, generally the
viscera of the abdomen, chiefly the spleen, liver, and gastro-enteric
membrane.

" 2. Splenitis," (says Dr. Drake) " is so common an accident of our
autumnal fevers, especiall your inflammatory intermittents, as to suggest
that we can no where look for the true anatomical character of that
fever more successfully than in the spleen. Why it should be so great
a sufterer cannot, perhaps, be told, except that it becomes greatly en-
gorged in the forming stage of the fever.

" 8. Next to the spleen, or equally with it, the liver is liable to fall
into inflammation upon the accession of the hot stage ; but this is more
especially the case in the remittent type.

" 4. The mucous membrane of the stomach and duodenum, with that
of the common gall duct, are liable to pass into the same condition.

" Thus all the subdiaphragmatic viscera, except the pancreas, are
subject to inflammation in this fever. Sometimes, however, from
idiosyncracy, or the cooperative action of certain causes, inflammation
of the brain, or its envelops, may happen ; and when the fever makes
its attack late in autumn, the combined action of vicissitudes of tem-
perature and of the specific cause, developed at an earlier period, may
determine the inflammation upon the lungs or pleura. Wherever the
inflammation maybe seated, it complicates the case, and creates a new
kind of danger. Although it may abate with the subsidence of the
hot stage, it does not cease. The afiected organ shows signs of sufier-

CONGESTIYE INTERMITTENT FEVER. 513

ing durino; the apyrexia, which it renders imperfect. The succeeding
exacerbation may be prolonged by it, and an intermittent may thus be
converted into a remittent ; while the latter, not unfrequently, as al-
ready said, passes nearly into a continued type, from the same patho-
logical cause. But the most dreaded combination of* this kind, which
we meet with, is that in which an inflammation of an organ is associated
with such a depression of the general forces of the system, that but a
feeble reaction occurs. That this is a reality, both the symptoms and
post-mortem appearances have shown. Such inflammations are never
very acute. The organ is greatly engorged, .but the actions which
constitute inflammation are very feeble, and often more conspicuous than
the vestiges of true inflammation. Between these cases and mere con-
gestion of the organ, there is often but a shade of anatomical difi^erence."
{Dr, Drake^ Diseases of the Mississippi Valley,)

PuoaNosis. — Favorable Indications. — The successive exacerbations
of the fever become lighter and of shorter duration ; the external heat
and dryness of the skin diminish ; the pulse, which had been above
100 per minute (in an adult), throughout the remission, is reduced to
88 and then to 72, showing complete absence of the fever ; the gastric
distress, pain and tenderness of the epigastrium, the pain in the head
and back, are diminishing; the skin becomes soft and moist, the tongue
less coated, the countenance more cheerful, and sleep is quiet and re-
freshing for some hours; the remissions become longer and more dis-
tinct till complete intermission is followed by protracted convalescence.
Unfavorable progress of a severe case is manifested by the absence of
any of these evidences of amelioration ; and in their stead, there is pro-
gressive increase in the severity of the symptoms, which finally give
place to those above mentioned as marking the approach to a fatal
termination.

The remedies that have proved successful in the treatment of inter-
mittents in every form are such as act' primarily on the ganglionic sys-
tem of nerves. Dr. Hale observes " that they may produce a conges-
tion of some of the nervous centres and thus be capable of creating in
healthy subjects symptoms analogous to ague. This explanation of
their modus operandi would agree with Dr. Lord's theory, that inter-
mittents arise from a retardation of nerve-force in the ganglia,"^ The
remedies that have been used with success in congestive intermittents
are limited in number. It is only necessary here to refer to Gliina^
Arsenicum.^ Nux,^ Opium>, (See p. 486, 492, 497, 506.) The size of
the dose is the only difficulty. When the malarious poison is strong, and
the quantity taken by the patient is large, the dose of the remedy,
though a true antidote^ may require to be larger. And this is evidently

* Transac 111. Med. Associa. 1862. p. 49. See p. 478 this volume.
VOL.I.-33.

514 DISEASES OF THE SANGUINOUS FUNCTION.

true wben the selected remedy is only partially liomoeopatliic to the
ease. This subject is illustrated by the quantity of one narcotic
poison required to antidote a large quantity of another narcotic to
which it is only a partial siniilimum. We select a case showing the
effect of poisonous doses of Opium in counteracting the effect of a
poisonous dose of Aconite."^

A female patient in the Pennsylvania Hospital took by mistake a
dessert-spoonful of tincture of the root of Aconite. She immediately com-
plained of extreme prastration, and a peculiar feeling of numbness and
tingling over the whole surface of the skin. She was found, three-
fourths of ah hour afterward by Dr. Benton, " lying in a sort of stupor,
the pulse at the wrist imperceptible, countenance pallid, extremities
cold and the surface bathed in a cold perspiration." An active emetic
was given to evacuate the stomach. Then an ounce of brandy, with
forty minims of Laudanum were given, and repeated every fifteen
minutes, until five ounces of Brandy and about three drachms of Lau-
danum had been taken; when the pulse was found to have risen to sixty
beats per minute, though still extremely intermittent. The Brandy
and Laudanum were now given at intervals of half an hour, u.ntil, in
j;he course of four hours from the commencementj she had taken five
and a half drachms of Laudanum without any symptoms of narcotism.
The pulse had now risen to ninety per minute, and warmth had re-
turned to the extremities. The Brandy and Laudanum were then only
given at longer intervals ; next morning the pulse was eighty. The
patient recovered without any bad symptoms.

Miasm is a poison that acts by depressing the vital force ; but a given
amount of miasm will not produce the same degree of prostration in
all persons who are subject to its influence ; therefore the quantity of
a remedy only partially homoeopathic to the case "must be proportioned
to the susceptibility of the nervous centres to be acted upon, — the ap-
titude of the vital telegraph to convey the impression, — and the venous
and nervous congestion to be overcome."

But, if we admit on theoretic grounds that there may be conditions
in which massive doses of strong agents may be justifiably given, we
can not apologize for the immense doses of Sulphate of Quinine now
popularly given in the different forms of autumnal fever. When small
doses do not succeed and do it without bad results, the largest will fail,
or Avill at least produce injurious aggravations. If drug-symptoms are
excited by small doses it is evident that still worse results will follow
large ones. The following symptoms embrace the principle charac-
teristic symptoms of Quinine, w^hen given in too large doses in this
disease : a swelling pulse, tingling in the ears ; pushed farther, it pro-

* Med. and Surgical Reporter. Vol. VIII. p. 362.

CONGESTIVE INTERMITTENT FEYEE. 515

duces : painful fulness of the brain, alarming sounds, ringing in the
ears, deafness, slight delirium, twitching ,of the tendons and hiccough.
Frequently repeated, heroic doses exhaust the vital powers, cause in-
direct debility and thus hasten that collapse which it is supposed to be
capable of averting.

When taken in the unreasonable quantities of " twenty, forty, and
one hundred grains" its eifects are thus described : Its action on the
brain becomes apparent. " Strange sounds distract the ears. The
pa4ient may imagine himself in a thunder-storm, with lightnings flash-
ing in his closed eyes, and burning in his brain, and still be sinking all
the time. The remedy, failing to counteract the disease, has attacked
the vital organs, and is prostrating still further the vital force. A
grain of Morphine will not give a moment's rest. Diffusible stimuli
only add fuel to the flame that burns within. Eubefacients give no re-
lief though used till the skin is sore ; and the capillaries are injected
till the surface is purple. The patient rolls from side to side ; throws
his limbs in every direction, calls for ice or cold water, which is rejected
as soon as swallowed ; he asks to be fanned, and for water to be
thrown in his face."

The size of the dose, within reasonable limits, is less important than
the accuracy of the prescriber in selecting the proper remedy. The
true specific will cure in a minute dose ; and many practitioners re-
strict themselves to the high potencies in the minutest doses. These
doses are efficient in good hands.

Arseniciim. — Case by Dr. Pearson, Iowa.— A strong muscular man,
of previous good health, except chills and fever some months previous,
for w^hich he had taken large doses of Quinine. Has now great dis-
tress from severe cramp-like burning pain in the region of the cardiac
orifice of the stomach ; the extremities are cold ; the pulse quick, but
not full; restlessness; disposition to change his position every few
minutes ; frequent attacks of nausea and vomiting. He took of Ar-
senicum, thirtieth, four drops in four ounces of water, two tea-spoon-
fuls, at first, and repeated it in fifteen minutes. In twenty minutes he
was much better, and was entirely relieved in less than an hour. He
took no other medicine, and there was no succeeding paroxysm.

Of the efficacy of Arsenicum in lower potencies we have the most
ample proofs.

The complications of intermittents present us with the greatest dif-
ficulties in practice.

Intermittent complicated with catarrh of the stomach, N"ux-v., Ipec,
Puis., Natr,-mur., Sepia. Dr. Kapka reported, that "after the wars of
1850 and 1851, he treated a great many Austrian officers, who were
suffering from obstinate intermittents, with chronic catarrh of the
, Btomach, for which they had been maltreated with Quinine, tie cured

516 DISEASES 0¥ THE SATfTGUINOUS FUNCTION.

tliem with Nux and Ipecac, and afterwards small doses of Quinine,
first trituration, during the intermission. {Iteport Genn, Central"
Verein.)

When the catarrh involves the intestines — Cham., Ipecac, Phos.,
Puis., Verat., Arsen.

Catarrh involving the duodenum — Cham., Merc, China, Nux-vom.,
Sep., Sulph.

Anaemia following ague — China, Ferrum-cyan., Arsen., Calc, Puis.

Congestion and persistent turgescence of the spleen is a comn^on
attendant and consequence of intermittents. Besides its primary func-
tions as a component part of the chylopoetic system, the spleen forms
also a natural reservoir for the reception of extra portions of the blood
when suddenly repelled from the external surface, and driven in upon
interior organs ; in this manner it shields the vessels of remote parts
from sudden and excessive distention. It is therefore liable to morbid
turgescence upon any sudden disturbance of the body, as after an am-
putation of a leg or an arm ; but more frequently on the occurrence
of the cold stage of fever. This is more conspicuous in persons who
are already in a diseased state, and the spleen is inclined to atrophy,
induration or inflammation from previous successive chills.

Treatment. — The best treatment for chronic enlargement of the
spleen is that which permanently cures the ague with which it is con-
nected. The remedies known to be most efficient in restoring this
organ to its normal size and condition are : China and Natrum-muria-
ticum. We have seen abundant proofs of their power in this way. It
Is only necessary to continue them for a sufficient time in very small
doses. Bromide of Potassium is also a remedy.

Genus IV.— REMITTENT FEVER.
1. BILIOUS REMITTENT.

Bilious remittent fever prevails in all countries and localities where
paludal malaria is developed in the connection with a high degree of
atmospherical temperature.

Diagnosis.- — In general the reinissions of the fever between the
daily periods of high excitement are well marked, the patient feeling
much relieved ; in other cases the mitigation is but slight, and the
fever has almost a continued form. There are always irritability of
the stomach, a sense of oppression and distress at the epigastrium,
pain in the head, back and limbs ; and the prostration of strength pro-
gresses rapidly from the commencement of the disease.

The milder form of bilious remittent fever is generally preceded for
some days, by listlessness, languor, bitter taste in the mouth, nausea,
aversion from food ; indescribable uneasiness and sense of fulness about

BILIOUS EEMITTENT FEYER. 517

the epigastrium, torpor of the liver, constipation, heaviness of the head,
pain over the eyes. The first appearance of active disease is the com-,,
mencement of a slight chill or sense of coldness, which creeps up the
back ; it does not amount to coldness over the surface and extremities,
but is much more unpleasant than mere w^ant of heat. In the course
of a few minutes the coldness is succeeded by flashes of heat; and in
the course of one or two hours the whole surface becomes hot; "the
skin is dry and constricted, the face flushed and turgid, the eyes red
and suffused, the respiration hurried and uneven, the pulse quick and
frequent, but rarely tense ; there is great prostration of strength, with
considerable restlessness and watchfulness. The patient complains of
pain and a sense of fulness, weight, and tension of the head, pain of
the back and extremities, particularly of the calves of the legs ; — and
there is a sense of weight or oppression, and often of pain at the epi-
gastrium," which point is generally tender on pressure, even when no
pain is complained of. The stomach is more or less irritable ; in some
cases the nausea is distressing, in others everything swallowed is in-
stantly rejected. Vomiting is a common symptom from the commence-
ment, but oftener it begins about the third day or later; the matters
thrown up being yellow, greenish, or bright green. The tongue is at
first moist, red at the edges, with a whitish, light-brown, or yellowish
fur of considerable thickness on its upper surface, and there is con-
stant thirst. The bowels are constipated, the urine diminished in
quantity and high colored. After fever has lasted two or three days,
the skin becomes yellow, the adnata of the eyes showing it first. The
exacerbation lasts from eight to twelve hours, when there is abatement
of the symptoms. In milder cases the skin becomes moist and the
patient falls into a refreshing sleep ; in cases more severe the skin con-
tinues hot and dry, and the patient is .still restless and sleeps irregu-
larly. After some hours of comparative coirifort the patient finds the
fever again rising ; and this exacerbation progresses in intensity till it
reaches the same height, or exceeds that of the previous day.

Lifiammatory Fofm of Bilious Fever, — The symptoms are the
same as in the ordinary form of the fever, just described, but they all
appear in an aggravated degree. The paroxysm of fever is more
violent and continues longer ; the remission is shorter and less per-
ceptible. ■

Phenomena of the Hot Stage/^ — 1. The sensibilities, previously
blunted become morbidly acute ; pain occurs in parts not previously
affected, and in parts where dull pain was previously felt it now be-
comes acute.

2. The circulation is quickened, the heart acts with increased force,

* Dr. Francis Condie— Addenda to Watson's Lectures, p. 502.

518 DISEASES OF THE SANaumOUS FUNCTIOJST.

throwing the blood to the periphery, from which it rapidly returns
towards the centre.

3. The heat-producing function is first restored, and then it speedily
becomes excessive ; intolerance of external heat is augmented.

4. The liver, which had been torpid and inactive before the com
mencement of the attack (see page 400), becomes more active than in
health, producing generally a large flow of bile ; but the bilious hue
becomes deeper, "showing that the bile is again absorbed into the blood,
or its elements largely increased.

5. After the reaction has reached its height it gradually begins to
abate, though in severe cases the skin remains hot and dry for a few
hours ; the action of the heart and arteries gradually subside in force
and frequency, the skin becomes softer, and in the milder cases it
relaxes into more or less perspiration. If this relaxation continues for
many hours the case is considered a mild one. If it be but partial, of
short duration, if the pulse continues frequent, (one hundred beats per
minute in an adult), the pain in the head, though mitigated, continues
to be felt, the fever does not intermit^ but only remits^ showing the
case to be one of a more serious character than a regular intermittent.
In the height of the exacerbation the sMn is "intensely hot, the eyes
are suffused, of a muddy, yellowish hue and often dull and languid ;
there are intense pain and a sense of insupportable weight and tension
of the head ; aversion from light and sound is ordinarily present, and
occasionally delirium ; there are great thirst, and a feeling, often almost
insupportable, of oppression at the chest, the respiration being quick
and laborious, frequently regular ; the pains in the back and extremi-
ties are often of great severity ; the pulse is quick, frequent, and more
or less tense ; occasionally it exhibits some degree of irregularity ; the
nausea and vomiting is generally peculiarly distressing — the matter
discharged being a thick ropy fluid, of a yellow darkish brown, or green
color ; the bowels are costive, or if open, discharge with tenesmus and
griping, a thin watery fluid: "There is always an intolerable sense of
oppression or constriction at the epigastrium, accompanied by a degree
of tenderness which renders the slightest amount of pressure insup-
portable—-or a severe pain and burning, attended in many cases with
great nausea, and frequent ineffectual eflbrts to vomit." There is great
restlessness, agitation and watchfulness ; the skin becomes gradually
brownish, bronzed, or deeply yellow, which is more particularly marked
upon the breast ; there is also a constant hawking and spitting of small
quantities of a tough glairy mucus.

When inflammatory bilious fever is permitted to go on for a few days
uninfluenced by treatment, the powers of life begin to fail. The sur-
face gradually becomes cool, and covered partially or generally with ^
cold clammy sweat ; the pulse becomes smaller and weaker ; the tongue

BEMITTENT FEVEE. 519

is covered witli a dark thick coating, continuing dry and chapped to a
late stage ; the respiration short, quick, and difficult; the abdomen
sometimes remaining swollen and t^^-mpanitic ; but more frequently this
state is reduced by dark dysenteric evacuations, which become a
length more and more fluid ; finally they are frequent, and in
vohintary, while the patient sinks into a state of stupor, which onl^
terminates in death.

In remittent as in intermittent fever there is a periodical exacerba-
tion followed by a remission ; and the paroxysms, like those of ague,
though coming every day, are most violent on every second day. In
the milder cases the exacerbation comes on successively later, day by
day, as the disease recedes toward the intermittent type; in more
serious cases, instead of being postponed beyond the regular hour, the
paroxysm anticipates it, and the case assumes more and more the fea-
tures of continued or typhoid fever; the remissions, then, become less
and less observable, and the disease assumes that low form wdnch when
protracted beyond the second week is known in the West as malarial
typhoid fever.

2. Gastric Remittent Fever. — Cliamdmstic Symptoms, — "Bitter
taste in the mouth; great thirst, with craving for cool and acidulated
drinks ; frequent vomiting of a green or dark-brown fluid ; total loss of
appetite and disgust for every kind of food ; great weight and anxiety
at the prsecordia; pain and tenderness at the epigastrium; intense
pain of the loins and knees ; soreness of the calves of the legs ; severe
and constant pain of the forehead; tongue coated in the centre with a
thick layer of yellowish mucus, and red at the sides and tip; the re-
missions are distinctly marked; bowels costive, or when dischargea
take place, these are thin and watery, often attended with griping and
tenesmus ; in the course of protracted cases the stools, not unfrequently,
consist of a reddish fluid resembling the washing of meat." In a
later stage the "tongue becomes dry, cracked, and covered with a dark-
brown or blackish crust; upon the separation* of which, the tongue pre-
sents a smpoth, shining and red surface. In the advanced stage, there
is often retention of urine, difficulty of swallowing fluids, meteorism of
the abdomen;" and, in fatal cases, colliquative diarrhoea, exhaustion,
coma, and death. In most fevers of the lower Mississippi, we have,
first or last, irritation or subacute inflammation of the mucous mem-
brane. In some cases it begins with the attack, in others it is to be the
efiect of common medical treatment. When it exists it becomes the
source of the principal difficulty in the case. As inflammation becomes
established the tongue assumes a clean dry, or glabrous and red ap^
pearance. When there is some degree of inflammation in the perito-
neal coats of the abdomen and intestines at the onset as well as in the
advanced stages of all continued or remittent foverSj the sligbtast ten-

520 DISEASES OF THE SANGUINOUS FUNCTION.

deriiess over the peritoneum must warn us of these conditions. This
sub-acute intestinal inflammation in the progress of fevers is often in-
sidious in its approach. Pain or soreness is at first hardly perceptible.
Dr. Armstrong says in this "secondary inflammation, the sensibility of
the nervous system is mostly diminished before the occurrence of the
inflammation." If not checked, it rapidly progresses and speedily in- ^
volves the general nervous and arterial systems. It is often mistaken
for asthenic excitement, and every common remedial measure accele-
rates the catastrophe. The patient dies, says Dr. Monette, "under ex-
citement without local origin, and which we are unable to subdue."

When febrile irritable excitement continues more than a few days
without apparent equivalent cause, we suspect sub-acute intestinal in-
flammation. A doughy feeling of the abdomen on pressure will prove
it unequivocally, whether there is much pain or not. The treatment
must be the same as that of peritonitis.

Of the abuse of blisters and purgatives in these cases, Dr. Monette
says: "I have seen blisters applied to overcome irritation of the brain
and of the general system, which would have been speedily relieved by
a laxative, followed by an opiate in a little weak toddy. We often find
cases of fever prostrated by a free use of purgatives or other anti-
phlogistics, which have only acted as causes of debility and irritation."
These cases, he says, "require only rest, opiates and weak brandy-
toddy, which would sustain the circulation and calm the nervous irrita-
tion, while antiphlogistics would increase all the dangers. Calomel is
especially pernicious; but opiates in small quantities of the milder
preparations indispensable. .The prejudice against them only applies
to extreme doses and improper cases." {Monette^ Fevers of Missis^
sippL TT. Med. Jour,, Feb. 1840^ p. 125.)

Now these are the very cases in which we long ago found Opium an
efficient remedy, and it was successful, becaus'e it is homoeopathic to
the torpor of the secretions and the nervous and mental stupor which
form the chief characteristics of these cases.

Indications of the Tongue in Malarious Fever, — The tongue is
the great index by which the physician estimates the pathological con-
dition of the digestive organs, the whole mucous membrane, and to a
great extent of the entire system. The tongue and the pulse may al-
most be called "the two eyes of diagnosis." The following indications
of the tongue are the result of extensive observations.

1. A pale moist tongue, covered with mucus indicates great torpor
in the portal circulation, or in the coeliac; a languid circulation and
functional torpor in the viscera of the coeliac circle, especially the sto-
mach and liver, sometimes torpor of the brain also, with deficient men-
tal energy. In any stage of fever in which this condition is seen,
stimulants are borne without injury. If the tongue begins to

EEMITTENT FEVER. 521

show red edges, or become red and dry on its surface, whether rougher
or smoother, all stimulants must be discontinued, and no drinks, but
demulcents, diluents and mucilages can be allowed. The redness
shows change from torpor to increased action and sensibility. In this
condition irritant purgatives. Calomel and all carminative substances
often given with it, are peculiarly injurious.

2. White tongue J or of a natural healthy color, but covered over
with white fur, like white powder sprinkled over it, shows less visceral
torpor and some irritation of the mucous membrane of the stomach ;
but the free exhibition of stimulants i§ certain to do great injury.
Calomel in small doses, repeated, increases the irritation which tends
to the development of inflammation and typhoid fever.

8. Bed tongue^ moist and raw, denotes extreme irritation of the mu-
cous membrane of the stomach, almost reaching sub-acute inflammation,
but without congestion of the viscera. When the other coats of the sto-
mach are inflamed the tongue becomes dry and red, more intensely so at
the edges. In this condition of the tongue, no matter what the general
symptoms may be, no stimulating drinks or food can be borne. The
inflammation which already exists will certainly become rapidly and
fatally worse, if any alcoholic drinks, meats, richly seasoned food of
any kind or spices or carminatives are allowed. Calomel in this state
is still more injurious than in the last mentioned, and Quinine never
fails to aggravate what appeared before as a remittent fever, exerting a
most deleterious influence, and rendering the case far less manageable
by proper treatment. (Monette)

4. I)ry^ red chapped tongue, — This shows inflammation of phleg-
masia! character, afiecting all the coats of the stomach or intestines
or both. The treatment can only be that which is proper in acute
gastritis, which see.

5. Red^ d^y and smooth or glalrous Tongue, — This indicates a
condition similar to the last, but more especially inflammation of the
mucous membrane, differing probably in degree. The treatment is the
same.

6. Brown Tongue^ moist and covered with thicTc Irown fur, —
This shows a high degree of irritation in the lower bowels, with rather
defective action of the stomach. Here irritation has often been trans-
ferred from the stomach and small intestines ; or the lower bowels are
loaded with sordes accumulated during a stage of torpor of the secret-
ing organs which formed the first stage of the fever. The treatment
must be the same as proper in colitis, as given under that head.

Causes. — These are the same as the causes of intermittent fever.
It is common for unacclimated persons to be attacked with remittent
fever; and after some days to find it changed, naturally or by the in-
fluence of treatment, into regular intermittent. After residing for years

522 DISEASES OF THE SAITGUINOUS FUNCTIOl^.

in a malarious region persons wlio have often suffered from ague are
still liable to occasional attacks of it, on encountering too much fatigue
or sudden exposure. But unacciimated persons would have remittent
fever from less severe causes; and all of both classes might be subject
to either form of malarious fever in seasons more than ordinarily sickly J
but strangers would be likely to be more violently affected.

Teeatment of Bilious Remittent and Gastric Fevers. — The fol-
lowing remedies will be successful in the different forms of remittent
fever; for a given case it will be necessary to select a single remedy
at a time according as the symptoms may be found to correspond. See
the symptoms as given at the page referred to from each of the follow-
ing remedies :

When the gastric symptoms are predominant: Ipecac, Nux-vomica,
Puis., Bry., Cham., Lobelia, Eupatorium, Veratr.-alb., Tart.-emetic.

When the bilious symptoms predominate : Aeon., Bry., Cham., Nux-
vom., Puis., Arsen., Coloc, Ipec, Sulph,

When there is evident irritation of the mucous membrane of the
stomach and bowels : Bell., Chin., Mercur., Puis., Rhus-tox., Arsenicum,
Cham., Cina, DiJc, Nux-vomica.

When the symptoms denote the existence of worms : Cina, Cinnabar,
Spigelia, Aeon., Sulphur.

2. NON-MALARIOUS CONGESTIVE FEVER.

Diagnosis.— -The precursory stage of congestive fever is char-
acterized by restlessness, irritability, indisposition to mental or bodily
exertion, fatigue from the slightest exercise, vertigo, giddiness, appre-
hension, pulse often below the natural standard. This stage continues
from a few hours to six or seven days, when the second stage develops
itself.

The symptoms will now be modified in accordance with the organ
which sustains the violence of the attack. If the brain be the suffer-
ing structure, the patient will complain of headache, oppression or
tightness in the head, pupils contracted or dilated, the ideas confused,
the pulse slow and laboring, and finally, coma, paralysis, and convul-
sions may supervene.

When the bowels are the seat of the congestion, we shall observe an
anxious and distressed expression of countenance, eyes sunken and
glazed, more or less nausea and vomiting, bowels burning hot, and
tender on pressure, while the extremities are cold; tongue slightly
coated with a whitish or reddish fur ; uneasiness, with constant desire
to change position ; frequent sighing ; bowels constipated or relaxed ;
and, finally, spasms and stupor, with stertorous breathing.

If the disease concentrates in the lungs, there will be rapid, laborious

NON-MALARIOUS CONaESTIYE FEYEE. 523

and obstructed respiration ; pulse irregular or intermitting ; cough ;
face and skin purple from imperfect decarbonization of the blood; sur-
face cold, and pains in the chest.

In all of these varieties of congestion, the physical and mental ener-
gies of the system are below the natural standard, the pulse is gene-
rally unusually slow and feeble, the function of the lungs is imperfectly
executed, th§^e is an unequal distribution of heat, and diminution of
sensibility throughout the body.

Causes. — Excessive cold, atmospheric changes, drinking large quan-
tities of cold water when the body is heated, insufficient clothing, im-
proper food, severe mental or physical exertion, sudden news, grief,
fear, depression, disappointment, mortification, &c.

Treatment. — The remedies which have been used with most success
in congestive fever, are, for the cerebral form, BelL^ Ago7i., Opium^
Stram., Ilyoscyamiis^ Conium-maG,^ Ooffea,^ Mosch, and Cam;pKor,

For the abdominal form, Ipecao.^ Yeratr., Arsen,, JVtox, Cuprum^
Mereur.^ Phos.^ Carbo-veg.^ Secdle-Gor,^ Hhiis^ Bry», Ars,

For the pulmonary form, Bryon.^ Aeon,, jPhos., ZaGhesis, Senega,
JRhuS'tox., TarL-emet., Hyos., Ammonium-Garb,

Administration.— -Congestive fevers often attack the organism sud-
denly and violently, and if not promptly arrested, run on to a speedy
and fatal termination. In severe cases, therefore, as soon as the remedy
has been selected which is homoeopathic to the malady, it should be
repeated at short intervals until a decided impression is made upon the
symptoms. After a reasonable time, if no effects are apparent, give a
still stronger dose or repeat the medicine.

Let it be remembered, in all violent maladies, that our object is, to
produce a specific effect upon the diseased structure as soon as pos-
sible, in order that we may supersede the morbid by a healthy medi-
cinal action. We need have no fear in this fever of creating too great
a medicinal aggravation, for there is a low grade of erethism and im-
pressibility of the whole organism, and we can readily apply an antidote
to any over-action which may be excited, and thus control its influence,
while, if we permit the natural affection to make progress from a too
timid and sparing exhibition of remedies, disorganization will be likely
to ensue.

In this form of fever, we generally employ the first, second, and third
attenuations, — the dilutions in drop, and the triturations in grain
doses.

3. IRRITATIVE FEVER.

Under this title are embraced all those cases of idiopathic fever
which arise from causes of irritation that have nothing specific or pe-
culiar in their mode of action. The cause may be trifling and may only

524 DISEASES OF THE SANGUINOUS FUNCTIOK.

induce an over-excitement of one or more of the functions. This ex-
citement may be propagated, by nervous communication or otherwise,
to different parts of the system, and throw all the functions into a state
of derangement which will be capable of sustaining itself for a longer
or shorter time after the direct cause of excitement shall have ceased
to operate. The fever does not depend, like the phlegmasise upon
the continuance of any local disease ; but, having been on^ce excited, it
it goes on by independent action to its na,tural termination. ( Wood.)
This termination may be reached in a very few hours, or may be post-
poned for several days ; but when the disease runs on beyond the
fourth or fifth day, it is generally attended by local inflammation,
which will be most frequently found in the stomach and intestines.

For the Irritative Fever excited by Dentition, see page 227.

The treatment of Irritative Fever may be generally restricted to the
removal of the exciting causes. The remedies ordinarily needed will
be found at pages 228 and 625.

4. INFANTILE EEMITTENT.

This is. a disease peculiar to childhood and is usually caused by the
use of unhealthy and indigestible food, the irritation of teething, worms,
repelled eruptions, sudden drying up of ulcers, discharges, &c. The
affection is characterized by prominent disorder of the stomach and in-
testines, in most instances, but occasionally the brain or lungs seem to
be chiefly affected. In all cases, however, whichever part the disease
may seize upon, there occur regular remissions and exacerhations.

Diagnosis,— The malady under consideration makes its appearance
with the premonitory symptoms of ordinary fever, as slight chills, rest-
lessness, thirst, and wandering pains in the back, bowels and limbs.
When the hot stage is fully developed, the patient refers most of his
sufferings to the stomach and intestines ; they become painful, tender
upon pressure, and there is either obstinate constipation or diarrhoea.
The evacuations are usually darkish, offensive, and indicative of a de-
ficiency of bile. When the disease js concentrated in the stomach,
there is burning thirst with vomiting of liquids as soon as swallowed;
the tongue is usually covered with a moist, whitish fur, and red at the
edges. If the inflammation be not promptly arrested, but is permitted
to progress without the aid of appropriate remedies, lesions will occur
in the digestive tube, or disorder of the brain or lungs will be likely to
supervene.

6fet^5e5.— Undue exposure to cold, sudden change of temperature,
improper food, worms, teething, repelled eruptions, abrupt suppression
of accustomed evacuations, and the injudicious use of irritating medi-
cines.

INFANTILE REMITTENT. 525

Treatment.—- The remedies suitable for tlie treatment of this affec-
tion are in the first stage the higher dilutions of Aconite^ followed by
those medicines which accord with the peculiar symptoms of each case.
As soon as the fever has been sufficiently subdued by the former
medicine, some of the following articles may be resorted to with ad-
vantage ; TpeGaciianha^ Gina^ Ohamomilla, Merourius^ Belladonna^
AT8eniGU7n>^ Pulsatilla^ Nux-vomicaj Spigelia, Sulphur.

Since in most instances the gastro-intestinal mucous membrane is the
seat of the malady, it will be necessary to make a free use of Tpeca-
ctcanha^MerG., Piilsatilla^ Wux^ Cham.^ Calcamara, Should the brain
or lungs become involved, Belladonna^ Bryonia^ Nux^ Opium and
Stramonium will prove efficient remedies.

Dr. Dry s dale has found this fever, as it occurs in England, exceed-
ingly intractable, notwithstanding the most assiduous care and atten-
tion on the part of both physician and friends. In children of scro-
fulous constitutions, it has been known to persist for months, in spite
of every remedial measure. In cases of this description, he advises
Sxdphur^ Calcarea^ Arsenicum and Silioea,

In highly impressible and irritable children, we have often witnessed
an almost constant tendency to febrile attacks during dentition. The
alimentary canal, the brain and the nervous system, appear, to remain
in such a condition of erethism, that the slightest exciting causes, as
errors in diet, worms^ suddenly checked perspiration, &c., serve to de-
velop the affection. In instances of this kind. Aconite^ Belladonna
and Gham^omilla are peculiarly appropriate remedies, and will gene-
rally enable us to subdue permanently this morbid excitability. These
remedies should be given in drop doses of the twelfth to the sixteenth
dilution, once in twelve hours, until every sign of undue irritability has
disappeared. Hartmann commends a few doses of Goffea-cruda, or of
GalGarea-Ga/rbonica^ when this erethism is obstinate, and has con-
tinued for a long time.

If the febrile attack has already made considerable progress, with
excessive irritability of the stomach, and immediate ejection of every
thing which enters it, however simple; distention, pain, and tenderness
of the stomach and bowels upon pressure ; hot and dry skin ; burning
thirst; tongue covered with a whitish fur, and red at the edges ; great
restlessness and irritability ; loathing of food ; dark, yellow, slimy, or
green diarrhoea, we may give a grain of the third trituration oi Ipeoa-
Guanha, or a drop of the sixth dilution of Ghamomilla^ once in two
hours, as long as is deemed necessary.

If the disease is still farther advanced, and the countenance has as-
sumed a pale, or dingy sunken and cadaverous aspect ; dark and puffy
appearance under the eyes ; coldness and dryness of the skin, or cold
clammy sweat ; burning pain in the stomach and intestines ; thirst ;

526 DISEASES. OF THE SANGUmOUS FUNCTION.

Constant nausea ; tlie smallest quantity of food or drink, increasing the
burning and distress, until they are rejected; watery diarrhoea, with
smarting and tenesmus ; great prostration ; frightful dreams ; anguish
m\A uneasiness, especially at night; dark, dry and trembling tongue;
black and dry lips ; grinding of the teeth, we should emiploj Arsenicum,
at the twelfth dilution — a drop in a tea-spoonful of water every two
hours, until the requisite effect is produced.

When in addition to the symptoms enumerated above, the child is
exceedingly restless and sensitive to light, or the slightest noise ; with
flushed cheeks ; red, glistening and protruded eyes ; hot head ; constant
raising of the hands to the head ; rolling of the head from side to side;
sudden starts from sleep, with screams; spasmodic twitches in different
parts ; dilatated or contracted pupils ; short and oppressed respiration,
we should administer Belladonna at the twelfth dilution — a drop in
water, every two hours, until a decided impression is evident.

When the fever is accompanied by obstinate constipation, frequent
desire to urinate; burning heat of the whole body; morning exacer-
bations ; rigidity of the limbs ; or drawing, contractive sensations
through the body ; occasional spasms ; frequent trembling both when
sleeping and after an exertion; shudderings and chills from the least
contact of 'cold air; great sensitiveness of the whole body; unpleasant
symptoms often excited by motion of contact ; and indications of gastric
or bilious disorder, we may employ JVux-vomica, Sit the twelfth dilution
•—a drop in water, every two, three or four hours, as circumstances re-
quire.

When the malady has been caused by the irritation of worms, it will
be necessary to use Ginay or Spigelia, These medicines may be em-
ployed at the third attenuation, and a dose given three times daily un-
til, the morbid disposition of the alimentary canal is corrected.

Bryonia is applicable in cases attended with disorder of the pul-
monary tissues. In addition to biliary and gastric derangement, there
should be dry racking cough ; stitches in thei^chest and sides ; painful,
anxious, and hurried respiration; bruised pains, and soreness in the
limbs ; pains aggravated by motion or contact; hot skin; thirst; alter-
nating heat and chills; nightly delirium; irritable and quarrelsome.
This remedy may be used at- the sixth dilution — a drop once in two to
four hours.

Diilc-amara is the specific when the fever can be traced to exposure
to wet and cold which has caused a sudden check to the perspiration.
In these casea the force of the disease is expended upon the mucous
membranes of the digestive and respiratory organs, as is indicated by
watery diarrhoea., pains in the stomach and bowels, oppression at the
chest, dry coryza, cough and difficult respiration. Its administration
is \}ii% same as Bryonia,

SPOTTED FEVEE. 527

IF the attack is attributable to abuse of fat, crude and indigestible
food, and is accompanied with prominent gastric derangement, Pulsa^
iilla sliould be employed at the sixth dilution— a drop every four hours
until the disturbance is corrected.

5. CEKEBRO-SPINAL MENINGITIS.-SPOTTED FEVER.

An epidemic known by the above names is prevailing at this time in
some portions of the United States and is regarded as the same disease
as was so extensively fatal in the years 1812 — 14, and again in Vir-
ginia in 1822. In more recent times, it appeared in Michigan during
the winter of 1848 — 1849, and caused a large number of deaths in
various places in that state. It was generally regarded as a typhoid
congestive fever, and was treated with exciting stimulants on the sur-
fice, and muriatod Tincture of Iron and Cantharides Tincture internally,
aided by concentrated food of a stimulating nutritious character. Es-
sence of beef and egg-nogg were favorite articles.

The present epidemic presents the same general features as it has
appeared in different parts of the country. It has hitherto generally
baffled the efforts of physicians, and proved fatal in a few hours.

Symptoms. — It commences with a. chill, which had not been antici-
pated by any premonitory symptoms. The patient .thinks he has the
ague, and expects the cold stage to be followed by the usual degree
of fever. Instead, however, of the common reaction and development
of heat on the surface the chilly condition and the shrunken appear-
ance of the skin and features continue for a long time ; and the patient
gradually sinks into a state of stupor from which he rarely revives.
In the course of a few hours the muscles are observed to be rigid;
the pupils of the eyes become insensible either to light or touch ; the
surface of the body becomes extremely sensitive to the touch ; the
head is drawn back, the jaws fixed ; the breath is drawn forcibly, with
a hissing sound, as if by great effort through the closed teeth ; the
patient is blin^S and deaf. In children, the stupor is liable to be
broken by frequent convulsions. As the disease progresses the stupor
increases ; large dark spots rise upon the skin, some of them proceed-
ing to form blisters. In some cases the patient lingers for some days,
during which all the nerves of sensation, and those of motion belonging
to the lower extremities, are paralyzed, and he is both deaf and blind.
In some cases there is a partial revival from the stupor, and apparent
convalescence begins ; but in only an *hour or two a fearful delirium
follows ; the stupor becomes gradually more profound than ever, and
death speedily ensues. In the few cases in which recovery takes place,
it is only after a protracted course of typhoid fever; and paralysis,
loss of sight, or of hearing is generally permanent, if not remedied.

Case. — A boy, aged fifteen, was suddenly attacked by a chill in the

628 DISEASES OE THE SANGUWOUS EUNCTIOK.

forepart of the day, and having the. usual symptoms of a common form
of ague, excited little attention ; as several hours passed without re-
action, the family became alarmed, and a physician was called, who ar-
rived about 11, p. M. The boy was then lying in a state of partial
stupor, from which he could be easily aroused to answer questions ;
there was hurried breathing ; flushed face ; pulse imperceptible ; hands
quite cold ; head slightly thrown back ; muscles of the neck some-
what rigid; pupils dilated; limbs and body covered with large spots,
some of which were red and others purple or black ; a few of the black
spots elevated and resembling blisters. No reaction could be excited
by the strong stimulants used, and the boy died in a short time ; the
face after death turned quite black.

In the same manner it is common for death to result upon the full
development of the cold stage, no reaction following, except when
brought about by stimulants. The characteristic symptom is the ap-
pearance of spots on the skin which give the popular name of "spotted
fever." If the patient lives through the first stage of prostration,
fever succeeds, which is of a strongly-marked typhoid character; there
is then hurried breathing; pain in the back and head ; flushed face of
a dark, red, or purplish hue ; tongue dry and brown or black; stupor
and delirium ; in nearly all cases there is evident disease of the spine.

Causes. — Cerebro-spinal meningitis is not a contagious disease, but
depends remotely on a peculiar epidemic influence not yet understood.
In the localities in which it has prevailed, it evidently has manifested
its power in places where the common autumnal intermittents and re-
mittents have already debilitated the constitution in most of the in-
habitants ; and then it selects from them such as are in a peculiar
state of predisposition to be attacked by violent disease from any
common cause. Such are the persons who, in other seasons in the
same' localities, are liable at almost any time to be suddenly over-
whelmed by a congestive chill from which there may be no recovery
or return of consciousness.

Pathology. — The pathological features of this disease can not be
distinguished from those of congestive intermittent. There is the same
adynamic condition of the patient previous to the attack, and the same
organs are involved in the congestion. In cerebro-spinal meningitis
there is generally a more complete concentration of the morbific in-
fluence on the brain and spinal column; and in the cases that live
through the first stage these structures are the seat of inflammation,
which becomes permanent instead of giving place to a new cold
stage.

Treatment. — This must be conducted on the same general principles
as we are governed by in congestive intermittent. During, the parox-

IDIOPATHIC TYPHOID. 529

ysm the reaction -will be brouglit about by the same measures as are
employed to remove a congestive chill.

General Remedies. — The following remedies have been used with
success : Aconite, Bell., Arsenicum, Nux-vomica, Cantharides, Opium
China, Bryonia.

Brandy.—-'FoT the purpose of supporting the vital powers, and pre
venting threatening collapse, or for arousing the system from that state,
it is a universal practice to give Brandy ; and this is generally done
without much regard to the quantity that may be required. In general,
small doses may be safely tried and the effect observed. When it is
truly indicated, its homoeopathicity to the case is evidenced by its
soothing and restoring influence ; and it is observed to quiet the irritated
stomach, calm the excited brain, and render the pulse stronger and
slower. It acts unfavorably when it causes nausea, pain in the stomach,
headache or symptoms of intoxication.

Malignant Double Tertian of the Mississij)j)i, — A severe parox-
ysm of chill at ten in the morning and a light one at four, p. m. on the
following day. Some patients die in the first cold stage, sinking imme-
diately into fatal collapse ; and few survive the third chill without very
active treatment has preceded it. In many cases the stomach and
bowels take on a choleric action. Some after one or two convulsions
sink into profound coma, and in these cases, where there is a show of re-
action, it is feeble, irregular and terminates in icy coldness of the skin ,
the tongue moist, very pale and cleaa, or covered with a blue moist
fur ; little thirst. For Treatment see Congestive Intermittent,

This "sinking chill" has been mistaken for Armstrong's congestive
typhus, but they are antipodes in pathological condition. {Dr, Hogg^
Fevers of Natchez, 1Q2>% kQ)

6. Idiojpccthio Typhoid Fever of the South- Western States,
DiKGiso^iB,— Typhoid Fever, [ Typhus,

More insidious in its approach

than typhus.

Color of the eruption is different.

Diarrhoea and intestinal haemor-
rhage are common attendants.

Expression of countenance that
of intense anxiety.

Complexion clear, flush of bright
pink.

Treatment. — In the initiatory stage. Dr. Kellogg succeeded with a
few doses of Bryonia in the morning and Nux- vomica at night.

Vol. I— 34

Often seen at New-Orleans in
the winter-months.

Initiatory stage more brief. The
patient yields immediately to pros-
tration. •

Never present in typhus.

Expression stolid, apathetic.,
amounting almost to idiocy.

Complexion thick, and flush of
a dark, dusky red color.

630 DISEASES OE THE SAITGUTNOUS FTJNCTIOK.

Second Stage. — Arsenicum and Rhus-tox. the chief remedies. These
remedies with Belladonna, Bryonia, and China were always successful,
with no other aids than occasional sponging with cold water.

Bilious Typhoid Feeder. — PhosphoriG-aGid, — ^Dr, Pearson, of Mt,
Pleasant, Iowa, gives a case : A young man, aged nineteen, having
been sick ten days and abandoned by his physician as incurable.

Symptoms :- — wild, muttering delirium, talking incoherently ; in-
ability to articulate distinctly, or to protrude his tongue, which was
dry, covered with a dark fur, and tremulous ; pulse weak, one hundred
and fifty per minute ; extremities cold ; diarrhoeic stools, which were
passed involuntarily.

Phosphoric-acid, 12*^, four drops in four ounces of water, two tea-
spoonfuls every two hours. In twelve hours • improving ; pulse one
hundred and twenty, bowels better. There was then gradual improve-
ment, so that in forty-eight hours consciousness was restored and the
diarrhoea had entirely ceased. Recovered in less than three weeks.
Took only Phosphoric-acid, 12^, Bryonia, 12°, and Rhus-toxicodendron,
12^.

A similar case which was regarded as an extreme one, was treated
in the same manner. A girl, aged thirteen years, thoroughly drugged
by two physicians, under whose care a sister had died, presented all
the symptoms of typhus in the worst form : unconsciousness, involuntary
diarrhoea ; pulse weak, and one hundred and fifty per minute. This
case was cured by the above remedies at the thirtieth attenuation.
An obstinate cough, threatening consumption, remaining after recovery
from the fever, required Sulphur and Iodine, 200°, in alternation every
four hours. Four months after the last visit it was "impossible to re-
cognize in the healthy looking girl, the slightest resemblance to the
emaciated patient previously treated." Dr. Pearson says : ^'Phogphorio-
acid is the only medicine I have ever found capable of making a speedy
impression on the pulse in this disease; and whoever prescribes it be-
low the 12th°, and continues to repeat it often, will run the risk of
losing his patient. These conclusions cannot well be called hasty,
since years of experience have amply confirmed them.'' Some diseases,
both acute and chronic, appear to require for their successful treat-
ment medicines as high at least as the twelfth attenuation. Among
the former are some cases of typhoid, typhus, and lung fevers.

Genus V. — ENECIA

CONTINUED EEVER.

In this division of fevers may be included those arising from func-
tional derangement^ from inflainmation,, from congestion^ typhus^ &c.

CONTIlirTJED FEYER. 531

1. FEVER FROM FUNCTIONAL DERANGIEMENT.

DiAaNOSis. — ^This is generally the mildest and least dangerous of all
tlie continued fevers. It commences with slight chills, alternating
with flushes of heat, lassitude, restless, nights, wandering pains in the
head, back, and limbs, which are soon succeeded by increased action
of the heart and arteries, dry and hot skin, thirst, furred tongue, scanty
and high-colored urine, and moderate derangement of almost every
function. If the malady is met at the onset with suitable remedies,
its progress is cut short, and immediate convalescence ensues; but if
it be allowed to continue unopposed, although it occasionally subsides
spontaneously, it generally terminates in one or the other forms of con-
tinued fever.

Causes. — Overloading the stomach with fat, crude, and indigestible
food, insufficient clothing, irregular habits, dwelling in damp and ill-
ventilated houses, and the habitual and intemperate use of coffee, tea,
and tobacco.

Treatment. — ^Aconite, from the first to the third dilution, if ad-
ministered early, is sufficient to cure most cases of this form of fever ;
but if the disorder is neglected until inflammation or congestion oc-
curs in some structure, then those medicines which operate specifically
upon the parts affected, are to be employed, selecting those, of course,
the pathogenetic symptoms of which cover the most perfectly those
of the malady.

2. FEVER FROM inflammation. (SYNOCHA.)

Diagnosis. — In this form of fever the general symptoms, as hot and
dry skin, rapid and full pulse, dyspnoea, thirst, nausea, oppression at
the epigastrium, restlessness, furred and dry tongue, are present ; but
the symptoms which more particularly characterize the disease, are
determined by the organ which is prominently affected.

When the inflammation is located in the membranes of the brain,
the face becomes flushed, the eyes red and sparkling or protruded,
staring, and distorted, the carotids throb violently, pupils contracted
or dilated, expression unnatural, furious delirium, pulse full, rapid, and
finally, if the disorder progresses, sopor, muttering delirium, subsultus
tendinum, and convulsions.

If the disease attacks the lungs, we shall have rapid, anxious and
oppressed respiration, shooting pains in the thorax, troublesome cough
with difficult expectoration, pain and soreness during inspiration, and
perhaps other symptoms pertaining to inflammation of the pulmonic
structures.

If the gnstro-intestinal membrane be aflected, we shall have the signs

532 DISEASE OF THE SANGUINOUS EUKCTION'.

peculiar to inflammation of this tissue, as nausea and vomiting, paina
in the bowels, increased on pressure, tongue red, countenance expres-
sive of anguish, thirst, bowels hot and swollen.

Causes.— Atmospheric vicissitudes, extremes of cold or heat, errors
in diet, and over-exertion. Inflammatory fever often succeeds neglected
or mismanaged fevers from functional derangement, especially in cases
where some organ has been previously debilitated, and in this manner
rendered susceptible to inflammatory action. Indeed, it is probable
that inflammations seldom occur in parts which are perfectly healthy
and vigorous, but that when the exciting causes of fever operate in
these cases, they merely give rise to slight and easily remedied func-
tional derangements. Whenever, therefore, any structure of the or-
ganism is in a state of unnatural irritation or debility, this constitutes
a powerful predisposing cause of inflammatory fever, which only re-
quires some farther morbific influence to ensure its full development.

Treatment. — As in this form of fever there is an exaltation of most
of the functions, and particularly of the circulatory vessels. Aconite
is an indispensable remedy, always in the onset and frequently during
the course of the malady.

This remedy, as all are aware, exerts a peculiar power over the ac-
tion of the heart and arteries, and is, therefore, particularly appro-
priate in those cases distinguished from the first by full and rapid
pulse, hot and dry skin, thirst, &c.

In those instances where cerebral disorder predominates, Bella-
donna^ Ojpium^ and Stramonium will be found essential in the treat-
ment, either alone, or in alternation with Aconite,

If the pulmonary tissues are inflamed, suitable remedies may be found
in Bryonia^ Tartar-emetic^ Ipecacuanha^ and Phosphorus,

For gastro-enteritic inflammation, recourse must be had to one or
more of the following medicines, viz. : Merc.^ JVux,, Ipecac^ Pulsa-
tilla^ Dulcamara^ Chamomilla^ Arsenicum^ and Veratrum.

Administeation-. — In the selection of remedies much depends upon
the age, sex, temperament, as well as the peculiarities of each parti-
cular case. For children and adults who are very impressible, we ad-
vise the higher potencies ; while in cases of vigorous and unsusceptible
persons, the very lowest attenuations will prove most efficient.

In regard to the repetition of doses^ no definite rules can be pre-
scribed beforehand ; every thing must of necessity depend upon the
nature and violence of the disease, and the eflect which each particular
dose produces.

Gelseminum,—FeYeT resulting from atmospheric changes ; or follow-
ing sudden check of perspiration.

Symptoms. — General irritability, confusion of head and flying pains;
soreness of the throat ; irritation of the nasal passages ; heat of facC;

INFLAMMATORY FEVER. 533

with injected conjunctiva; painful cougli; cerebral headaclie, witli a
full, crowded sensation, worse in forehead and temple ; pain in back and
limbs ; resembling lumbago ; soreness of muscles ; chills, increased by
movement; skin dry and hot to the feel ; restlessness ; pulse accelerat-
ed, full and bounding; thirst and sleepnessness. A drenching per-
spiration often follows a dose of the third or tw^elfth attenuation, with
long continued sleep ; and the patient arouses, relieved of all his suffer-
ings, except a feeling of prostration. Appetite deficient.

Mercury in Inflammatory Fever. — Mercurial fever is described by
Dieterich as a form of fever " which comes on a few days after the use
of large doses of Mercury, characterized by great restlessness, dryness
of the mouth, headache, loss of appetite, nausea, hot and dry skin, quick
pulse, red gums, and swollen tongue ; it usually terminates in a critical
discharge (as profuse salivation, purging or sweating). [Pereira, Mat
Med.Yol,!, p. 815) states that, during salivation by Mercury, the
blood, when d?:awn from a vein, puts on the same appearances as it
does in inflammatory diseases. Druitt thus describes mercurial fever :
" Increased heat; preternaturally frequent, hard and vibratory pulse ;
pain and aching in the head, back and limbs, with a sense of lassitude
and weakness ; general deficiency of the secretions ; dry and white
tongue ; thirst, nausea and loss of appetite ; the blood generally buffed
and cupped." [Surgeon^ s Vade Mecum. p. 5, Druitt) " As the fever
declines, if a favorable termination occur, the system not uncommonly
relieves itself by a critical evacuation;— from the skin, by abundant
acid perspiration; from the kidneys by the free deposition of lithates
in the urine." [Erichsen^ Science and AH of Surgery, f. 18.) " The
preparations of Mercury act as direct antiphlogistic agents, lessening
the quantity of fibrin in the blood, and equalizing the circulation."
[ihid, p. 17.) Dr. Pereira says.. Mercury is used "in inflammation
most successfully, and this mineral is hence named an antiphlogistic ;
but its curative power is not satisfactorily accounted for by the equali-
zation of the circulation, the augmentation of the secretionSj or the in-
creased activity of the absorbents." {Mat, Med. Vol. I. p. 826.)'

Typhoid and Typhus Fevers, from the effect of Mercury, are thus
decribed by Mr. Pearson and by Mr. Dieterich, under the name of
" adynamic mercurial fever." " It is characterized by great depression
of strength, a sense of anxiety about the prsecordia, frequent sighing,
trembling,: partial or complete, a small, quick pulse, sometimes vomit-
ing, a pale, contracted countenance, and a sense of coldness. When
these symptoms are present, a sudden and violent exertion of the animal
power wiir occasionally prove fatal." Dr. Christison states that Mer-
cury produces an eruption of purple spots. {On Poisons, Christison,
p. 407.)

Typhus and typhoid fevers commence very similarly to inflammatory

534 DISEASES OF THE SANGUINOUS FIJI^OTIOJSr.

fever, but, instead of terminating in a critical discharge, increase in
severity ; and the essential symptoms are great prostration of strength,
tendency to death, frequent, soft and compressible pulse, a pale, death-
like countenance, dry tongue, and the eruption of a mulberry rash in
typhus, — -in typhoid, of rose-colored spots. Dr. Pereira has several
times used mercurials as siliagogues in fever, and for the most par
with advantage. [Mater, Med. Vol. I. p. 825.) Dr. Copland says, his
impression is that death after salivation has been established is very
rare. [Diet Pract Med, Vol. II. p. 929.) Dr. Macartney has never
known it fail in arresting the progress of the disease, "provided the
fever be not combined with visceral affections, or characterized from the
beginning with unusual prostration of strength." [Treatise on Inflam-
rnation^ p. 162.) The grand genus of Continued' Fevers has been
extended to embrace all the Diseases of 'Irregular Fehrile reaction.

The reaction is sometimes intense, and may be promptly arrested,
and subject to a thousand aberrations, as if the vital forces obeyed the
toxio cause^ which is invisible but powerful.

In these diseases the whole organism is affectedj and at the end of a
certain preparatory period, the affection manifests itself either upon
the skin, or upon the mucous membrane, in ah appreciable pathological
product ; the pathological product consists either in an eruption, a
ganglion or flux.

The blood in all of these diseases suffers a profound alteration, a
veritable decomposition, as has been well demonstrated by Prof. Andral
and others. .

This grand genus of Febrile diseases is divided into two groups^
Enecial Feyees. Eruptive Feyees.

Typhus. Small-pox.

Typhoid fever. Measles.

Plague. Scarlatina.

Yellow fever. Urticaria febrilis.

Typhoid pneumonia. Sudor Anglicus.

Hectic fever. Anthrax.

Pertussis.

Each of these diseases is the product of a peculiar infection, of a
poisoning of the organism, of a profound alteration of the animal sub-
stance effected by a specific miasm or virus. The precise nature of
these infections may not be perfectly known ; but their effects are
sufficiently characteristic to enable us to select the proper remedies in
individual cases.

Each of these miasms is capable of producing a specific disease in a
healthy person, even though he be living in accordance with the best
of ordinary hygienic principles. Of the general characteristics of these
diseases which manifest themselves in every case, a few are:

DISEASES OF IRREaULAR FEBRILE ACTIOJT. 535

Profound alteration of the fluids of the body, before they produce
any appreciable local lesion.

Depression or sometimes complete prostration ; sometimes an aber-
ration of the febrile reaction which seems to be controlled by a more
powerful morbid force.

This deleterious agent controls, masters, crushes ; destroying in
few days the most vigorous constitutions, and at other times sparing th
most delicate.

The susceptibility of the patient to remove the impression of the
poison varies in different persons, depending on some idiosyncracy,
some peculiarity of the constitution, or some previously existing state
of health. From the instant that the morbid leaven begins to operate
the physiological laws are entirely changed. The vital reaction ceases
to be a safe-guard to the organism. The curative effects of nature may
be aided, but they are too feeble to be trusted. Our whole dependence
must be upon specific remedies.

The effects of some specific poisons on the organism exposes to us in
a partial degree the nature of the virus that causes these fevers.
There is some resemblance between the plague and the bite of the
viper: — between yellow fever and the bite of the Lachesis-trigono-
cephalus, and also of the Rattlesnake ;-^between vaccine and small-
pox;— between poisoning by White Hellebore or preparations of Copper
and cholera ;— between the effects of small doses of Arsenic and typhoid
fever.

The affinity and intimate relations which unite the exanthematous
with the typhoid and pestilential group of fevers may be seen in many
of their characteristic features ; thus :

In the exanthematic fever the eruption is sometimes insignificant ;
and we often see in typhoid fevers the skin covered with vesicles or
papillee ; and in cholera there is a constant alteration of Brunners
follicles.

The confluent small-pox, and typhus offer a very similar lesion of the
intestinal glands. Rapou says, in one case the characteristics of typhus
and small-pox were so blended that he could not distinguish between
them. {Iiaj}Oic on Typhoid Fever,)

The consecutive fever of cholera is a true typhoid fever ; and cholera
is also accompanied by sweat. We remember a case during the epi-
demic of 18'34, where there was profuse perspiration from the beginning
of the disease till death, and there was no other symptom observable
neither diarrhoea or vomiting.

536 DISEASES OF THE SANGTJINOUS FUNCTION.

3. TYPHUS.

Few diseases have attracted more attention, and been the cause of
more bitter controversies in the medical world than typhus fever.
While some have maintained that it is a malady peculiar to the cold
seasons of temperate latitudes, and caused by exhalations of animal or
vegetable matters in a state of putrefaction, [Dewees^ Bancroft^ &c.)
others assert with equal confidence that it occurs in all climates, at all
seasons, at every period from infancy to old age ; and that it does not
arise from any specific cause, (sui generis,) but may proceed from marsh
miasms, animal exhalations, intense cold, errors in diet, over-exercise,
and a variety of other causes. [Nathan Smithy Machintosh^ &c.)
Some suppose it contagious, and others non-contagious.

The word Typhus was originally used to denote a fever, the promi-
nent feature of which consisted of a state of stupor, — or, more correctly,
a disease that " burns with a concealed and smothered flame." It ap-
pears to belong exclusively to the North temperate zone, and even here
it avoids extreme latitudes. As yellow and intermittent fevers occur
in warmer climates and near the level of the sea, so typhus fever and
those resembling it have their base in a high latitude, and at a greater
elevation. Typhus fever is seldom seen far beyond the parallel of 45^^
North. It is neither seen among the fur-stations of the Hudson's Bay
Company, nor among the Esquimaux in their unventilated snow-huts.
In Western Europe it prevails between the parallels of 44° and ^0^
North. In Siberia it has not been observed ; it decreases with eleva-
tion, and to this cause has been attributed its absence from the hospital
at Madrid, 1995 feet above the level of the sea. It occurs in every
season, but is most prevalent in autumn and winter. In most of the
cities of Europe typhus has become endemic, and it has never been ab-
sent from Vienna since the wars of the first French empire. It oc-
casionally spreads as an epidemic, extending to distant continents. In
New- York it has appeared, after crossing the Atlantic, in 1818, 1827,
1828, 1887, and 1846-1847. In the last-named year 1896 died of
typhus, and 657 of dysentery in the hospitals, generally of a typhoid
character. In one year 289,480 immigrants arrived in this country ;
bringing the fever with them in crowded and ill-ventilated ships, and
carrying it into the tents and hovels which became their first homes in
America. Some vessels had lost from thirty-five to one hundred
on the passage. Of 100,000 persons who left tl^e British Isles in one
year, 5000 died at sea, 8889 at Grosse Isle;; the whole number of
deaths being more than 40,000. {Report to Amer. Medical Associa-
tion. 1848.)

Of the 160,184 immigrants of the year 1847, who landed at New-
York, 5,277 fever natients were admitted into the marine hospital at

TYPHUS.

537

Staten Island, and 662 died. The whole number of deaths from typhus
that year at the quarantine hospital and in the city of New-York was
estimated at scarcely less than 2000.

During the Crimean war, typhus fever commenced in the French and
Pussian armies in the summer of 1855 ; and soon after the capture' of
Sehastopol (in September) it began to assume an epidemic character.
"From that time till May, 1856, it ravaged the armies of the Crimea
with a fury unknown since the great epidemics of the imperial wars.''
[Report on Diseases of the Army of the East. 1856.)

Respecting its nature and seat, it has had the honor of being located
by different medical writers in every part of the body from the crown
of the head to the soles of the feet. At one time the whole world
placed it in the blood; then, another generation of theorists arose who
seated it in the solids; at another period Broussais, of France, made
the discovery that its place was the gastro-intestinal mucous membrane,
and that Hippocrates, Galen, Celsus, Stahl, Boerhaave, Cullen, Hoff-
mann, Brown, and other authors, had been laboring under a succession
of errors, upon the subject for more, than two thousand years. Still
later, some theorists have found out that its position is in the brain and
nervous system ; while a few very sensible persons have arrived at the
conclusion that the exact nature and seat of typhus is yet involved in
obscurity.

At the present moment there are a great variety of opinions respect-
ing it. One class of medical men suppose it to be a disease affecting
principally the brain and ganglionic system of nerves. Another class
suppose its action to be in "the mucous membranes and lymphatic
glands, especially those of the ileum, whence it has been termed typhus
ahdominalisP (Hartmann^ Others, still, suppose it to be a disease
of a dynamic character, or an affection of the " vital properties" of the
system. In regard to this last supposition it can not be confuted, be-
cause it means nothing at all. It is as senseless and absurd as it would
be to attribute it to a derangement of the electric, magnetic, galvanic or
any other " properties", which we may assume that the organism pos-
sesses.-

The malady assumes different characteristics according to the pre-
disposition of the individual when exposed to the influence of the con-
tagion. If his system has been debilitated by over-exertion of body or
mind, by grief, care, misfortune, disappointment or shame, the brain
and nervous system will be prominently affected, and we shall be pre-
ented with that variety termed cerehral typhus.

Should the stomach and intestines happen to be in a state of irri-
tation and debility when the contagion is absorbed, they will receive
the impression, and we shall have what is denominated ahdominal
typhus.

538 DISEASES OF THE SANGUmOUS FUNCTIOK.

If the organ predisposed be the lungs, the morbific agent will spend
its effects at this point, ^vA jpneumo-ty])lius be the result.

So long, however, as the whole organism remains in a perfectly sound
and vigorous condition, with the mind cheerful and moderately active,
it will be able to resist the influence of the miasm, and in all probabili-
ty escape the malady. The law is fundamental and cannot be too
often inculcated, that just in proportion as the organism, or any part
of it, diverges from the normal standard, in the same ratio will the sus-
ceptibility of such affected structures to morbific or remedial influences
be increased.

Diagnosis. — The symptoms which appear at the commencement of
typhus, are : lassitude, debility, sense of fatigue, impaired memory,
slight chills, alternating with flushes of heat, dull pains in the head,
back and limbs, loss of appetite, and melancholy. These symptoms
often continue one or two wrecks, the patient not feeling sick enough to
take his bed, or sufficiently well to attend to his occupation, when he
becomes more restless during the night, delirium sets in, he is obliged
to keep his bed from debility, his tongue, which was at first coated
with a thin, white fur, becomes dark, dry, and cracked, and as the dis-
ease advances, the old fur passes off, leaving the surface red, glazed,
and dry. As the disease progresses, the eyes become suffused, the
countenance loses its natural expression, the muscles are weak and
tremulous, a viscid saliva is secreted, which collects and dries upon the
lips and teeth, the surface acquires a dingy color, there are subsultus
tendinum, defective vision, partial los.s of hearing, a tendency to slide
down to the foot of the bed, involuntary discharges from the bowels
and bladder, picking at the bed-clothes, low muttering delirium, and,
finally, coma, convulsions and death.

The symptoms and course of the complaint will, of course, be modi-
fied in accordance with the severity of the attack, the part affected,
and the plan of treatment pursued.

If we may be allowed to judge from the opinions which have from
time to time been expressed by some of the eldest, most experienced
and distinguished members of the old school, upon this subject, we will
say, that the course of treatment ordinarily recommended and pursued
by allopathists, is productive of far more injury than benefit in typhus.
In proof of this we quote from the work on typhus fever, by Prof.
Nathan Smith of Yale College, published 1831.

After commenting upon the various contradictory methods of treat-
ment advised by different authors, as the antiphlogistic, stimulant, tonic,
derivative, &c., he says: "I am clearly of opinion that we had better
leave the disease to cure itself, as remedies, especially powerful ones,
ure more likely to do harm than good."

TYPHUS.

539

In anotlier place he declares, that " the use of powerful means, \Yith
a view of curing this disease is liable to do great mischief."

These are the matured sentiments of a man who was not only a man
of books, but who enjoyed an immense practice in several of the dif
ferent New England States for a period of more than forty years
Many other, more recent authors have avowed similar views, and al
though they do not yet admit the truths of the new law and principles
of cure, they entertain an entire lack of confidence in the therapeutical
doctrines of the old system, so far as typhus, as well as many other
maladies are concerned. It may, then, with much propriety be affirmed,
that serious injury is often inflicted in typhus by allopathic treatment,
and that many of the symptoms above enumerated are aggravated, if
not actually superinduced by blood-letting, counter-irritants, and poAver-
ful drugs. For the distinguishing characteristics of typhus and typhoid
see Typhoid Fever, — Diagnosis,

Causes.-— The presumption is very strong that the cause of typhus
is a specific agent, sui generis^ and that it is set free from the animal
body during the course of a fever, or when a number of individuals are
crowded together In close, filthy, and 111-ventilated apartments. This
specific poison rarely, if ever, makes a serious impression, imless the
organism is previously predisposed to its influence. When all of the
organs are in a normal condition, and operate in a healthy manner, an
equilibrium is maintained throughout the system which enables it to
resist the action of noxious agents. The ideas which we have here
advanced in regard to the specific nature of typhus-contagion, were
maintained by a number of medical men many years ago. Amongst
whom there may be named Dr. Smith, of Conn., who gives the folr
lowing reasons in support of this opinion: "On the Connecticut river,
for tvf o-hundred miles from north to south, and on all its tributary
streams on both sides, for a hundred miles in width, there has been no
instance of any person's having contracted the intermitting fever, from
the first settlement of the country to the present time ; and yet the
typhus-fever has prevailed, more or less, in every township within that
tract of country."

If, as many writers assert, the miasms of intermittent, yellow, and
typhus fevers are analogous, should we not constantly witness these
maladies running into each other, or assuming indiscriminately these
different forms in the same location ? But a still stronger reason is ad
duced by Dr. Smith in support of his position; he asserts that ••there
is a remarkable odor arising from a person affected with typhus, so
peculiar, that I feel assured, that upon entering a room blindfolded,
where a person has been confined for some length of time, I should be
able to distinguish it from all other febrile affections. This is an addi-
tional circumstance in favor of the existence of the specific cause

540 DISEASES OF THE SANGUINOUS FUl^CTIOK.

assigned above, as several other diseases which arise from contagion
are attended by an odor peculiar to each, which, when once fixed in
the mind, enables a person to recognize their presence ever after.
This is strongly evinced in small-pox, measles, malignant sore
throat, &c."

It is also a fact worthy of note that typhus-fever was entirely un-
known to the savage tribes of America previous to the settlement of
the whites ; and even at the present time, those bands which have not
been contaminated by the eimliBing aggressions of the usurpers of the
soil, but continue their wild, roving, active and simple modes of life,
are not at all subject to this fever. The moment, however, they for-
sake their simple and primitive customs, and adopt our dissipated and
enervating habits, enclosing themselves in close, ill-ventilated, and
heated apartments, drinking of spirituous liquors, using freely of con-
diments, tobacco, tea, coffee and rich, greasy and indigestible food,
they become affected with contagious and miasmatic disorders, and
often die in great numbers. This fact goes to prove that typhus is a
disease pertaining exclusively to civilized life, and that it requires the
unnatural and artificial customs and habits of the white race to ensure
its production.

Typhus originates in circumstances tending to impair the essen-
tial or vital properties of the blood, more especially over-crowding, de-
fective ventilation, insufiicient nourishment, and hence its prevalence in
times of scarcity and famine. Its accession is marked by no special
symptoms, but such as occur in many acute diseases : chilliness, alternat-
ing with heat of skin ; quickened pulse succeeded by muscular pros-
tration; more or less sensorial disturbance ; and between the fifth and
eighth day, a peculiar morbillous-like eruption not fading on pressure,
and persistent — the duration of the fever being about fourteen, seldom
exceeding twenty-one days. In fatal cases, there is no specific lesion,
congestion of the internal organs being the only change observed. If
there be other lesions they are superadded or accidental. {Tweedie)

Typhus is pre-eminently the type of a blood-disease ; the fever-poi-
son acting primarily on the blood, and leaving, after death, little trace
of structural change ; prevailing extensively as an epidemic ; and when
once established from whatever cause it may have been induced, it
spreads by contagion, regardless of age, sex, or local circumstances.

But, as the constituents of animal and vegetable substances are so
nearly identical, it has been supposed that the typhus-poison may also
arise from vegetable decomposition in close and heated apartments.
Of one thing we may be assured respecting both animal and vegetable
matters : that when decomposition occurs in dark, damp, and confined
places, a far more active and virulent miasm is generated, than when
the same substances undergo transformations in the open air.

TYPHUS. 541

The effect of crowding men together in close quarters, badly ven-
tilated, has been shown on a large scale in India. At one time the
English government held in confinement 40,000 of the native Hindoos
of whom from 4,000 to 10,000 died every year. The average mortality
by crowded and unventilated barracks in the English army has some-
times been enormous, as at Barrackpore, where the number of deaths
from fever and cholera seldom fell short of one-tenth of their whole
number ; while officers and other inhabitants who lived in well-ventilated
houses, did not find the place particularly unhealthy. Among the
marching regiments, the soldiers wh(^were packed together at night,
ten or twelve in one tent, lost from one-tenth to one-sixth of their num-
ber, when the thermometer was at 96°, while the officers and their wives
were generally exempt from disease. In 1756, 140 British prisoners
were confined for one night in the celebrated Black Hole in Calcutta,
a prison only eighteen feet square with two small windows. The want
of air caused the death of 123 prisoners out of the whole number.
Most of those who survived till morning were seized with putrid fever
and died within a few days more.

On the^first of Dec. 1848, 150 deck-passengers of the steamer Lon-
donderry were ordered below by the captain, and the hatches closed
upon them; seventy were found dead the next morning.

CATALYSIS. SEPTIC DISEASES.— DISEASES OF FERMENTATION.

When we desire to render an animal insensible to the action of Wor-
rara or Strychnines placed where it can be absorbed, we try to lower its
physical powers. If we desire to preserve it against contagious dis-
eases we must increase those powers.

But these septic poisons are almost invariably organic substances,
and are produced within the living organization. In some cases the
poison is formed within a special apparatus, as in hydrophobia. (See
that Disease.)

But there are other virulent diseases in which the blood really ap-
pears to contain the morbid principles. This is the case with glanders.
And it is a well-known fact, that healthy horses, and even men, may be
affected with the blood of a diseased horse, as well as with the slimy
matter that escapes from the nose and mouth.

The animal secretions do not contain it, though at the same time the
pathological fluids — the pus, the fluid contained in hydrocele and other
morbid secretions do. For this reason alone are the autopsies performed
in animals that die of the glanders attended with so much danger ; the
virus pervades the whole system, and the slightest wound is sufficient
to inoculate the complaint.

Contagious pneumonia in horned cattle could not be communicated
by inoculation of the blood, or any of the fluids of the body. That

542 DISEASES OF THE SAI^'GUmOUS FUNOTIOK.

virus cliooses the lungs for its exclusive seat, and tlie liquids therein
contained, pus, lymph, &c., are alone capable of communicating it
This virus is very virulent, as whatever part of the body is 'the seat of
inoculation, becomes rapidly inflamed and mortified.

Process hy which Putrid Affections are originated, — Nothing ib
easier than to produce putrid diseases in animals. Thus, when trans-
fusion is performed under ordinary conditions^ — when the blood is con-
veyed directly from one animal into the veins of another — no accident
is produced; but if the blood is allowed to remain for a short space of
time in contact with the atmosphere, and if the serum is then injected
into the vessels, all the symptoms of putrid resorption are observed,
and the animals die after exhibiting all the characteristic symptoms of
putrid infection. [Bernard.)

The bloodj therefore, is capable of acquiring toxic properties without
the intervention of any foreign principle, merely through the modifica-
tions which take place when life is extinct. The same results may be
excited without even drawing blood from the veins. If the blood of a
fasting animal is directly injected into the veins of a healthy one, the
latter is- poisoned in the same manner as before, and yet the,, blood in
this case has not undergone any previous decomposition. The in-
troduction of foreign principles of course acts upon the blood with still
more intensity; nearly all the substances known under the name of
Ferments are endowed with the property of communicating a delete-
rious influence to this fluid. When yeast is introduced into an animal's
veins, passive hssmorrhage and other adynamic symptoms are imme-
diately produced and death takes place in a few, days. Now if the
animal blood is transfused in rapid succession, exactly the same efiect
is produced, as if yeast and not blood had been poured into the vessels.

It seems likely that in this case a series of decompositions takes
place within the blood, and which give rise to other ferments. The
well-known experiment related in Pringle's work on Army Diseases ap-
pears to correspond with our own experiments. In order to prove the
influence of putrid, emanations even at a distance on the chemical
phenomena of life, he plunged a thread into the yolk of a rotten egg
and then suspended it in a jar containing the yolk of another egg, and
he found that under these circumstances, decomposition took place with
far greater rapidity than usual. {Claude Bernard, 1860.)

We therefore see that all these series of phenomena hold intimate
relation to that mysterious chemical process known under the name of
catalysis. The theory of fermentation is at present imperfectly known?
and there exists a whole series of diseases which evidently result from
the chemical diseases that take place within the body.

By the operation of the principle of catalysis, one substance may
be brought to so act upon another as to develop in it latent pow-)'.&'

TYPHUS. 543

and properties not hitlierto seen. A few drops of diluted Sulphuric-
acid boiled witli starch, sets in operation an action which decomposes
any quantity of starch, and causes these decomposed elements to re-
arrange themselves in a new and different manner under the form of
dextrine, and finally of cane-sugar. At the expiration of this process
the acid may be removed unaltered in quantity or in quality. A few
drops of another acid would not have answered the same purpose.
This law of Catalysis holds good with regard to the operation of homooe-
pathic remedies. If in finitesimal atoms of homoeopathic medicines can
be brought into contact with tissues with which they have no relations
or affinities, no special effects are observed ; but when these atoms are
brought to bear upon disordered parts with which they are in homoeQ-
pathio TCifport^ we witness effects as wonderful as those of the magnet
in vivifying unlimited numbers of atoms of unmagnetized steel. There
must be a relation between the diseased jDart and the remedy. (See
articles on this subject, N, A, Journal of HomcBop., Vol. IL, p. 21,
and Vol. VII., p. 81.)

Tkeatment. — In the management of inflammatory typhus the liberal
use of cold water, both internally and externally, has been found highly
beneficial, and there is no doubt of its immense power as a curative
agent, when judiciously employed. As early as 1796 the free use of
water was strenuously recommended by Dr. Nathan Smith. In speak-
ing of the hot stage of typhus, he says: "The most effectual mode of
reducing the temperature of the body, is by the use of cold water,
which may be taken internally or applied externally," by which means
^*we may lessen the heat to any degree we please."

"The method which I have adopted is to turn down the bed-clothes,
and to dash from a pint to a gallon of cold water on the patient's head,
face and body, so as to wet both the bed and body-linen thoroughly.
As soon as the linen and bed-clothes are dry, if the heat returns again,
the water should be again applied until the heat is subdued."

We are aware that physicians have been deterred from the free ex-
ternal use of cold water in fevers, through fear of aggravating existing
inflammation, causing metastases, congestions, &c., by repelling the
blood from the surface to the internal organs, but the danger from this
cause is purely imaginary; for cold water, externally applied, not only
operates by abstracting the superfluous heat, and reducing the animal
temperature, but it also acts as a tonic, imparting tone and vigor to the
debilitated and relaxed capillaries in which the morbid action is sup-
posed to reside.

In slight cases, frequent sponging of the surface will be sufficient to
accomplish our object; but in more severe instances the method above
recommended may be resorted to.

By adopting this course of treatment, while at the same time we ad

544 DISEASES OF THE SANGUIISrOUS FUITOTION.

minister appropriate remedies, the disease will run a milder coursGj
and most of the grave symptoms too often witnessed will be absent
It has been a question whether typhus can ever be cut short by reme-
dies; some maintaining that it may be broken up in the first stage^
while others are of opinion, that it must have its course ; upon this
point, Dr. Drysdale observes: "We do not believe it possible to cure
typhus; all we can do is, to conduct it to a favorable termination by
carefully watching and curing all the intercurrent afiections so apt to
appear in it, by judicious management. At the same time we have al-
ways given the remedies usually recommended, especially Shtts^ Bry-
onia^ and Arsenwum^ and we believe that convalescence will be much
hastened by judicious treatment." Dr. D. advises the use of brandy
and wine in addition to our remedies during the stage of collapse,
"especially when there is great want of animal heat, and the pulse is
very quick and small, attended with much trembling of the hands, and
constant muttering delirium."

The appropriate remedies will be determined by the form the malady
assumes, and the exact nature of each particular case,

^(^^5.— >Dr. Taylor (in his New Treatment of Febrile Diseases,
1850, London) says, he treated numerous cases of inflammatory and
fevers, measles and other exanthemata by rubbing equal parts of lard
and suet into the skin, and using no internal remedies. He says, it
reduces the frequency of the pulse and wards off the typhoid con-
dition; the dry and brown tongue becomes clean; the patient falls into
a sound sleep; delirium and their symptoms subside. Repeat it two
or three times a day. \

TYPHUS CEREBRALIS.

Belladonna^ Bryonia^ 0-pium, and Rhus^ will cover most of the
symptoms which are ordinarily present in this form. The following
are the indications for these medicines.

Belladonna, — Countenance flushed and bloated; eyes red and
sparkling, or dull and turbid; or pale, brownish and glassy; wild ex-
pression, stupid, fixed, or wandering look ; visible pulsation of the caro-
tids; respiration irregular, short and quick or slow and deep; pupils
contracted or dilated, generally immovable ; pulse variable, but gene-
rally quick and resisting ;, tongue red, moist or dry, or yellowish white:
breath offensive ; urine brownish or red ; spasm ; distortion of the
face and eyes; head very hot, while the extremities are cool.

Fulness and heavy pain in the head; strong pulsation of the caro-
tids and arteries of the head; double vision, sparks before the eyes,
or weak sight, humming in the ears ; inflammation of the throat, chest
and abdomen ; pains, heaviness, or numbness of the limbs ; palpitation
of the heart ; pressure and cramp-like pains in the stomach ; dryness

TYPHUS CEREBEALIS. 545

of the mouth; adipsia or thirst; continued watchfulness or lethargy;
constipation or diarrhoea with tenesmus ; constant moaning.

Mental or Moral Symptoms. — State of mind apathetic ; or irrita-
bility of temper; illusions of the senses, and frightful visions; or
gloomy, suspicious ; constant moaning, or drowsiness ; profound coma

Administration. — A drop of the third dilution in water every two
hours until the desired impression is produced. In many persons the
higher dilutions are more prompt in their action.

Remarks. — Belladonna is indicated in typhus presenting a sub-
synochal character. It is contra-indicated in great depression of the
cerebral and nervous energy ; but applies in vascular and nervous
erethism.

Bryonia,— Y2i(iQ swollen, red and burning ; eyes red and swollen or
dull, glassy, turbid or sparkling and suffused dryness of the nose;
groans ; respiration difficult, short, rapid, anxious, or sighing ; thick
and tenacious expectoration; petechise ; mouth dry; tongue dry, and
coated with a dirty or yellowish fur ; lips brown and dry ; trembling
of the limbs and appearance of great weariness and debility; pulse
variable ;• urine pale, or brownish without sediment.

Fulness, heaviness, and pressure in the head, from within outwards,
worse on movement ; confusion and dull pains in the head ; vertigo
buzzing in the ears ; dulness or acuteness of hearing : sensation of dry
ness in the throat; profuse sweat during heat; bitter, sour or putrid
taste ; thirst; nausea; hiccough or pressure at the stomach ; constipa-
tion ; abdomen inflated ; weariness and pains in the back, loins and
limbs, aggravated by motion ; abdominal pains ; drowsy during the day /
restless in the nighty with delirium.

Irascibility ; passion; fear of the future ; anxiety; fear; stupidity;
delirium, with raving respecting business ; visions on closing both eyes.

Administration.— Same as Belladonna.

Remarks.- — Bryonia is applicable in the cerebral and abdominal va-
rieties, and in typhoid pneumonia, especially in the first period before
the muscular and nervous strength have become materially depressed.
After the system is reduced to a certain extent, it may be alternated
with one of the other remedies with benefit. Bryonia is often appro-
priate after Belladonna.

Aconite, — In the first stages of this as well as in most other maladies
in which there is excessive action of the circulatory vessels, Aconite is
an indispensable remedy. Its properties and uses are so well known
and have already been so fully presented, that nothing further need be
given here. Its powers in reducing the general febrile action may need
the aid of some other measures in subduing important local inflam-
mation.

Opium, — Face dark red, or brownish, hot and bloated ; pupils di

Vol. I.— 35.

546 DISEASES OF THE SANGUINOUS FUNCTION.

lated and immovable ; lower jaw hanging from relaxation ; letliargy,
with snoring ; mouth and eyes open ; irregular and slow respiration ;
pulse slow or suppressed ; bluish color of the skin ; convulsive move-
ments of the limbs ; offensive black feces ; involuntary evacuations ;
urine scanty, high colored, depositing a brick-dust sediment.

Sensation of great heaviness in the head, vertigo, dizziness, buzzing
in the ears ; general diminution, or entire loss of sensibility ; cloudiness
of sight ; paralysis of the tongue ; sensation of weight and pulsations
in the stomach and abdomen ; difficulty in evacuating the bladder;
great oppression at the chest ; hoarse, dry cough, with bloody expec-
toration; troublesome itching of the skin; convulsions.

Stupor ; 'loss of consciousness ; delirium ; frightful visions.

Administeation".- — A drop of the third dilution in an ounce or more
of water, a table-spoonful once in two hours, until a medicinal aggrava-
tion or amendment occurs,- — afterwards repeat acc©rding to the exigen-
cies of the case.

Iihus4oxiGodsndTon. — VQtQQh.\dd\ face red and swollen ; blue
circle around the eyes; nose pointed; lips dry, brownish or black;
eyes red, with viscid secretion at the angles ; eyes fixed and dull ; nose
dry, swollen, and tender when touched ; tongue dry, red or dark ; mouth
filled with viscid mucus, which collects upon the teeth, forming sordes ;
constipation or diarrhoea ; teeth dry, white and shining ; color and con-
sistence of faeces variable ; retention or incontinence of urine ; clear
red, or turbid urine ; paralysis of the lower extremities ; pulse quick
and small ; coma, with snoring and moaning.

Stupefaction; vertigo ; dizziness ; bruised sensation within the head;
soreness of the scalp; painful oppression in the stomach; pulsations
in the epigastric region ; spasms and pinchings in the abdomen ; pains
in different parts as if from a bruise, worse during repose, or at night,
and relieved by movement ; great weakness ; tendency tofaintness;
pain and difficulty in swallowing; tenesmus, with loose slimy, frothy,
sanguineous, white, yellow or red evacuations ; constant and pressing
desire to urinate ; oppression at the chest, with difficult respiration ;
soreness in the limbs, back, and neck, when touched or at rest ; raw
feeling in the throat and chest ; excessive weakness ; trembling or
sweats.

Muttering delirium, or coma somnolentum with snoring ; anguish and
digestion in the evening and at night; inclination to weep ; fear of
death ; frequent sighing.

Rhus alone is not a specific for typhus fever, but it develops in the
gastro-intestinal mucous membrane symptoms similar to those it pro-
duces on the skin. This condition is an extensive erythema with rais-
ing of the epithelium into pustules or serous vesicles.

This erythema is not just like that of typhus fever; these last are

TYPHUS ABDO^inTALIS. 54:/

like variola-pustules and have been compared to them : they run a
fixed course. Hahnemann found Rhus effectual in curing the epidemic
typhus of. 1813.

It suits more particularly the pathological states which exist in what
is called typhoid enteritis. Here the low typhoid state depends on the
sympathetic effects of the acute inflammation of the skin and mucous
membrane, when this inflammation affects a large number of nervous
papillge which are spread over these surfaces. Whereas in typhus the
adynamia, coma, seem to constitute the foundation of the disease.

Administration. -A drop of the first dilution in an ounce of water;
a dessert-spoonful every two hours; if no decided effect ensues after
a reasonable time, give a drop of the mother tincture in a table-spoon-
ful of water, repeating as may be necessary.

In many cases a higher dilution will do better than either of the above.
We have seen the thirtieth of Rhus successful in a case in which the
sixth did not appear to do well.

MeTGurius-mviis. — Has been often successfully employed in cases
where there is great weakness, rapid sinking of strength, profuse per-
spiration, fainting fits, trembling and numbness of the limbs, cramps and
convulsive movements, great agitation and uneasiness of body and mind.

Acetic-acid is often the only remedy that is necessary, as has been
proven in many epidemics prevailing in whole villages and cities.
When the pulse and strength begin to fail, then Arnica may be used
with great success in alternation with the acid.

Acetum. — Sponge the body with vinegar and water.

TYPHUS ABDOMINALIS.

Teeatmekt. — From the elose analogy of appearances produced upon
the intestinal canal by fatal doses of Arsenicum and by fatal abdomi-
nal typhus, it would be a natural conclusion that Arsenicum is for this
disease a valuable homoeopathic remedy. There has been, however,
a wide difference of opinion between some of our most eminent practi-
tioners. Many, like Hausmann, Fleischmann, Gumpendorf,* Stapf.
Jahr, Henderson, Laurie, Currie, and Hartmann, have eulogized Arse-
nicur)% for this form of typhus, in the most enthusiastic manner ; at the
same time a few, as Wurmb, Lorentz, &c., have denied that it possesses
any special curative properties in any stage of the malady.

The weight of testimony is in favor o^ Arsenicum when judiciously
employed ; and indeed we believe in those cases of ulceration of the
mucous membrane of the ileum, Peyer's glands, &c., and in those in-
stances where the blood becomes congested in different parts of the in-
testinal canal, giving rise eventually to spacelation if unopposed, that
Arsenicum is a specific of positive and decided power. In support of
this opinion, we refer with confidence to the numerous hospital and

548 DISEASES OF THE SANGUINOUS FUNCTION.

private reports that have been published in Europe within a few years.
In relation to the cause or omises of the ulcers so often discovered
by the Hippocratics in autopsical examinations of those who have died
of typhus abdominalis, an allopathic physician of forty years' standing
in Massachusetts, Silas Brown, makes the following inquiries in the
Boston Medical and Surgical Journal. After expressing himself as
" fully persuaded that one of the great secrets of curing patients is not
to kill them," he proceeds : " I should like to be informed whether there
is not danger in giving inwardly, in any quantity, Strychnia, Creosote,
Prussic Acid, Mtrate of Silver, and a host of other virulent caustic
poisons ; and whether some of them would not have a tendency to
cauterize or constringe the delicate absorbents and other vessels of the
digestive organs ; and whether such medicines have congeniality or
affinity enough with the membranous and vascular portions with which
they come in contact, to become sanative medical agents; or whether
they would not have a tendency to produce obstructions and those
ulcers which we meet with in the jpost-moTteTn examinations of those
subjects who die of typhus fever. '^^ He requests an answer, and we
venture the suggestion that he may safely adopt an affirmative one.

Arsenicum. — Skin dry or yellowish, or cold and bluish ; reddish or
dark spots on the skin; petechias; eyes dull, glazed, and sunken; pu-
pils contracted; face shrunken, hollow, pale and cadaverods, or yellow
ish, bluish, or leaden colored; expression of countenance distorted and
unnatural; cold sweat on the forehead; lips dark, dry, and cracked;
teeth dry, white and shining; sordes upon the teeth; tongue dry,
shrivelled, bluish or black, with trembling and inability to protrude it;
faeces variable, generally loose, darkish or gr^eenish, and foetid;, urine
reddish, brownish, yellow, or turbid; tymptxnitis; guggling noise of
liquids swallowed; respiration short and snxious; cramps in the legs;
pulse irregular, or quick, weakj small and frequent, or feeble and
trembling; voice sepulchral and tremulous; coma or low muttering de-
lirium, trembling of the limbs; subsultus tendinum; sometimes deaf-
ness; hippocratic countenance; colliquative sweats ; extreme debility or
complete" prostration; burning and heat at the pit of the stomach and
epigastrium ; nausea, and vomiting especially after eating or drinking ;
violent pains and burnings in the abdomen, generally on the left side;
sometimes only pain on pressure ; pains in the right hypochondrium ;
stitches in the side with anxious and difficult breathing; universal loss
of strength and excessive restlessness; stools dark, greenish, putrid,
foetid and involuntary; head painful, weak, confused, as if stunned;
distention of the abdomen; stiffness of the limbs. The patient is dis-
satisfied, restless, anxious, discouraged; or muttering; delirious; sleep
disturbed, with unpleasant visions.

Administkatton. — In extreme cases, a grain of the second or third

TYPHUS ABDOMINALIS. 549

trituration may be given every half hour, gradually lengthening the in-
tervals as circumstances require.

Remarks. — ^Arsenicum is especially serviceable in the third stage
of abdominal typhus, when ulcers have formed. It will also frequently
apply in the second stage when the bowels become relaxed.

Belladonna, — Countenance flushed and bloated ; eyes red and spark-
ling, or dull and turbid; or pale, brownish and glassy; wild expression,
stupid, fixed, or wandering look ; visible pulsation of the carotids ; re
spiration irregular, short and quick, or slow and deep ; pupils con-
tracted or dilated, generally immovable ; pulse variable, but generally
quick and resisting ; tongue red, moist or dry, or yellowish white ;
breath offensive ; urine brownish or red ; spasms ; distortion of the face
and eyes ; head very hot while the extremities are cool.

Fulness and heavy pain in the head; vertigo; dizziness; violent
throbbings in the head ; strong pulsation of the carotids, and arteries
of the head ; double vision, sparks before the eyes, or weak sight ;
humming in the ears ; inflammation of the throat, chest, and abdomen ;
pains, heaviness, or numbness of the limbs ; palpitation of the heart ;
pressure and cramp-like pains in the stomach ; dryness of the mouth ;
adipsia, or thirst ; continued watchfulness or lethargy ; constipation,
or diarrhoea with tenesmus ; constant moaning.

State of mind apathetic ; or irritability of temper ; illusions of the
senses, and frightful visions ; or gloomy, suspicious ; constant moan-
ing, or drowsiness ; profound coma.

Administkation. — A drop of the third dilution in water once in two
hours until the desired impression is produced.

Remarks.-— Belladonna is indicated in typhus, presenting a subsy-
nochal character. It is contra-indicated in great depression of the cere-
bral and nervous energy ; but applies in vascular and nervous erethism,

Bryonia, — Face red, burning, and swollen, or dull, glassy, turbid, or
sparkling and sufiused ; dryness of the nose; groans; respiration dif-
ficult, short, rapid, anxious, or sighing ; thick and tenacious expectora-
tion ; petechiae ; mouth dry, and coated with a dirty or yellowish fur ;
lips brown and dry; trembling of the limbs, and appearance of great
weariness and debility ; pulse variable ; urine pale, or brownish and
without sediment.

Fulness, heaviness, and pressure in the head, from within outwards,
averse on movement ; confusion and dull pains in the head ; vertigo ;
buzzing in the ears ; dulness or acuteness of hearing ; sensation of
dryness in the throat; profuse sweat during the heat; bitter, sour or
putrid taste ; thirst ; nausea ; hiccough, or pressure at the stomach ;
constipation ; abdomen inflated ; weariness and pains in the back, loins,
and limbs, aggravated by motion ; abdominal pains ; drowsy during the
day / restless in the night, with delirium.

650 DISEASES OF THE SANGUINOTJS FUNCTIOlSr.

Irascibility; passion; fear of tlie future ; anxiety; fear; stupidity.;
delirium, with raving respecting business ; visions on closing the eyes

ADMiNiSTEATioisr.— -Same as belladonna.

Remarks. — Bryonia is applicable in the cerebral and abdominal va-
rieties, and in typhoid pneumonia, especially in the first period before
the muscular and nervous strength have become materially depressed.
After the nervous system is reduced to a certain extent, it may be al-
ternated with one of the other remedies with benefit. Bryonia may
often follow JBelladonna with propriety.

Aconite. — In the first stages of this as well as in most other mala-
dies in which there is excessive action of the circulatory vessels, Aco-
nite is an indispensible remedy. Its properties are will be fully de-
scribed under Inflammation, ^qq Index. It is only necessary here
to advise the young practitioner that while endeavoring to reduce the
force of the general circulation, according to principles already ex-
plained, he should not neglect important local inflammations. It may
be administered in the same manner as Selladonna.

OpitcTn.—'FsiGe dark red, or brownish, hot and bloated ; pupils dilated
and immovable; lower jaw hanging from relaxation; lethargy, with
snoring ; mouth and eyes open ; irregular and slow respiration ; pulse
slow or suppressed ; bluish color of the skin ; convulsive movements of
the limbs ; offensive black faeces ; involuntary evacuations ; urine
scanty, high colored, depositing a brick-dust sediment ; sensation of
great heaviness in the head, vertigo, dizziness, buzzing in the ears
general diminution, or entire loss of sensibility; cloudiness of sight;
paralysis of the tongue; sensation of weight and pulsations in the
stomach and abdomen ; difficulty in evacuating the bladder ; great op-
pression at the chest; hoarse dry cough, with bloody expectoration ;
troublesome itching of the skin ; convulsions ; stupor ; loss of con
sciousness ; delirium ; frightful visions.

Administeation.— A drop of the third dilution in an ounce of water
■ — a table-spoonful once in two hours until a medicinal aggravation or
an amendment occurs, — afterwards repeat according to the exigencies
of the case.

HhuS'toxicodendron. — This remedy is particularly adapted to the
nervous forms of typhus, and may often be used with advantage in
cerebral typhus after Bryonia^ or Aconite^ or in ganglionic typhus,
when the following symptoms present themselves :

Petechige ; face red and swollen ; blue circle around the eyes ; nose
pointed ; lips dry, browish or black ; eyes red, with viscid secretion at
the angles; eyes fixed and dull; nose dry, swollen, and tender when
touched; tongue dry, red, or dark; mouth filled with viscid mucus,
which collects upon the teeth, forming sordes ; constipation or diar-

TYPHUS ABDOMINALIS. 551

rlioea ; teeth white, dry and shining ; color and consistence of feces
variable ; retention or incontinence of urine ; clear, red, or turbid urine;
paralysis of the lower extremities ; pulse quick and small ; coma^ with
snoring or moaning ; stupefaction ; vertigo; dizziness; bruised sensa-
, tion within the head ; soreness of the scalp ; painful oppression in the
stomach ; pulsations in the epigastric region ; spasms and pinchings in
the abdomen ; pains in different parts as if from a bruise, worse during
repose, or at night, and relieved by movement ; great weakness ; ten-
dency to faintness ; pain and difficulty in swallowing ; tenesmus, with
loose, slimy, frothy, sanguineous, white, yellow, or red evacuations ;
constant and pressing desire to urinate ; oppression at the chest, with
difficult respiration ; soreness in the limbs, back and neck, when touched
or at rest ; raw feeling in the throat and chest ; excessive weakness,
tremblings, sweats; muttering delirium, or coma somnolentum, with
snoring ; anguish and dejection in the evening and at night; inclination
too weep ; fear of death ; frequent sighing.

Administeation. — A drop of the first dilution in an ounce of water ;
a desert-spoonful every two or four hours. If no decided effect ensues
after a reasonable time, give a drop of the mother tincture in a table-
spoonful of , water, repeating as may be necessary.

MercuriuS'Vivus has been successfully employed in cases where
there is great weakness, rapid sinking of strength, profuse perspiration,
fainting^ts, trembling and numbness of the limbs, cramps and convul-
Bive movements, great agitation and uneasiness of body and mind.

GaTnphor, —K\i^d.m was highly successful with this remedy in the
so-called slow nervous fevers^ in which the temperature of the body is
lowered, the sensibility is depressed, and the vital powers greatly di-
minished. He was enabled to succeed because Camphor is capable of
producing a state similar in every respect^ as observed by G. Alexander,
Cullen, and F. Hoifmann.

PhosphoriG'acid.—Geinexni stupor of all the organs, apathy, dizzi-
ness ; tongue dry and cracked ; teeth covered with a coating, lips black;
cough frequent and dry ; lying constantly on the back or side ; con-
tinual delirium or dull mutterings ; subsultus tendinum; fixed look^
with hollow, glassy eyes; extreme slowness in replying the questions ;
petechia or clear brown spots; desire to escape; skin dry and burning;
stools aqueous, abundant, and involuntary; scorbutic alteration of the
buccal mucous membrane; cold perspiration on the face, hands, and
pit of the stomach; pulse frequent, feeble and intermittent. This
remedy was given by Rapou in injections to arrest intestinal haemor-
rhage, a symptom of great danger. Nitric-aoid is also effectual for
the same purpose; four drops in two or three ounces of water.

Bryonia. — Cases assuming the form of cerebral typhus ; violent de-
lirium, with intense febrile heat, great thirst and dryness ; vesicular

552 DISEASES OF THE SANGUINOUS FUNCTION.

eruption in the mouth; abdomen swollen, epigastrium tender; urine
dark; shooting pains in the sides of the chest, drowsiness during the
daj, restlessness at night, small and soft pulse ; clammy perspiration ;
trembling of the hands. Dr. Anelli of Presburg, succeeded with this
remedy in those cases in which a severe chill and vertigo were followed
by persistent heat for two days. A diminution of heat was followed
by delirium, loss of consciousness, reaching -in the course of two weeks
profound stupor. In these cases the abdominal symptoms were absent
and a majority of them terminated fatally under allopathic treatment.

Wilis-toxicodendron,— A.'^^Yo^rmiQ in all the stages of the disease,
especially in cases that take the form of nervous fever, with stupor;
also, when exhausting alvine discharges induce great prostration. Rhus
moderates the fatal colliquative diarrhoea, and diminishes the cerebral
congestion. Confusion and shooting pains in the head; dry, burning
heat; tension and stiffness, or wandering pains in the nape of the neck
and breasts, aggravated in the evening by motion; fatigue and lassi-
tude; when the nervous symptoms appear and the tongue is coated;
there is diarrhoea, with borborygmus, chills, vertigo, with irregular
closing of the eyelids; alterations of the colors of the face; dryness
of the throat, vomiting, yawning, heaviness of the head ; pressure on
the eyes; painful sensibility to light and noise; defective memory; ten-
dency to delirium; underlip and tongue dark. Shus^ in the pre-
monitory stage often presents the full development of the feve|» (See
United States Journal of Homoeo^atliy^ 1860, p. 590.)

CarlO'VegetaMlis is also a remedy of importance in the last stages
of abdominal, and in all stages of putrid typhus. In the former, it may
sometimes be exhibited in alternation with Arsenicunij with good effect.
The following are the symptoms : Hippocratic countenance ; face pale,
yellowish, or dingy ; eyes sunken^and glazed, with nocturnal agglutina-
tion ; lips dry and cracked ; tongue dry, dark and tremulous ; position
upon the back ; cold, clammy sweat ; pulse rapid, trembling, and almost
imperceptible ; tremblings and jerkings of the limbs ; urine red and
high colored ; faeces putrid and offensive ; an entire prostration of the
animal powers ; heavy, pressing, or drawing pains in the head ; ulcera-
tion and bleeding of the gums ; rattling in the throat ; cramp-like
pressing, or burning pains in the stomach and intestines ; burning
pains and oppression at the chest ; rigidity or complete paralysis and
relaxation of the na.pe of the neck and limbs ; bowels swollen a.nd
tender on pressure ; feet, legs and hands cold ; numbness of the limbs ;
coma or sleeplessness, with muttering delirium, mind dull, confused,
wandering, or stupid.

Administkation. — A dose of the third trituration may be given in
water, every half hourjin extreme cases2 until the necessary impression
Is made*

TYPHUS ABDOMINALIS. 553

TIartmann recommends Stwphysagria in the first stage of the dis-
ease, when the following symptoms appear : " Sordes on the teeth, pale
and bleeding gums, with painful swelling of the gums, and rapid decay
of the teeth ; vanishing of thoughts and ideas ; weakness of memory ;
dulness of mind, great indifference and ill-humor ; vertigo, with stupe-
fying headache ; dimness of the eyes, itching, stinging, and heat of the
canthi ; fulness in the pit of the stomach, with frequent hiccough and
vomiting ; tension across the hypochondria, oppressing the breathing ;
pressure, weight and tension in the abdomen ; cutting pain in bowels,
with nausea, copious diarrhoeic stools."

Muriatic-acid is a highly important remedy in many cases of ad-
vanced typhus, when the patient is stupid, unconscious of surrounding
occurrences, and extremely prostrate. Other symptoms are, constant
tendency to settle down towards the foot of the bed, low muttering de-
lirium, groaning in sleep, moaning, picking at the bed-clothes ; inability
to protrude the tongue, dry heat, with transient and partial sweats ;
general uneasiness, " depres^o^ of the lower jaw, digging with the head
into the pillow, turning up the whites of the eyes, slavering, &c."
[Hem^el) We may employ the first to the third dilution — a drop in a
drachm of water, every two hours, as long as necessary.

Phosphorus. — Dr. Kidd says he has found Phosphorus a valuable
remedy in the treatment of the typhus which devastated Ireland during
the years 1847 and 48.

HhuS'tox,^ Bryonia and Arsenicum are also highly commended by
Dr. Kidd when " from the very commencement, the heat of skin and
acceleration of pulse are very inconsiderable, and in the middle and
latter stages, are almost invariably below the natural standard. For
two or three days the patient would labor under lassitude and languor,
with loss of appetite and of sleep, the tongue being generally the first
index of the probable mischief in store. About the fourth or fifth day,
the disease being generally well marked, with a very slight heat of
skin, which feels soft and clammy, being covered with moisture, (not
like the ordinary feel of a perspiring skin, as if the skin were damped,
and by some contrivance the evaporation prevented ;) the pulse very
little, if at all altered, except in strength, which even at this period
would be somewhat deficient ; the tongue presented a most character-
istic appearance ; in general dry, hard and glazed, like brown leather,
or deeply covered with brown or blackish fur. In some cases it ap-
peared soft, moist and tremulous, covered with a perfect and uniform
layer of pure white paste or mucus, (this in generally omened a very
severe and dangerous form of the disease ;) the gums and teeth became
covered with brownish incrustations; thirst being incessant and in-
satiable, with nausea and vomiting; in many cases abdominal symptoms,
as tension and tympanitic resonance of the abdominal walls, with

554 DISEASES OF THE SAlSTGIJIlSrOUS FTJITCTION.

tenderness and sliooting pain over either iliac region, (in general the
right ;) bowels seldom costive, in general relaxed, with or without pain ;
urme in a few cases suppressed, in most unchanged ; "head in general
implicated ; in most from the beginning, with aching and heaviness at
the forehead, throbbing at the temples, vertigo, sense of emptiness and
bewilderment; delirium mostly at night, with low muttering, or with
stupid, heavy insensibility and incoherence of speech. The eyes ap-
peared dull, inanimate, and listless, with the head instinctively turned
fi'om the light. In a few cases towards their termination, a peculiar
fe'ort of stolid deafness supervened, which gradually disappeared as con-
valescence advanced.

"Almost invariably the lower extremities w^ere complained of being
dead and numbed, rendering the least motion impossible, (but without
any actual pain,) the feet and legs feeling cold and damp.

" General debility and prostration set in early in the disease, and
proved the most obstinate of the symptoms." {Truths and their Be-
cejption^ &c., by J". Kidd, M. D. London,^1849.) Dr. K. relied upon
the four medicines above named in this form of the malady, and the
results show a mortality of less than two per-cent. His success in the
numerous cases of continued fever which came under his care was no
less gratifying. The low dilutions were employed for the most part;
but in a few cases drop doses of the tinctures were deemed neces-
sary.

The other medicines necessa,ry in the treatment of certain stages of
this,. as well as the other forms of typhus are: Bhus-tox.^ Acid-nit/ir.^
NuX'Vom,^ Secale-ooT,^ Mercur, Opiwn, Camjph,y Ohina^ Nux-mos,^
ValeT,^ Stram.^ Hyos.^ and Lach These remedies will all occasionally
be called into requisition, so that their effects upon che human system
should be well understood and appreciated.

It will be observed that we have divided typhus into iut three va-
rieties. Other authors d^Md^ typhus ^lotridusy typhus contagiousus^
typhuslentus^ tyjphus petechiaUs^ &c. In practice, however, we seldom
find any one of these forms distinct and unmixed* but the brain, ner-
vous system, lungs, and abnormal viscera partake more or less in the
general disturbance^ causing each particular case to present peculiar
and diverse symptoms. So in regard to the treatment of this fever, it
will often be found, from its commencement to its termination, to re-
quire one or more of the medicines which we have placed under each
form of the malady. The systematic connections are so strongly pro-
nounced, betw^een the important organs in which the different varieties
of typhus are located, that one can not be affected without imparting
the disorder to others.

Physiologists note it as a curious fact, that no two human faces are
•exactly alike, and it may be asserted with equal safety, that no two in

TYPHUS ABBOMmALIS. 555

stances of typhus fever ever presented, from first to last, precisely the
sanne symptoms. Therefore it is, that in all cases of this as well as of
other maladies, we must trust to sympto'ins alone^ and be guided by
them in the application of our remedies, rather than by the name of
the disease! Our nomenclatures and classifications unquestionably
facilitate the investigations and diagnosis of complicated cases, but they
can be of very little importance in the practical exhibition of medi-
cines.

Dr. Baertl who treated about thirty cases of this disease,^ found it
contagious, though commencing as an epidemic.

Treatment.— In the forming stage, Puis, and Nux.

When the fever and cerebral congestion are already manifest, Aeon,
and Bell., beginning with the former.

MerC'dulG,^ third trituration^ — Marked sensitiveness in the coecal
region; stools greenish, bloody, slimy, with tenesmus; burning in the
anus ; frequent pinching in the bowels, every two or three hours. In
the course of twelve to twenty-four hours the stools become less fre-
quent, more consistent, become yellowish or brownish. Other symp-
toms at the same time improve.

OalGarea-Garhonica^—Dv. Baertl cured all his cases w^hich progressed
to the third stage with this remedy, giving only Bell., 12^, every six
or three hours.

Symptoms. — -The diarrhoea increased and the strength declined ; the
delirium and waking visions became more prominent. If amendmenfe
did not soon occur, Calc.-carb., 6°, was given ^lone every six or three
hours, one drop in a spoonful of water. Under this treatment the dis-
ease rarely lasted beyond the 21st day of the disease. Even the
worst cases recovered under the use of these two last medicines, espe-
cially the Calcarea. In contrast we give a case of allopathic practice.

Case of Dr, Spurzheim, — He had been sick both in England and
France, and had submitted to medical treatment; and from its effects
he had inferred that it was not safe to place too much confidence in the
skill of the faculty or the virtue of drugs. He said he was present
when Cuvier was bled and protested against it, believing that literary
men did not bear that evacuation well He stated that his own con-
stitution was very irritable, and from childhood he could never bear the
powers of medicines. He was therefore in his last illness averse to all
medicines. When over-persuaded he took one drachm of Epsom-salts
Baying it would purge too much, which it did, and was checked with
Opium.

Dr. Jackson who thenceforward attended him says : On the 30th
October his tongue was perfectly dry, except a line on each side, dark

* Horn. Vierteljahrsschrift, Vol. XII. Part. 1.

556 DISEASES OF THE SANGUINOUS FTJNOTIOlsr.

but not thickly coated ; mucli thirst, no appetite ; occasional purgatives
had been given, pulse 96, firm, and with the hardness of age rathei*
than disease, though he was only 55. Pulse intermitted frequently,
though he said this had been the case for three years without any other
symptom of diseased heart; respiration natural. Could expand his
chest freely ; he struck it and it resounded well ; declared he had no
symptom of disease of that cavity; skin rather soft but slightly hot and
dry ; free from pain ; no bad feeling in the head ; occasional uneasi-
ness in the bowels, which he always removed at will with a lavement ;
nothing morbid in his evacuations ; most distressing symptoms were,
extreme restlessness, appearance of impatience, and very great watch
fulness.

From this to Nov. 5th the symptoms gradually grew worse, without
much change from day to day. On the 81st Oct., skin very moist, but
no other amendment. Exacerbation again in the evening, continuing
as usual to 3 or 4 a. m. Some sleep, though not more than three
hours in the night ; at times he showed great impatience and irritability
of temper, of which there was nothing in his usual health. This state
passed insensibly into delirium.

Nov. 5th he was plainly worse ; pulse quicker, though retaining in a
good degree its firmness. The tongue, which had been perfectly dry
from the beginning, now diminished in volume as if its whole substance
was dried ; respiration somewhat irregular ; frequent twitchings of the
muscles ; picking of the bed-clothes ; delirium increased. Next day
the bad symptoms much worse ; disposed to coma with intervals of de-
lirium ; respiration more hurried and irregular, some rattle in the
throat; pulse now 120, more feeble and unequal in force. From this
time all the symptoms were of unfavorable character, till the night of
Nov. 10th, he died a little after midnight.

The name of the disease was not perfectly decided. Dr. Jackson
said : " Call it a continued fever, in which nervous symptoms pre-
dominated ; there was no putrescency, no strong inflammatory symp-
toms. If called a pure typhus the name would mislead many. It may
be called a synochus, though not without dispute." "I would de-
scribe the disease thus : It was a continued fever, in which symptoms
of the access came on insidiously and were alone for many days. The
symptoms of the other stages were never permanent, those of crisis
never appeared ; there was no evidence of any inflammation any
where ; if it did exist it must be called latent. On the 30th of October
he was in the third week of the fever, though he had not been confined
to the house a week. In this advanced stage I have learned that
medicine is not of any avail." \Oa;pen's Biogra;phy of Spurzheim^
p. 130. Boston, 1832.)

TYPHOID FEVEE.

557

4. TYPHOID FEVER.

TYPHUS ABBOJVJINALIS EXANTHBMATICUS. ENTERIC FE^^ER.

'Geneeal Symptoms. — Shooting, throbbing headache in the forehead
and occiput ; vertigo ; dry cough, gradually becoming worse, increasing
the headache ; prostration, apparent from the patient's aspect ; these
symptoms followed by a general rigor, subsequently alternating with
heat, finally ending in continuous dry burning heat ; temperature of the
skin much increased. Pulse from the commencement accelerated, full,
though rather soft, 100 to 120 per minute. Rush of blood to the head;
redness of the face ; noise in the ears ; tongue clean or furred white,
subsequently becoming dry ; impaired taste ; pressure in the praecordial
region, or especially in that of the spleen ; no appetite, thirst, con-
stipation or diarrhoea ; evacuations of .fluid, yellowish or greenish ap-
pearance ; later these are mixed with flakes or with blood ; pinching
pain in the bowels, and often burning pain in the anus ; in the third
stage there is meteorism of the abdomen ; pressure on the abdomen
causes rumbling there, especially in the region of the csecum.

Urine scanty, turning muddy after standing a short time, and de-
positing a copious sediment ; and later in the disease is diminished in
quantity.

In the latter part of the disease the lips, teeth and tongue are covered
with brown sordes, are very dry, and the patient longs for water, the
strength declines and the patient becomes emaciated.

As the disease progresses nervous symptoms become more prominent

In this stage there is strong delirium, inducing many patients to get
out of bed. The nights from the commencement were very restless as
the patient lay in a stupefied state. This uneasiness increases with
the delirium, till a soporous state terminates in entire unconsciousness ;
the tongue is then drier, the pulse becomes more rapid and weaker ;
the breathing more hurried and labored. A characteristic of this form
of typhus is a kind of purpura on the surface, consisting of small red
spots, some of which are elevated; they begin to come out on the
abdomen, and in some cases extend over the limbs ; it varies in depth
of color, according to the severity of the disease from a pink to bluish-
red. In the later stage the skin becomes cooler. In many cases the
sputa were mixed with streaks of blood, and were expectorated with
difiiculty.

Causes. — Intestinal fever is a contagious disease. The following
characteristic features distinguish contagious fevers :

1. There is in contagious fevers a latent period after the occurrence
of the affection.

2. There is exemption conferred by one attack against any future
attacks.

558 DISEASES OF THE SANGUINOUS EUNCTIOK.

8. Large numbers of persons, though freely exposed to the fever-
poison, yet remain proof against it.

The immunity conferred by one attack against a future one was first
pointed out by Bretonneau. He said that in thirty years he never saw
an instance of this fever occurring twice in one person. Ghomel says,
no authentic case has been recorded, although the number of cases of
typhoid fever annually studied is large. M. Louis, the greatest au-
thority on this subject, living or dead, says, the town of Caumont was
twice swepf'by an epidemic of this fever, with a.n interval of eight
years between, and all persons attacked by the first visitation were
spared on the second. Dr. Budd says, he has sought for seven years
for persons who in their lives had typhoid fever more than once. ' He
has found four probable cases in ail. But he remembered many who
performed for weeks and sometimes for months together the ofiice of
nursing others, and were incapable of taking the disease themselves.

Conditions for the growth and develojpnrbent of the specific fe^er-
foison. The operation of all the poisons belonging to this group is
entirely dependent on their own reproduction in the living body. This
has been proved in the case of small-pox by inoculations on the grand-
est scale. In regard to all other contagious diseases we may not be
able to understand all that is involved in "the latest period." "But it
' is," says Dr. Budd, " as clear as day that its root lies in the infinitesimal
minuteness of the dose, which inoculation experimentally shows •to be
sufficient to the speedy effect of the morbid poison ; and to the intimate
nature of the material conditions which protect for the remainder of
life the body that has once gone through one of those diseases against
any future attack from it, may, possibly, always transcend our means
of research. The disease, called small-pox, occurs but once in life
simply, becausp the small-pox-poison can not grow again in the body in
which it has once bred. The same is true of intestinal fever."

The minute speck that is inserted by inoculation is so inappreciable
that the inoculated body takes at first no distinct recognizance of its
presence. It issues before long in a new stock sufficient to poison to
death the body, in which it is propagated, and sufficient also to impart
the seeds of death to myriads of others. Germ and offspring, seed and
crop, lie both before us distinctly displayed, as the seed corn and the
product of the farmer's cornfield.

In intestinal fever, as in small-pox, it is the act of growth (with all
that is incident to it) that kills. " The living human body is the soil
in which this specific poison breeds and multiplies ; and that most spe-
cific of all processes which constitutes the fever itself is the process
by which the multiplication is effected."

From what surface is the specific poison cast off by which the dis-
ease is propagated? All the emanations from the sick are infectious,

TYPHOID FEVER. 559

hut wliat is tlirown off from the intestines is comparatively more viru-
lent than any thing else.

The only means of preventing their exciting the disease in other
persons must consist in sufficient provision being made for preventing
the discharges from the human intestines from contaminating the soil
and air of the inhabited area. Without this the most complete venti-
lation is insufficient.

There is no safety but in good drains from houses, and water closets
in the best condition. Otherwise the disorder, which possesses such
virulent powers of propagation by contagion may become a most
deadly scourge. The alvine evacuations should be swept far away
from the house in which the sufferer lies. If this be not done, and
the discharges are allowed to accumulate day by day upon the soil in
which the dwelling stands, and to exhale their poison into the air
breathed by the inmates, or to distil it slowly into the water they drink,
most fatal results may be anticipated. The sanatary arrangement just
named has power almost invariably to prevent the spread of fever, but
in their absence every member of the family may be stricken down in
succession. Like malignant cholera, dysentery, and yellow fever, intes-
tinal fever is one that infects the ground, thus a quasi-miasmatic
chasacter attaches to them all.

All the morbid products thrown off by the intestinal fever patient
contain matters in which the fever-poison has set its seal in the most
consummate fashion. They are the most specific of all the exuyia
from the diseased body. And the sewer, which is their common recep-
tacle, is as the direct continuation of the diseased intestine.

As the poison that produces typhus fever acts on the blood alone,
that which causes typhoid enteric fever operates on the blood, but also
induces special lesions in the solids. It is a specific disease, not con-
tagious in the proper sense of that word, and caused generally by vi-
tiated air containing the emanations from large bodies of human be-
ings crowded together, aided by mental and bodily fatigue.

The precise nature of those emanations which produce this fever
are unknown. Impure air of every kind is unhealthy; but the offen-
sive gases generated from decomposing animal or vegetable substances
may cause disease, nausea, and great depression of the vital powers;
yet this fever seldom results from any of them. Mr. Brown, of Chatham,
(Eng.,) has endeavored to show that typhoid has always originated
"from the application to the alimentary canal of the excretia of the
intestines that have undergone alterations outside of the body." Thus
"faecal matters (altered in their nature) are swallowed in almost all
towns and cities, and even in lone houses in the country, in conse-
quence of the proximity of wells to privies and drains ;" hence, " blood
poisoning and disordered sympathetic nerve-force result, the skin and

560

DISEASES OF THE SANGUINOFS FUNCTION.

glands of the small intestine become diseased," and " typhoid fever,
which is essentially a privy-soil fever, is originated; but night soil can
give rise to other diseases, as cholera, diarrhoea, and dysentery. Oc-
casionally the opening of a long-closed privy is directly followed by
typhoid fever of a malignant type." {Brit Med. Jour, 1858.)

Typhoid fever is never absent from large cities. Where it has become
endemic. At certain times its power is heightened by great meteoro-
logical or other changes ; and, in imitation of plague, cholera, or yel-
low fever, it marches forth from its strong-hold, and reigns in both city
and country as an epidemic. .

It is generally admitted that typhus fever is induced by the respir-
ing of air charged with a large per-centage of effete animal matters
thrown ofi* from the lungs or skin of masses of people occupying
crowded apartments. It is essentially a product of over-crowding, and
is different from typhoid fever. In one experiment "an animal extrac-
tive matter was obtained from the respiratory and cutaneous excretia
of numerous individuals congregated in one apartment. This extrac-
tive matter was injected into the blood of a dog. The animal died of
low fever in fourteen days ; which it will be observed, constitutes the
full period of typhus fever. (BraitTiw, Retr, 1858. p. 21.)

Distinction between Typhoid and Typhus Fever.

Typhoid oe Enteric Feyee.

Has less of an epidemic, and
more of a local character.

Is known by its leaving well-
marked traces on the organism
after death.

Typhus.
Typhus is pre-eminently the type
of a blood disease — the fever poi-
son acting primarily on the blood,
and leaving, after death, little trace
of structural change ; prevailing
extensively as an epidemic ; and,
when once induced, it spreads by
by contagion, regardless of age, sex
or local circumstances. [Tweedie)
Epistaxis.
Present in one-third of the cases. | Seldom or never occurs.

Heakino.

Equally affected in both dis-
eases.

Eyes.

Deafness more or less complete.

Conjunctiva but slightly inject-
ed ; pupils larger than natural.

Generally moist. When dry,
it is often small, red, glazed, and

Conjunctiva much more con-
stantly and intensely injected;
pupils abnormally contracted.
Tongue.

Covered with thin white mucus
in the early stage ; less frequently

TYPHOID FEVER.

561

Typhoid ok Enteeio Fevee.
fissured; when brown, its hue is

Typhus.

less deep, — yellowish, rather than
blackish-brown, with red tip and
edges ; surface smooth, covered with
pale brownish-yellow fur, and ap-
pearing red between the fissures.
Scarcely able to protrude the
tongue.

moist throughout the disease. Only
one-fifth of a large number could
protrude the tongue ; showing ex-
treme prostration. The tongue,
teeth and lips were then covered
with a dark-fuliginous incrusta-
tion, nearly black ; surface shriv-
elled or fissured, sometimes coat-
ed with blood. The sordes exhi-
bit blood discs from local haemor-
rhage.

Intestinal Haemorrhage.
Occurs in one-third of the cases. Seldom or never occurs except

from haemorrhoids. Constipation
more persistent; no gurgling over
the region of the caecum.

Constipation followed by watery-
diarrhoea with griping. Abdomen
inflated ; noise excited by pressure
over the right iliac fossa.
Appetite and Thirst.
No difference between the two I
diseases. ]

Pulse.
It fl-uctuates from day to day. |

CoHOH AinB Physical Sigks.

Sonorous rale present in eleven-
twelfths of the cases.

Dulness of the lung rare.

In only one-third of the cases.

Frequent in both diseases.

Dulness of the most depressing
part of the chest, from intense con-
gestion of the lung, is common.
Sloughikg.

Erysipelas.
Occurs in nearly one-third of I In less than one-twentieth of the
the cases. I of the cases.

Cadaveric Rigidity.
Continued longer. | Ceased quickly after death.

Discoloration of the Walls of the Abdomen, and of Skin cover-
ing LARGE Veins.
Seldom seen. | Very frequent.

Vol. L— 36.

562

DISEASES 0F THE SANGUINOUS FUNCTION.

Typhoid or Eistterio Feyer.

Typhus.

further

Emaciation.
than i]

Progresses
typhus.

In protracted cases it is extreme.

Spots on the Skin.
None visible after death. | Continue visible after death.

Head.

After death, the vessels of the
pia-mater were abnormally filled
with blood in one-third of the cases ;
intensely injected in one of fifteen
cases ; the cerebral substance con-
gested in one-seventh of the cases.

In many cases, no trace of dis-
ease discovered in any organ. The
pia-mater and arachnoid separated
with abnormal facility in nine of
eleven cases ; the vessels of the
pia-mater were congested in nearly
one-half, and intensely congested
in one-fifth of the whole of the
cases. Cerebral substance abnor-
mally congested in one-half.
Age.

More common in persons under
forty years of age.

More
fifty.

common m persons over

Mode of Attack.

Disease commences insidiously
and progresses slowly. Heat of skin
moderate or absent.

Heat more marked in the early
stage and in the exacerbations.

Early symptoms more violent;
their accession more sudden.
Duration.

Average duration in fatal cases,
twenty-two days. In some instan-
ces it extends to forty, fifty, or tieth.
sixty days.

Eruption.

In fatal cases fourteen days.
Few or none live beyond the twen-

Of a different character, though
of a reddish hue.

The spots disappear on pressure,
last but for a few days only, and
are succeeded by a fresh eruption
as long as the disease continues.

Is known as the mulherry rash.
It a?Z -comes out early in the dis-
ease ; at first elevated, then darker.

Is seen in three-fourths of the
cases, and in all over twenty- two
years old. Appears from the third
to the seventh day, first on the
trunk anteriorly, the spots varying
in size from a point to three or
four lines in diameter, having an
irregular outline. Sometimes fe\>'

TYPHOID FEVER.

563

Typhoid or Enteeio Fever. Typhus.

in number ; oftener, numerous small
sp-ots uniting to form large ones.
Color dusky-pinkish, afterwards
more dark, each patch remaining
till the disease terminates. The
depth of the color is proportioned
to the gravity of the fever.

Miliary Vesicles, or Sudamin^.
May be seen in both diseases in I Not seen in patients over forty,
patients under forty years of age. |

Expression, Manner, Hue of Face, &c.

Not indicative of extreme pros-
tration, countenance anxious, com-
plexion clear, flush of brightish
pink color on one or both cheeks,
circumscribed.

Countenance less anxious, com-
plexion thick and muddy, flush of
the face uniform and of dusky
red color.

Headache.

It disappears only about the
fourteenth or seventeenth day.

Rarely absent in the beginning.
Disappears about the tenth or
twelfth day, or after that time
comes at intervals.

In some cases it occurs

Delirium.
before Begins before

the fourteenth day, in others by
the eighth ; slowly increasing in
severity.

and is then less

times noisy.

but

the fourteenth,
violent. Some-
often low

and muttering.

Somnolence.
Begins after the fourteenth day. | Begins before the fourteenth day.

Coma- Vigil. .
Seldom or never occurs. | It occurs in one-fifth of the cases

Spasmodic Movements.
They occur in equal degree in
both diseases.

Involuntary Discharges from the Bladder and Bowels.
Occur at a late period. | Occur at an early period.

Loss of Muscular Power.

One-fourth of the patients keep
he bed entirely before the seventh
day. Prostration not great before
the fourteenth to the twentieth.

Patients all keep their beds en
tirely before the seventh day.
Prostration extreme by the ninth.
Loss of expression of the face.

564

DISEASES OF THE SANGTIIlSrOUS FUNCTION.

Typhoid oe Enteric Feyee.

Typhus.

H^MOEEHAaE into THE CaYITY OF THE AeACHNOID.

Not found in any case.

TJicerated
fixtal cases.

Ulcerated
the cases.

Occurs in one-eiglith of the
cases examined.
Pharynx.
in one-third of the 1 Not seen in any case.

(ESOPHAOUS.

in one-fifthteenth of I Free from ulceration.

Stomach.

Mucous membrane not softened
throughout its whole extent in any
case of fifteen.

In a very few cases it is soften-
ed ; in some all the coats of the
stomach softened.

Small Intestines and Mesenteric Glands.
Peyer's patches, and the corres- Invariably normal,
ponding mesenteric glands are in-
variably diseased. In sixty cases of
typhoid fever in the Crimean hos-
pitals, these glands were affected
in fifty-nine.

Large Intestines.
Mucous membrane found ulce- In no instance found ulcerated,
rated after death in more than a
a third of the cases.

Spleen.
Enlarged in all cases; softened Before the age of fifty it is en-
in one-third of the cases onlv. larged ; after fifty it is smaller ;

and softened as in typhoid. The
bile is thicker and of dark green
color. Kidneys, liver, and pancreas
more fiabby -than in typhoid. Heart
flabby, lining membrane darker red
than in typhoid.

Patholooy. — The first morbid change observed in the intestine in
enteric fever is slight swelling of the mucous membrane, covering
Peyer's patches ; to this rapidly succeeds the deposit of typhous matter,
which soon presents the appearance of a deep brown or yellow sloughy
patch ; this is in a short time detached, leaving a cavity or ulcer on the
inner surface of the intestine, known by the name of a typhous ulcer.

The seat of the lesion is the lower third of the small intestine, the
number and size of the ulcers increasing as they .approach the c^cal
valve.

TYPHOID FEVEE. 565

The typhous ulcer, when it corresponds to the infiltration and detach-
• ment of a large Peyerian gland, is elliptical in form ; when it corres*
ponds to a solitary follicle, or a rounded patch, or to the partial detach-
ment of a glandular plexus, it is round; when corresponding to a par-
tial detachment, it is irregular or sinuous.

The ulcer varies in size from that of a hemp-seed or pea to that of a
half crown.

The patches are placed opposite to the insertion of the mesentery,
their long diameters being always parallel to the longitudinal axis of
the intestines. The typhous ulcer ¥<^as only seen by Rokitansky to
form a zone in one instance out of many hundreds.

The base of the ulcer is formed by the delicate layer of sub-mucous
tissue, which covers the muscular coat, a well-defined fringe of mucous
membrane forming the margin.

Ter'inination of the typhous tdceration.—MilA. cases terminate in
resolutioii ; in severe ones the ulcers may cicatrize. In one or more
patches in patients who have died from other causes, smooth polished
ulcers have been seen near the caicum. They were covered with a thin
transparent pellicle, continuous with the sub-mucous tissue around the
ulceration.

The conditions necessary for the favorable healing of the ulcers are:
1. the cessation of the deposition of the typhous matter, and complete
extinction of the typhous dyscrasia ; and 2., the holding out of the vital
powers to withstand the exhaustion caused by the ulcerative process.

When cicatrization does not take place the destructive process of
ulceration successively lays bare the mucous, the areolar and muscular
coats, until the thin transparent peritoneum alone remains. When com-
plete perforation takes place, the contents of the intestines escape into
the peritonial cavity and give rise to acute peritonitis. The perforation
is usually very small and is found in the centre of the ulcerated patch.
This occurred in 20 out of 1820 cases in the London Fever Hospital.
(Tweedie,- Lumleian Lectures^ 1858.)

Changes m the Blood. — In typhus and typhoid fevers the blood be.
comes altered in its chemical composition. The quantity of fibrin is
never above the normal standard, but diminishes in proportion to the
duration of the disease ; the blood corpuscles increase ; but the red
color and fibrinous consistence are lost That the blood is liable to
alterations in its consistence in disease, will be shown under the head
of diseased states of the blood. It was remarked by Borden, that
blood is fluid flesh ;" and it is known that it contains the same proxi-
mate principles as the solids of the body, and also that it is organized and
apparently endowed with vitality. Dr. Stephens says, that he and other
practitioners of the West Indies observed that in persons exposed to
the fever-producing malaria, the blood was altered before other symptoms

566 DISEASES OF THE SANGUIKOTJS FUNCTION.

of fever were discovered. From this altered state of the blood in typhous
fevers arise the nasal and intestinal haemorrhages that often occur be-
fore their termination. .'¥ or Treatment see page 547.

5. YELLOW FEYEE.

Mode of Attack, — In some cases it may strike its victim suddenly
prostrate, overwhelming in its severity the whole system, and thus
preventing any reaction of the capillary vessels ; or it may advance
mildly, differing but little from an ordinary attack of remitting fever.
In some instances it bears a strong resemblance to the higher grades
of bilious fever. Much depends upon the peculiar circumstances of
the individual attacked. If he is recently from a temperate climate,
and unaccustomed to hot regions, he will be more susceptible to the
action of the poison than if he had been previously acclimated.

Medical men have supposed that after a certain period of exposure,
the system becomes so completely accustomed to the miasm, that it
loses all susceptibility to its influence, and in this manner the process
of acclimation is accomplished. There is doubtless some truth in this
idea, but there are other causes which exercise quite as important an
influence in this process. Those persons who abandon a temperate for
a tropical climate, do so in that physical condition which the require-
ments, habits and regimen of the former naturally generate. In a pre-
vious chapter we have seen, that in cold regions, where the atmosphere
is highly condensed, a large amount of animal food is requisite to supply
the system with sufficient carbon and hydrogen to resist and neutralize
the action of the inspired oxygen- With these habits, appropriate only
where a condensed atmosphere is respired, individuals seek the tropics
with bodies abounding in carbon, and continuing, in most instances,
their accustomed regimen of animal food and stimulants, thus burden-
ing their systems with an amount of the elements of nutrition far greater
than the oxygen contained in the rarefied air which they inhale can de-
compose. See page 186.

It is probable, therefore, that one of the chief predisposing causes
of yellow fever, is the presence of a greater amount of carbon in the
system than the inspired air can properly act upon. The exact equili-
brium between the supply of the elements of the food and the absorbed
oxygen, is disturbed ; and the carbon predominates, and all of those de-
rangements, which proceed from a superabundance of this agent neces-
sarily ensue.

The inhabitants of tropical climates have comparatively but little
desire for animal food, but prefer farinaceous diet, vegetables and
fruits ; in this manner naturally securing to themselves a due propor-
tion between the elements assimilated and the oxygen absorbed ; while
the inhabitants of the north find it necessary to consume large quanti-

YELLOW FEYEE. 567

ties of meat and otlier articled abounding in the elements of nutrition
in order to preserve a healthy equilibrium. We, therefore, strongly
urge it upon persons who remove from cold to hot climates to adapt
their systems, by appropriate regimen and strict temperance in all
things, for the change, and we confidently predict that they will enjoj
as great an immunity from this dreadful scourge as the natives them
selves.

Preriionitory By'Ufijptoins. — Giddiness, wandering pains in the back
and limbs, " cold in the head," slight chills, nausea, headache and fre-
quent sensations of faintness. Later appears a febrile paroxysm, fol-
lowed by a perfect lull of the symptoms; subsequent appearance of
jaundice, hsemorrhages, gastric irritability, dysuria.

Second Stage. — After early symptoms have continued a few hours,
a decided reaction occurs ; the circulation becomes excited, the face
flushed, the eyes red, brilliant, injected; pulse from 100 to 130 ; there
are violent pains in the head, back, loins and extremities, distress of
the stomach, and vomiting of acid bilious matters ; the surface becomes
dry und burning hot ; mouth and throat dry, with intense thirst and
sometimes delirium ; urine scanty and high colored ; tongue covered
with a pasty white coat, vfith red edges and apex; in some cases mu-
cous or bilious vomiting.

The duration of this paroxysm is usually about tvrenty-four hours,
although occasionally it continues, thirty-six hours or more, after which
there is generally a remission of all the symptoms, except a distressing
sensation in the stomach,' with nausea and vomiting. The patient re-
mains in this state with a considerable degree of comfort for a few
hours, with partial perspiration, when there is a recurrence of many of
the former symptoms in an aggravated form. The stomach now be-
comes extremely painful, burning and sensitive ; vomiting is violent and
incessant; flatulence, thirst, and nausea; the fluids ejected are of a
darker color ; there is often diarrhoea, generally constipation ; the skin
and eyes acquire a yellow lemon tinge ; there is tossing and restless-
ness ; dysuria ; and the mind becomes confused and wandering. The
pain in the head, back and limbs are less violent than before, and the
pulse, tongue and skin may remain nearly natural ; but the case is
hourly becoming worse, and the fever assumes a typhoid character.

The duration of this second stage varies from twelve to forty-eight
hours, with sometim_es slight remissions towards the termination of the
paroxysm, when the third or last stage sets in. This stage is character-
ized by greenish yellow, brownish or claret-colored vomiting ; the com
plete development of the dreaded " hlach vomit^^ leaving but a ray of
hope. At this period the temperature of the skin falls, and the powers
of the system all sink rapidly ; the pulse flags, and perhaps intermits ;
the tongue becomes dry, black and shrivelled ; the breathing irregular

568 DISEASES OF THE SANGUITSTOUS FUNCTION.

and laborious ; cramps seize tlie calves of the legs and the bowels ^
the whole countenance loses its natural life-like expression ; the ex-
tremities become cold; colliquative sweats, petechia in protracted
cases ; diarrhoea, haemorrhages, loss of intellect and coma occur, and,
finally, convulsions and dissolution end the scene.

This is only a brief outline of the more ordinary symptoms and
course of the malady, and w^ill, we trust, serve to aid the inexperienced
practitioner in his diagnosis. Each case, however, must necessarily
present modifications according to the predisposition, habits and pecu-
liar circumstances of the individual attacked. We give a few memo-
randa of some of the earlier epidemics.

In 1825 the yellow fever was carried to Washingt^^n, Mississippi, by
the people, flying from Natchez. Its course there is given by Dr.
Monette : Th% commencement in almost every case was between mid-
night and morning, with stretching or uneasiness and yawning, slight
sensation of cold, though not a chill ; the rigors short and followed by
ardent fever ; skin hot and dry, harsh to the touch ; countenance
flushed, and scarlet color; indescribable anxiety; eyes watery or
suffused with blood. Pain in various parts of the body, worst in the
head, eye-balls and back ; sensation of soreness in the left umbilical
region ; functional derangement extensive ; disease hastening on to a
fatal termination. During the first days of the disease, frequent eruc-
tation of wind ; burning and distention of the stomach. The stage of
excitement continued from 1|- to 8 days. Then the stage of collapse
ensued; pulse became feeble, extremities and surface cold; when free
stimulation can alone prevent extinction of life. A stupor generally
prevailed from the commencement, with fulness in the head, tightness
across the eye-brows, pain and soreness in the upper portion of the
globe of the eye and levator muscles ; the patient therefore lay with
eyes closed, and inattentive to surrounding objects. Delirium in the
lighter form common, but not furious. The tongue livid, in the first
stage covered with white mucus ; in advanced stage, brownish, dry and
extremely rough. The surface hot and dry until collapse commenced ;
in severe cases no means succeeded in exciting favorable diaphoresis
till the approach of death was shown by the clammy and cold sweat.
Pulse, in first stage 90 to 120, full, frequent and soft ; and this con-
tinued till death approached, when it became quicker, more feeble,
progressively imperceptible. In some the pulse was diminished in
activity by treatment. It then continued for 86 to 40 hours before
death, slow, full and soft; apparently in all respects the pulse of perfect
health, though death was rapidly approaching. The bowels were at
first inactive ; after purging was excited, the evacuations continued
copious, numerous and watery, covered with white scum, seeming to be
the mucous membrane of the bowels ; great prostration and the hippo-

YELLOW FEVEE. 569

cratic countenance soon followed tlie operation of a purgative. No bile
was passed from the stomacli or bow^els. The skin was not yellow in
all cases. In some the whole body was deeply tinged like jaundice ;
especially just before death. The lungs are alw^ays deeply affected, and
the disease seems to invade the body through the lungs.

Epidemio of 1839. — The population of Natchez in August was
estimated at 5000, of these 265 died of yellow fever, besides a few
more who were taken to the country. Many left the city on the com-
mencement of the disease, and by the first of October not more than
1500 remained. Large numbers of the acclimated and blacks took the
fever, of whom some died who had had it before. It commenced insidi-
ously ; many seemed exhilarated and boasted of their good health but
a few hours before they were attacked. Others were greatly depressed,
and indifferent to surrounding objects ; horripilation increased till there
was slight coldness of the hands and feet and sense of chilliness down
the spine ; lasting from a few minutes to some hours. In the mild cases
the excitement was free ; pulse from 85 to 100, full, firm, resisting.
Skin hot and dry, and seldom yellow. Pain in the head, back and
limbs moderate ; restless, watchful, but rarely delirious ; tongue moist
and clean, or covered with thin white fur; considerable thirst; after
a few hours the stomach irritable and sore to the touch ; frequent vom-
iting of fluid resembling that of 1837 ; bowels slow ; urine scanty and
high colored; in fatal cases it was entirely suspended. In these sore-
ness of the abdomen and vomiting increased; hiccough common; in
some cases a morbid secretion of gas by the stomach was more dis-
tressing than the vomiting.

In more violent forms of the disease there was no appreciable chill;
skin cool or moderately warm and of a leaden hue ; excitement irre-
gular, pulse varied from 100 to 130, with throbbing of the carotids ;
shrunk features ; cold or cool extremeties ; little pain ; great oppres-
sion of the stomach, with soreness to the touch in some cases ; tongue
moist, pale, expanded, with a pale blue fur and red edges ; thirst and
distressing vomiting ; constipation obstinate ; evacuations, if procured,
of a dark and muddy cast, or liquid and nearly colorless ; urine scanty
thick, dark ; resembling black vomit, or totally suspended. In some
cases black vomit early, and death occurred within three days. Many
seemed to die without signs of inflammation; but from nervous ex-
haustion. In these there was no black vomit. The skin became in-
variably yellow after death.

Haemorrhage from the nose was favorable, but from the mouth,
bowels or kidneys always unfavorable, and generally followed by death.

The signs of convalescence or death were obscure. One man who
had been sick six days was mortified, and death took place in ten
hours more ; though then, there were no symptoms of approaching

570 DISEASES OF THE SANGUINOUS FUNCTION.

death. The mind was calm, pulse open, soft, 80 per minute, stomach-
quiet, but bowels liquid. No prophylactic but temperance was effect-
ual. Calomel was relied on by many ; but several were attacked when
under its. influence, and some died when highly salivated, though i
was generally favorable. (Dr. Hogg^ W, Med. Jour., 1840, p. 418.), .,

Causes. — When animal and vegetable matters are submitted, for
considerable length of time, to the daily influence of intense solar heat,
and a certain amount of moisture in the crowded and filthy streets of
cities, or other confined places a miasm is generated, which, under
favorable circumstances, will cause yellow fever. Concerning the
nature of this miasm, nothing is positively known ; but it is evident
that the continued high degree of temperature to which these substan-
ces are exposed, and the confinement of their noxious emanations within
the limits of crowded cities develops a more virulent morbific agent
than originates from a similar exposure of the same matters in the
open country, or to a more irregular and less intense heat, such as
usually occurs in more temperate localities. Among predisposing
causes we mention : — too free use of animal food and stimulants ; irre-
gular habits, mental anxiety, depression of spirits, fear, grief, exposure
to night air or to a burning sun, and, indeed, whatever else tends to de-
bilitate the organism.

The nature of the specific poison that produces yellow fever, is still
an enigma among medical philosophers. The opinion is gaining ground
that the specific cause of this disease consists of minute fungous spo-
rules. Mr. Hassell says, {Zanoet, Feb., 1853,) that the matter of
" black vomit," examined by him with the microscope, consisted of a
vast number of irregular, brown-colored bodies, resembling blood discs,
shrivelled and discolored, but insoluble in Acetic-acid. From this in-
solubility he inferred that they could not be blood discs, and that they
must be sporules of a microscopic fungus, and that they might be im-
portants agents in keeping up the vomiting.

The relation between yellow fever and intermittents will we think be
found to consist in their being each, produced by a specific malaria
consisting of an infinitesimal fungus entirely distinct from all others,
though in many respects they obey similar laws, as has been fully
illustrated by Dr. J. K. Mitchell, of Philadelphia.

On no other theory yet proposed can we explain the introduction of
yellow fever by means of trunks and unwashed clothing from infected
places into new localities where it never appeared before. It has sure-
ly been often proved that yellow fever is a non- contagious disease /
but it is equally well established that it can be introduced.

Thus, Dr. Holcombe, (iT". Amer. Jour. Hommojp., 1856,) says he has
seen enough in this year alone, to say nothing of two years previous,
to convince him that the yellow fever as it appea,rs on the banks of the

YELLOW FEVER, 571

Mississippi, is "a palpably contagious disease, communicable by con-
tact of a person^s' clothing. This little village of Waterproof, La.,
never presented a case of it until this year. It has raged above and
below us, but never appeared amongst our population, the autumnal
remittents and malignant intermittents when prevailing here were never
known to turn into yellow fever, or be mistaken for it. A stranger
from New-Orleans, sick of the disease, is landed from a boat, he con-
valesces and leaves ; but in the course of a week others are taken, and
very soon the constantly increasing virus infects the whole atmosphere,
and we have more than 100 cases in the course of a month. A gentle-
man residing several miles out of Natchez rides into town to see his
brother's family, sick of yellow fever, assured by the physician of its
non-contagious nature. In a few days he sickens ; next his wife, then
the chamber-maid, then their children, and so on until 12 or 13 cases
occur, all the persons in the place being exempt except those who came
near the sick persons or the sick rooms. A negro accompanying his
young master to college, is taken sick one night at a gentleman's coun-
try-seat remote from all towns and public raads, where every one else
is and has been for weeks in perfect health. He gets well and goes
away ; but several of the family who were with him sicken, and three
die of black vomit. It is now found that the same disease has also
broken out at the place the negro started from, he having had the
germs of the complaint in his system in a state of incubation. We need
not adduce more examples. We have seen and heard of so many
similar cases that we feel impelled to recommend unprotected, unac-
climated persons to get out of its way, and to lend our cordial support
to all sanatary, hygienic and quarantine regulations which may promise
deliverance from its visitations."

These facts certainly prove that yellow fever can be conveyed from
one place to another, and from one person to another; but we are also
obliged to accept a vast number of other well-attested facts which
would, if seen alone, prove that the disease is not always communicable
by contact. We think, however, that all the facts on both sides of this
long-debated question are explicable on the theory above alluded to.
Yellow fever, if not always communicable by contact^ is beyond all
question a eommunicahle disease ; one that may be carried in trunks
or clothing, in filth and animal impurities, which in darkness and damp-
ness furnish the most favorable place for the growth of cell-spores.
When thus carried to a northern city, these minute cryptogamic fungi
encounter the usual difficulties of tropical plants attempting to estab-
lish themselves where the soil and climate are not the most favorable
They m<2y grow in New- York, though transplanted from Havana or
Vera Cruz ; but if they do grow it must be under the molt favorable
conditions ; the soil, temperature, &c., on which the prosperity of the

572 DISEASES OF THE BAJS'GUIKOUS FUNCTION.

whole tribe of fungi depends, must be favorable. The germs, when once
ashore, may slowly migrate towards the land, and even by chance be
wafted to other neighboring spots, where they may grow and create
new foci of disease. As in such places yellow fever is an exotic, it
cannot flourish as successfully as in its native climate; and it is always
destroyed by the first frost. We thus see how it is that yellow fever,
though not contagious, can he imported ; that it spreads but little in
northern villages ; that it may become epidemic in cities in which great
impurities are permitted to accumulate ; that in the warmer cities of
the South it may originate from cell-spores of the preceding season
which the mild winter had not entirely destroyed.

It is then easy to understand how yellow fever 7)iay be imported,
and we can also understand why it is rarely done. We may see why
a disease not contagious may travel occasionally to a hamlet or vil-
lage. And we may "account for its apparently spontaneous appear-
ance in such places as Charleston, Savannah, and New-Orleans, in
which the winter may not be severe enough to kill the germs, but may
so effect them as to make their reaction difficult or partial " The
New-Orleans Board of Health in the report of 1860, thus concludes :

" The data which precede are, we believe, amply sufficient to con-
vince the most skeptical of the spontaneous occurrence of S'jporadic
yellow fever in New-Orleans. We hope they will prove sufficient to
men of the profession, as the medical history of the year 1860. The
logical conclusion we may draw from the facts which we have cited, is,
that it is of the utmost importance to protect the city from the impor-
tation oi yellow fever, since the imported fever tends evidently to be-
come epidemic^ whilst indigenous yellow fever appears, on the con-
trary, to assume a sporadic character."

With the history of yellow fever before us, we are able to under-
stand how a crew, perfectly healthy, may bring with them in the closed
hold of their ship the germs of disease, which may afterwards infect
those who unload the ship. These first cases may, after a few days
be followed by other cases in the vicinity, originating from a new crop
of cell-spores grown upon the land. On this theory we can explain,
more satisfactorily than on any we have examined, the anomalies and
inconsistencies of Asiatic cholera; "its progress along streams, its
preference for the damp parts of cities, its domestication in India," its
capricious choice of places in which to break out anew. We must
presume that the specific causes of these two diseases are distinct from
each other; but that the producing cause of each, most probably
" consists of invisible organic spores, which are capable of being con-
veyed in the atmosphere, reproducing themselves where the proper soil
is found in which they can grow, and dying out when this appropriate
soil is not found." Sec " Caicses of Malarious and Epidemic J)is-

YELLOW FEVEK.

573

easesP by J. K. Mitchell, M.D. Phila. 1847 and 1859. Also Amer,
Horn. Eemew. Vol. II. p. 49.

Patpiology. — Dissectionof those who have died of this fever has shown
no evidence of inflammation as the cause of death. Neither fibrinous
effusions, adhesions, thickening, indurations or ulcerations, the common
traces of inflammation have been fo.und. The burning of the stomach,
the tenderness on pressure are only evidence of "a perverted applica-
tion of the nervous energies, emanating from the nervous centres," with
depraved secretion, especially in the liver and kidneys. " The next
remarkable efiect, says Dr. Holcombe, "is the stasis of the blood; and
when we recollect that the blood-vessels are supplied with nerves from
the great sympathetic, we may readily conceive the dependence of this
symptom, also, on the state of the ganglionic centres. The next symp-
tom we might expect to be arrest of secretion, and f b it is. A diseased
organ already secreting badly, or abnormally, in which deteriorated
blood stagnates, is not likely to secrete at all. The liver is generally
the first to stop working; the kidneys the last. The matter vomited
for some time previous to black vomit has seldom a trace of bile. Ab-
sorption, however, is still comparatively active. The bile last exuded
from the hepatic cells, and stagnating in the radicles of the biliary
duct, from absence of the vis a tergo, is taken up into the circulation,
and gives the yellow tinge to the urine, skin, conjunctivae, &c. The
same thing happens in jaundice, and is a symptom of very little impor-
tance. The state of the liver, in yellow fever, is but one link in a long
chain of morbid phenomena, and by no means the most essential one.
The absorption of the last particles of urea, secreted in the cortical
portion of the kidneys, is a more dangerous symptom, because urea is
a prompt and fatal poison to the nerve centres." (iT. Amer, Jour,
Horn. Vol. III. p. 489.)

There is a progressive poisoning of the blood in yellow fever, as in
other zymotic diseases. This "deterioration of the blood is not pro-
duced by the multiplication of virus in the molecular form." The virus
enters the blood when the disease is propagated by contagion. It acts
on the nerve centres as do other absorbed poisons, and the changes it
produces there cause the vitiation of the blood that is seen in yellow
fever. The change of color is often produced by apparently trifling
causes. " A fit of passion produced almost instant jaundice, absorp-
tion of bile, effusion of yellow serum into the cellular tissue, conjunc-
tivae, &c., in Murat, when he was king of Naples.'^

The hsemorrhagic transudation of the second stage depends upon
^the want of plasticity and arterialization of the blood, and the relaxed
state of the capillaries, induced by their abnormal innervation." Black
vomit, the most dreaded of these exudations is blood chemically modi-
fied by the gastric secretions. The vomiting preceding its appearance is

574 DISEASES OF THE SANGUINOIJS FUNCTION.

almost always intensely acid. Tlie blood is poured out by a kind of
exosmosis ; for the membranes are free from any trace of rupture.
The albuminous part of the effused fluid is coagulated into that finely-
granulated state, compared to coffee-grounds, while the coloring matte.r^
already dark by carbonaceous matters, is rendered pitch-black by the
sulphuretted hydrogen and other chemical agents always present in
the intestinal tube. This coffee-ground substanqe is only found in that
tube, the haemorrhages from other points being uniformly of dissolved,
molasses-like blood." {Holcombe on Yellow Fever,)

Yellow fever shows itself in its most fatal form when concentrated,
as on board a ship, and it can from such a point be propagate-d to an
indefinite extent ; but when it is diluted by being spread over a large
part of a town, its virulence is greatly diminished; it then can only be
propagated in the milder form, and is still further modified by being
communicated from one person to another. The conclusions reached
by Dr. Neidhard are :

1. That yellow fever will only show its most deadly effects when in
its most concentrated form ; 2. that there must be a peculiar suscep-
tibility of the individual to this particular poison at the time of his ex-
posure, in order to show its most fatal effects. These observations hold
good with all epidemics.

The epidemic commenced in 1853 in Philadelphia, in the vicinity of
a vessel which had arrived from Cuba, on the 12th of July. The crew
were reported healthy on their arrival, but the hold emitted an offen-
sive smell, when the bilge-water under her flooring was agitated by the
pumps. The disease spread from the centre of South-street wharf, in
the vicinity. The official reports showed 107 cases with a mortality
of nearly eighty per-cent. Dr. Gilbert, the port-physician, and Drs.
Sewell and Stokes reported, that black vomit occurred in twenty-six
out of forty-four cases, and exhibited under the microscope the true
blood corpuscles; the peculiar yellow, sometimes bronzed skin, was
more apparent after death. The post-mortem examinations, made in
eleven cases, showed invariably the yellow or ochre-colored liver, and
the coffee-ground fluid or melanic blood in the stomach and intestines,
as the true evidences of the malignant form of the fever.

TREATMENT.-T-The remedies most commonly applicable to the treat-
ment of this 'affpction are, TpeoaGuanha^ Belladonna^ Bryonia^ HJvus^
Arsenicicm^ ?iT\di Aoonite, The other medicines likely to prove ser-
vHceable are Nux-vomica^^ Mercurius, Veratrum, China^ Sulphm-^
Cantharidesy GarbO'Vegetabilis^ and Crotahcs, Dr. Taft, of New
Orleans, whose, success in the treatment of yellow fever Was so great
as to attract the marked attention of a large number of citizens, and
raised high expectations of important improvements in the manage-
ment of this disease, relied chiefly upon the following remedies :

YELLOW FEVEK. 575

In the first stage : Aconite^ IpeGacuanha,, Belladonna^ Bryonia^
which were often used also in the next stage.- — Second and third
stages.— li\ addition to the above : Ehus-tox., Arsenieum, Veratrum^
Cantharides^ Oarlo-veg,^ Nux-^om, These medicines were usually
employed by Dr. Taft at the first attenuation, and frequently repeated,
either singly or in alternation, as the circumstances of each case ap-
peared to require.-

Camphor, — In the cold stage tincture of Camphor, one drop every
ten minutes, is effectual here as it is in the cold stage of epidemic cho-
lera and of intermittent fever, li^ primary effect "is a great reduc-
tion of animal temperature." The effect is but transient, it needs to be
often repeated, and it is soon out of the way of the next remedy.

4^conite and Belladonna in alternation are the specific remedies for
the first stage. "They are complements to each other in making out
the whole morbid picture." These remedies followed by Ipecacuanha
were sufiicient for all the milder cases in late epidemics.

In the yellow fever of the Mississippi Drs. Holcombe and Davis of
Natchez used, In addition to the above, the following remedies : Arse-
nicum, Lachesis, Crotalus, Mercurius, Colocynth, or Phosphorus.
Veratrum for vomiting and abdominal pains. Tartar-emetic for pro-
longed and distressing nausea; also Ghamomilla in cases of women
and children. Gantharides for strangury, Nux-vomica in intemperate
persons ; Ghamomilla, Sabina, or Secale generally caused the symp-
toms of threatened abortion to disappear. Rhus and Bryonia for the
prostration, which followed the acute stage of the disease. Bell.,
Coffea, Hyoscyamus for nervous sleeplessness.

When the first symptoms declare themselves, as dizziness, slight
■ chills, pains in the back and limbs, uneasy sensations at the epigas-
trium, with nausea^ vomiting, and sensation of faintness, Ipecacicanha^
at the third iattenuation, should be immediately exhibited. This re-
medy may also be found serviceable during the second and third stages
in alternation with some other article. During the further progress
of the disease the following remedies will be found available.

Belladonna, — Glowing redness and bloated appearance of the face;
eyes bright red and sparkling, or fixed, glistening and prominent;
tongue loaded with whitish mucus, or yellowish, ar brownish ; pulse
variable.

Dry burning heat ; sharp, darting and shooting pains in the head ;
throbbings in the head ; burning thirst ; painful heaviness and cramp-
like pains in the back, loins, and legs ; pressure, cramplike, and con-
tractive pains in the stomach; inclination to vomit, or violent vo-
mitings.

During the remission, mela,ncholy ; dejection ; when reaction comes
on, great agitation, ^vith continual tossing and anguish.

576 DISEASES OF THE SAK&UIISrOUS FIJISrCTIO:N".

ADMiNis^TnATioi^^.— Belladonna is for the most part applicable to the
first stage of yellow fever. One drop of the third potency may be
given once in one, two, three, or four hours, according to the vio-
lence of the symptoms.

Bryonia, — Skin yellow ; eyes red, or dull and glassy, or sparkling
and filled with tears ; pulse rapid, and full or weak.

Severe pain and sensation in the stomach, vomiting, particularly after
drinking ; burning thirst; pains in the back and limbs ; headache ag-
gravated by movement; eyes painful on motion; sense of fullness and
oppression in the stomach and intestines.

Anxiety, with dread and apprehension respecting the future ; loss
of memory ; delirium.

Administratio^t. — -Two drops of the first dilution , in an ounce of
water, — a dessert-spoonful every two hours until an impression is pro-
duced.

Rhus. — Surface of a dirty yellow color ; eyes glazed 'and sunken ;
tongue dry and black ; lips dry and brownish ; pulse quick and small ;
loquacious delirium, or coma with stertorous breathing; constant
moaning.

Distressing pain and burning in the stomach ; nausea and vomit-
ing ; paralysis of the lower extremities ; spasms in the abdomen ; want
of power over the abdominal muscles ; colic ; diarrhoea ; diiSculty in
deglutition, and pain on swallowing.

Intellect dull and clouded ; constant uneasiness ; delirium.

Administratiok. Two drops of the third dilution in an ounce of
water, a dessert-spoonful at intervals of one, two or three hours or more
as the symptoms may require. When prompt effects are not observed
from the third dilution, the first may be substituted in drop-doses.
The higher dilutions in some cases are more effectual than the low.

Arsenicum. — Face of a yellowish or bluish color ; eyes dull and
sunken, with a dark mark under them ; sclerotica yellow; nose pointed;
coldness of the body, with cold and clammy sweat ; lips and tongue
brown or black; colliquative sweats ; pulse irregular, or quick, weak,
small and frequent, or suppressed and trembling.

Sense of extreme debility ; dull throbbing, stunning or shooting
pains in the head-; burning or sharp and darting pain in the epigas-
trium or in the region of the liver ; limbs feel stiff and useless ; fre-
quent evacuations with tenesmus, or painless and involuntary; oppres-
sion at the chest with rapid and anxious respiration; cramps in the
calves of legs; great oppression at the stomach, with violent vomiting,
especially after drinking ; drawing and cramp-like pains in the ab-
domen ; sensation as if a weight was pressing upon the abdomen.

Indifference; weakness of memory; stupidity; delirium, with great
flow of ideas ; loss of consciousness and of sense | raving.

YELLOW FEYEE. 577

AcMiNiSTRATioisr. — In urgent cases, a drop of the third dilution may-
be exhibited every half hour, until some change is produced in the
symptoms. In less dangerous cases the intervals of administration
may be lengthened as circumstances may require.

Aconite,— Smtsible in the first and second stages, when there are
burning and dry skin; red cheeks; full and rapid pulse; red and sen-
sitive eyes ; tongue natural or covered with a whitish slimy coat ; lips
and mouth dry; vomiting of mucus and bile; urine dark red.

Violent febrile reaction; sensation of intense heat; great thirst;
acute pains in the temples, forehead, or on one side of the head ;
vertigo on rising; eyes weak and sensitive to light; pains and sore-
ness in the back and limbs ; nausea ; general sense of debility ; great
heat and irritability of the stomach; short and anxious respiration.

When the fever is on, great anguish, anxiety, and restlessness ; for
the most part nightly delirium.

Administration. — A drop of the first dilution may be given in
water every two hours, until the active febrile symptoms abate. Aco-
nite and Belladonna may sometimes be alternated with benefit in the
first periods of the" disease.

Remarks. — In a majority of cases a few doses of this remedy will
be found indispensable during the first reaction. This corresponds with
the experience of many physicians, who have treated the disease
Aconite has been recommended as a specific for this disease.

Nux-vomica. — Skin yellow; face pale or yellowish; especially
round the nose and mouth ; lower part of the sclerotica yellow ; eyes
inflamed with redness of the conjunctiva ; eyes surrounded with a dark
circle and full of tears ; tongue with a thick white or yellow fur, or
dry, cracked and brown, with red edges ; pulse variable.

Burning pains in the stomach ; pressure or cramp-like pains in the
epigastrium; vomiting of acid, bilious, or mucous matters; frequent;
and violent hiccough; eyes sensitive to light ; vertigo, or pains in the
head ; tremors of the limbs ; cramps in different parts ; thirst for beerj,,
brandy, or some stimulant ; contraction of the abdominal muscles ;
loose discharges of slimy or bilious matters or blood; burning pains
at the neck of the bladder, with diflSculty in urinating ; coldness, para-
lysis, and cramps in the legs ; feet benumbed and cramped.

Excessive anxiety, uneasiness, fear of death ; despair, or loss of
consciousness and delirium, with moaning, or muttering.

Administration. — Two drops of the third dilution in one ounce of
water, — a dessert-spoonful once in from two to six hours.

Meroiirius, — Yellow color of the skin ; eyes red, blood-vessels of
sclerotica injected ; eyes sensitive to light : paralysis of one or more
limbs ; tongue with moist thick white fur, or dry and brown mucus ,

Vol. L__37.

578 DISEASES OF THE SANGUmOTJS FUNOTIOK.

feces variable ; pulse irregular, or quick strong, and intermittent, or
weak and trembling.

Excessive inclination to sleep; or restlessness from nervous irritation ;
sense of fatigue and debility ; rapid loss of strength ; dizziness, or vio-
lent pain in the head ; violent convulsive vomiting of mucous and bi
lious matters; burning pain and tenderness of the stomach ; consti-
pation, or diarrhoea, with discharges of mucus, bile or blood ; coldness
of the arms and legs,, with cramps ; excitability and sensibility of all
the organs.

Anguish and agitation; weakness of memory; apprehensions ; dis-^
couragement ; moroseness ; raving.

Administkation. — -A grain of the third trituration in one ounce of
water,— a dessert-spoonful every two, four, or six hours.

In a case of poisoning by Calomel, related by Hoffmann, black vo-
miting is mentioned as the chief symptom. This symptom is almost
peculiar to yellow fever. Dr. Wood says, he " has employed Calomel
in some bad cases of this disease, with the happiest results. In one
of them the matter ejected from the stomach had begun to assume the
flaky character of black vomit, and yet the patient recovered." {PracU
Med. Vol, I. p. 820.) It is only successful in homoeopathic doses.

In the catarrhal bilious fever of 1838, Dr. Monette says, "the irrita-
tion of the bronchial tissue, upon the use of Calomel, was speedily
transferred to the alimentary canal, and many fatal cases occurred under
this practice."

In. extreme irritation of the stomach from duodenal inflammation
Calomel increases the intensity of the disease. It is the peculiar sen-
sibility of this portion of the alimentary canal to Calomel that gives
Calomel its importance in general practice. "In inflammation of the
duodenum there is the most deadly sickness with efforts to vomit; ten-
derness over the region of the /stomach ; and the pylorus seems per-
manently constricted so as to prevent the passage of all ingesta. If
the inflammation is severe or protracted, the skin becomes yellow.
This symptom is present in duodenal inflammation, whether the case
assumes the form of jaundice, bilious fever or yellow fever*

VeTatTum'al'bum,—-^2.Q,^Qii 2. yellowish or bluish color, cold and
covered with cold perspiration; eyes dull, clouded, yellowish and
watery ; lips and tongue dry, brown and cracked ; hiccough ; cold-
ness of the hands and; feet; trembling and cramps of the feet, hands,
and legs, evacuations loose, blackish or yellowish; pulse slow and
almost extinct, or smallj quick, and intermittent.

General prostration of strength ; confusion of head or vertigo ; deaf-
ness ; difficult deglutition; intense thirst; violent vomiting of green
bile and mucus, or black bile and blood ; burning in the stomach; great
exhaustion cramps in the stomach, abdomen and limbs ; diarrhoea.

YELLOW FEVEE. 579

Timid ; despondent ; restless, loss of sense ; coma or violent de-
lirium.

Abministkatioit. — A drop of the third dilution in an ounce of water ;
a dessert-spoonful frequently repeated until an effect is apparent.

Sulphur, — External Indications. — Face pale, or yellowish ; eyes
red, or ^^ellowish ; aphthae in the mouth ; tongue dry, rough, and red-
dish, or with white or brownish, bloody or purulent saliva.

Physical Sensations. — Dizziness, or sharp pains in the head ; itch-
ing and burning pain in the eyes ; roaring in the ears ; nausea, with
trembling and weakness ; vomiting of bilious, acid, blood^^, or blackish
matters ; pressure and pain in the stomach ; pains in the back and loins.

Mental and Moral ^Symptoms. — Melancholy; sad; timid; unde-
cided; wandering.

Administration. — A grain of the third trituration in an ounce of
water ; a dessert-spoonful every four or six hours, extending or dimi-
nishing the intervals according to the exigencies of the case.

Tartar-e'metiG, — Dr. Leon, of New-York, formerly of New-Orleans,
says, that in yellow fever he found the following symptoms yield rea-
dily to this remedy: nausea or vomiting, with a sense of sinking at the
stomach, as if the patient would not survive a moment ; general pros^
tration of the whole system; white fur on the tongue ; profuse cold
perspiration; rapid and weak pulse ; drowsiness, and disposition to go
to stool. He gave one grain of the first trituration to six ounces of
water, in doses of a dessert-spoonful every hour or two. This course
generally subdued this group of symptoms within twenty-four hours.
Dr. Leon also employed it with success in the bilious fever of Loui-
siana and Mexico.

Gantharicles — is sometimes indicated in the third stage with com-
plete insensibility, cramps in the abdominal muscles and legs, suppres-
sion of urine ; haemorrhages from the stomach and bowels, and cold
sweat on the hands and feet. It may be employed at the first dilution,
a drop every half hour, until a decided impression is produced.

Carho-vegetahilis, — Has been employed with success in the third
stage.

Nitrate of Silver, — Dr. Holcombe used it with success when the
patient, in spite of the preceding remedies, was sinking ; "the vomit-
ing became worse, with brownish stains in the matter ejected," or ap-
pearances indicating haemorrhage from the gastric mucous membrane.
He used the second centesimal trituration. Even this small dose, of a
teaspoonful from a half tumbler of water, in which had been dissolved
" one ten-thousandth part of a grain of Nitrate of Silver," often pro-
duced the aggravation of nausea. When this remedy or Lachesis did
not produce improvement the case was considered hopeless.

580 DISEASES OF THE SAI^GTJIKOUS FUNCTION.

Sul^liiiTiG-aGid, — ^Yellow fever, witli hgemorrhage and symptom?
resembling gastritis ; large shreds of mucous membrane being ejected,

Orotalus-horridus, — Dr. Holcombe, in 1863, pointed out the resem-
blance of the symptoms of yellow fever to the pathogenetic eifects pro-
duced by the virus of certain serpents, particularly Crotalus and
Lachesis, and from the use of the latter substance he obtained satis-
factory results.

The next year Dr. W. L. Humboldt said he had already tried the
experiment of inoculating with the virus of the rattle-snake, as a pro-
phylactic against yellow fever ; and that, in the course of nine years,
he had inoculated 1438 individuals in New-Orleans, of whom only
seven afterwards took the disease, and two died. He says he derived
the idea from the observation that galley-slaves, brought from Mexico
to Vera Cruz, if bitten by vipers on the way, always had decided symp-
toms of yellow fever. His process consisted in inoculating with the
virus of some serpent (not known to others), and treating the symp-
toms produced with the poison with a syrup of the Mikamia-guaco,
the well-known antidote to all snake-poisons.

In 1854, Dr. Humboldt made his experiments of inoculation on a
large scale, in Cuba, under the auspices of the Governor General.

Symptoms pkoduced by Inoculatiok, as modified by the Gua-
00. — At the moment of inoculation, vertigo, which soon passes away
nervous trembling, which is rarer, but lasts a long time.

After seven hours the pulse is permanently modified ; it is either too
frequent or too slow, stronger or weaker. In eleven hours there is
febrile heat. At the end of fourteen hours, headache, want of appe-
tite, thirst. At the end of sixteen hours, red countenance, injection
of the conjunctiva, epiphora.

The swelling of the gums is observed from the commencement, to
which are added slight colic-pains produced by the remedy (Guaco),
which the patient has taken immediately after inoculation.

At the end of eighteen hours, pain in the gums, the margins of which
redden round the teeth ; pain of the salivary glands and in the direc-
tion of the different nervous branches of the face aiid teeth.

In nineteen hours, pains in the lower jaw, and in the direction of the
submaxillary nerve ; lassitude.

In twenty hours, bitter taste ; drowsiness, coryza, and oedema of the
face.

In twenty-two hours, constrictive sensation of the throat, without
visible alteration of tho m^ucous membrane.

In twenty-three hours, yellow jaundice. I^ twenty-four hours, hae-
morrhage from the gums.

In twenty-eight hours, yellowness of the sclerotica, and shivering.

YELLOW FEVEE. 581

In twenty-nine hours, angina tonsillaris. In thirty hours, pain in
the kidneys.

In thirty-six hours, swelling of the eyelids. In thirty-eight hours,
pain of the muscles and joints.

In forty hours, toothache. In seventy-two hours, swelling of the
lower lip. At different hours, sexual excitement. During convales-
cence, itching of the cuticle ; cutaneous eruptions of various kinds.

The inoculation always produced a decided effect on the pulse. In
those who had naturally a quick pulse the inoculation caused a dimi-
nution of its frequency, while it accelerated the pulse in those in whom
it was naturally slow. On the whole, the number of cases in which the
pulse was diminished was greater than that in which it was accele-
rated in proportion of sixty-two to twelve. There was also a notable
weakening of the force of the pulse in every case.

Headache was one of the most common symptoms. It lasted on an
average twenty-one hours. It was usually seated in the frontal and
orbital region. Increased heat of skin in all, whether the pulse w^s
increased or diminished in frequency.

Deglutition was difficult in all cases, the tongue coated in most.

Itching of the skin was complained of after the acute symptoms had
subsided.

Manzini, the reporter of Humboldt's experiments, arrives at the con-
clusion that ^^ the inoculations produce a portrait of the most important
phenomena of yellow fever. These consist of an expression of counte-
nance of a peculiar kind, similar to that in eruptive forms ; to which
i& joined a drunken appearance in the eyes, which are injected; after
which come headache and pain in the loins, the changes in the gums,
and, later, the jaundice, the haemorrhages, and suppression of urine."

From the work of Dr. Neidhard, of Philadelphia, " On the Efficacy
of Crotalus-horridus in Yellow Fever," &c. (New- York, Radde, I860),
we learn that the inoculations of Humboldt embraced 2477 individuals
belonging to the Royal Army and Navy. The exact result of this is
not given. On page 77 it is stated that " out of 701 inoculated at the
Military Hospital, 121 were attacked by yellow fever, of whom 47 died."

Whether the inoculation was successful or not in its object, it at
least furnished us with a well-defined group of symptoms, closely re-
sembling yellow fever.

Dr. Neidhard had only the opportunity of observing the results of
Crotalus on five cases during the epidemic of 1853 ; but the good
effects he observed in these cases, from the use of Crotalus in the
second and third trituration, leads him to believe it to be the sovereign
remedy in yellow fever. He employs it only in triturations, as alcohol
destroys the virus. He also had the opportunity of employing it in a
few cases in 1858, where it was again efficacious, except in the case

582 ' DISEASES OF THE SAKaiimOUS FUNCTION.

of one patient, whose constitution had been undermined by intempe-
rance, having taken six or seven glasses of brandy ^^r diem.

Diet. — Arrow-root, rice water, black tea with a little sugar and
cream in it, are proper in the first stage, as well as the second in
which canine hunger is somotimes distressing. A teaspoonful of pure
cream, at considerable intervals, is safe and agreeable. Small quan
tities of ice at a time, held in the mouth, relieve the thirst.

The results of homoeopathic treatment are well shown by the expe-
rience of Drs. Holcombe and Davis in Natchez, in 1853. The former
treated 140 cases of unequivocal yellow fever, losing 9 cases. Dr. F.
A. W. Davis, who is called by Dr. Holcombe " the able pioneer of ho-
moeopathy in this region," treated 415 cases, of which 24 died. In
subsequent years these cases were extended to 1016 cases in all, of
which 55 died, equal to a mortality of 5.4 per cent.

6» COLD PLAGUE.— Pneumonia Typhoides.

This once dreaded epidemic has presented itself under different as-
pects in different parts of the American republic, and has now become
so far domesticated as to have lost its original specific character.

Its first appearance was in Connecticut, in 1771 ; and next in Vir-
ginia, in 1796. In 1812 it made its appearance in IS'ew-York and
several of the New-England States ; and about 1814 spread over the
new States of the West. In subsequent years it grew milder or less
decided in its characteristic features, and attracted less attention. As
late as 1828-4 some cases occurred in Missouri. Wherever it ap-
peared all diseases immediately assumed its peculiar livery, and fre-
quently terminated in death unexpectedly.

The Typhoid I^netcmonia^ called " cold plague," from the coldness
and torpor of the skin in its first stage, was a pneumonia combined
with a remittent bilious fever of a typhoid type. Sometimes the pneu-
monic feature predominated, sometimes those of typhus fever.

Symptoms. — The disease began with a chill of unusually long dura-
tion, and the danger was generally proportioned to its length. Some-
times there was sudden prostration of strength and perfect torpor of
the skin. Sometimes there was congestion of the lungs, evinced by
violent pain in the chest, difiiculty of breathing, pain in the back, and
in some one or all the limbs ; nausea and vomiting of bilious matter ;
usual symptoms of bilious fever ; yellow eyes, skin, and tongue ; others
had a dysenteric disease. But generally the pneumonic symptoms
were the most alarming. The pain in the chest extremely acute in some,
was only a heavy stricture and heaviness in others, with difficulty of
respiration. The tongue at first coated with white, with yellow middle
and lively red at the edges. Cough ; expectoration tinged with blood.

COLD PLAaiJE. 583

In otlier cases tlie chest was less affected, but the symptoms showed
extreme debility, disposition to syncope. The heat of the skin was
sometimes diminished, seldom increased. The pulse was in many
cases little altered, in others, it was slow, remittent, depressed ; or, if
frequent, not tense, but feeling like an elastic tube partially filled.
The bowels were generally constipated, even when dysentery attended.
The head Was painful, delirious; there were false perception ending in
stupor. Sickness of stomach arid vomiting.

Diagnosis.-— This was always sufficiently clear upon observing the
chief symptoms already given, and recognizing the fact of the preva-
lence of the epidemic. In sporadic cases the decision might not be
positive, but the features of prostration and coldness of the skin, long
continued, were characteristic.

Causes. — The only remote cause must be sought in a peculiar epi-
demic state of the atmosphere, which can not be explained. It cannot
depend on anything that is common to all places where the disease
appeared, for it extended over large tracts of country in which no gene-
rally prevailing causes of disease could exist. Wherever its influence
reached, all the inhabitants who lived within the territory invaded,
became subject to some diseases bearing some part of its general
character. Where it prevails it may be excited by all the usual
causes of disease, which in some other situation would cause fever,
ague, dysentery, pneumonia, or other disease. It is most likely to
commence in warm damp weather ; to attack those who live on poor
diet, or wear insufficient clothing; young persons exposed in biad
weather, or who have been debilitated by previous disease, are pecu-
liarly liable to attack. But no cliass of persons can claim exemption
from its power.

Pathology. — Dissection has shown the heart and large vessels, and
particularly the lungs, engorged and distended with blood. The air
cells were so congested that the air could hot come in contact with the
minute ramifications of the bronchia. This peculiar congestion of the
lungs was the chief cause of sudden death in most cases. When life
was prolonged a sufficient time it ended in inflammation. Congestion
of the other viscera, ending also in inflammation, existed in bad cases
in which the lungs suffered less. In all of these its pathology was
almost identical with that of typhus fever.

Prognosis. — ^This was favorable if the treatment commenced early;
but this was not general, and a large proportion, perhaps nearly one-
third of the persons attacked, died. Among the unfavo-rable signs
were : Heavy stupor and coma, in a case that had commenced with a
protracted cold stage, with slow reaction ; tongue covered with dark
brown crust; purple or bluish spots about the lips, breasts, and arms,
giving the disease the name of " spotted fever."

684 DISEASES OF THE SANGUIKOTJS FUNCTIOI^.

TiiEATMENT.- — Oil this point it is only necessary now to refer to the
remedies given below, and to the treatment of congestive mala-rial
fever, p. 513. ' .

7. PNEUMO TYPHUS.

The medicines which have proved most efficient in this form of dis-
ease are : Aconite, Bryonia, Phosphorus, ATrmnonia-GaTb,, Acid-
jphosph., and Merc.~viv, When the affection is characterized by
accelerated circulation, great heat of skin, thirst, difficult, anxious^
short, and rapid breathing, with painful stitches in the chest and sidej,
when inspiring ; cough on motion ; full, hard, and rapid pulse, Aconite
should be administered. A dose of the third dilution, every hour or
two, until an impression is made upon the symptoms.

After Aconite has been administered, and symptoms remain unsub->
dued, it will be necessary to resort to some of the following remedies^
the instructions for which we proceed to describe.

Bryonia, — -Symptoms the same as under cerebral ty^phus, 'p. 545,

Physical Sensations. — Confusion, fullness, heaviness, and swimmmg
in the head ; headache, aggravated by movement or opening the eyes ;
respiration difficult, short, anxious, rapid, or sighing ; oppression of the
chest ; stinging in the chest when coughing or breathing deeply.
Shooting pains in the chest, side, and abdomen ; pains in the limbs on
movement ; nose swollen, dry, and painful to the touch ; throat dry,
with sharp pains when touched or in motion ; nausea and oppression
at the stomach ; constipation and diarrhoea alternating, the one in the
night, the other during the day; urine scanty and high colored ; cough,
with stingings and stitches in chest and side, with yellowish or bloody
expectoration, or pains in the head ; shooting pains under the left
shoulder-blade when coughing ; tongue dry, contracted, dark, or yel-
low ; pulse rapid and full, or quick, weak, and irregular.

Administkation. — Same as under cerehrdl typhus, p. 545.

Phosj)horus, External Indications. — Yellow, brown, coppery, or
bluish spots upon the skin ; viscid secretion about the eyes, particu-
larly at night ; quivering of the eyelids ; dryness and obstruction of
the nose ; face pale, dingy, or red and bloated ; eyes sunken and sur-
rounded by a dark circle ; lips dry and bluish ; ulcers at the corners
of the mouth; tongue with a dry and dark, or whitish fur; pulse quick
and hard.

Stunning headache, vertigo, and dizziness, worse in the morning ;
smarting or burning sensation in the eyes; throbbing in the ears;
deafness ; offensive discharge from the nose ; dryness and raw sensa-
tion in the throat; nausea and pains in the stomach ; uneasiness and
painful contraction of the abdomen ; ^ stitches and roughness in the

PNEUMO TYPHUS. 585

chest ; expectoration of mucus, slimy, sanguineous, or purulent matter ;
sharp pains in the shoulder-blades ; stiffness of the neck ; trembling,
coldness, and numbness of the limbs ; great oppression at the chest,
with distressed and anxious respiration.

Mental and Moral Symptoms. — Despondency, anguish, and fear,
especially at night ; disposition to weep or laugh.

Administeation. — A drop of the third dilution in an ounce of water ;
a dessert-spoonful once in two to six hours, until an effect is percep-
tible.

Ammonium-carb. — ^Miliary eruptions, or redness of the skin \ eyes
dry ; nose obstructed with dry coryza ; face pale and bloated ; lips
dry and dark colored ; fseces in small hard lumps ; respiration short
and anxious ; breath offensive ; tongue covered with slime or vesicles ;
pulse weak and rapid.

Great restlessness at night ; drowsy during the day ; disturbed sleep
at night, with frightful dreams ; pains in the head ; nausea ; ringing in
the ears, worse at night ; sensation of excoriation in the mouth and
throat ; constant thirst ; constipation and itching at the anus ; fre-
quent desire to urinate during the night ; hoarse, or short dry cough,
with tickling and roughness in the throat ; mucous and sanguineous
expectoration ; sharp pains in the chest and sides, on coughing, breath-
ing, or moving ; drawing pains in the nape of the neck and small of the
back ; extremities stiff and numb ; cramps, coldness, and swelling of«
the feet ; excessive weakness of the limbs ; right side worse than the
left.

Discouragement; anxiety; oppression; anguish; sad, weak, timid ;
mental distress, worse at night.

Administration. — A grain of the first trituration every two, four, or
six hours, as the nature of the case requires.

Acidum-jphosj^lioriGum. — Eruption of small pimples on the skin ;
redness of the skin ; coma ; eyes dull, glassy, fixed, with pupils dilated ;
coryza, with redness of the nostrils ; face pale, or covered with pimples ;
teeth yellow; gums swollen and bleeding; tongue covered with thick
and adhesive mucus ; feeces hard, knotted, and slimy ; urine clear or
white, depositing a white sediment ; pulse quick and weak.

Great physical and, mental prostration ; pains. in the chest, abdomen,
and head, worse during repose^ relieved by motion ; head confused,
bewildered, with pains when moving it ; eyes weak and sensitive to
candle-light; music , painful to the ears; cheeks hot and burning;
nausea and oppression at the stomach ; diarrhoea ; frequent inclination
to urinate ; tightness and oppression in the chest ; cough, with puru-
lent expectoration ; sharp pains in the chest ; burning sensation in the
hands and feet.

Indifferent, taciturn, peevish, stupid.

586 DISEASES OF THE SANGUINOrS EUNCTIOlSr.

Administration. — Suitable in some cases of advanced pneumo-ty-
phiis. A dose of the third dilution may be given once in four to six
hours.

The following medicines may be named as appropriate under certain,
circumstances in pneumo-typhus, viz. : Lachesis^ Tart.-emet,,, Senega
Mercicr,^ Lobelia-infiata^ Rhus^ Arsenicum.

8. HECTIC FEVER.

Diagnosis. — -The ordinary symptoms of this fever are : daily febrile
paroxysms, general debility, emaciation ; skin pale, face often tinged
with the " hectic flush," irritable stomach, loss of appetite, moderate
thirst, night sweats, tendency to perspire through the day, diarrhoea,
pulse quick, small, and 'sharp.

Causes. — The combination of symptoms denominated hectic fever
in most cases, proceed from long-continued and profuse suppuration ,
but they may arise from protracted local irritation without suppura-
tion. Some writers suppose that hectic can only proceed from the
absorption of pus ; but this is erroneous, as the symptoms of hectic
often make their appearance before suppuration occurs. In nearly all
instances it is a secondary affection, consequent upon either protracted
disease in some vital part, some of the joints, or of somie extensive Sur-
face. It proceeds more readily from diseases of the "bones, ligaments,
and tendons, than from those of the muscles, skin, cellular membrane,
&c." [Sir JL. Coojper.)

It may, then, be considered as a constitutional disturbance, origi-
nated and kept up by some previous local disease, and which cannot
be permanently cured until the original cause upon which it is depen-
dent is eradicated or removed.

In those cases where it is kept up by the incurable diseases of the
joints, bones of the extremities, or other parts which can be safely re-
moved by the' surgeon, amputation or excision should be at once re-
sorted to, and the hectic symptoms will speedily disappear. Mr. Hun-
ter remarks that " a hectic pulse at one hundred and twenty has been
known to sink to ninety in a few hours after the removal of the hectic
cause." Several instances have occurred in our own practice in vfhich
an almost immediate and entire cessation of the hectic symptoms, such
as sleepless nights, febrile paroxysms, night sweats, diarrhoea, rapid
pulse, &c., has resulted from amputation or excision of the offending
parts.

When the original cause is a suppuration of some important organ,
like the lungs, liver, stomach, &c., our prognosis must generally be
unfavorable. In these instances it is of the utmost importance to the
homoeopathic practitioner that he make a thorough investigation of

EKUPTIYE FEVEKS. . 587

all remote causes, in order to arrive at an accurate knowledge of the
latent and original sources of the malady. He will thus be able to
direct his remedial applications with judgment, and afford to his pa
tients the only possible chance of cure.

TREATMENT.— In the selection of remedies everything must of ne
cessity depend upon the original cause — its seat, nature, and violence
and upon the secondary consequences to which it gives rise. It should
always be a prime object to direct our most potent remedies with per-
severence against the local affection, and if any latent or apparent in-
fluences exist, against these also.

If we are called to a case of hectic fever, proceeding from an inflam-
mation of a scrofulous character, advantage will be derived from the
use of some of the following medicines : Sulphur^ Aurum-Tnur.^ Gal-
carea^ China^ Iodine^ Ol,-jeGor,-aseL^ Aeid.-nitr., Aoid.-mur.y
Acid^-phos., JPhos,, Arsenicum^ SiUoea, and MercuTius.

In cases proceeding from syphilitic or mercurial diseases of the
bones, ligaments, &c., the medicines adapted to the cure of these dis-
orders should be selected.

If a chronic miasm, whether psoric or otherwise, originated the dis-
turbance, then strike deeply at the original cause with anU-psoriGS
as well as at present symptoms, and good results may accrue in appa
rently desperate cases.

ORDER II.-EXANTHEMATA.

Eruptive Fevers*

Genus I.-FEBRILE OUTANEGUS DISEASES.

The general characteristics of the exanthemata are derived from :

1. The presence and course of the accompanying fever.

2. The course of the eruption, which is very likely to be symmetri-
cal on both sides of the body.

8. From the law of universal susceptibility.

4. From the law of contagious origin.

5. From the law of non-recurrence.

6. From the law of epidemic diffusion.

The fever is almost always inflammatory, as in nineteen-twentieths
of the cases of small-pox and measles. Low nervous fever charac
terizes scarlatina and erysipelas. Malignant fever appears in some
cases of small-pox and scarlatina.

Origin of Eruptive Fevers. — It was believed long before the dis-
covery of vaccination that eruptive fevers were originally derived from
cattle. As late as 1844: small-pox, measles, and scarlet fever were
unknown in Australia and Tasmania.

688 DISEASES OF THE SANGUIKOUS FIJlSrOTIOK.

Communication ly Contagion, — The infective poison or materiel
morbi may obtain access to the human body by three modes :

1. By inhalation of air tainted by the breath or perspiration of the
patient. This is called infection, and is seen in small-pox, measles,
plague, typhus, scarlatina.

2. Miasms gain access by solution in the fluids or humors, and sub-
sequent application to the unbroken surface. In this waj jpsora, tinea
capitis^ gonorrhoea, and venereal disease are communicated from one
person to another. This mode is called contagion^ a contactu cooyo-
ris. In this case the materies morbi must be dissolved. The germ
of disease is conveyed in the fluid form into the interior of the frame,
where it mixes with and taints the blood.

8. Some of the morbid poisons are not admitted into the body unless
they are applied to an abraded or wounded surface. Of this kind are
hydrophobia, vaccinia, farcinoma or glanders.

Dr. Farr, in his Fourth Eeport proposes to call " all those diseases
which have tlie property of communicating their own action and afiect-
ing analogous transformations, zymotio diseases (from ^v/xow, to fer-
ment), and the disease itself ^ymozio. Zymotic diseases will compre-
hend all those associated under the names of epidemic, endemic, and
contagious maladies."

One remarkable characteristic of zymotic miasms is, that they operate
upon the healthy body without the aid of predisposing causes. A man
in perfect health contracts small-pox or measles; and this state of the
body is the best possible for insuring the success of inoculation and
vaccination. There are then no predisposing causes of these diseases.

" All miasms of animal origin are capable of attaching themselves
iofomites^ and (provided they be excluded from the air,) of retaining
their communicating property to a considerable length of time. This
great law of nature is of universal application, and is the foundation
of that important practical measure, quarantine. Thus tinea capitis
spreads by means of hats, combs and brushes ; Egyptian ophthalmia
by towels and sponges ; small-pox and typhus by clothes and bedding •
plague by personal apparel, and all rags or substances of rough surface
or downy texture. Forty days was formerly considered a sufficient
period to permit the poison to develop itself into an active form ; it is
now known that the incubative stage of the plague never exceeds seven
days. Therefore a week of quarantine would be sufficient ; and two
weeks should satisfy the most scrupulous anxiety. The poison may be
carried in clothes of wool, cotton, leather, every kind of apparel. Me-
tallic substances can not harbor contagion.

Each year is distinguished by the supremacy of some master-epide-
mic of either small-pox, measles, scarlatina, whooping cough, erysipelas.
In some years, says Dr. Gregory, more die from one of these diseases,

EKUPTIYE FEVEE8. Oby

in another year from another; but it is observed that about the same
number in the aggregate die each year ; as putting all together, 350,000
must annually die in England and Wales. The question has been
asked, " Why this vicarious mortality ?" It is answered that " the
sickly hot house-plants of the nursery must be weeded out. If they
don't die of one epidemic they must of the next."

Effects of the Matter of Contagion on the Human Organism, —
1. Palpable Contagions, — -In every form oi parasitic^ fungous or
mere cell organization the poisons which are capable of reproducing
themselves in the body have the power of exciting the most fearful
commotions in its various organs. The lower organized beings of both
the animal and vegetable world are always developed in the midst of
previously existing disorganization, putrefaction, impurity. When trans,
planted to any soil suitable for their growth and propagation, they are
always deleterious though they differ in the degree of their malignity.
The injury caused by the lichens and mosses to trees on which they
grow may be small. The strength of the live-oak of the South allows
it to spare y^\\hoVit peroeptiMe injury the small amount of sap needed
by the creeping tillandsia %isneoides, A considerable degree of health
may exist in persons whose intestines are infested with the lumbricus
or other parasites. But we think they are always deleterious to some
degree ; and, generally, they are highly, fearfully so ; and " many dis-
eases are proved to be dependent upon or arise from parasites." (Mit-
chell.) Some parasites are peculiar to the human body, and have never
been found any where else. In some diseases the true materies morbi
is believed to consist of minute parisitic animalculm^ and in other
diseases the poison is found in the form of minute fungous plants.
Either when transplanted into a human body, "finds," says Dr. Dickson,
" in the diseased body its nidus, its soil, its local habitat ; its trans-
ference to a healthy body is followed by the production of such disease
as fosters it and propagates and multiplies it infinitely."

A malignant, diseased or contagious cell, such as we have in a case
of cancer^ is always found in the animal body in connection with that
specific form of disease. When it is transplanted to another body it
can commence the work of multiplying itself or of transmitting the
materials of growth and supply into a pernicious organized structure,
every new cell of which will be like itself, and like it capable of self-
multiplication. This mode of vegetable increase and germination has
been supposed to be really a form <di fermentation. In the case of
each specific poison there is a peculiarity which distinguishes it from
all others. See Cancer,

2. Impalpable Contagions, — These are known only by their power-
ful efiects, being always invisible and imponderable, but efficient!}^
active at considerable distances, l^hey are chiefly, perhaps entirely,

590 DISEASES OF THE SANGUINOUS FUNCTION.

confined to the febrile class of contagious or infectious diseases, wliereas
none of the non-feorile contagions are diffusible in the air, but require
contact. In small-pox the atmosphere of the patient becomes charged
with contagious atoms, which have been eliminated from the body and
adiated from it. In some instances it may be supposed that the ani-
inal exhalations accumulating among the densely crowded population
of cities, furnish all the elements essential to the germination and
growth of the organic germs, whether fungous or animalcular, of which
contagion consists ; they may then multiply and propagate themselves
in the atmosphere, and may extend widely, promptly among the crowded
population of large cities. Diseases commonly contagious or infectious
within short distances only, are then said to become epidemic, pesti-
lentially prevalent. Healthy bodies may be infected in great numbers
without any known approach to a diseased body. Dr. Dickson says,
in 1847-48 he " attended forty patients with small-pox," not one of
whom had been exposed to it. In none of these did it arise sponta-
neously ; the seeds of the disease were imported from abroad. Among
the diseases which display contagion in both the palpable and im-
falpahle forms, we may enumerate small-pox, plague, erysipelas, hos-
pital gangrene, varicella, scarlatina, measles, and some others. Glan-
ders which always originates among horses, may be communicated
among them by inoculation as well as by diffusion in the air ; in com-
mon with vaccine and hydrophobia it is communicable to man only by
inoculation or direct contact to an abraded surface. {Amer. Jour,
July, 1849, p. 107-118.)

8. Zymotic Diseases which are always Efidewjic and sometiTnes
Contagious. — Here we may enumerate typhus, pertussis, puerpural
fever, infectious dysentery, yellow fever, and cholera Asiatica. These
diseases are all possessed of separate specific characters, are capable
of diffusion in the atmosphere as epidemics; though they are contagious,
at least communicable in some degree ; they are self-multiplying ; and
the specific poison of each is capable of exciting its own peculiar fer-
mentation by which it can radiate from a single centre the germs by
which thousands can be infected from a single centre.

1. SOARLATINA— SCARLET FEVER.

This fever has been divided into three varieties, namely ;

1. Scarlatina sim^plex y 2, Scarlatina anginosa ; 2>, Scarlatina,
maligna.
In its simple form scarlet fever is not attended with danger, but runs
its course mildly like a simple continued fever, and terminates in ^\q
or six days in convalescence.

In the other varieties, however, inflammations and congestions often

SOAELET FEVEE. 591

Bupervene soon after the attack, and if not promptly met by suitable
remedies, gangrene, sloughing and fatal disorganizations occur in the
throat, larynx and other important parts of the organism.

Scarlet fever is of much more frequent occurrence in the fall and
winter than during the summer months. Its attacks are usually con-
fined to children that have passed the nursing period, and persons under
twenty years of age ; but it may occur at any time of life from infancy
to Old age.

1. SCARLATINA SIMPLEX.

Diagnosis. — Shiverings, succeeded by heat, moderate thirst, frequent
pulse, slight soreness of the throat, nausea, loss of appetite, headache.
After these symptoms have continued about forty-eight hours, a scar-
let eruption makes its appearance upon the face, extending gradually
downwards to the neck, trunk and extremities. This eruption consists
of an immense number of fine pimples, (aptly compared by Dr. Arm-
strong to a boiled lobster shell,) either running together and diffusing
themselves uniformly over the skin, or appearing in patches in different
parts of the body. Upon the appearance of this eruption many un-
pleasant symptoms, as nausea, oppression at the stomach, dyspnoea, &c.,
abate, and the case then progresses until the fourth or fifth day of the
fever, when desquamation of the cuticle takes place, and a happy con-
valescence usually ensues.

II. SCARLATINA ANGINOSA.

Diagnosis.— The anginose variety of scarlet fever is ushered in with
chilliness and shiverings, succeeded by intense heat and pungency of
the skin, frequent and hard pulse, nausea, vomiting, headache, sore
throat, painful deglutition, intense thirst, pain and tenderness of the
epigastrium, abdomen tender ; pain and stiffness of the neck; tongue
covered with a whitish or yellowish fur, through which the papillss
are seen red, inflamed and prominent ; fauces, throat and tonsils swol-
len, deep red, inflamed or ulcerated ; eyes red and injected ; voice thick
and hoarse; sometimes dyspnoea and cough,' and universal tenderness
of the whole surface.

These symptoms continue for an indefinite period, varying from two
to five days, when the eruption shows itself, being uniformly diffused
over the body ; the skin desquamates in from six to eight days from the
commencement of the fever, the febrile symptoms all subside, the ulcers
in the throat granulate kindly, and a speedy convalescence obtains.
On the contrary, if the eruption prematurely disappears from the sur-
face, the ulcers assume a foul and unhealthy appearance, secreting an
an acrid and highly irritating fluid; while the fever continues to rage
with unabated severity, we may have a supervention of abdominal,

592 DISEASES OF THE SANGUINOUS FUNCTIOl!T.

bronchial, or cerebral inflammation, "vvliicli will complicate tlie malady
in a serious and perhaps fatal manner.

" In this fever," says Dr. South wood Smith, " the temperature, as in-
dicated by the thermometer, rises several degrees higher than in any
other." The pulse is also more rapid and strong than in almost any other
fever, indicating conclusively that it is an affection of an inflammatory
character.

III. SCARLATINA MALIGNA.

Diagnosis. — Scarlatina maligna was formerly known in some parts
of our country under the name of " putrid sore throat," and is at present
designated by some writers as scarlatina tyjphoides. It is unquestion-
ably one of the most dangerous maladies with which the physician has
to contend. It generally commences with the common precursory
symptoms of the anginose form, which, however, very soon give way to
a train of symptoms bearing a close resemblance to typhus. The
eruption is either entirely wanting, or makes its appearance only par-
tially, in irregular blotches of a pale color ; the heat of the skin often
subsides below the natural standard ; the pulse becomes very frequent
and weak ; the countenance assumes a besotted expression ; the eyes
become dull and sufiused ; the throat is filled with ash-colored ulcers ;
fauces, larynx and bronchia inflamed and swollen ; an acrid discharge
issues from the nostrils ; the tongue, at first red, soon becomes dry and
black ; the surface in the advanced stages acquires a dark red or
mahogany color, and petechia, diarrhoea and haemorrhage finally ensue.
The ulcers in the throat often slough, and extend in all directions, in-
volving in their ravages the cartilages of the larynx and the soft parts
within the nostrils.

• If the disease seizes particularly upon the brain, lungs or abdominal
viscera, there will be a predominance of those symptoms which charac-
terize the disorders of these particular parts. From the tendency of
this malady to these different organs, some authors have subdivided
scarlatina maligna into the inflammatory, congestive, and mixed varie-
ties. Examples have occasionally occurred in our own practice, in
which, in the very onset of the malady, those symptoms have appeared,
indicating congestion of the brain,— as coma ; slow, oppressed and
noisy respiration ; sighing ; face pale or livid ; skin cold ; pulse slow
and irregular ; pupils contracted or dilated. In these cases the erup-
tion seldom comes out well, but is of a pale color, and shows itself
irregularly in different parts of the body.

In other instances the inflammation seizes upon the laryngeal, bron-
chial, or intestinal mucous membranes, thus often deciding the case
against the patient, when the local affection of the throat seemed to
be progressing favorably.

SCARLATESrA. 593

Causes.— Scarlatina can only proceed from a specific morbific con-
tagion, respecting the nature of which we are entirely ignorant.
Whether this contagion is generated and diffused solely by those suf-
fering under the disease, or whethei', as some pathologists assert, it may
be generated in the atmosphere independently of the animal body, is
a question which admits of discussion, although we entertain the former
opinion. Of this we are confident, that when the agent is infinites-
simally diffused in the air, it is capaMe of being absorbed into the
circulation or at least of making its morbific impression on the sentient
extremities of the nerves of the air-passages, and thus producing its
specific eft'ect on the organism.

Some have doubted the contagiousness of this affection, because
certain individuals of families occasionally escape, while others are
affected ; but let it be remembered, that this happens now and then in
small-pox, plague, t3^phus, and all other maladies which are universally
deemed contagious.

We have before observed, that the contagion of typhus can not make
a serious impression upon the organism, so long as every part is in a
state of perfect health and vigor. The same remark will apply with
equal truth to scarlatina. In these cases the tissues on which the
poison operates are stronger than the noxious influence, and are thus
enabled to resist its' action until some cause predisposes the system to
receive the impression.

Treatment. — Belladonna. — The provings of Belladonna upon the
healthy subject, as well as the numerous successful experiments made
at the bed-side of the sick, have stamped it as a remedy of distin-
guished importance in the treatment of scarlet fever. It has even
been extolled by eminent practitioners of the old school, and in some
instances adopted, both as a remedy in this disease and as a valuable
prophylactic against it.

In scarlatina simplex, an occasional dose of this medicine at the
third attenuation, will suf&ce to conduct the patient safely through the
malady. Should the fever run high, the Belladonna may be advan-
tageously preceded by Aconite,

In the anginose form, where there is intense inflammatory excite-
ment, swelling and soreness of the throat, painful deglutition, quick
pulse, burning hot skin, nausea, tenderness of the epigastrium. Bella-
donna \% still the grand remedy. If the fever assumes a violent cha-
racter, evincing a tendency to excite the inflammatory action in any
particular structure. Aconite may here also be administered with ad-
vantage, either by itself, or in alternation with Belladonna, So long
as the local inflammation in the throat is retained within due bounds,
and the eruption shows itself in a proper manr^er, remaining out a
sufficient length of time, we shall receive ample aid from these potent

594 DISEASE OF THE SAJnIGUIjSJOUS FUI^OTIOIT.

remedies. The following special symptoms of Belladonna are given
by Drs. Curre, Hermann, Laurie, &g. :

Spots of a scarlet or deep red color on the face, or other parts of the
body ; swelling of the submaxillary glands, and those of the neck ;
eyes red, sparklmg and convulsed, or fixed, shining and prominent;
pupils dilated or contracted ; tongue red, hot and dry, or white in the
centre, with red edges ; throat, tonsils, uvula and velum-palati dry, in-
flamed and swollen ; suppuration of the tonsils ; strong pulsations of
the temporal arteries ; inflammation of the stomach and abdomen ;
constipation, or involuntary evacuations ; urine turbid, of a brownish
red or yellow color Avlth a red or whitish sediment ; pulse small and
quick, or strong and quick, or full and sloiv, or small and slow, or hard
and tense ; pulsations of the carotids ; face hot, red and bloated ;
sweat with the heat, or after it.

Vertigo, confusion, fullness, heaviness, pressure ; shooting or expan-
sive pain in the head, aggravated by motion of the head or eyes, by
contact, and by cold air, mitigated by holding the head back, and by
supporting it ; mouth dry and hot ; dryness and burning in the throaty
with painful and difficult deglutition ; loss of appetite ; nausea and
vomiting; great thirst; sense of fullness and distention in the stomach
and abdomen after eating ; drawing pains in the back and shoulders ;
difficult respiration ; violent cough ; shiverings, alternating with heat,
or followed by heat, worse in the evening or night ; adypsia, or exces-
sive tliirst ; dry, burning heat.

Great agitation and tossing about ; anguish and inquietude in the
afternoon and night ; delirium, with muttering groans and cries ; vivid
and frightful dreams ; starting from sleep with fright, groans and cries ;
ill humor and irritability.

In the seven cases, given by Pereira,^ of poisoning by Bell., the
symptoms seen were : " Dryness of the fauces, causing excessive diffi-
culty of swallowing and alteration of the voice ; second, scarlet erup-
tion on the arms and legs. The boyf at Guy's Hospital poisoned with
Belladonna-berries had swollen face, throat hot and dry, hands and
face flushed; could not swallow. The man, aged seventy-five years,
who took four or five grains extract of Bell, by mistake, lost the power
of articulation ; mouth and fauces as dry as a chip. The chief action
of the Belladonna was on the medulla-oblongata.J In the case re-
ported by Mr. Wade,§ the extract locally applied, caused "the mucous
membrane from the posterior third of the palate, as far down as could
be seen, to show a deep crimson color, and the tonsils were much en-
larged." Christison speaks of " redness of the throat" in one casej

* Materia Med. Late Editions. f Taylor on Poisons.

X Provincial Med. and Surg. Association Proceedings.
^ Lond. Med, and Phys. Journal. Apr. 1827.

SOAELET FEVER. 595

and aphthous inflammation of this part in two others. It seems there-
fore that this dryness of the throat is the result of the arrest of secre-
tion which accompanies congestion and inflammation, and that Bella-
donna is a tissue irritant to this portion of the alimentary mucous
membrane. Hence its therapeutic value in various forms of angina.

Irritation of the Shm ccmsed hy Belladonna,^ — It produces simple
redness, redness with swelling, (usually in the face,) or scarlatinoid
eruption.

UomoeopathiG tise. — Belladonna easily cures erythema, simple non-
vesicular erysipelas. Carbuncle, furuncle, and whitlow, are all of an
erysipelatous nature, and all require Belladonna. Puerpural fever is
partially under the control of Belladonna ; and this curative power in
this disease depends on the disease being related to erysipelas, having
its location in the peritoneum. In scarlatina the ess-ential symptoms,
the rash, the angina, the delirium are under its control, the fever
and renal inflammation are beyond its control. Its prophylactic power
in this disease arises from the power ail specifics possess of previously
occupying the ground; thus all becoming prophylactic of those dis-
eases in which they are curative, as Quinine is of ague, Cuprum of
cholera,, and Mercury of syphilis.

Antidotes to Belladonna poisoning. — Mineral alkalies-— Ammonia,
Potash, Soda, Opium. Its most nearly related medicines: Hyoscyamus
and Stramonium. The three are thought by some chemists to possess
a common active principle, like Ignatia and Nux-vomica. Opium is
aow regarded as the most certain antidote to the poison of Bella,-
donna as well as Aconite. See p. 514.

Aconite, — Face red, hot and bloated, or alternately red and pale ;
skin dry and hot ; forehead cold, and tips of the ears hot ; deep red-
ness of the throat; bilious or mucous vomitings; urine scanty, deep
red, with brick-colored sediment; pulse hard, frequent; respiration
rapid and difficult.

Physical Seistsatioits. — Oppression or throbbing in the head, aggra-
vated by motion; talking, rising up, &c. ; better in the open air; great
sensibility of affected parts to the touch, or on movement ; pains in the
joints and limbs ; fainting and weakness ; extreme thirst; coldness of
the surface; with internal heat, or burning over the whole body; pain
in the throat in swallowing; bitter or putrid taste; loss of appetite;
sense of swelling, weight or pressure in the pr^ecordial region ; hot
and burning urine ; bruised pains in the loins, back, and nape of the
neck.

Discouragement and agitation ; noise appears insupportable ; humor
changeable ; at one time sad, depressed, irritable, contradictory, des-

* Dr. Richard Hughes.

596 DISEASES OF THE SANGUINOTJS EUNCTIOIS".

pairing, at otlier times excited, gay, and full of hope; inquietude under
disease, and even despair respecting a cure.

Ipecacuanha. — If there is slight fever through the day, but an in-
crease in the evening, with sleeplessness, sadness, despondency, and
tears, Ipecacuanha is our remedy.

Face pale, sallow, yellowish, and bloated, with livid circles around
the eyes ; tongue loaded with a white or yellowish fur; profuse secre-
tion of saliva ; vomiting of green bilious, acid, slimy, or gelatinous
matter ; sweat ; foetid breath ; turbid urine, with sediment like brick-dust.

Nausea and vomiting of drinks or food ; no a^ppetite ; insipid and
clammy taste ; adypsia ; violent itching of the skin ; empty risings ;
great uneasiness in the stomach and epigastrium ; feeling of empti-
ness and flaccidity in the stomach ; sensation of debility in the bowels,
worse on motion ; colic with agitation ; tossing, with cries ; diarrhoea,
with nausea ; griping and vomiting.

Anxiety and fear of death ; moroseness ; cries, and howling; vague
desire for different things.

Pulsatilla.- — When the disease commences with prominent derange-
ment of the stomach and bowels, headache, vertigo, shiverings, weak-
ness, nausea, and bleeding at the nose, soon succeeded by hasty anx-
ious and oppressed respiration, mucous vomiting, taste of food, longing
for acids, spirits or beer, Pitlsatilla is appropriate.

In scarlatina occurring in individuals of decidedly scrofulous dys-
crasias, 8uljphur or CalGarea-ca^Tbonica may be required.

Zinc, — This remedy has been recommended by Dr. Elb, of Dresden,
in cases where paralysis of the brain is threatened, or where it already
exists. He has also used it with success in the malignant form, with
vi'olent delirium, alternating with sopor ; icy coldness of the skin from
sunken vitality ; small and frequent pulse, and fixed and stupid expres-
sion of the eyes. Dr. E. usually employed the first trituration in doses
of one grain every two or six hours.

Mercuriics. — Occasionally troublesome ulcers form in the mouth,
throat, and upon the tonsils, covered with ash-colored sloughs; deglu-
tition becomes exceedingly difficult, and is attended with a stinging
pain ; the fluids which the patient attempts to swallow, often escaping
through his mouth and nose, wdth perhaps an acrid discharge from the
nostrils, and profuse secretion of saliva. Under these circumstances
Mercurius is the proper remedy.

Muriatic-acid, — In malignant scarlet fever, where in addition to the
above symptoms, we have inflamed, swollen, and tender salivary glands,
dark-colored ulcers, with a decided tendency to slough and extend,
together with great debility, lassitude, tremors, obtuseness of intellect,
cold extremities, amd other signs of a typhoid condition, Muriatio-
or JSfitric-acid^ from the first to the third dilution should be exhibited.

SCAELET FEVEE. 597

Brj/onia.-— 1l in connection with the above symptoms there should
be present a considerable amount oi jpiilmonary or cerebral excite-
ment, indicated by delirium, restlessness, contracted or dilated pupils,
heaviness and dull pain in the head on motion, difficult, anxious, and
sighing respiration, sensation of weight and pressure upon the chest,
troublesome, hacking cough, with soreness and sensitiveness of the
whole surface, Bryonia^ the third dilution, or higher in some con-
stitutions.

Arsenioum.,— Arsenicum is a remedy of great power in the advan-
ced stage of malignant scarlatina, where there are extreme prostra-
tion, pain in the stomach and abdomen, diarrhoea, eruption of a livid or
mahogany color; ulcers dark and foul, tongue and lips dry and black,
pulse extremely frequent and weak ; cold and clammy sweats, hippo-
cratic countenance. This remedy has often rescued patients from
the grave who have been given over in despair by physicians of the
old school.

Opiiom. — Should profound coma supervene during the course of the
malady, with snoring, and open mouthy open and convulsed eyes, red
and puffed face, hanging jaw, difficult slow or intermittent respiration,
convulsive movements of different muscles, retention of urine. Opium
will be found to be the best specific ; and we are satisfied that it will
rarely disappoint our expectations in cases of this description.

Becession of the Eruption. — When the rash suddenly disappears
during the eruptive stage, Drs. Schmidt, Hartmann, and others recom-
mend very highly AcetaU-cii^prum as a specific against this symptom.

Sulphur^ Iodine^ Bryonia^ Phosphorus^ and Belladonna^ all de-
serve consideration, and will, in some cases promptly restore eruptions
which have been prematurely repelled.

The other remedies which may be consulted in cases where those
above described do not accord with the symptoms, are: Cinna,^ Nux-
vom,^ Carh.-veg,^ Ehus-tox.^ Si/ram^,^ Phos,^ Kreosote^ Hyos,

For the troublesome sequelae^ which sometimes follow scarlet fever,
as dropsical affections^ purulent otorrhoea^ deafness^ furunculi^ en-
largements and suppuration of the glands of the neck, axilla and
groin, appropriate remedies may be found in Apis-mel., Arsen,^
Pig., Hellebore^ SulpK, Hepar, Senega, Cham,, Aur,-mur,^ and
Mercurius,

Administeation. — We most frequently employ the first, second and
third attenuations, but in young and impressible children, we often re-
sort to the higher dilutions with the most satisfactory result. Some
cases are characterized from the commencement by a high state of vas-
cular and nervous excitement, others evince a loss of vascular and
nervous power, and a very low grade of impressibility. The propriety,
therefore, of the employment of both the high and low attenuations in

598 DISEASES OF THE SAKGITIKOUS FUKOTION'.

different instances is evident. If dilutions are used, a drop may be
given at a dose, in a drachm of water ; but if the triturations are se-
lected, one grain is a sufficient dose, given dry or in 'water. We ad-
vise a frequent repetition of the dose until decided changes arise from
the remedy, or until we are satisfied that it is not producing the re-
quired effect upon the disordered structures.

Apis-mellifica. — Heat, redness, irritation of the skin, great rest-
lessness and nervous agitation ; sensitiveness of the entire surface of
the body ; oedematous and erythematous appearance around the ulcers
in the throat; frequent and painful urination; redness, heat and burn-
ing of the tongue; disturbed sleep and thirst. The third dilution of
Apis has given speedy relief in many cases.

For its use in the dropsy following scarlatina, see that article,
page 603.

Arunh-tripMllum. — Case by Dr. Lippe, Phila.-^ — A boy, aged six
years, had scarlatina, Eeb. 14th, 1861. Began in the form common in
severe cases; was treated with high dilutions of Belladonna (200),
Tartar-emetic, Sulphur, &c. On the next morning he was covered by
the eruption and appeared up to the 17th to be doing well. But then "his
nose was stuffed up, corners of the mouth sore, could only breathe with
his mouth open, Lycopodium, 200th." On the 18th he had had a bad
night, very delirious, the nose had discharged a good deal of thin w^atery
ichorous fluid, nose sore, lips very sore, cracked and bleeding, as well
as the Cornells of the mouth, the mouth felt so sore inside that he was
unwilling to drink ; tongue red, papillae swollen and standing up, be-
tween the abdomen and the legs sore moist places, the same on the
os-coccygis,the sub-maxillary glands swollen, pulse 140, hard and full;
voice hoarse. Arum-triphyiium six pellets, sixth, dissolved in a half
tumblerful of water, one teaspoonful every two hours. On the 19th he
was slightly better. Arum-tr., thirtieth. On the 20th still better, me-
dicine continued. On the 21st improvement more decided ; had passed
quantities of pale urine and hawked up much mucus. Continued to
improve without further treatment till March 13th, when he had violent
coryza, cured by Nitric-acid 200, one dose. A week later had at night
hoarse, dry, croupy cough, great hoarseness, cured by Hepar, 200.
Chief indications for Arum-tr. : — great sore feeling of the mouth, red
tongue, elevated papillae, corners of the mouth and lips cracked ; stop-
page of the nose. without much coryza; urine abundant and pale ; sub-
maxillary glands swollen; eruption all over, the body; much itching
and restlessness ; great hoarseness, which continues to increase, though
other symptoms improve.

C^'i^r'wm.— -Rademacher gives the following case : "A man in the

*= Amer. Horn. Review. Yol. III. p. 28.

SOAELET FEYEE. 599

flower of his age. On the first day of the fever the pulse was strong,
full, quick ; the angina moderate. Head painful ; face red ; eyes
brilliant; urine clear and acid, and darker than natural. Natrum-
nitricum was given. On the second day there appeared a slight red-
ness on various spots of the body, and all the symptoms were aggra
vated. On the third day the symptoms were increased, the eyes wer
reddened, and the urine darker, but still acid and growing turbid on
cooling. The Nitrate of Soda was now given up. But the physician
waited till next morning to learn more fully the character of the mor-
bid state. On the following morning the indications were plain, but
the life of the patient was in great danger. He could not rise in bed,
his head was in the state that precedes delirium, or was in the first
stage of it ; the memory so weak that he could not find the desired
words, though conscious that he used the wrong ones. The pulse
quicker, but had lost its fullness. Eruption as before. The urine
dark, acid, and turbid on cooling." Rademacher thought the whole
phenomena, viz.: the peculiar state of the head, weakness of the
muscles, and acid urine, pointed out a condition curable by Copper.
He directed small doses of acetated tincture of Copper to be taken
at regular intervals within twenty-four hours. The effect was remarks
able on the same day. About twelve • hours after commencing this
remedy the progress of the disease was brought to a stand, and to-
wards evening the head was evidently better. Next morning the
patient was free from all dangerous symptoms.

Dr. Kissel says, on this subject: "The diseased process, arrived at
a certain point, can thus be arrested by Copper, but the exanthema
must run its course, though new eruptions of it and extension of the
disease to the meninges can be prevented. In some cases of this
disease, with diarrhoea, it is advised to give the Cuprum in an oleagi-
nous emulsion.

In some epidemics of measles, varioloid, and erysipelas of the facCj,
Cuprum-aceticum has been found the specific.

Ad&ps. — Dr. Schneemann, of Hanover, proposed the inunction of
the body by lard. Dr. Ebers treated thirteen cases in this manner^
of which he cured twelve, the remaining one being hopeless when com-
menced. At the same time he was engaged in treating nine other
cases in the common (allopathic) method, of which he lost five and
cured four. He concludes :

1. That inunction with lard does not interfere with the appearance
of the eruption on. the third day, and its decline on the fourth or fifth

2. That other complications of the disease disappeared more favor
ably under this treatment than under any other.

3. Under this treatment there was no desquamation ; and in no case
was there any subsequent anasarca.

600 DISEASES OF THE SANGUINOTJS FUNCTION.

4. This treatment destroys the contagious principle. The lard
should be well rubbed in warm on the skin, to be absorbed morniDg
and evening.

A'mmoniuTn-car'b. — -When scarlatina assumes a typhoid character,
and there is any tendency to decomposition of the blood, this is a re-
medy of great value. Many eminent physicians of our school rely
upon this drug in nearly all cases of scarlatina maligna, and their suc-
cess has been highly gratifying.

It should be prescribed in the first trituration— -always recently pre-
pared.

2. SCARLET RASH.

This appears to be a modified form of scarlatina. It is generally
met with in complication with that disease, small-pox, or measles.

DiAaNOSis.— The eruption is darker than that of scarlet fever, being
almost purple ; the pressure of the finger leaves no white mark ; and,
on passing the finger over the skin, small grains are felt beneath it.

The disease does not run a regular and definite course, like other
eruptive diseases. The efflorescence may disappear suddenly or may
spread over the body ; the parts of the surface covered by the erup-
tion are liable to perspiration. Persons who have once suffered from
it are not exempt from future attacks.

Prognosis.— It is not generally as dangerous as scarlatina. When
the efflorescence disappears suddenly alarming symptoms sometimes
follow. The sore throat is not generally as severe as in scarlatina ; it
is sometimes present when the eruption is wanting.

Treatment.—- ^c<9m^(3 alone is generally sufficient to cure this dis-
ease when it is uncomplicated.

Coffea. — After Aconite, when there is restlessness, agitation, pain
in the head or extremities.

£elL—The scarlet rash complicated with true scarlet fever, sore
throat, and pain in the head or delirium.

Ipecac. — The rash attended by nausea, vomiting, or diarrhoea.

Bryonia, — After Ipecac, in cases in which there is congestion of
the chest, hurried respiration, pleuritic pain.

3. SEQUELiE OF SCARLATINA.
Scarlatinal Nephritis. Post Scarlatinal Dropsy.

This disease appears in three different forms : 1. That in which the
disease commences primarily from the state of the skin as disordered
by the specific scarlatina poison, aggravated by exposure to cold.

This form of dropsy usually makes its appearance in from ten to
twenty days after the subsidence of the original symptoms. The swell-
ing is first observed in the face and upper part of the body, to which

SCARLET FEVEE. 601

it is sometimes confined, though more generally it extends over the
whole body. In severe cases the urine is thick, scanty, and dark
colored, passed only at intervals, or almost entirely suppressed. There
is more or less fever, with night restlessness. In. mild cases the con-
dition of the urine is but little changed.

In the first stage the disease seems to consist in a dropsy of the sub-
cutaneous cellular tissue ; but in the second stage it generally involves
more or less deeply some vital organ; the effusion is discovered on the'
brain, in the chest, within the pericardium, or in the abdomen ; and the
disease runs a rapid course, giving little time for efficient treatment.
The extent of the anasarcous swelling does not always indicate the
degree of danger, and, in many cases,. the child is beyond the reach
of medical skill before the parents are alarmed.

Causes.— This disease is generally excited by exposure to cold at
too early a period after an imperfect recovery from scarlatina. It is
remarked, too, that it quite commonly occurs in children who have had
the original disease in a light form, especially in the milder epidemics.
Tweedie says it has "never been observed to supervene in cases of
malignant scarlatina.''

The cause of post scarlatinal dropsy is attributable to the passage
of the debris of the ^^ fever through the tubuli uriniferi, thus producing
in them irritation, congestion, retention of urine, and the usual pheno-
mena of albuminuria. The urine is usually albuminous, and the symp-
toms disappear as soon as the kidneys are relieved,

2. The second form of scarlatinal dropsy is that in which " the
dropsy arises from disease of the kidneys themselves, consequent
upon the scarlatina virus locating upon them, instead of being deve-
loped on the skin." In this form of the disease the danger consists,
not in the concentration of the force of the virus upon some vital organ,
as is common in the preceding variety, but from the deadly influence
of the malignant poison exerting its power primarily upon the kidneys.
These great eliminating organs fail immediately to perform their office ;
before the oedema has exerted any injurious influence in other parts
of the body, death may supervene from reabsorption of the ursemic
poison which they should have expelled from the system.*

8. Scarlatinal liheumatisnh.^ — In this form, about the time that
the eruption is followed by desquamation, there becomes visible a pe-
culiar inflammation, manifested by shining redness, swelling, and in-
tense pains in the ankles and wrists. It resembles arthritic inflamma-
tion in its great tendency to metastasis to the heart ; but it difters
from all ordinary arthritic inflammation by its strong tendency to

* Dr. J. H. Frost. Amer. Horn. Rev. Vol. II., p. 433.
t Braithwaite's Retrosp. No. 33, p. 30.

602^ DISEASES OF THE SANdUINOUS FUNCTION.

purulent effusion into the affected joints, and great swelling in the
neck, enlargement of the submaxillary gland, and other marks of acute
scrofulosis. It is sometimes epidemic.

Such cases are generally fatal.^

Pathology. — In scarlatinal, as in every other form of dropsy, the
kidneys are more or less afiected. And the concentration of the force
of the disease upon these organs is the most insidious and danger-
ous form in "which it ca,n terminate. In the skin the capillary ves-
sels are more or less congested and obstructed, even in mild cases ;
and the same inflammatory action which diminishes the secretion
of urine prevents perspiration ; this causes great increase in the
fluid exhaled, as inflammation of the serous membranes, as the peri-
toneum usually causes dropsical accumulations in the cavity of the
abdomen ; and that of the arachnoid and its divisions produces hydro-
cephalus.!

Dropsy after scarlatina, says Tweedie, " is of an acute or sub-acute
kind ; arising from increased action of the sanguiferous system, the
consequence of this increased action is the effusion of serous fluid into
the external tissues of the body, or, where there is still greater vascu-
lar excitement, into one or other of these cavities."

"As the scarlatina subsides desquamation begins, and the urine be-
comes even more abundant than in health ; but this desquamation, by
preventing the return of the skin to the performance of its proper
functions, perpetuates the evil influence exerted by the primary dis-
ease, and continues to impose a double duty on the kidneys — a burden
evidently greater than they can long sustain. And so, when convales-
cence seems almost complete, dropsy ensues from the failure of the
kidneys to carry off the unusual exhalation, while at the same time
attempting to do their own work and that of the skin. Or, where from
exposure to cold in this period, a still more serious impression is re-
flected from the tender skin upon the already over-burdened kidneys,
they become congested and entirely obstructed ; the ursemic poison,
accumulating for a short time, and finding no outlet from the system,
is suddenly reabsorbed, and coma, vomiting, and convulsions close the
scene.f

Dr. West, on diseases of children, says:

" The chief sufiering, however, is referred to the chest from pulmo-
nary oedema ; the respiration is labored and accelerated, and the child
is frequently unable to assume the recumbent posture, and is moreover
distressed by a frequent hacking cough. Under these circumstances
life is sometimes prolonged for several days, though in a state of ex-
treme suffering, remedies proving unable either to increase the action

* Frost. t Oragie's Pathol. Anat. p. 190. J Dr. Frost.

SCARLET FEYEE. 603

of the kidneys, or to relieve the dropsy. Death is sometimes preceded
by a sudden aggravation of the signs of disorder of the respiratory
organs, which assumes all the painful characteristics of oedema of the
lungs ; and in other cases, a comatose condition comes on, such as often
precedes death from Bright's disease in the adult."

Dr. B. F. Joslin, Jr., gives some cases, treated at the Half-Orphan
Asylum, N.-Y., winter of 1860. {Amer, Hornoe^ojp, Beview^ I86O0
p. 339.)

Charles Smith, aged six. Feb. 29th.' Fever ; red eruptions ; ^t)mit-
ing; headache. Pulsatilla 30. — March 1st, white dry tongue; redness
continues, Aeon. 30. 2d, Pulsatilla 30. Doing well till the 16th.
Then stiff neck ; glands swollen. Bell. 30 and Merc. 30. 21st, inflam-
mation in front of neck to the right side with deep swelling, Bell. 30.
23d, opened abcess on neck, Sulph. 30. 26th, oedema of face. Apis
30. 27th, seems better ; pulse 92, Apis 30. 28th, face more swollen;
no oedema of feet; pulse 80, irregularly intermittent. Apis 1. 29th, face
^not so much puffed; pulse 100, regular, Apis 1. April 2d, pulse 76,
not quite regulur, Apis 1. 3d, less swelling of face, pulse 100, Apis
1. 5th, feels w^ell ; less swelling of face ; pulse 92, not quite regular,
Apis 1. 8th, skin hot ; thirst ; pulse 148 ; respiration good 32 ; the
weather is to-day rainy and close, and has an unfavorable influence
on his case, Aeon. 30 and Bell. 30.

April 9th, feels well and appears so ; pulse 96 ; had rapid respira-
tion all night, but is now quite easy ; last night, evacuation in bed.
Aeon, and Bell. 10th, Doing well ; pulse 104, Apis 1. 11th, respira-
tion good, still has some swelling of face. Apis 1. 12th, pulse 114,
respiration 28, Apis 1. 13th, says he feels well, but does not appear
quite so bright as usual; no appetite; pulse 116, Apis 1. 14th, appe-
tite better; pulse 112, Apis. 16th, doing well; pulse 92, Apis 1.
17th, doing well, pulse 100, Apis 1. 18th, seems well, Hepar 30. Has
remained welL

We have seen a case cured in the following manner. A boy of
^VQ years, whose brother had just died of the same form of disease,
relapsed after a supposed recovery from scarlatina. Immediately the
action of the kidneys was almost entirely suspended and the dropsical
bloating commenced. The same allopathic physician under whose
treatment the brother had died was now called. He proposed blis-
ters, which were objected to ; a homoeopathist was called, who made
his best efforts for four days, without any apparent result. The drop-
sical accumulation increased. At this stage a poultice of flax-seed of
large size and warm was prescribed and it was applied to a large sur-
face, covering the region of the kidneys, and demulcent drinks were
given. Immediate improvement was seen, A free perspiration and

604 DISEASES OF THE SANGUINOtFS FUKCTIOl!^.

increased flow of urine commenced, tlie inflammatory and dropsical
symptoms rapidly subsided, and the little boy speedily recovered.

See an interesting case of desquamative nephritis in the U. S. Jour-
nal of Homoeopathy (Vol. I. p. 271.), cured by Arsen. 8° and Apis 3^,

4. RUBEOLA.— MEASLES.— MORBILLI.

Formerly, measles and scarlet fever were described and treated as
one Ind the same disease, the differences which were ^observed in dif-
ferent cases being ascribed to modifications originating from peculiari-
ties of constitution, the state of the atmosphere, and other accidental
causes. About fifty years ago, however, Withering and several other
writers recognized a distinction between them ; and measles, for the
first time, was accurately described and ranked as a distinct malady.

As it generally occurs, it is unattended with danger, unless interfered
with by purgatives, emetics, and infusions. Fortunately, it is confined for
the most part to children, for when adults are the subjects of attack,'
it is far more severe and dangerous. Like scarlatina, one attack
renders the subject secure against any future operation of the con-
tagion. •

This disease frequently appears as an epidemic, especially in the
spring. It is generally mild, though sometimes extremely violent and
dangerous. It occurs in every climate, attacking principally children,
though older persons are liable to it, if they have hitherto escaped it.
The disease is generally communicated by contagion, and it breaks out
ten or fifteen days after the infection.

Diagnosis. — Spots that are generally more or less raised on the
skin ; they are one or two lines in diameter, and at first they resemble
flea-bites ; they generally cluster in groups, having an irregular shape
somewhat resembling a half moon. Several days previous to the ap-
pearance of the spots, the patient is affected with catarrhal symptoms,
such as short dry cough, red eyes, with lachrymation, frequent sneez-
ing; the spots remain upon the skin for three or four days, after which
they scale offl While the spots are out the cough and redness of the
eyes continue. The desquamation of the epidermis is sometimes
the only sign by which we are able to recognize the existence of the
eruption.

The disease runs its course in three stages :

1st Stage. — The Febkile Stage. — The febrile stage lasts three dn^js
and sometimes a little more. The fever is remittent and attended with
the catarrhal symptoms ; sensitiveness and light inflammation of the
eyes; puffiness of the eyelids; lachrymation; photophobia; frequent
sneezing and discharge of water from the nose ; troublesome, short and
dry cough, with hoarseness and difficulty of breathing, frequently ac-

MEASLES 605

companied by moaning ; roughness and slight soreness of the fauces ;
pain in the back or epigastrium ; aching in the forehead, delirium,
spasmodic symptoms ; diarrhoea ; white-coated tongue, with bright red
edges. During the period of dentition, and in children generally all
the inflammatory symptoms are more violent than in full-grown per-
sons ; but the suffering and accompanying pulmonic or .cerebral con-
gestions, the oppression of the chest and the after phenomena which
often render the disease formidable, are all more severe and threaten-
ing in adults. In all the more serious symptoms continue to increase
in severity till the eruption appears on the skin.

2d StxIqe. — The Eruptive Stage. — The eruption appears at the
end of the third or fourth day ; generally in the face, arms and breast.
The spots increase in number and distinctness for three or four days,
and if they are very numerous, are attended with swelling of the face
and hands. The fever and uneasiness increase, the eyes continue sen-
sitive to light ; the cough increases to bronchitis or pneumonia.

On the fourth day the symptoms abate; the eruption then grows
paler, and if the fever should continue it must be because there is an-
other complication, or because of the violent irritation of the skin, in
consequence of the severity of the eruption.

3d Stage. — Desquamation.— The scaling off commences in the
sixth or seventh day, and sometimes even later* If the eruption be
slight, the scaling is scarcely perceptible ; in its stead we perceive the
healthy sweat, the critical urine and diarrhoea, terminating fia the dis-
appearance of all the remaining phenomena of the disease.

In this stage the patient is often exposed to real danger. The ca-
tarrh may increase to pneumonia, which is followed by hectic fever,
hydrothorax, haemoptysis, and in scrofulous subjects by real consump-
tion. Measles may be likewise followed by other cachexias, such as
otorrhoea, with pain and deafness, obstinate inflammation, &c»

During the fever, the cough is often very troublesome, and sometimes
terminates in inflammation of the bronchia or lungs. Schroen thus
describes^ the malady; "small red spots, in the centre of which we
generally find a white pimple. These spots soon become confluent,
and spread over the whole body after being preceded by catarrhal
fever for three or four days, attended with redness of the mucous mem-
brane of the mouth, with cough, catarrh, dread of light, and flow of
tears. They disappear upon pressure, and develop themselves again
from the centre towards the periphery after the pressure is removed.
The pimple becomes a small yellow prominence in the course of six-
teen hours, when a scurfy desquamation commences."

The attentive observer will have no difficulty in distinguishing this
malady from scarlatina by the following diagnostic symptoms: The
^riinary symptoms of measles are red and watery eyes, sneezing,

606 DISEASES OF THE SANGUINOUS FUNCTIOK.

fluent corjza, short cough and some hoarseness. These signs, which
are almost uniformly present in this disease, are usually wanting in
scarlet fever. In the general character and appearance of the erup-
tion there is also a marked difference. The scarlatina rash is com-
posed of innumerable fine pimples, resembling in appearance the shell
of a boiled lobster, uniformly diffused over the surface, and of a 'bright
scarlet color. The eruption of measles appears in spots (sometimes
papular) resembling flea-bites, which run together and form semi-lunar
patches. There is a roughness or elevation where the eruption exists,
perceptible to the touch ; and which is not usually observed in scarla-
tina. But one of the best marks of distinction is the difference in the
color of the rash, that of measles being d. piirplish^ or darhish scarlet^
while that of scarlet fever is a light scarlet.

Measles is a disease, which, under different circumstances, assumes a
great variety of forms, both as to its general character and violence.
During some seasons it prevails as a mild and simple affection, requir-
ing little or no treatment ; while at other periods it assumes a highly
inflammatory, congestive or typhous character. Sometimes almost all
cases seem to have a tendency to run on to pneumonia ; at other times
"cerebral or typhoid symptoms predominate ; in still other instances,
gastric disorder prevails ; but in the great mass of cases the malady
is mild and tractable.

In contemplating the numerous varieties of this, as well as of most
other diseases, the impartial physician must acknowledge the utter un-
certainty and empiricism of prescriptions guided only by the name of
the disease.

Causes. — In common with the other contagious disorders, measles
arises from a specific morbific contagion. This has been amply proved
by Home, Dewees, Speranza, and Majendie, who, in numerous instances,
succeeded in communicating this affection by inoculation. The season
of the year, the condition of the atmosphere, and the peculiar circum-
stances of the individuals exposed, exercise a powerful and perhaps
controlling influence, in determining the character of the epidemic.
When measles happens to prevail during seasons oi influenza^ typMis^
or dysentery^ the disease will partake of the peculiar character of the
existing epidemic, and its course will be modified accordingly.

Treatment. — The most common medicines in the treatment of
measles are Aconite and Pidsatilla ; next in importance stand Bryo-
nia^ BelL^ Ipecac,^ Merc.^ Sitljph,^ Oiipr.-acet^ Rhus.^ Acid.-phos.^
Arsen.j Cha^n. and jStihiu?n,

Schroen recognizes five different varieties of measles, founded upon
the characteristic symptoms present in each given case; viz., first the
simple or erethistic, in which Aconite is the appropriate remedy;
second, the inflammatory^ requiring the use of Aconite, Bryonia and

MEASLES. 607

Belladonna ; third, tlie gastric^ demanding the employment of Bryo-
nia^ Pulsatilla^ Chamomilla^ IpecaGuanha^ and Veratrwn / fourth,
the typhus, or irregular, calling for JRhus.-tox,, China^ Nux-vom,,
and Belladonna] fifth, the septic, or malignant, corresponding with
Acid-phos., Acid.'Sulph., Aoid^-rnur,, Opii and Arsenicum,

At the commencement of an attack, when heat, thirst, quick pulse,
red, inflamed and watery eyes, sneezing, fluent coryza, cough, dyspnoea,
oppression at the chest, and sore throat are present. Aconite at the
third potency is the most suitable remedy. So long as the disease
progresses mildly, running through its regular stages in due form, no
other medicine will be requisite to complete the cure. Even in those
complications which call for the use of other medicines, as pneumonia,
croup, cerebral, or gastric disturbance, whether occurring before, dur-
ing, or subsequent to the eruption, should the inflammatory excitement
run high, Aconite will still be required. Its repetition must, of course,
be subject to the circumstances of each particular case.

When there exists a predominance of catarrhal symptoms, and a
tardiness in the appearance of the eruption, we have an appropriate re-
medy in Pidsatilla, This medicine may often succeed Aconite with
peculiar advantage in the catarrhal forms of more than ordinary se-
verity. In these cases some writers claim for this agent important
prophylactic properties. It is also a valuable remedy in retrocession
of measles, attended with one or more of the following symptoms :
hoarseness, swelling of the parotids, puffiness of the face, pain in the
ears, discharges from the ears, hardness of hearing, dry, short cough,
great restlessness, pains in the head, back and loins, and mucous di-
arrhoea.

Dr. Croserio believes Pulsatilla to be especially adapted to measles,
not only as a remedy, but as a prophylactic. He asserts that " it is to
this disease almost what Belladonna is to scarlet fever. The precur-
sory symptoms of measles accord perfectly with the febrile symptoms
oi Pulsatilla, viz.: chills, heat, lassitude, throbbing pains in the head,
anxiety, nausea, Vomiting of bile, or glairy mucous, violent coryza, red
eyes, lachrymation, photophobia. Then follow pricking of the skin, red
spots like flea-bites, excoriation and creeping in the throat, diflicult de-
glutition, dry, fatiguing cough, epistaxis, &c. If giveu in the precur-
sory stage, I have often seen the disease terminate in abundant per-
spiration in twenty-four hours."

Belladonna is indica.ted when the throat is much inflamed and swol-
len, with very painful and difficult deglutition, short, hacking, throat
cough, inflamed eyes; nervous, uneasy, and sometimes delirious; hurried
respiration ; headache, intense thirst, dry, hot skin, and signs of cere-
bral disturbance. It has likewise been recommended in cases of sudden
disappearance of the eruption, after having been out one or two days.

608 DISEASES OF THE SAIJTGUINOUS FUNCTION.

" When tlie eruption suddenly disappears and is succeeded by fever,
violent headache and breathlessness, great benefit will be derived from
the administration of Aconite and A Tsenicuim alternately ; and after-
wards, when the head appears to be the chief point of attack, indicated
by excrutiating headache, screaming or moaning during the night,
Belladonna and Cit2^Tum'aGetiGicrrb^ repeated every hour or two, will
afford marked relief." [British Jour, of Horn, ^ No. XXIV. p. 232.)

Bryonia will apply in cases attended with marked pectoral symp-.
toms, like stitches or darting pains in the side and chest, anxious?
sighing, difficult and painful respiration, and very great general un-
easiness. . w

" Hartmann says that Bryonia " is also a powerful remedy in reinrO"
cescent measles^ in reproducing the eruption on the surface, or in ren-
dering its disappearance harmless. In these I give Bryonia in the
fifteenth dilution, and notice that it is chiefly indicated, if after the
retrocession of the eruption a morbid affection of the eyes supervenes?
which resembles that which I lately noticed when speaking of oph-
thalmia."

TpecaGuanTia should be administered when there is ga.stric disorder,
indicated by nausea, vomiting, pain and oppression in the stomach, and
inability to retain food or drinks.

For the ulcers which sometimes form in the mouth and throat, also
the glandular swellings which occur in the neck, Merourius is a valu-
able specific.

As a remedy for the restoration of retrocescent measles, as well as
for the inflammatory affections of the eyes, which now and then remain
as sequelae of this malady, Sulphur is sometimes a remedy of the
highest importance. Many cases, after having apparently run their
courses in a mild and regular manner, leave the patient with some an-
noying dregs, like discharges from the ears, weak eyes, eruptions of
various kinds, or chronic cough, with profuse expectoration; they are
attributable to some miasm, which has been roused during the course
of the disease. For the cure of cases of this kind, Sidjphur is an in-
dispensable agent.

We occasionally meet with nervous or typhoid symptoms which render
the use of Arsen,^ BhuS'tox^y St/pamoninm^ Ojp, and PTios, necessary ;
whatever symptoms present themselves, the judicious physician will be
able to select from the great number of medicines of which the pure
effects are known.

' Lacliesis. — Case "by Br, G, Dunham.— K girl aged 9 years, had
scarlatina three months ago very severely; it left her delicate and deaf.
Exposed to measles ; eruption appeared six days after, " along with a
cojnous discharge frorn^ the earsP Two days after the discharge and
eruption suddenly ceased. She became immediately feeble and pros-

WHOOPma COUGH. 609

trate ; there were wild, muttering delirium ; thirst; singular, biting heat
of the skin. Third day of the disease: She had lain in alternate
stupor and delirium for 24 hours; delirium, low, muttering; pulse soft,
wavy, hardly to be counted ; calor mordax ; respiration rapid, whistling,
attended with moaning; occasional cough, and a grasping at the throat
as if to tear the clothing from it. Pupils widely dilated ; no stool for
two days; urine scanty; countenance cadaverous; odor of breath pu-
trescent. At 11 A. M. she took Lachesis 30^, six globules in water, a
tea-spoonful every two hours.

At six p. M. she was sitting up in an arm-chair playing with some
toys ; rational ; skin pleasant temperature ; pulse 80, regular a-nd soft.
After the second dose she had slept quietly, had no more delirium or
thirst. She took no more medicine ; the rash did not re-appear ; but
she convalesced steadily from this point

5. PERTUSSIS.— Whooping Cough.

Prom the time of Autenreith, the relationship between whooping-
cough and other acute exanthematous fevers has been suspected. Dr.
Volz claims that pertussis should be classed among the exanthemata,
for the following reasons : It often appears as an epidemic ; it is con-
tagious ; children are more certain to be attacked by it than adults •
it occurs but once in a life-time, and has some relation to measles ; it
pursues a regular and uninterrupted career in the individual; all of
which peculiarities show a strong similitude between whooping cough
and the exanthematous fevers. There is indeed seldom any eruption
visible in this disease ; but in many cases of the common exanthemata
the eruption is wanting. Neumann has seen whooping cough accom-
panied by an eruption resembling measles in form, but having the color
of scarlatina and appearing chiefly on the breast and arms. This
eruption is rare, but it has been seen by others. The pathology of
pertussis presents some changes in the glands of the mucous membrane
of the intestinal canal, which Rokitansky regarded as peculiar to cer-
tain forms of disease,^including the exanthemata. Volz concludes that
pertussis is to be classed among the diseases produced by an abnormal
change in the blood. He found no remedy but Belladonna available
in its severity. [Hdser's Archiv^ Bd. IV.) Belladonna has often pro-
duced the eruption on the skin above mentioned, and entirely controlled
the cough at the same time. This has been more successful when the
aggravation is carried to the extent of " reddening the skin," than a-ny
other old school treatment. It reveals the nature of the disease, and
shows at the same time that Belladonna is only a partial similimum, to it-.

For History and Treatment, see p. 438, 439.

Vol. I.-39

610 DlSHAfe^S OF aflE SANGUmOUS FUNCTION

6. ROSEOLA.

Diagnosis. — This is one of the mildest and least da,ngerous of all
the eruptive fevers. It is characterized by an eruption or efflorescence
of a rose color, preceded and accompanied by some slight symptoms
of febrile disturbance. The rash shows itself on the third or fourth
day of the fever, and comes out in distinct and irregular spots upon
diiferent parts of the surface, or the spots run together, giving to the
skin an almost uniform redness. The cuticle is neither elevated, nor
is there any appearance of papulge ; but a simple blush of a rose color
characterizes the eruption, and serves as a mark of distinction between
it and that of other diseases of this kind. The appearance of the rash
is often attended with itching and tingling, which are present more or
less until the eruption vanishes, which is usually in five or six days,
without desquamation of the cuticle or any unpleasant after symp-
toms.

Causes.— Roseola is for the most part confined to infants and females.
It arises from undue exposure to cold, after having been confined in a
warm room, indigestible food, dentition, gastro-intestinal irritation, and
the abuse of stimulating infusions, cathartics, &c.

Treatment. — Rigid dietetic regulations, a moderate, dry and equal
temperature, mental and physical rest and quietness, and a,n entire ex-
clusion of all "herb teas" and other "domestic remedies," will generally
secure the patient from any ill consequences from this simple affection.

7. URTICARIA —NETTLE RASH.

Diagnosis. — The primary symptoms of urticaria are, languor, op-
pression, and sickness at the stomach, foul tongue, bitter taste, giddiness,
creeping chills, succeeded by preternatural heat of skin and thirst. Dur-
ing the early period of the disease, elevated, circular and florid spots
or weals, each with a whitish spot or point in its centre, appear, some-
times in only one part of the body, at other times generally diffused
over the whole surface. These weals are attended with an exceeding-
ly annoying itching, stinging and burning sensation, somewhat resem-
bling the stings of nettles. The itching, as well as the febrile excite-
ment, is always worse in the evening or during the night ; but when
the eruption is upon the surface, the nausea and distress at the stomach
abate, and do not return until another eruptive period, unless there is
a sudden retrocession of the weals. Frequently the blotches are ele-
vated, rough to the feel, numb and insensible, and resembling stings.
When deep seated in the skin, they are brought to light by friction and
scratching. Sometimes they appear in a few hours. They are ex-
ceedingly evanescent, and frequently appear and disappear on the sam^

I^ETTLE RASH. 611

day. Both in shape and sensation they resemble the blotches occa-
sioned by nettles, and are distinguished by the peculiarity of disap-
pearing in warm and coming out in cold weather. They are liable to
constant changes of locality, to such a degree that a blotch does not
in some cases remain in one spot an hour at a time. Their retrocession
is seldom accompanied by any material alteration of health, but is
sometimes attended by slight fainting and headache, with some degree
of fever.

In some instances the eruption appears suddenly without any febrile
or other premonitory symptoms, and without any apparent exciting
cause. At other times, certain articles of food, like shell-fish, porgies,
esculent vegetables, acid fruits, or stimulants, like wine, spirits, hot
ptisans, condiments or frictions upon the skin, seem to become its ex-
citing causes. It usually terminates in a few days, but now and then
it persists many months, sometimes apparent upon the skin, at others
suppressed.

" Its sudden disappearance without leaving a trace behind, and its
equally sudden reappearance, are quite characteristic. Inclination to
vomit is also present in all the va.rieties of this disease, and vomiting
frequently occurs as a crisis." {/Sehrwn,)

Some nosologists have divided this malady into two, and some into
four varieties ; and others, like Bateman, and a few of the older writers,
have gone so far as to recognize and describe seven ; but these fine
and arbitrary distinctions are not founded. in nature, and therefore offer
no aid in diagnosis ; while, on the other hand, there is danger that they
may confuse and embarrass the inexperienced practitioner. We know
that the eruption is very irregular in regard to the periods of its ap-
pearance, and also in the size, form, general aspect, and diffusion of the
weals ; yet we see no necessity for complicating our classification with
so many varieties, for we might with as much propriety go on with
divisions, ad infiniUmi^ as to stop after having described six or seven
genera, since the most acute nosologist will sca.rcely be able to dis-
cover any two cases presenting precisely the same symptoms in all
respects.

If, however, we were to adopt any classification, it would be that of
Schroen, who distinguished two forms of the malady, the aoute and the
ohronio. Under the former he includes : first, xirticciTia inaculosa^
or spots of different degrees of redness, attended with sensation of for-
mication and intense itching ; second, tirticaria vesicularis^ or vesi-
cular prominence, with empty and almost transparent apices ; third,
urtiGarixi tuberosay OY hard, tense, and painful tuberosities, generally
appearing in the night. Amongst the chronic varieties he ranks urti-
caria evanida^ resembling the urticaria tuberosa, appearing on expo-

612 DISEASES OF THE SANGXnN-OrS FUNCTIOI!T.

sure to cold, and disappearing on the application of warmth. This
variety sometimes continues for weeks and even months.

Causes. — The remote cause of nettle-rash is supposed to consist of
specific miasm, either generated within the organism or introduced
from without, and which is liable to be roused into action by numerous
exciting causes. The proofs of this are numerous, and we think satis-
factory ; for, if it were merely an effect or symptom of one of the vari-
ous exciting causes, like indigestible food, certain kinds of fish, acid
fruits, vegetables, wines, liquors, &c., it would disappear as soon as the
exciting cause was withdrawn, and all irritation from this source ob-
viated ; but, in very many instances, no such result takes place, and,
after the noxious article has been entirely removed, and the part pre-
viously deranged restored to its usual normal condition, there is a per-
sistence of the urticaria for months, and even years — it appearing and
disappearing at frequent intervals, without the slightest apparent rea-
son.

Another fact which sustains this opinion is that, if the eruption be
suddenly repelled by the use of lotions or cathartics, serious internal
disorders frequently supervene as a consequence of the retrocession,
which terminate, if the weals are not reproduced either spontaneously
or aTtificially, in dissolution. A painful case, illustrative of this posi-
tion, occurred under our observation a few years since. The patient
was a lovely and highly interesting young lady, who for some slight
exciting cause was afflicted with urticaria, although previously she
had remained for many years in excellent health. The malady
annoyed her by turns for more than three months, when, from the
application of a lead water lotion, the external symptoms suddenly
vanished, leaving in their place wandering pains in the chest and side,
some cough, fits of oppression at the chest, and difficulty of breathing.
These symptoms of pulmonary disturbance continued to increase, until
she was pronounced by two eminent physicians of a neighboring city
to be past cure with tubercular consumption. About this period the
case came under our charge, in what seemed to be the last stages of
consumption. Notwithstanding, however, the unpromising condition
of affairs, the patient slowly but gradually recruited, so that in six or
seven months the abscess which had existed in one lobe of her lungs
was healed, and the lungs, with her whole system, were restored to a
comparatively sound and healthy state. In this condition she con-
tinued for nearly two years, when a second attack of urticaria super-
vened, affording still farther relief for a few days from all remaining
diflBculties, and the rash permanently disappeared. From this time
^Aer symptoms were all aggravated, her old complaints returned, the
luugs again became ulcerated, so that in a few months the malady
adv^«^£d to a fatal termination. Is this an isolated instance ? With-

NETTLE HASH. 613

out doubt the experience of almost every physician could furnish one
or more cases of the same description.

This example offers conclusive evidence that an intimate connection
existed between the two diseases, and that, whenever the rash was
upon the surface, nothing disturbed the lungs ; while, the moment re-
trocession ensued, pulmonary symptoms manifested themselves. If
urticaria is a purely local disease, depending upon a distention or
spasm of the extreme cutaneous vessels, how can the suppression of
such local inflammation affect so seriously internal organs ?

It must be confessed that our knowledge respecting the causes and
intimate nature of cutaneous affections is at present quite limited ; but
when we take into consideration the fact that so many internal consti-
tutional maladies take their exit through the surface in the form of
eruption, we are constrained to believe that this is almost uniformly
only a symptom of some internal disorder.

Treatment. — As it is of the first importance in all cutaneous dis-
eases that the eruption should be urged and retained upon the surface,
in order that the miasm may not fall upon any vital organ, we should
select our remedies chiefly from those which exercise a specific action
upon the skin.

Another point, of no less importance in the management of eruptive
fevers, consists in securing for the patient a dry, moderate, and equable
temperature. This precaution, combined with cleanliness, and a placid
and composed frame of mind, will always aid us materially in our thera-
peutical measures.

The medicines which are the most appropriate for the treatment of
this complaint are : Acon,^ SulpLy Dulo., Hhus., Galc-carb., Lycojp,^
NatT.-nhUT,^ Acid, -nitric.^ Puls.ylgnat^ Ipecao.

Aconite will only be required in those cases which are attended
with undue febrile and nervous irritation. It may be administered as
advised under measles.

Sul2)hur, — This, medicine should always be prescribed in cases
occurring in individuals of a marked scrofulous dyscrasia, when the fol-
lowing symptoms are present :

General appearance of debility; pale, sallow, and sickly expression
of face ; redness of the margins of the eyelids ; swellings of the glands
of the neck.

Eruption and violent itchings, occurring in the night from the heat
cf the bed, and occasionally from exposure to cold air; great sensitive-
ess to cold ; dizziness and pains in the head; spasmodic twitchings
of the eyelids ; bad taste in the mouth ; nausea ; pyrosis ; weakness
and oppression at the chest.

Melancholy, sadness, irritability.

In a case in which there was fever at night, derangement of stomach,

614 DISEASES OF THE SANGUmOUS FUNCTION.

itching eruption on the skin over most of the body, occasionally reced-
ing when it caused nausea and pain in the stomach, pahis in the limbs.
Aconite, followed by Sulphur, cured in a day or two. Relief in a few
hours.

Administeation. — One grain of the third trituration in two ounces
of distilled water ; a dessert-spoonful once in twelve hours.

DulGamara is useful in urticaria which proceeds from taking cold,
and is attended with nausea, vomiting, oppression at the stomach, heat
of skin, thirst, bitter taste, diarrhcea, and great general uneasiness.
The symptoms are aggravated at night, during repose, and by the heat
of a room ; but they disappear in the open air.

Administkation. — A drop of the third dilution, in a small quantity
of water, may be given once in six to twelve hours.

Shus-tox. — Eruption, attended with itching and burning during
inaction, or on entering a room from the open air ; disappearance of
the weals on exercise, followed by shifting rheumatic pains, pains and
pressure in the stomach, difficult respiration and anguish. This medi-
cine is particularly applicable in urtioaTia vesioularis.

Administration. — Same as JDuhamara,

CalGai'ea-Garbonica is indicated in cases where the rash vanishes
on going into the fresh air, and is excited by the application of cold
water ; face yellow, upper lip swollen, skin rough and covered with
goose-pimples, stunning lateral pains in the head, with nausea and
vertigo at night or in the morning on waking, with faintness ; anxiety
anguish, apprehension.

Remarks. — Calcarea-GarboniGa is suitable in obstinate GhroniG ur-
ticariaj especially when occurring in scrofulous or cachectic constitu-
tions. It is sometimes necessary to persist in the use of this remedy
for several weeks.

Administration. — A drop of the third dilution in an ounce of water ;
a dessert spoonful once or twice in the twent^^'-four hours.

LyGopodium. — Rash and itching during repose, headache in the
afternoon or at night, smarting of the eyes by candlelight, nausea when
in a hot room, relieved in the air, silent and peevish.

Administration. — Same as CalGarea-GarboniGa,

Natrum-imtriatiGUTn^ at the sixth potency, may be prescribed when
there are languor, uneasiness, nausea, headache, weakness when lying
down at night, relieved on rising in the morning, eruption coming out
after violent exercise.

Nitric-aGid^ third dilution, will be proper for patients of a debilitat-
ing night-sweats, weak, enfeebled, subject to haemorrhages from the
bowels, lungs, nose, &c., and rash caused by exposure and cold air. A
drop should be prescribed, two or three times daily,

Pulsatilla^ sixth dilution, when the elevations are redder than the

AOHOROUS EXANTHEM, 615

,Bliin, when the itching is of a burning or pricking character, worse at
night in bed, in a hot room, or by scratching ; better in the^ open air,
worse every other evening ; heaviness and disposition to numbness in
the limbs ; great sensibility to the open air.

Ignatia^ sixth dilution, is particularly adapted to attacks occurring
in nervous and hysterical females ; the eruption is brought out by
exercise, and is often preceded by nervous symptoms ; there is also
fullness and pressure of the head, with sparks before the eyes ; also
gighing and irregular respirations.

Ipecacuanha^ third trituration, is useful in cases attended with ex-
cessive vomiting, oppression at the chest, and dyspnoea; it is also a
valuable remedy*in asthma from suppressed urticaria.

Other remedies worthy of consideration are : Arsenicum^ Balsam-
copaibm^ Iodine^ and Bryonia^ in the chronic forms ; and in the acute
varieties, Clematis^ StapJiysagria^ and Belladonna^ for urticaria
^esicularis ; TJrtica and Hepar-sulphur^ for urticaria tiiberosa ;
Mercurius^ Iodine^ AuruTrb-muriaticum^ and 8ej>ia for urtica/i'ia
^maculosa,

Administeation.— The above remedies may be given dissolved in
pure water. They may be repeated in six, eight, or twelve hours, ac-
cording to the urgency of the symptoms. In all cases of this descrip-
tion, where a latent miasm is suspected to exist, a persevering and
judicious course of anti-psoric treatment should be adopted after the
eruption has disappeared and the acute symptoms have subsided.

Urticaria^ jperwphigus^ as well as herpes zoster^ being often depen-
dent on the sycotic poison, are sometimes very obstinate. In some
cases Dr. Wolf succeeded with Thuja, 30^, where Apis had failed,
though tjie latter had cured urticaria in various forms.

Genus II.— EMPLYSIS.— -Achoeous Exanthem,
1. MILIARIA.— Miliary Fevee.

Diagnosis. — This disease is ushered in with lassitude, slight creep-
ing chills, pain in the loins and lower extremities, oppression at the
prsecordia, cough, general uneasiness, more or less heat and thirsty
rapid pulse, and high-colored urine. These precursory symptoms con-
tinue about five days, when a very fine eruption, resembling millet
seeds, makes its appearance on different parts of the body. The little
vesicles which compose this eruption are round, hard, and transparent,
becoming after a time opaque. As they are about coming out there is
an itching, stinging, and burning sensation in the skin, the oppression
at the chest and stomach is increased in severity, and, in general, a
profuse perspiration, of a disagreeable sour odor, breaks out over the

616 DISEASES OF THE SANGUINOUS FUNCTION.

whole surface. After two or three days the vesicles become opaque^
then soon dry up and fall off in the form of a scurf.

Some writers consider miliary fever as a purely syirvjptomatiG affec-
tion, while others, with equal tenacity, maintain that it often occurs
idiopathically. According to our own opinion it is not improbable that
it may be dependent upon some latent miasm, which only requires an
exciting cause, like puerperal fever, heating and stimulating ptisans,
undue exposure in heated and close rooms, &c., to call it into action.
We are confirmed in this opinion from the fact that in nearly every case
with which we have been made acquainted, where the eruption has re-
troceded, whether by improper use of external lotions or otherwise,
there has been a supervention of some serious internal disorder.

If this view of the cause of the malady be correct the therapeutical
indications are evident, and the prudent physician will use every means
which our specific medicines afford to aid nature in casting off the
poison from the system through the medium of the skin.

Treatment. — In conjunction with our internal remedies, it is essen-
tial that the patient be kept in a dry apartment, of uniform tempera-
ture, and be confined to a strict dietetic regimen. By these means we
shall prevent the retrocession of the rash from the sudden application
of external cold, and avoid those unpleasant complications which errors
in diet are so apt to induce. A strict adherence to the above rules,
with an occasional dose of Aconite of the third dilution, will generally
suffice for the cure of this complaint.

After the eruption has manifested itself, if the patient is troubled
with a train of nervous symptoms — like sleeplessness, general uneasi-
ness, partial loss of power over the voluntary muscles, spasmodic
twitchings, and constant desire to change position— a dose of the sixth
dilution oi IlyosGyamus may be given, and repeated as circumstances
require.

Should the brain become affected in any stage of the disease, Bella-
donna may be exhibited, in the same manner as advised under measles.

Ghamomillaj at the tenth potency, should be administered when
infants and children are the subjects of attack. If the malady com-
mences with strong febrile excitement; ^this medicine may be preceded
by Aoomte.

Bryonia is also highly recommended in cases of miliaria in infants
and parturient women. It may be administered in the same manner
as Bella'donna,

IpeeaGiianka will apply when the eruption is accompanied with
laborious and noisy respiration, nausea or vomiting, groaning, aversion
to food, chilliness alternating with flushes of heat, and sweet, insipid
taste. The third trituration should be employed— one grain every four
or six hours, until the symptoms yield.

COW-POX. 617

2. VACCINIA.—Oow-Pox.

The genuine cow-pox appears on the teats of the cow in the form
of vesicles of a blue color, approaching to livid. These vesicles are
elevated at the margin and depressed in the centre. They are sur-
rounded with inflammation. The fluid they contain is limpid. The
animals are indisposed ; and the secretion of milk is lessened. They
are locally treated by solution of Sulphate of Zinc and Copper, other-
wise they would degenerate into ulcers which are exceedingly trouble-
some. Saccharum-saturni would probably be better as a wash. Simi-
lar effects were induced on the hands of the milkers. They have some
fever and swelling of the glands of the axillse. The active matter
may excite the disease if applied anywhere to the abraded surface.

Mode of performing Vaccination, — Make a very oblique punc-
ture with the point of the lancet in the arm, near the insertion of the
deltoid muscle, the lancet being charged with the fluid matter. To
render the infection more certain, take more of the virus and draw
it across the puncture. Sometimes it is inserted in more than one
place.

Dr. Hoffmann, of Poughkeepsie, N.-Y., says ;^

He has succeeded in different ways ; one is "to grasp the arm of the
child, so as to tighten the skin on the part selected, (perhaps over the
lower part of the body of the deltoid muscle, and, with the point of
a sharp lancet, charged with the fluid matter, make a very small oblique
puncture in the skin. If the puncture be small, causing only the ap-
pearance but no flow of blood, the virus, being deposited beneath a
valve-like portion of the skin, is very likely to be absorbed." But, in
order to render the infection more certain, the lancet may be charged
again and an additional amount of the virus laid upon the puncture.
The small amount of fluid, including a minute quantity of blood, that
now lies within and upon the puncture should be permitted to remain
exposed to the air till it coagulates or dries. It should then be shielded
from pressure or disturbance. A small piece of court-plaster may be
placed over the wound, but, if it can be shielded by sufficient care
without this, it is perhaps better.

Second Mode, — Having obtained some of the fluid virus fresh, or
(if not able to get it,) pulverized a small amount of the scab with a
drop of water on the bottom of a glass or plate ; proceed by charging
the point of a sharp lancet with the virus, and making in rapid succes-
sion five or six scarifications in one direction, then crossing them by
the same number, and finally rubbing the flat blade smoothly over.

The Time for taking the Virus, — It may answer as soon as the

* U. S. Jour. Homoeop. Vol. II. p. 334.

618 DISEASES OF THE SANGUINOUS FUNCTIOK.

matter is formed ; but if taken too early, the vesicle may be injured.
It is better to leave it untouched till the eighth day, when its power is
at its best degree of perfection. At an earlier period it may be used
with safety, yet with less certainty of success.

Course of the Vaccine Disease, — The first sign of infection begins
about the third day. A small red spot rather elevated appears at the
place where the puncture was made. It may be retarded by various
causes, and may be prevented by any other disorder, as dentition or
debility.

Too much inflammation occurring within two or three days after
inoculation often attends when the operation is unsuccessful.

The areola begins to enlarge about the ninth day and declines about
the eleventh and twelfth day when it begins to dry. The drying pro-
cess begins with a brown spot in the centre. In proportion as this en-
larges, the surrounding efflorescence increases till at length nothing
remains but the circular scab of the dark brown mahogany color ap-
proaching to black.

The true, genuine cow-pox pustule, which is a reliable proof of the
proph^dactic virtue of the vaccine, is "flat and depressed in the centre;
and on the eighth or ninth day is surrounded with an inflammatory
redness, which is the chief sign that the organism has been thoroughly
infected with the vaccine. If the pustule be full and convex, and if it
begin to rise three or four days after vaccination was performed, the
prophylactic power of the virus can not be relied upon ; the matter
was perhaps too old, or was otherwise not good.

Permanent Evidence of successful Vaccination, — -1. The proper
vaccine scar should be distinctly defined after a lapse of twenty years ;
in order to this it is indispensable that the scab should remain on, or
that cicatrization should not be completed till the twenty-first day. In
some it is completed by fourteen or fifteen. Then " vaccination is im-
perfect."

2. The true and perfect vaccine scar is circular or nearly so. When
common inflammation supervenes early, the scar is irregular in form
and the system is still open to small-pox more or less modified. The
diameter of the circular scar is not material; but we think the largest
compatible with safety equal to a dime in size.

3. The vaccine scar should be indented and radiate; though this
mark is not insisted on as a sine-qua-non^ in proof of perfect vac-
cination.

Sources of Imperfection of Vaccination,— 1, EiFete virus. Always
use fresh matter, or from scabs perfectly preserved. 2. Pre-occupation
of the system by some other important diseased process, as dentition,
vesicular inflammation, fever, whooping-cough, porrigo favosa, or

COW-POX. 619

feerpes. 3. Lastly, advanced period of life wlien vaccination is per-
formed.

The real virus from the cow is so diflBcult to procure, that the
safest method is to select it from the healthiest child of the healthies
parents. There is grea diflerence in the power of the scabs in pro-
ducing the vaccine disease. The best a.nd most reliable are of a dark
brown color, easily pulverized, and as brittle as glass. Those of poorer
quality are pale, will bend but not break ; they are with difficulty pul-
verized, and are composed chiefly of fibrine.

Observations on many thousands of cases lead to the following con-
clusions :

1. That every individual is subject to vaccination. 2. Re-vaccina-
tion is not necessary before puberty. 3. At puberty the system under-
goes a change which makes vaccination again necessary. 4. Vacci-
nation when perfect is a sure preventative of small-pox. 5. Re-vac-
cination is a sure preventative of varioloid. 6. The third vaccination
is inert. 7. The system is susceptible of varioloid after puberty
whenever the individual without re-vaccination is exposed to small-pox.
8. Re-vaccination is not generally necessary if the first operation was per-
formed after puberty. 9. Those who disregard vaccination are always
liable to small-pox when exposed to it. 10. That if every individual were
perfectly vaccinated before puberty, and re-vaccinated afterwards, small
pox would disappear from the earth.

Of the Period at wJiioh Vaccination may he-jperformed with th&
hope of jpre'oenting Small-pox. — The infection when communicated
is not indicated by any perceptible symptoms ; and it is, therefore, im-
possible to define the period when vaccination will no longer be able
to ward off the small-pox. Hartmann says : " If small-pox shall have
attacked one member of a family and other members of the family
have not been vaccina.ted, va,ccination will prove ineflBc lent to protect
them from the disease." We have seen vaccination eflFectual in saving a
whole family, one of whom already had the small-pox and was lying in
their midst.

Irregular Course of Yaccine Disease. — Hartmann says, he has
seen '^ on the seventh day of vaccination metastasis to glandular
organs." This is not dangerous though the diseased action be trans-
ferred to the testicles or parotid glands ; as it generally disappears of
itself on the ninth or eleventh day, when the nervous and vesicular ex-
citement has subsided. It has frequently happened, that " morbid symp-
toms which would not yield to any remedy, such as chronic inflamma-
tion of the meibomian glands, or the discharge of badly-smelling pus
from the ears, ceased entirely after vaccination." In such cases the
vaccine disease ran its regular course, and was accompanied by more
fever than usual.

620 DISEASES OF THE SANGUUSTOUS FUNOTIOISr.

Bad Hesults of Yaccination, — A Massachusetts paper of April,
1860, says : " A large number of persons in Westport, Mass., recently
inoculated with vaccine matter obtained from the city physician of
Boston, have been afflicted in an extraodinary manner. A Mr. Fletcher
died in a few days after being vaccinated. His arm commenced swell
ing and mortification soon took place."

Dr. Williams, of the Cleveland Medical College, says : "A few
years ago the City Council of Cleveland passed an order requiring the
positive vaccination of all persons who had not been previously vac-
cinated. The order made no distinction among cases and was indis-
criminately carried into execution. The results were in some cases
truly alarming. In several children terrific ulcerations and disorganiz-
ing inflammations followed which ended in death. Others recovered,
but retained for a long time malignant sores, extending to the bone, or
nearly laying it bare around the arm. Those who performed the vac-
cination claimed that the matter they used was perfectly pure." (iV. A.,
Jour. HoTYKBOjp, Nov. 1857. p. 158.)

Bad Results of YacGination from the diseased Oonditionof the Pa-
tient— A physician of Poughkeepsie, N.-Y., vaccinated an apparently
healthy child and in a week was summoned to look at the child. "It
was covered with deep, ugly looking ulcers, secreting thin, acrid pus.
It had hitherto been the picture of health ; it was now feeble, emaci-
ated, its voice having a piping sound." The virus was known to be
from a healthy child whose parents were also healthy ; other children
had been vaccinated with the best results from the same virus. The
physician found in this case that the parents of the child were more
or less diseased, the father confessing to have syphilis when young.

The matter for the performance of vaccination should be only taken
from healthy subjects, free from all eruptions or glandular diseases.
But the best matter may excite a latent dyscrasiain a patient supposed
to be healthy. Hence proper antipsoric treatment should precede as
well as follow vaccination.

Distinction hetween Yaocinia and true Small-pox. — In claiming
the appropriateness of the vaccine disease as a remedy to prevent
small-pox it is not pretended that the two diseases are precisely alihe
in their nature. Indeed, they are not alike but only similar. The
distinction is thus drawn by Dr. Henderson, of Edinburgh. 1. The
mildest case of modified small-pox in which only a half dozen pocks
occur on the skin is capable of producing by inoculation or contagion
nothing but small-pox; and it may produce severe and even fatal
small-pox in others, vaccinia may be said, however, to be still milder
than the mildest small-pox.

2. Dilute small-pox virus with water and thus weaken it to the lowest

COW-POX. 621

potency; it is still capable of acting by inoculation, and it will still
produce small-pox, not a solitary vaccine vesicle.

8. Dilute small-pox virus with cow's milk and it is said, by Dr. Basil
Thiele, that according to 8000 experiments, made by him, inoculation
with the mixture will produce the vaccine vesicle and not the small-
pox eruption ; the two diseases then are not identical. If only similar,
very similar it may be, the conclusion manifestly is that vaccination,
by producing a disease similar to the small-pox, and which can occur
only once in a life, prevents the occurrence of small-pox ; that in a
word, vaccination acts homoeopathiGally^ or according to the law of
similars. {On Homoe^ojpathy^ p. 240.)

Vaccination, says Hahnemann, can not protect us from small-pox by
acting otherwise than homoeopathic ally. The diseases are similar in
appearing generally but once in the course of a person's life ; they
leave behind cicatrices equally deep; they both occasion tumefaction
of the axillary glands ; they have fevers that are analogous ; an in-
flamed areola around each pock; and finally ophthalmia and convul-
sions. Other traits of close resemblance often exist between the two
maladies.

" The cow-pox would even destroy the small-pox on its first appear-
ance, that is, it would cure this disease when already present were not
the small-pox stronger than it. To produce this effect, then ft only
wants the excess of power, which according to the law of nature ought
to accompany the homoeopathic resemblance, in order to effect a cure.
(§ CLVIII.) Vaccination, considered as a homoeopathic remedy, cannot,
therefore, prove efficacious except when employed previous to the ap-
pearance of the small-pox, which is the stronger of the two."

" When so employed, it excites a disease very analogous (and conse-
quently homoeopathic) to the small-pox, after whose course, the human
body, which as usual, can only be attacked once with a disease of this
nature, is henceforward protected against a similar contagion.^

How mjuch Benefit has Vaccination conferred on the World f
In 1806 the bills of mortality seemed to show that the average dura-
tion of human life was twenty-eight years ; in 1886 a committee of the
New- York Medical Society estimated the average duration of life at
thirty-three years, and they credited vaccination with having done more
than any other sanatary measure for thus adding five years to the length
of human life. Before vaccination was discovered, one-tenth of the
whole human race died of small-pox taken in the natural way. Only

* This mode of hom(Bopathic cure in antecessum (which is called preservation or
prophylaxis) also appears possible in many other cases. For example, by carry-
ing on our persons Sulphur, we think we are preserved from the itch, which is so
common among wool- workers ; and by taking the smallest possible dose of Bella-
donna, we are protected from scarlet fever. (Organon.)

622 DISEASES OF THE SAKGTJINOUS FUNCTION.

three years before Jenner's discovery 36,000 died in England in one
year. His discovery promised to banish the most fatal of the dis-
eases which preyed upon the health and happiness of the human fa-
mily. And now, after the experiments of three-score years medical tes-
timony proves that vaccination is the only protective means for guarding
against small-pox, and that when the system is fully under the vaccine
influence the protection is perfect. When this is doubtful, there is as
yet no resource known but re-vaccination ; and, if after trying it there
be a doubt remaining, there is no resource but to repeat the operation
till the best vaccine virus that can be found can produce no effect upon
the system. Let re-vaccination be tried on all who have been vacci-
nated in infancy or youth; let the matter be selected with care; and
the protection given may be regarded as complete. It can not be said
that a single vaccination gives that perfect protection. The longer the
interval since vaccination has been practiced, the greater chance of
exciting true vaccine disease by re-vaccination. The influence of the
vaccine is not certainly for life, but for a term of years, which varies
in different constitutions, from ten to fifteen years, often much longer;
in some persons it extends through life. Lorette's experiments led to
the conclusion "that matter taken from a secondary pustule will pro-
duce a full and complete primary vaccine disease. We see the same
in small-pox, where the varioloid often communicates confluent small-
pox."

Permanence of the Power of Vaccination.— 1, "Is the preserva-
tive virtue of the vaccine virus absolute, or only temporary ?"

In 1842 the French Academy des Sciences offered prizes for the
settlement of this question; and it required that if the latter opinion
should be reached the answer to the question should "determine by
precise experiments and authentic facts the period during which vac-
cination preserves from variola." The answer which was accepted by
the Society was given by M. Serres. He says :

"The comparison of results enables us to draw three conclusions: —
1. The preservative power of vaccination is absolute and general for
eight or nine years after its performance, and even to the tenth or
twelfth year in a great proportion of cases.

2. When this period is passed, and especially under the influence of
epidemics, a part of the number vaccinated, and a part only are liable
to variola.

3. The greater number of the vaccinated are probably protected
for life.

II. " Has the cow-pox a more certain or permanent preservative
power than virus already employed during the greater or less number
of successive re-vaccinations ?"

COW-POX. 623

Answer. — The local elFects of the new virus are more marked ; but
the preservative power is not proportionate to these.

1. Small-pox, says Serres, appeared at the college of Soreze and
attacked forty pupils of whom only two had been vaccinated. All the
remaining pupils, two hundred in number, were vaccinated and small-
pox ceased.

2. In 1821 small-pox attacked twelve children at Mantua foundling
hospital, the remaining two hundred were vaccinated, and the disease
disappeared.

III. "Supposing the preservative power of the vaccine to become
enfeebled by la.pse of time, should we renew it, and by what means ?"

Means proposed for Renewal of the Virus, — Inoculate the cow
with the grease from the heel of the horse, or with true small-pox from
the human subject. Both of these expedients have often failed, but
they have often succeeded. It is best to seek the true vaccine virus
at its source as proposed by Jenner.

IV. " Is it necessary to vaccinate the same person several times ?
And if so, after how long an interval ?"

Answer. — The preservation is almost absolute up to the period of
adolescence^ After that period certain of the vaccinated are liable to
attacks of variola until the age of thirty or forty years. After that
period their preservation is almost absolute and certain. The only re-
liance to arrest epidemics is in re-vaGGmation, The fact that the vac-
cine disease may be excited by re-vaccination is no evidence that the
patient would have taken the small-pox. But the process of re-vacci-
nation does arrest epidemic small-pox; and this fact, fairly and fre-
quently observed, has silenced the opposition of all Europe.

To ensure the safety of the army the Prussian government issued
an order March 6th, 1831, demanding the re-vaccination of all who
entered the army. The order was made absolute ; and all surgeons
were compelled to report their results to the royal military council
every year. The report for 1833 concludes : that "there were strong
grounds of doubt of the extent of the protective agency of vaccination.
Either from the possible failure of the original operation, or from the
effect wearing out by lapse of time, enough had been proved to justify
the re-vaccination ; and that after the re-vaccination of all doubtful
men there were no cases of small-pox or varioloid, though the men had
been closely in contact with very many cases of small-pox."

In France the Academy of Medicine appointed a committee to in-
vestigate the same point. M. Lorette reported that he re-vaccinated 3600
persons. In one ca.nton where epidemjc varioloid prevailed, out of
eighty-six re-vaccinated, twelve presented examples of a second eruption
so regular and perfect that it was impossible to distinguish it from the
primary disease. Of these he says two-thirds presented vaccine cica»

624 DISEASES OF THE SANaUINOTJS EUITCTIOIsr.

trices too deep and well defined to leave any doubt of the perfection
of the primary vaccination ; therefore these individuals exhibited ex-
amples of two distinct and perfect eruptions of vaccina.

The period after the first vaccination influences the success of a
second trial. Before the age of ten years, re-vaccination only produced
false vaccinia. Another committee decided that " re-vaccination was
most successful for the young and middle aged." Hufeland says;
" Varioloid attacks almost exclusively adult subjects, or those who have
been vaccinated from ten to twenty years."

A committee of New- York physicians in 1836 reported that the per-
sons attacked with varioloid in the United States " were such as had
been vaccinated from fifteen to thirty-five years before ; and hardly in
any case did it afiect those who had been vaccinated within ten
years.

CharacteristiGS of False or Imperfect Vaccine Disease, — It begins
by the first or second day, is developed with such rapidity that it attains
its height by the time the genuine begins to show itself. The pustule
presents no central depression, is without a silvery lustre, and has no
elevated rim ; it rises nicely to a point, and thus becomes crowned with
a yellow or dirty layer, which bursts and gives out a single flake of
matter ; this when dried resembles gum in appearance ; and this is all
accomplished in eight or ten days at farthest. There is now little doubt
that the false vaccine is owing to matter too far advanced, or to the re-
sistance ofi*ered by the economy from previous vaccination or vario-
lation.

3. VARICELLA.— Chicken-Pox.

Diagnosis. — There are a few points of similarity between milder
cases of small-pox and the more severe forms of varicella which require
an acute observer to discriminate between them during the early part
of the attack. Both diseases commence with similar primary fever,
which continues until the eruption makes its re-appearance; the pus-
tules in both instances resemble each other; both are alike contagious
and communicable by inocculation.

At the eruptive period, however, an attentive observer will perceive
that the resemblance usually ceases, for the pustules of variola make
their appearance in a uniform manner, first on the face, then successively
upon the neck, arms, breast, body and lower extremities, occupying
usually but twenty-four hours for the completion of the eruption, we have
seen it take several days, while the pustules of varicella come out in
repeated series, first upon the breast, then upon the face, head, arms,
body and lower extremities, and require three or four days before the
eruption is complete. Therefore we often observe during the progress

PELAGRA. 625

of the latter, some vesicles drying up, some in a state of partial deve-
lopment, while others are but making their first appearance. The vesi-
cles of chicken-pox contain a whitish or yellowish lymph, which seldom
adva,nces far towards the suppurating stage, and even in those cases
where pus is formed, there is never any secondary or suppurative fever
as in variola.

Causes. — ^Varicella, like other contagious diseases, is a distinct af-
fection, and proceeds from a peculiar specific cause. This is apparent
from the fact that inoculation with varicellous matter never gives rise
to any other malady than varicella itself.

It is not only a much milder disease than small-pox or varioloid, but
is of much shorter duration, running its course generally in six or seven
days, when the pocks all disappear, leaving smooth surfaces.

Teeatment.— Varicella, as it commonly occurs, requires no medicinal
treatment. A due regard to diet, avoidance of exposure to cold, damp-
ness, &c., being only necessary to ensure its safe progress.

In cases where the malady assumes unusual severity, manifested by
a high grade of febrile excitement, determinations of blood to the
brain, lungs or abdominal organs, then the medicines that are homoeo-
pathic to the existing symptoms may be administered.

The remedies most frequently used in such cases are, Aconite, Coff.^
Bell,.) Merc,^ Hhus-tox,, and Sulphur. The strength of the medicines
as well as the repetitions of the doses, the same as under varioloid.

4. PELAGRA.

Dr. James Johnson, one of the " most accomplished medical scholars
in the world," thus describes this disease, known as " the scourge of
Italy :"'^ The phenomena which result from the physical operation of
climate on the human race, and which are equally curious and melan-
choly to contemplate, may be seen in a large scale in the great hos-
pital of Milan — the pelagra of the Lombardo- Venetian plains.

This horrible malady has been observed since the middle of the
last century, and is rapidly increasing. It has been supposed that one-
seventh of the population may be afiected by it.

It begins by an erysipelatous eruption on the skin which breaks out
in the spring, continues till autumn, and disappears in winter, chiefly
affecting those parts of the surface that are habitually exposed to the
air or sun. This cutaneous symbol of an internal disorder is accom-
panied or preceded by remarkable debility lassitude, melancholy,
moroseness, hypochondriasm, and sometimes a strong propensity to
suicide. Year after year the cutaneous eruption and annual disorder

* Johnson, On Change of Air, p. 54.
Vol. I.— 40.

626 DISEASES OF THE SANaUINOUS FUNCTION.

become more and more aggravated, with shorter and shorter intervals
in winter. At length the surface ceases to clear itself, becomes per-
manently enveloped in a thick, livid, leprous crust somewhat resembling
the dried and black skin of a fish. By this time the vital functions are
reduced to a low ebb, and frequently the intellectual faculties also.
The miserable victim loses the use of his limbs, particularly the infe-
rior extremities ; he is tormented with violent colic, headache, nausea,
flatulence and heartburn; — the appetite being either weak or voracious.
The countenance is sombre ; teeth rotton, inside of the mouth ulcer-
ated. Mucous membrane highly irritable ; diarrhoea; burning pain in
the head and along the spine, from whence it radiates to various other
parts, but more especially to the palms of the hands and soles of the
feet, tormenting the wretched victim by day, and depriving him com-
pletely from sleep at night ! He frequently feels as if an electric spark
darted from the brain, and flew to the eye-balls, the ears and nostrils,
burning and consuming these parts. To these seven afflictions of the
body are often added hallucinations of mind. The patient fancies he
hears the incessant noise of mill-stones grinding near him,— of ham-
mers resounding on anvils, of bells ringing, or the discordant cries of
various animals. Advancing further the disease sometimes takes the
form of various other maladies, as tetanus, convulsions, epilepsy, dropsy,
marasmus, mania. Over the beds of the Milan hospital are written
the compound names atropia pelagrina, hydrops pelagrina, paralysis
pelagrina, &c. The patient at last ceases to suffer and death relieves
him when disease has reduced him to an appearance resembling a
mummy. Many anticipate a fearful death by the dreadful expedient of
suicide, and the tendency to self-destruction by drowning is so general
that the suicidal disposition was called by one writer " Hydromajfiia."
Pelagra most frequently affects, persons living in the country, including
the lower classes of the people; it may effect persons of every age
down to children. It is found in the whole of the flat country on both
sides of the Po, especially the level plain between that river and the
Alps. It has been described by niany native authors, including Strambi,
Trapolli, Soler, Zanati.

Such is a disease which afflicts one- seventh of the population of that
delightful land, the climate of which has been eulogized by every an-
cient and modern poet, painter, novelist and romantic tourist. "Words-
worth saw the beauties of external nature, and enjoyed them as Virgil
has taught all men to appreciate them nineteen centuries ago. Sogers
found among the same scenes only the sunniest spot of earth:

" Where the world danced,

Listening to Monto quaffing gramolete,

And reading in the eyes that sparkled round,

Ten thousand love adventures written there." {Rogers^ Italy,)

SMALL-POX. 627

Causes.— The cause of this frightful malady is no more known than
the cause " of hepatitis on the coast of Coromandel, of elephantiasis in
Malabar, beriberi in Ceylon, barbadoes-leg in the Antilles, goitre
among the Alps, the plica polonica in Poland, cretinism in the Valais,
or malaria in the Campagna di Roma. It is an emanation from the
soil, whether conveyed in the air, the food, or the water. If any of
these endemics above named originated in the filthy habits of the peo-
ple, we ought to have them in Sion, or the Jew's quarter in Rome, the
narrow lanes of Naples, and the allies of filth in all Italian towns and
cities. But the Jew's quarter of Rome is the filthiest and the health-
iest spot in that famous city. The inhabitants of some wretched Nea-
politan villages are eaten up with dirt, starvation and malaria ; but no
goitre, elephantiasis or cretinism is ever seen there. Each country
then which produces its peculiar endemic, produces them from hidden
sources that human sagacity has not yet been able to penetrate. Medi-
cal men have generally thought palagria in Lombardy to result from
the poverty and wretched condition of the poor. No- doubt this pov-
erty and the filthy habits of the people in many places contribute to
call forth and perpetuate a disease which proper sanitary conditions
and correct medical treatment ought to exterminate.

Genus III.— EMPYESIS.— PUSTULOUS EXANTHEM.

L VARIOLA.— Small-Pox.

The Greeks and Romans knew nothing of small-pox. The first
notice of any disease that presents any of the chief features O'f small-
pox occurs in a chapter of Procopius in Bello Bersioo (lib. II., chap.
22,) where he describes a dreadful pestilence which began at Pelusium
in Egypt in about the year 544 a. d., or 1318 years ago. It spread
towards Alexandria on one side and Palestine on the other. A very
short time afterwards unequivocal traces of small-pox are seen in tile
countries bordering on the Mediterranean. Bruce, the traveller in Abys-
sinia, supposes it to have first appeared in the yea.r a.d. 522. But it was
not clearly described till it was done by Rhazes of Bagdad in the
year 900. From the east small-pox travelled westward, and reached
England just before the year 900. {Lectures on the Exaoithemata^ iy
Dr. George Gregory^ St. Thomas Hospital^ 1843.) In 1527 it was
brought to America.

So long as no means were known of mitigating the severity of small-
pox the number of deaths from this disease was enormous in every
country to which it had found its way. Before the introduction of in-
OGulation^ and when the disease was always taken in the natural w^ay,
the number of deaths was one in six, and a large proportion of those
who escaped with life were dreadfully disfigured. Under the influence

628 DISEASES OF THE SAN&UINOUS FUNOTIOISr.

of, inoculation the deaths were reduced to one in fifty ; and further im-
provement in the treatment by physicians reduced the deaths to one
in two hundred. But the disease was more widely diffused by these
efforts to diminish its mortality. There were more sources from which
small-pox could be taken in the natural way. Inoculation therefore
made its way to public confidence through much opposition; and it was
not fully established in the public mind after eighty years of discussion
and experiment. In England alone 40,000 persons annually died of
small-pox. Dr. Lettsom estimated the deaths in Europe at 210,(500 per
annum ; and Bernoulli made the annual number of deaths in the world
at 600,000.

A half century before the discovery of inoculation, 72' persons out
of every 1000 of the population died of small-pox. In forty years
after this discovery, or after 1770, the deaths rose to 85 per 1000 in-
habitants. And such was the condition of the world when Jeiiner be-
gan his experiments on the powers of vaccination to supercede small-
pox. In 1798 he, performed his grand experiment of inoculating Sir
James Phipps with small-pox, relying on only a previous vaccination to
protect him from the more fatal disease. The result was successful.
The patient found himself insusceptible to the small-pox poison ; and the
world rejoiced in the hope that the most loathesome and dangerous of
known diseases was about to be banished from the world.

Ya/rieties of Small-^ox. — Two varieties of this disease have gene-
rally been recognized by nosologists ; one termed distinct^ the other
confluent,

1. The former of these is more mild and less dangerous than the
latter, being attended with less severe constitutional disturbance, and
having detached, distinct pustules, fewer in number, and which are
surrounded by a pale-red areola.

2, The Gonflicent variety is distinguished by the pustules running
together and meeting each other, the surface presenting the appear-
ance of a uniform and homogeneous swelling.

Diagnosis. — -An eruption consisting of acuminated pustules which
first appear on the third, fourth or fifth day of the contagious fever in
the shape of red spots ; these spots gradually elevate themselves into
pustules during three days, suppurate for three other days, after which
they dry up and form scabs, which in falling off leave small irregular
cicatrices. Tftis is the course of a single pock. As the breaking out
of the fresh pocks continues for three days, the period of dessication
terminates about a fortnight after the appearance of the first pock.

Small-pox may be divided into the following stages or periods, viz :
1. The primary fever ; 2. the eruptive stage j 3. the maturing
period^ 4. \hQ period of exsiccation,

1, The primary fever in the distinct variety is ushered in with

SMALL-POX. 629

lassitude, rigors, pains in tlie head, back and loins, slight sore throat,
soon followed by nausea and vomiting^ pain at the ^igastrium^ often
severe, with tenderness on jpressure^ hot and dry skin, thirst, scanty
and high-colored urine ; these symptoms continue for about three days,
when the erujptwe stage begins.

*Eruj)tive Stage,-— T\iq eruption first comes out in small i-ed spots or
points, which in the course of forty-eight hours become rounded into
pimples with vesicles upon their tops and slight depressions in the centre.
They show themselves first upon the face, and then in irregular suc-
cession upon the scalp, neck, arms, breast, body, and lower extremities,
requiring about twenty-four hours for the full development of the erup-
tion. After this period, there is a marked remission of all the febrile
symptoms, which continues for three or four days.

The Maturing or Swpurative Stage now commences. There is
now a renewal of the febrile disturbance still more violent than at first,
which commonly continues during the remaining course of the disease.
This period continues from three to five days, when the serous fluid
within the pustules acquires a purulent character, becoming thick and
yellow. On the tenth or eleventh day, the pustules burst, giving vent
to the matter which collects upon the surface of the pock, forming dark
scabs or crusts, which in a few days fall off', leaving the skin scurfy and
sometimes pitted.

Now commences the period of exsiecation, which occupies from
three to five days ; after which, if the malady has pursued a moderate
course, the morbid symptoms all subside, and convalescence ensues.
Thus it will be perceived that the regular course of the disease occu-
pies about fifteen days ; this course, however, is subject to modifications
from a great variety of causes, such as the supervention of pneumonia,
bronchitis, ophthalmia, abdominal inflammations, disease of the glands,
retrocession of the eruption, &c.

Confluent Variety, -- In this variety the primary fever is of a more
violent character, the eruptive period more irregular, usually commen-
cing at the end of two days from the onset of the malady; there are
often spasmodic twitchings of the muscles, at, or previous to the a.p-
pearance of the pustules, the secondary or suppurative fever frequently
assumes a typhoid form, salivation occurs about the period of the erup-
tion, after which the tongue, mouth, and throat become dry and dark ;
pocks form in the mouth, throat, larynx, pharynx, rectum, and urethra ;
and occasionally symptoms manifest themselves which indicate a high
degree of malignancy. The face is often much swollen and disfigured
from the pustules running into each other, so that the eyes become en-
tirely closed, and the nostrils obstructed. The matter of the pustules
is of a dusky color, and is sometimes so acrid as to irritate the sur-
rounding skin.

.630 DISEASES OF THE SANGUINOUS FUNCTIOIT.

What has been denominated varioloid is nothing more or less than
an exceedingly mild form of small-pox, modified by previous vaccination,
or some other Accidental influence. The primary fever is very
mild, the eruption distributed over the body in patches, the suppu-
rating process slight and imperfect, attended with little or no secon
dary fever.

Causes. — All agree that small-pox variola proceeds from a specific
morbific poison, sui generis. There are, however, causes constantly in
operation, which exert a powerful influence in modifying or aggravat-
ing the character of the malady, respecting the nature of which authors
are not so well acquainted. At some periods small-pox is charac
terized by a high degree of putridity, the symptoms assuming a low
typhoid form, and a majority of the cases proving speedily fatal in spite
of all remedial measures. At other seasons we may have a predomi-
nance of pulmonary or cerebral symptoms, attended with a high grade
of synochal fever, and requiring a very different course of treatment
from the form above mentioned. Again it may run its course in a re-
gular and moderate manner, without serious complication from distur-
bance of any capital organs, and demanding but little aid from reme-
dial agents. Some writers have supposed that these different modifi-
cations were owing to certain occult conditions in the atmosphere, and
also that the existence at the same time of other epidemics, has a ma-
terial influence over the character and progress of small-pox. This is
no doubt true ; but there are other causes more under our control, which
are of no less importance, as predisposing agents to the more violent
forms of the malady. The most prominent of these are small and ill-
ventilated dwellings, a lack of healthy and nutritious food, want of
cleanliness, insufficient clothing, immoderate use of ales and impure in-
toxicating liquors ; and the pernicious custom of crowding together in
the same apartments, a number of individuals, who thus inhale, a good
part of the time, a vitiated and unhealthy atmosphere. The fatality
of small-pox when it seizes upon this degraded class, indicates the im-
portance of the influences just enumerated in aggravating the charac-
ter of the malady. Does it not then behoove the guardians of the
public health during the prevalence of contagious affections to look
well to these deleterious agencies and remove from their towns the
filth, dissipation and corruption of these hot-beds of contagion.

Dr. Granger, of St. Louis, has employed both variolin, and vaccinin,
extensively as remedies in variola, and with excellent results. He in-
forms us, that under their use the pustules shrink away before arriving
at maturity, and that the severity and duration of the disease is much
diminished. He also observes that it is rare that indentations follow
the use of these medicines. He employs the second and third tritu-
ratiops.

SMALL-POX. 631

Treatment.— The following are the ordinary medicines, used in the
treatment of small-pox : Acoidte^ Belladonna^ Rhus-tox.^ Vaocinin^
VarioUn^ Sulplucr^ Ojphtin^ Mercurius^ Bryonia^ Pxdsatilla^ Nux-
vom., Carbo-veg,j Arsenicum, StiMum,

Aconite, second or third dilution, is the proper medicine during the
primary fever, provided the attack is regular, and there exists no ten-
dency to inflammation or congestion of any important organ.

In case the eruption is slow in making its appearance, or the process
should be attended with great internal oppression, either Rhus or Sul-
phur, third attenuation, may be exhibited ; a dose every three or four
hours.

Belladonna is the specific, when, during any part of the malady^
inflammation or congestion attacks the brain. In cases of this descrip-
tion this remedy exercises a twofold effect; first, by its special action
upon the cerebral organs, and second, by its power of forcing and of
retaining the eruption upon the surface. The third dilution may be
used in these instances-— one drop every two hours until amelioration
of the symptoms is evident.

Tartar-eraetic, — The identity of the Tartar-emetic pustule with that of
small-pox induced Dr. Liedbeck, of Stockholm, to try its effect in this
disease. He, says, he has never seen a case of small-pox terminate fa-
tally when treated by Tartar-emetic. In small doses it moderates the
fever and the pustules run their course without leaving a vestige of
their presence. He gives one-half to a grain, dissolved in a pint of
water, a table-spoonful every four hours. The first dose often makes
the tongue clear, the fever subsides, and the difiiculty of swallowing is
less. Dr. Berg says, it is the only remedy to be relied upon when
there is irritation of the respiratory mucous membrane.

In the epidemic of Stockholm, of 1838, this complication caused all
the deaths. After nine years further experience he would refer to
administration of tartarized antimony as the substitute for vaccination.
In confluent small-pox, it reduces the fever, allays the irritation of the
skin better than any other remedy. Dr. Stewart, of Natchez, says, he
has used it in small-pox for several years.

Case.- — J. H , a boy aged four years, has had fever for four days ;

eruption slowly appearing. Fever too high to the full development of
the eruption. Aconite and Tartar-emetic. The next day the eruption
was more full; the third day fever less ; urine still deficient and high
colored. Epigastrium full, bloated ; eruption maturing. Fifth day, ,
the fever high ; eruption very full over the whole surface ; body and
limbs swollen ; eruption confluent over the face and some other parts.
From this time the Tartar-emetic wacs given constantly, and Bryonia
only one day. There was a steady progression in the maturation and

632 DISEASES OF THE SANGUINOUS EUNCTIOJ!^.

then in the dessication of the pustules. On the fourteenth day the
fever was gone, the scabs separated, the skin only remaining tender.

S'iilpliUT. — At the commencement of the attack, and about the pe-
riod of dessication, it will often prove exceedingly serviceable in deter-
mining the eruption to the surface, and in disposing it to progress
kindly. In individuals who suffer from a psoric taint, it cannot well be
dispensed with. It may be administered at the third trituration, in
grain doses, and repeated sufficiently often to ensure the favorable
appearance of the eruption. It has been used to prevent the pitting
of the skin.

Vaccinin and Yariolin have been highly extolled as a remedy iii
all stages of this affection. It is said, that by the use of these agents
variola is rendered a very mild and harmless disease. It is claimed
by those who have made considerable use of them, that all of the
stages of the malady are shortened in duration^ and that a majority of
the cases thus treated resemble varioloid rather than real small-pox^
These medicines have been used in the form of trituration of the third
attenuation.

Yariolin is an isopathic remedy. Hartmann says : ^^after control-
ling the eruptive fever, congestion of the brain, delirium, burning heat
of the skin, dryness of the tongue, thirst, &c., by Bell. I have suc-
ceeded in shortening the course of the eruption and preventing the ex-
cessive suppuration with Variolin."

Mercur.' — Fever violent, nose throat, eyes severely affected^ Ptya-
lism. See p. 634.

When there is much swelling of the face, fomentations of tepid milk,

CfemjpAor.— Sudden dessication of the pustules and disappearance of
swelling of the face are indications of approaching death. Repeated
doses of Camphor will rouse the system. It is only possible to main-
tain life by the use of stimulants.

Peognosis.— -Small-pox is a most painful, dangerous and disgusting
disease. The more numerous the pocks, particularly in the face, the
more complicated the disease.

Old or enfeebled persons, and pregnant women, are particularly
liable to death from small-pox. The disease is more fatal when it ap-
pears in an epidemic form ; is more so at the middle of the epidemic
than at its beginning or end. Convulsions occurring before the erup-
tion appears do not indicate danger ; but they are highly dangerous
when they occur during the period of dessication. There is great
danger when the eruption appears very suddenly, and in clusters, or
when the pocks are depressed, pale, discolored or sanguineus. Dis-
.charges of blood from the kidneys and bowels are highly dangerous.

CoNSEQXjE3S[03ss OF Smali^-pox, — Chromc Ophthalmia, -^-lie^^x-
.gulph., Digitalis, Sulphurj RhuSj Arsenicum, Merc-hyd,, and Euphrasia.

YAKIOLOIB. 638

Frequently reGurring ^^^fe.— Sulphur, Mercurius, Cinna, Kaii-hyd.

Caries after Small-pox. — Asarum, Silicea, Mezereunij Aurum,
Phos., Nitric-acid.

Convulsions occurring in children during the eruptive and febrile
stage. Expose to cool air ; give Aconite and Belladonna at short in-
tervals ; enemas of tepid water. If the child be pale, with cold extre-
mities, frequent emission of pale urine, there is a nervous disposition
jDredisposing to spasms. Put the patient in a warm bath and admi-
nister Zinc, third trituration one dose every hour.

If the convulsions depend on gastric irritation or worms, treat those
conditions.

In the eruptive stage more than any other the pocks incline to be-
come malignant by combining with typhoid or putrid symptoms, or
disappear suddenly. In these cases Arsenicum^ Ammonia-carK^
Bhus-tox,^ Bryonia, and Nit/riG-aoid. will be required.

2. VARIOLOID.— Modified SMALL-Poy *

After Jenner and his followers had succeeded in the course of a
thirty years' war in convincing the public of both hemispheres that
vaccination was the true and perfect preventive of small-pox, it was
thought that the grand desideratum was reached, and nobody feared
the dying out again of the virtue of the remedy. But a new disease began
to show itself, attacking those who had been protected by vaccination.
It was called varioloid, from its reseniblanoe to true variola. The
question was asked, " What is varioloid f^

A multitude of indubitable facts warrant us to conclude that it is
merely a modification of small-pox ; that it produces in unprotected
persons genuine variola ; in a few instances it has produced the con-
fluent form of the disease and even death. It then appears that vac-
cination is not d. pejfect preservative against small-pox. The question
arises, " To what extent is it to be relied upon ?" Physicians have been
unwilling to admit failure or imperfection in any thing that has been
generally advocated. And the opinion given by Dr. John Bell in a
dissertation that obtained the Boylston prize for the year 1825 con-
tinues to receive the sanction of the profession. He says : " Reason
and probability are highly in favor of the truth of Dr. Jenner's opinion
that the security which vaccination offers is in direct proportion to the
degree of perfection of the vaccine process ; and that in consequence
it is advisable re re-vaccinate as long as a.ny effect is produced," It is
claimed that this advice of Jenner, if followed, would keep varioloid out
of the world.

Bryonia will be called for if pneumonic symptoms obtain Tb««»

684 DISEASES OF THE SANGUmOUS FUNCTION.

remedy will also prove serviceable in typlioid forms, attended -with
gastric or biliary derangements.

Bryonia may be administered in mild cases, at the tliird dilution,
and in severe congestive forms at the first — a drop every two or three
hours in water.

Merourius-viv.j third trituration, should be administered, if saliva
tion, ulcerated throat, or diarrhoea with bloody stools, and tenesmus
occur. It is also a remedy of value during the suppurative stage, and
in the ophthalmias which often accompany and succeed the variolous
attack.

Opium, at the third dilution, will always be appropriate whenever
coma and nervous sensibility, stertorous respiration, convulsive move-
ments, and impaired muscular action supervene during the progress of
the malady.

In cases of great malignancy, with a tendency to gangrene and other
symptoms evincing a low typhous grade, Oarho-veg,, Acid-nitr., Acid-
9nur,j or ArseniGum may prove serviceable when all hopes from other
remedies have been abandoned. From the first to the third attenua-
tions should be employed in these instances. The age, sex, tempera-
ment, and the peculiar circumstances connected with each particular
case, must determine the proper strength of the medicine and the fre-
quency of its repetition.

Thuja, — ^Concerning the three miasms, psora, syphilis and sycosis, it is
true that we have no certain means of distinguishing between them so as
to be certain in a given case which predominates. For a large majority
of the symptoms in chronic diseases are such as are found among the
symptoms of all three of the miasms, and we have not yet been able
to make a sifting and separation of them. Boenninghausen says he
was the, first to discover the almost specific power of Thuja in small-
pox, in diabetes mellitus, in certain malignant aphthae, in children, in
volvulus, &c. He says the identity of variola with sycosis seems suffi-
ciently demonstrated; the great extension of the miasm through the
process of inoculation is placed beyond a doubt; and the treatment of
numerous chronic diseases, of which psora has hitherto erroneously
been regarded as the anamnesis has taken quite another aspect, and
has become much more certain.

It is believed that small-pox, as well as the vaccina, are of sycotic
origin. The vaccine is the result of the inoculation of the cow with
small-pox matter. Dr. Wolf says, " Sycotic patients are greatly disposed
to infection by small-pox. Thuja is the true antidote against small-pox
virus ; and after vaccination a dose of Thuja should be given as soor
as possible to antidote the poison."

Tartar- emetic is as successful in varioloid as in variola.

THE PLAGUE. 635

3. THE BLACK DEATH OF THE FOURTEENTH CENTURY.

This disease was the same as the oriental plague. It was marked
by inflammatory boils and tumors of the glands, imposthumes on the
thighs and arms, which proceeded to suppuration, discharging offensive
matter. Buboes formed in the groin, an infallible sign of the oriental
plague. In some cases there were blisters and black spots over the
body, separate or confluent. In many, one of these symptoms alone
caused death. Others recovered after passing through them all. Some
became stupefied and fell into deep sleep, losing the power of speech
from palsy of the tongue; others remained sleepless without rest;
fauces and tongue black as if diffused with blood ; burning thirst which
no drink would quench ; some ended their own lives in despair. The
disease was contagious ; it spread from the attendants of the sick
through whole families, till, often, the last one died. All of this is
common in the oriental plague. But the black death presented other
symptoms not generally seen before or since. The organs of respira-
tion were seized with putrid inflammation ; there was violent pain in
the chest, expectoration of blood ; the breath giving a pestiferous odor.
In some an ardent fever with evacuations of blood were fatal in three
days. Buboes, inflammatory tumors did not at first appear ; but the
disease in form of a carbuncular affection of the lungs destroyed life
before other symptoms could be developed. Later, there were buboe
in the axillae and groins, inflammatory boils over the body ; and it was
not till after seven months that some patients recovered from matured
buboes. In Egypt the inflammation of the lungs was predominant and
destroyed life quickly and infallibly, with burning heat and expectora-
tion of blood. In Florence the buboes or pest-boils were predominant
in the beginning; they were as large as an apple, beginning in the groin,
then coming out on other parts ; black and blue spots were thickly
diffused over the body, and they proved equally fatal with the pest-boils.
No power of medicine brought relief; nearly all died after these signs
appeared, in the first three days, and without ^appearance of fever.

In Germany the symptoms were the same. In Austria is was
specially malignant at Vienna : red spots, black boils or tumid glands
portended death as early as the third day. In France many were
struck as if by lightning and died on the spot. Those with tumors
buboes, &c. died on the third day.

In England the symptoms were nearly as alarming; spitting or
vomiting of blood was sometimes fatal immediately, or in twelve hours,
always within two days ; boils on the surface portended certain death.
Authors describe buboes, boils, '' knobs or swellings in the groin or ax-
illa, blains, blisters, pimples, wheals or plague sores." In some a
vesicle scarcely perceptible gave little distress, but it was a lodgement

636 DISEASES OF THE SAKGUIISrOTJS FUNCTI0:N".

for the poison wliich spread inwardly and soon brought out the fatal
boils, or carbuncular inflammation fell upon the most important viscera;
epistaxis, coughing up of blood, h93maturia, fluxes of blood from the
bowels are mentioned as fatal symptoms by the only two medical au-
thors whose descriptions have reached us. They saw the disease ia
1348, 1360, 1373, 1382.

After its first fury was spent the pestilence passed into the oriental
plague.

Causes. — The black death was, no doubt, dependent on a specific
poison, whether this was or was not the same as that which originated
the oriental plague. It certainly showed itself in increased virulence
as its sphere of operation enlarged and degenerated into the more ordi-
nary form of plague about the time that it withdrew from Europe. It
is probable that the filthy lodging and bad food of the people of Europe,
their imperfect clothing, the severe seasons and absolute scarcity in
that century favored the spread of the pestilence in an aggravated form.

Like the plague of the East it was marked by being highly contagi-
ous, affecting animals as well as man ; the breath of the sick communi-
cated the infection to all who approached them. Parents abandoned their
children, children their parents ; those who fled from the city carried
the seeds of disease to the country. Sailors at sea found death in the air
of their favorite element. Ships were seen drifting about the seas and
dashing against the shores ; and when land was reached their crews
had perished to the last man.

It is supposed that the plague in some form has often appeared in
Europe, though the histories that have reached us are quite imperfect ;
and that improved modes of living among the various nations have ban-
ished it in latter times. Everything connected with food, clothing and
lodging, even among the poorest, has been greatly improved beyond all
that any body could have thought possible 500 years ago. The plague
prevailed in Edinburgh in 1513-14, in 1520, 1568, 1574, 1585, 1604,
1606, and for the last time in 1645. In England it has appeared at
later dates. In 1665 it made its final appearance and carried off
68,000 of the inhabitants of London ; the next year the great fire de-
stroyed the greater portion of the ill-ventilated dwellings of the crowded
parts. The introduction of water into the city and improved buildings
afterwards probably contributed to the banishment of the plague from
Britain. (See Epidemics of the Middle Ages. E. Hecker. Berlin,
1833. 12mo. p. 205. Wehster's History of Epidemics, 1800.)

4. THE PLAGUE.- PESTIS.

The plague is said to resemble in many respects malignant typhus.
The only phenomena which serve to distinguish it from this fever, being

INFLAMMATION. 637

the numerous buboes and carbuncles wbicb appear on the body. By many-
it is supposed to be really nothing more or less than a genuine typhus
fever, rendered peculiarly putrid and malignant by the atmospheric and
other influences which prevail -in Egypt and the other oriental nations
in which it has prevailed. As in the worst grades of typhus, maculae,
petechias, diarrhoea, haemorrhages from the bowels, &c., generally su-
perven<^ in the advanced stages of the disorder, in addition4o the buboes
aiid carbuncles. The enforcement of quarantine laws has banished
the plague from Constantinople since 1887.

Our knowledge in relation to this disease is so limited, it being de-
rived from the imperfect descriptions we have seen by other writers
that no attempt will here be madfe to detail its symptoms. But if we
may be allowed to judge of its nature from those phenomena which
seem to be characteristic, we suppose the following remedies will corres-
pond with its manifestations, and prove to it homoeopathic, namely :
Ai'sen., Acid-nit/r., Rhus-tox,^ Verairum^ Merc^ Bell,^ Gliin,^ Ipecac.^
CarbO'Veg,

ORDER III.-^PH LO aiS T I O A

Inflammatory Diseases

INFLAMMATION.

STmroTUEE OF THE Capillaky Vessels. — These minute termina-
tions of the larger blood-vessels are always the seat of inflammation.
Their walls are so exquisitely thin and transparent that it is almost im-
possible to see them; and the precise point at which the arteries ter-
minate and the veins begin can not be determined. We will, therefore,
seek an analogy in the excretory duct of the liver, a.nd trace it into the
organ. At first, it consists plainly enough of two tunics, which, as they
extend into the liver, become so excessively attenuated, that we are un-
able to separate them or distinguish them from the surrounding struc-
tures. The inner coat must extend to the extreme end of the tube, or
the acrid bile would too much irritate the delicate surface it covers.
We may presume that in all these fine structures both tubes are pre-
served. Bichat and Beclard thought otherwise, and that the capillary
vessel w^as formed entirely from the inner coat of the blood-vessels,
excluding the others. We think, however, that both tubes are retained,
though we a.re unable to demonstrate them to the eye, and that
the capillaries are nourished and animated, like the rest of the
vascular system, by vessels still more minute, a.nd nerves so exces-
sively delicate, as to elude the most powerful microscope. ( G7X€S^
Elements) This view is confirmed. by the later observations of Muller,
(Elements of Physiol, p. 877,) and the researches of Schwann, with

638 DISEASES OF THE SAKGUINOUS FUNCTION.

magnifying glasses of high powers, on the arteries of the mesentery
of the frog. He says, "Muller decides the question as to the capil-
laries having distinct parietes ;" and their circular fibres are arranged
as they are in arteries."

Phenomena of Inflammation. — Increased sensibility is produced by
some hurtful agent. The system tries to dislodge it by reflecting the
local impression on the brain and nerves, and through them to the
heart, which is excited to increased action and sympathy. The heart
next sends more blood than natural to the part, and the capillaries are
perceptibly enlarged. These fine vessels have the power of contract-
ing and dilating, but they have no vermicular motion, and are there-
fore unable to carry on the circulation without the propulsive action
of the heart. The action of the heart increases slowly, but the in-
crease is soon perceptible. (See p. 196.)

Inflammation may be studied under its different aspects in three
stages : 1. The Stage of Incubation. We see this stage displayed,
when we irritate the fin of a fish, or the web of a frog's foot. In health
these parts show under the microscope numerous vessels filled with
red blood, rolling along in beautiful order. If the part be now irri-
tated with hot water or alcohol, the vessel will be enlarged by the
crowding of the blood into them by the increased sympathetic action
of the heart. Hundreds of vessels, previously invisible, shoot out in
different directions, connecting themselves with the sides of the former
ones. These vessels were there before, and only become visible on the
red blood being forced into them. The blood globules travel with dif-
ficulty till they reach the extremities of the veins, which, being larger,
the blood-globules rush into them as into a vortex. If the exciting-
cause be now removed, the part becomes gradually restored to health.

Second Stage, — Congestion.- — If the exciting cause continues in ope-
ration an increased determination to the irritated part continues to ac-
cumulate in it an unnatural quantity of blood. After a short stage of
congestion or engorgement the third stage or that of inflammation pro-
per ensues. There is now an excessive reaction ; increased heat, red-
ness, pain, fulness of the vessels, increase of bulk of the whole part
affected. This proceeds to terminate in suppuration or gangrene, if
it should not first subside by resolution.

When it has progressed to the point of exhausting the vital powers,
the circulation ceases, the blood assumes a dark color, and the coats
of the vessels become so soft as to give way at the slightest pressure
and the healthy actions are finally suspended. The part is now red,
not, painful, tumid, and its molecular intervals are filled with coagulat-
ing lymph. The capillaries contain thick, viscid, partially clotted blood,
adhering with great tenacity to the inner surface, preventing artificial
injections or the removal of the blobd by washing or by pressure. Ib

nTFLAMMATION. 639

violent cases tlie blood flows through the vessels and forms new ones
along the cellular tissue, and through these new vessels it afterwards
circulates. This last phenomenon, which was noticed by Klacken-
brunner in the mesentery of the rabbit, is analogous to what occurs in
the organization of adventitious membranes. Contrary to what might
be expected, he found that it took longer to excite inflammation in
highly vascular organs, as the lungs and peritoneum, than in those of
slower circulation, as the liver and kidneys ; but, when it is once
established in the organs of high vascularity it progresses with the
greatest rapidity.

The distended Condition of the Part — This arises from the in-
creased quantity of blood attracted to it. The blood is dark, thick and
viscid, rendering artificial injections difficult. The force of the arteries
in urging forwards the blood is not increased in the vicinity of the
in&ammation, but the intensity is generally greater at the centre, and
gradually diminishes as we recede from that point to the surrounding
textures.

The cause of all active congestion resides in a condition of evanescent
or enduring paralysis of the blood-vessels, as we can not discover, in
any mechanical obstacle occurring at any point of the circle of circula,-
tion, adequate cause for the determination to any other point of a great-
er sanguineous afflux. All local hyperasmia may with propriety be
referred to the supervising regulation of the peripheral circulation —
that is to say, of the nerves wdiich supply the blood-vessels. {Joitrnal de
Pliysiologie^ hy Brown Sequard,) "It is no less true that local anse-
mia may equally result from irritation of these same nerves ; but as
their action is transitory, their excitation must be sustained, in order
that the effects produced shall maintain an equal degree of intensity.
As a prototype of such active congestion, w^e may cite the redness and
palloi; of the face, inasmuch as, by their appearance a,nd disappear-
ance, they show themselves to be directly under the control of nervous
influence.'^ In such a locality congestion is a trifling thing ; in other
organs it becomes far more serious. " There are viscera, enveloped in
thin, inextensible membranes," as the brain, the medulla-, the lungs,
liver, spleen, kidneys, &c." It is only necessary to recall their struc-
ture and functions to be satisfied that such phenomena, simple and in-
off"ensive though they may be elsewhere, may here involve the gravest
consequences.

The Seats o.f Inflammatioist. — Inflammations are very frequent in
almost every structure of the body. Even the nails, epidermis, and
hair seem to possess their fine capillary vessels, though their existence
has often been denied. And these structures are also susceptible of
inflammation. In children the skin and mucous structures are in a
high degree^ more liable to inflammation than the cellular or serous

64.0 DISEASES OF THE SAi;[GUmOUS FUNCTIOK.

tissue ; and it is usually ^'ell marked, violent, and rapid in is course
The synovial membranes, the fibrous ligamentSj bones, and cartilages
inflame with difficulty, but when they do the sufiering is very great.
The blood-vessels, nerves and absorbents may become inflamed, but
their conservative powers are remarkable ; as in gangrene they often
retain their vitality while the surrounding parts are passing rapidly
into a state of putrefaction. The organs most commonly affected in
this country are the lungs, spleen, liver, uterus, and brain. The heart,
ovaries, thyroid body, pancreas, prostate gland, testicles, and kidneys
are less commonly inflamed.

Peoducts OF Inflammation. — Organic or Structural Disease, —
Under this title is included all permanent changes in the texture of an
organ ; and all temporary changes in the tissues. It is doubted by
many, whether there can be any mexQ functional disease; as all phy-
siological change may' be presumed to be accompanied by, at least,
temporary change in the anatomical elements. {Gross.)

All organic changes are believed to be the result of acute or chronic
inflammation ; or of other less known modes of altered action, which,
like inflammation, can change the nature of the products of nutrition
and secretion, and thus create pathological products of peculiar and
permanent character.

Every inflammation, irritation or morbid action is originally local or
partial. It always makes its first impression upon some particular
part and this impression, after having continued awhile extends to some
other. Morbid action, or irritation of the mucous membrane of the
stomach is at first local, or more properly, partial, and may afterwards
extend to the sub-mucous cellular tissue, then to the muscular-fibrous
and finally to the peritoneal covering. Thus that which was at first a
partial becomes a general disease.

The period of life, in which inflammation is most common and most
dangerous is from its very beginning to the age of ten years ; nearly
one-half the entire mortality occurs within this period. Fatal affec-
tions of the skin, mucous, and lymphatic systems carry off immense
numbers of children, and inflammation of the arachnoid membrane are
almost equally frequent. Pleuritis, pneumonitis, cerebritis, hepatitis,
carditis, phlebitis, arteritis are frequent before manhood, and afterwards
not uncommon. At the age of puberty the hitherto dormant genital
organs are roused into activity ; and then, diseases of these structures
become very common ; and these organs also deeply sympathize with
the viscera, developing organic diseases of the uterus, ovaries, mam-
mae and testicles. Diseases of the bladder are rare in the young, but
very common in the old.

The Effusion of Coagulable Lymph is always an important result
of the process of inflammation. It is usually of a slight opaline cast,

INFLAMMATION. 641

though sometimes pale or milky white, or reddish from admixture of
hsematorine. When first deposited it is a soft, fluid, somewhat ropy in
consistence, throwing itself out in small filaments. After some time
its watery particles are absorbed, it becomes more consistent, and is
finally converted, in many cases, into a firm, dense structure, having
the attributes of cellular tissue, fibrous membrane, or even cartilage or
bone. The time required to eifect this change varies from a few
weeks to many months. Fibrine of the blood is only one of the ele-
ments of coagulable lymph, but the most important for the albumen of
the serum is also a part of its composition. It is not a mere excretion
extravasated from the blood-vessels, but a seoretion formed out of the
blood, and discharged from the capillaries. . The red globules may
contribute to its production and they, although altered to make it har-
monize with their alterated elements of the fluid, may aid in that spon-
taneous formation of red blood in the effused lymph.

The object of the effusion of coagulable lymph with fibrine is to
establish the union or adhesion of normal surfaces, w^hich adhesions
we think are excited by the irritation of the coagulum, Carswell and
other pathologists think the adhesions of fibrine identical with the ad-
hesions of the polypi in the heart to the columns carneae, a mode in
which, it is probable, vegetations of the valves of the heart are formed
Carswell admits two genera of analogous formations, one from coagu
lable lymph, the other from fibrine ; while Gross admits only the latter
The analogous tissues which Gross admits are : the cellular, serous, mu
cous, cutaneous, vascular, including the erectile, adipose, horny, includ
ing the cuticle, hair and nails, — fibrous, cartilaginous, and osseous, each
of which may be in connexion with its archetype in the healthy system.

Lymphization has been generally considered as nature's standing pre-
scription for incised wounds : cut arteries, lacerated wounds, attended
necessarily with sloughing, are to be filled up by this process, broken
bones are to be re-united and necrosed bones replaced ; diffusion of
pus restrained ; and tubercular cavities are occasionally filled. The
fatal effects of internal mortifications and sloughing may be averted ;
aneurism of the arteries obliterated ; great surgical operations ren-
dered admissible ; and the stumps of amputated limbs healed,

" Each component cell of a texture is an organism of itself. It ab-
sorbs, by endesmotic action, through its slender wall, the oxygen from
the blood-tide, and the nutrient materials from the liquor sanguinis.
Itself a microscopical object, it performs the double function of histoge-
netic respiration and assimilation. When either of these functions is
impaired, the integrity of the tissues will sooner or later be blasted,
and one or another variety of structural lesion be the necessary result
Tuberculosis, scrofula, and the various forms of cancer are held to be
but manifestations of diseased action involving the solids, and having

VouL— 41.

642 DISEASES OF THE SAInGUHSTOUS FUNCTIOIS".

their origin in some such source. Do not understand us as teaching
that these disorders consist essentially of morbid alterations in the
forms, or even in a derangement of function in the individual compo-
nent cells of the muscular, nervous, cellular, or other tissues— for we
do not accept any such material doctrine in explanation of the nature
of diseased processes, but simply that the first evidence which we may
have of the existence of certain maladies is a structural lesion which
renders it plain to be seen that the healthy organization of the parts is
endangered." Thus although the *^' morbid anatomy of tuberculosis
and of cancer is not all there is of the disease, it will nevertheless
afford us the most substantial token of its existence and ravages."

Through this beautiful process of cell-growth must be made all nu-
tritive repairs by which structural lesions of whatever variety are re-
medied ; repairs in the bones, the ligaments, the muscles, the nerves, the
blood-vessels, or in the cutaneous or mucous surfaces, must be effected
through it. The old doctrine of the restitution of injured parts by
^*the exudation of coagulable lymph," is exploded; and we now learn
that these little cells first select and then so appropriate their structural
elements as to carry the newly organizing bone through the successive
steps of mucous, cartiliginous and finally to the osseous or perfect
stage.^

Healthy cicatrization " depends, therefore, upon the development of
healthy granulations in cell-form. The marginal skin stretches and
draws nearer the centre of the wound, while the capillaries inosculate
with those of adjacent tissues."

Sometimes the adhesive and plastic character of the lymph, and its
long-continued contraction and shrinking up are the sources of diffi-
culties. After extensive loss of skin by sloughing from fire, the new
texture often produces deformity. Also, in inflammations of the cheek,
adhesions and indurations compress the jaws against each other from
the same cause. The eyelid may become agglutinated to the ball, the
larynx fatally closed up with false membrane, the urethra nearly obli-
terated ; the intestines combined into a compact mass ; the lungs and
pleura cemented to each other, and the viscera compressed till they be-
come atrophied.

Sekous Effusion.— This result of inflammation constitutes one of
the modes by which resolution or discussion is effected. Serous
effusion is the result of inflammation of a mild grade. An apparent
objection to this statement is found in the fact that effusion sometimes
occurs when there is simply an obstruction in the circulation. Thus,
anasarca of the legs from obstruction of the femoral artery ; and the
face, neck and arms may be loaded with serum from compression of the

* Dr. Ludlam, Lecture, Homoeop. Clinique, Chicago, 1862.

INFLAMMATION. 643

veins conveying the blood from these parts ; abdominal dropsy follows
obstruction of the portal veins. Contraction of the auriGulO'Ventri-
oidar orifice impeding the flow of blood produces dropsy, and also
oedema of the legs and feet. It is questioned whether these conditions
are the results of inflammation, or of obstruction without it. The exact
condition of the vessels is not easily known. In ascites we have a
large collection of water following obvious inflammation, without any
trace of inflammation being perceptible after death. But in some cases
the signs of inflammation, the discoloration, &c., — vanish at the approach
of death or during the last struggles of life ; and in others these
changes take place long before. Want of redness does not prove the
absence of inflammation, which is certainly shown by accumulations
of water and opacity of the affected membrane. If there be specks,
patches, or bands of fibrine, all doubt ceases.

Can obstruction, to the extent necessary to cause efliision, exist with-
out producing a state identical wdth inflammation or identical with it?
To this it is answered that the condition required is impossible* The
obstruction must cause congestion in all the parts from which the
vessel should return the blood; and this state can not long exist with-
out producing inflammation, — an altered condition of the sensibility of
the parts, redness and effusion of serum.

Objects of Inflam:mation.— Inflammation, granulation and pus may
arise for two distinct objects: 1. For the cure of mechanical injury;
for the discharge of sloughs and foreign substances from the solid
textures ; and, secondly, as a means of cure in disordered plasma.

1. In injuries to the common tissue, wounds, ulcerations, contusions
and fractures, the process of reparation comprises inflammation, gfia-
nulation, suppuration, and ulceration. New blood-vessels are formed
without bleeding, and there are discharges of pus. If physical hin-
drances interpose, the process is protracted and made chronic until
these are removed. If they can not be removed, the life of the person
is endangered and may be destroyed, unless amputation be performed.

In the diseased conditions of the blood from unwholesomeness of
food, privations or other causes, re-actions of some kind arise for its
depuration. These also comprise inflammation, granulations, suppura-
tion, and ulceration; furuncles, boils, pustules, eruptions and gout.

If hindrances interpose,— if the causes of distemperature of the
blood from the above causes be not abated, the process is protracted
and made chronic, until they are removed, and in many cases the qua-
lities of the plasma must be altered or improved by thorough change
of diet or habits of life.

In surgical cases, comprising injuries of the solid texture, the re-
actions arise for the healing of wounds, \h.Q discharge of sloughs, dead
matter and foreign bodies. There is direct evidence of what occasions

644 DISEASES OF THE SANGUIKOUS FUNOTION".

the action, what it accomplishes, and why it is protracted or danger-
ous. In the other group, — disorders of the blood (or medical cases;
the influence of the re-action, the qualities of the fluid of the blood can
only be inferred from the collateral events ; and these in gout, small-
pox and other exanthematous fevers point unequivocally to the thera-
peutical characters of inflammation. The surgeon may sometimes go
directly to the bottom of an unhealthy ulcerating wound and remove
some obstacle to entire recovery, by an operation which nature was not
competent to perform, and the patient is restored to health.

In other cases of severe injury, as of a compound fracture, or a
crushed joint, the surgeon surveys the whole of the injured parts, and
he has time and opportunity before therapeutical re-action, — that is
before inflammation, suppuration, granulation and ulceration have com-
menced,—to estimate the true extent of the injury. He weighs care-
fully in his mind the powers of nature, the degree of general health
of the pafient, and decides upon the question whether nature is com-
petent to perform a full reparation of the injury, or whether she would
make such bad work of it, that it is safer to amputate the limb, leav-
ing her an easier task to perform.

The inflammations encountered by the physician depend much on
the qualities of the blood itself. And here he must take the constitu-
tion as he finds it with its impure or imperfect fluids, and try by reme-
dies to restore them to a state compatible with a return of the orga-
nism to a state of health.

This is the finishing stage of the adhesive process, and the comple-
tion of the process of granulation. It is rapid in proportion as the
dfitmeter of the ulcer is small, the surface level, and the secretion of
pus diminished. A reason of the diiOGiculty with which a sinus heals is.
the advanced secretion of pus from its surface. Others are, its limited
contact with the skin, and the non-development of granulations, which
Immediately appear as soon as the sinus is laid open. When an ulcer
has formed upon an old cicatrix, its healing is usually tedious. This is
owing to the defective quantity of surrounding free cellular membrane
for the formation of granulation, and to the imperfect condition of the
circulation in secondary formations. Mr. Travers says, the shin which
forms on the surface of an ulcer, abscess, or wound is always formed
from the vessels of the skin of the. margin of the wound, and never by
the vessels of the granulation. We always observe it " gradually ad-
vancing from the margin, and equally reducing the diameter of the sore
from day to day ;" and we never see the skinning process without this
preparation of the border. The process is quicker or slower in pro-
portion to the distance of the skin from the centre ; the insular patches
observed upon the bed of an ulcer, especially unhealthy ones, may al-
ways be traced to a portion of undestroyed skin ; and, finally, " the

INFLAMMATION.

645

cicatrization beneath the surface, as of abscesses and fistulse, is not by
the formation of skin, or of proper granulation, but by an adhesive pro-
cess, which tacks the skin to the subjacent cellular texture condensed
by inflammation, drawing it inwards into folds and puckers ; in short,
a process similar to that which we see in obliteration of cists by pres-
sure, and in the formation of solid tumors to which the skin becomes
adherent during their growth."

In those cases in which the skin forms rapidly over an ulcer it has
been supposed that the vessels of the surface indirectly aid in the pro-
cess. This results from the contraction of the granulations, in their
union and levelling, giving a glazed appearance to their surface as the
secretion ceases and the pellicle begins to form. But the act of cica-
trization consists not in any fresh deposit ; it is simply the last stage
or completion of vascularization which renders the transparent lymph
surface nebulous or opaque, and this always commences from the margin,
whence the vessels are derived, and is progressive from the circum-
ference to the centre. The actual formation of membrane is never ac-
complished, such as could be separated by fair dissection at any stage,
from a cicatrix : " It Is a permanently opaque, unsecreting surface, a
condensation of the new lymph with the cellular texture beneath or
surrounding it, serving the negative purpose of a semi-organized cover-
ing, simply the protection of the part. Like all other new structures,
it is a copy, and differs, as all copies do, whether of nature or art, from
the original." {Traver's Physiol, of Inflamm.^^, 207.)

CicatriGes^ diseased states of, — The structure is imperfect, but
generally not painful; though when large and deep-seated, and when
connected with parts affected by any disease, they become more painful
than surrounding parts, and are more sensitive to changes of weather,
needing more protection. When situated over moveable parts, the
movement of muscles pains the cicatrix. It passes easily into inflam-
mation, and an erythema progresses readily to ulceration. The inflam-
mation often ends in gangrene. After a certain period many of the
arteries of the structure become hardened into cords and impermeable
to the finest fluids. Varicose veins sometimes ramify in cicatrices or
beneath them. These imperfect structures may be involved in oedema,
in ecchymosis, and in hypertrophy of its own substance or of the neigh-
boring skin. They may be the seat of conical elevations like corns,
but which can be removed by thorough washing ; and also, of other
horny substances of large size. M. Hutin saw one in form of a spiral
horn, ten centimetres in length. They are usually smaller, being hard
at their extremity and softer near the point of implantation. They
often arise from the extremity of the stump after amputation, and
chiefly of the thigh, where the cicatrice had been subject to much
pressure.

646 DISEASES OF THE SANGUTNOUS FUNCTION".

Mr. Hawkins has described a warty affection of cicatrices. M.
Hutin says, he found one of these as large as a small nut, and resem-
bling the warts of the fingers ; another resembled fungus hsematodes
and grew from a portion of the cicatrice of a large ulcer of the leg.
It may be that these growths are forms of cancer, which oftesn attack
the cicatrices of the lower extremity.

A soldier who had received some wounds on the left ear and left
shoulder had some vegetations from the bottoms of the wounds, which
were mistaken for granulations which were restrained by nitrate of
silver. In forty days the wounds healed, but the vegetations continued
to grow and were removed some years afterwards ; but they were re-
produced with the same activity, though in thirteen other wounds no-
thing of the kind was seen.

We may also in cicatrices have cysts^ cartilaginous and osseous de--
posits] the latter are surrounded by cellular membrane as di^ periosteum.

Contusions lead to rapid ulceration in this tissue. Wounds of cica-
trices may heal by the first intention, but the reparation is often de-
fective ; and suppuration is likely to destroy all the old cicatrix. —
[Htdin^s Prize Essay ^ Memmres de VAcad, Imperial. Paris, 1855.)

Morhid Blastema giving rise to Tissues endowed with Abnor-
mal Properties. — Those general dispositions of the economy known
under the name of diatheses^ are of this kind. They are supposed, in
||h.e first instance, to be accidentally produced (for disease must begin
somewhere), but which, once called into existence, possess the power
of maintaining themselves in being.

Thus when food, insufficient in quantity, or of an unwholesome kind,
has reduced an animal, previously in good health, to a consumptive
state, its offspring often inherits the morbid disposition which in the
parent was purely accidental, and syphilis, that well-known source of
heteromorphous production, is frequently transmitted from parent to
child.

Some of these pathological dispositions or diatheses are the result
of a profound change in the fluids of the economy ; sometimes they
originate in the introduction of particular poisons, which, when they
have once penetrated into the system, can in no way be expelled. If
the poison be one that none of the organism can eliminate it is clear
that, after penetrating into the torrent of the circulation, if it nowhere
find an issue, it remains to become the origin of permanent modifica-
tions in the economy.

Thus Iodine, when once introduced into the blood, is not eliminated
for a long space of time, on account of the affinity which the salivary
glands exhibit for this substance. We have then an instance of a body
which cannot (for a time, at least) be expelled, and the animal is
during this period laid under the iodic diathesis. Individuals affected

INFLAMMATION. 647

with cancer are not properly in a state of disease so long as the organ
in which it is situated is not essential to life ; a cancer of a limb may
possibly be removed without bringing the general system into immi-
nent danger. When cancer attacks the liver^ if the disease is no
extensive, the morbid productions are separated by large tracts of
sound tissue, which continue, as usual, to secrete the bile, and grap
sugar still exists within the glandular tissue. But, at a later period
by the disintegration of the elements which constitute the morbid pro-
duction, the whole economy has become poisoned by pouring into the
general circulation of fluids impregnated with the noxious principles ;
then, indeed, the affection becomes a general disease, and its nature
entirely changes. The cancer is not a diathesis in itself, but the con-
sequent cachectic state is that properly so called.

Results of Im^perfect Nutrition. — After each meal, when absorp-
tion has taken place, the epithelium which covers the villosities fall
off, and is renewed during the interval which elapses before food is
again introduced into the digestive apparatus. . A remarkable instance
of the rapidity with which tissue may be produced.

But when, through some agency of disease, epithelium is no longer
secreted, what, results ?

No obstacle is henceforth opposed to serous exudation from the
vessels ; no protecting surface resists the introduction of various
poisons into the blood, and no regulating power of absorption exists.
In this manner many diseases are traced back to suspended activity
of animal evolution as their primary cause.

Chronic inflammation of the trachea and bronchial tubes likewise
destroys the epithelium of the parts, the utility of which is well known.

Other diseases arise, not from interrupted, but from perverted evolu-
tion. Cells that pursue a regular course in their development com-
prise three distinct elements : 1. An envelop or cellular paries, the
physical properties of which take a permanent share in its action ; 2,
Liquid contents, the importance of which is principally derived from
their chemical composition; and lastly, 3. A nucleus in which the
powers of development appear to reside.

As soon as a morbid state of nutrition supervenes, the contents of
the cell are liable to alteration. Whether pigment or fatty substances,
or calcareous salts are therein deposited, morbid tissues are gradually
formed, and disease is introduced into the system ; it may then be pre-
sumed that all heteromorphous tissues entirely resemble normal ones,
and are subject to the same natural la^s.

This great principle was first explained by Muller, who is styled the
creator of cellular pathology. Virchow has since extended discovery
in the same direction.

The intercellular tissue, or blastema, says Virchow, constitutes the

648 DISEASES OF THE SANGTJIN0US FUNCTIOIT.

"territory of the cells." In order that it should be able to develop the
cells it is necessary that it should contain the elements necessary for
this purpose. It must always contain glycose, albumen, and fat ; the
absence of a single one of these three substances is a barrier to cell
evolution. And we therefore constantly find them existing in the
tissues of the embryo as well as of the adult.

Bichat, in his great work on Life and Death, undertook to inform us
of the many ways of dying, but there still remains another, that of
dying from imperfect nutrition. Patients often die without showing
after death the slightest modification in the anatomical condition of the
organs. In physiological experiments on dogs, death is often caused
by complete exhaustion. We see them arrive at the last stage of ema-
ciation, although the appetite continues unimpaired till the last mo-
ment, and the lacteals are found gorged with chyle, though after death
no pathological changes are perceptible.

What is the latent cause of this singular process ? ]N'utrition, when
considered in the depths of our organs, is, in fact, nothing more than a
peculiar mode of evolution. The economy produces within itself sub-
stances indispensable to life. Glycogenous matter affords us an ex-
ample of this ; formed within the body by a special process, it playa
an immense part in histological phenomena. As soons as it fails to bo
supplied, epithelium is no longer produced; various diseases are the
immediate result, and, under similar circumstances, life is inevitably
brought to a close. The physiological act called mitrition compre-
hends, therefore, two distinct parts : formation of cells is the first,
creation of blastema the second. And the latter is no less indispen-
sable than the former ; as soon as pathological influence arrests either
the one or the other, death is the consequence.

There exist, therefore, two distinct modes of dying : 1. Life is cut
short at once by an important injury to some essential organ; or,

2. It gradually fails through imperfect nutrition ; and this latter ter-
mination is the ordinary result in acute diseases. In certain cases
glycogenous matter is no longer produced ; ancT, after a given space
of time, the patient dies, although the appetite remains unimpaired till
the last moment. In making the post-mortem examination the lacteals
are found in a state of repletion ; but, when analyzed, the fluids of the
economy no longer present the slightest vestige of sugar. Death then
supervenes, and is the mere result of suspended activity in organs for
which proper nourishment is no longer provided.

We now conclude that we shall not find the system of laws govern-
ing the animal economy peculiar to its pathological condition, but that
the laws of physiology of health, fairly interpreted, are sufiicient to
explain the philosophy of all vital phenomena whether of health oi
disease.

INFLAMMATION. 649

Remote Causes of Inflammatory Diseases. — We find in animals
various predispositions, vi^hicli not only modify the action of medicines
administered to them, but also render them liable to diseases entirely
different when suffering' from causes entirely similar. " Being about to
perform certain experiments on animals kept fasting for a long space
of time, I left some dogs without food for several days ; but, during the
late severe frosts, these animals died unexpectedly. In making the
autopsy, we discovered pneumonia in one case, pleuritis in anqther,
and inflammation of the bowels in the last two. Thus under conditions
perfectly identical, these animals were afflicted with totally different
diseases. But similar results may be obtained at will by the ph3^sio-
logist. When rabbits are placed under total abstinence they generally
live a fortnight or three weeks ; but, when certain branches of the
sympathetic nerve have been previously divided, the animals die within
a few days, when deprived of food, through acute inflammation of the
viscera connected with the nervous twigs that have been divided.
When, some time ago, I commenced this series of experiments, I dis-
covered that the section of large divisions of the sympathetic nerve
was apparently unattended with the slightest inconvenience as long as
the health of these animals remained perfect. Some of them even
became pregnant, and brought forth their young ; but, as soon as a
general debilitation of the system arose from want of proper nourish-
mentj acute inflammation was produced in the organs deprived of ner-
vous influence. We had therefore succeeded in ardficially producing
particular idiosyncrasies in these animals, and coula predict with per-
fect certainty that as soon as health failed disease would arise on a
given point.

" Morbid predispositions must, therefore, be viewed in the light of
peculiar physiological conditions, which, in.,'most cases, depend upon
the nervous system ; and an immense progress would be realized in
medicine if it were possible to diagnosticate in a state of health the
predisposition to disease, and foretell the coming danger.'' [Claud
Bernard on Experimental Physiology. Lecture V.)

Treatment of Infla7nmation.-—TnYnmg now to the therapeutics of
inflammation it is clear that we may attack it in two ways. Through
the medium of the vaso-motor nerves we may act on the blood-vessels,
and through that of the cerebro-spinal nerves, or directly upon the
inflamed tissue. The rule according to which we prescribe would lead
lis in the former case to select such remedies as are known to produce
primary contraction and secondary dilation of the arteries of the par.t,
whose effects therefrom would accordingly be stated in our provings to
be congestion. According to the second mode we should choose a
counter-irritant of the part affected, which, according to the law of
similars, would extinguish the irritation already existing. Thus, in

650 DISEASES OF THE SANaUINOUS EUNCTIOH.

gastritis we might give Belladonna, which is a yaso-motor excitant, or
Arsenic, which is a tissue-irritant to the gastric mucous membrane.
And perhaps a better eiFect'would be obtained by alternating the two
than by giving either singly.

" It appears from this that there are at least two modes in whicl
drugs, chosen according to the rule ^similia similibus,' act in the re
cesses of -the organism. In the case of tissue-irritants there is a real
substitution of a drug-action, similar to the morbid process going on in
the part, for the latter action itself, and an extinguishment of it thereby.
This is Hahnemann's own earlier rationale of homoeopathic cure, and
so far appears to be correct. But when vaso-motor excitants are given
to relieve inflammation, the theory of Fletcher holds good, and their
action (save in the first brief stage of contraction, which rarely comes
under treatment) is really antipathic, although the law of similars will
suffice to guide in their selection. And a very important rule for the
dose will form a corollary to these principles. When we are treating
inflammation of any part with its proper tissue-irritant the dose must
be small, and may be infinitesimal. When we are exhibiting a vaso-
motor excitant the dose must be moderately large. The instance of
gastritis elsew^here cited may again serve to illustrate this rule : Dr.
Hughes says, " during my earlier inquiries into homoeopathy I had a
case of acute gastritis under my care which I treated with fiye drop
doses of tincture of Belladonna. Shortly after commencing to practice
homoeopathy I met with a similar case, for which I prescribed Arseni-
cum, 12. On comparing the two cases I hardly know which was cured
with the most gratifying rapidity. Consider what would have been
the result had I reversed the proportions of dose, and the value of the
rule will become still more apparent."

Of the remedies for inflammation we shall here sp%ak of Aconite
only. Other remedies will be considered under the separate diseases.

Aconite. — The views of the various homoeopathic authors may be
thus summarily presented :

Dr. Screen says. Aconite "supplies the place of the whole antiphlo-
gistic apparatus of the antiphlogistic school," is far superior to blood-
letting, salts, mercurials, and fomentations, in certainty as well as in
harmlessness. He regards it as "an indispensable remedy in all those
cases in which, through violent reaction of the organism, there is added
to the primary affection of a single system or organ, a general febrile
disturbance, which is manifested by precursory, often deep-seated
shaking chills, followed by local or general long-continued heat, hot
dry red skin, quick full pulse, bright eyes, violent continuing thirst,
total loss of appetite, hot urine, restlessness, sleeplessness, exhaustion,
more or less violent delirium, with distinctly marked paroxysms and
remissions." {Hygea, V.,. 97.)

mFLAMMATIOK.

651

Heiclielieim says, ^^Aconite is the specific remedy," " in all plilegmo-
nous inflammatory diseases in wbicli the arterial capillary system is
more particularly affected, and the inflammation itself exhibits propor-
tionate reaction of the vital power." " The more distinctly marked in
the given case is the increase of the arterial circulation, if it be limited
by the affected organ — as, for example, in inflammation of the lungs
and heart, or by the constitutional structure of the individual affected
— so much the more certainly will Aconite prove a curative remedy."
(//y^^^, v., 203.)

Griesselich says its proportionate field of action is, in " acute dis-
eases, marked by excessive and preponderating activity of the arterial
system. Its operation on the arterial system is unmistakeable ; its re-
action upon the nervous and lymphatic systems easily substantiated
from physiological principles. Aconite corresponds most to individuals
with a prominent phlogistic tendency."

Wurm says that, in addition to allaying fever in inflammation of the
lungs, " it acts specifically upon the parenchyma of the lungs, and that
this action is greatly assisted by the powerful influence it possesses
upon the arterial blood current.'^ {Hygea^ IX., 53.)

" In pleuritic effusion, if the plastic material predominates. Aconite
should be given; not that it 'acts upon the pleuritic effusion itself,' bu
because it is necessary * in breaking up the fever.' " Wolff* says, the
utility of Aconite in inflammation does not depend on "its specific re
lation to the totality of the inflammatory process, but only to one factoi
of it, the morbid movements of the blood and its stagnation." {Ilygea^
XVIIL, 253.) Diez says. Aconite " corresponds to the first stage of
inflammation ; as such, and apart from its various modifications, it oc-
cupies the foremost rank among all the medical plants that have been
proved up to the present time."

According to Meyer, "Aconite's sphere of action is manifested prin-
cipally in the ganglionic system, and exercises here its special in-
fluence upon the nerves of the capillary vessels, exciting fevers, con-
gestions, and inflammations. It is subordinate in its action to the
apparatus of the motor nerves, where — apparently in consequence of
congestion—-it sometimes excites convulsions and a paralytic condition.
In the sphere of the sensory nerves it increases, on the one hand, their
activity, and calls forth a variety of painful sensations ; and, on the
other hand, depresses their sensibility till it reaches total extinction.
On the central nerve fibres, or upon the mind and disposition, it pro-
duces an elevating effect, producing depression only in its reciprocal
action. For the rest it seems to have a special relation to the secre-
tion and separation of bile." [Hommop, Vierteljahrsch.^ I., 390.)

Schneider thus sums up the principal forms of the condition pro-
duced by Aconite:

652 DISEASES OF THE SANGUIKOUS FUXCTIOJST.

"1. Synocha and inflammation, arising from primordial irritation of
the nerves of the central vessels, as distinguished from exanthematous
and traumatic irritation, which proceeds from original irritation of the
nerves of the vessels of the periphery.

" 2. Rheumatism ; viz.: Those congestive or inflammatory painful
afiections of the joints, muscles, or sensory nerves which arise in con-
sequence of cold.

" 3. Gastroses ; also with predominant affections of the liver, amount-
ing to jaundice.

" 4. Paralysis of the nerves of the blood-vessels, as in cholera.

" 5. Convulsions J but we regard all kinds of convulsions as conse-
cutive, proceeding from ancemia or hypermTnia in the centre of the
higher nerve life.

"6. Paralysis in the sphere .of the physical nervous system." [Hand-
huch der reinen JPharmaGodynamikj I., 39.)

Genus I.— APOSTEMA.— 1. ABSCESS.

From dbscedere^ to depart, to separate ; because parts which were
before contiguous become separated. Abscessio^ imposthume: a col-
lection of pus in the cellular membrane, the viscera, or the bones, pre-
ceded by inflammation. Abscesses receive different names according
to the position in which .they are situated. The disease is always the
effect of a preceding inflammation.

Geneeal Remarks. — When an infiarriTnation begins the tempera-
ture of the part is increased, its vessels are injected with more blood,
which at first extends only to the vessels which previously carried red
blood ; the vessels are distended and their powers of resistance les-
sened ; the. more fluid parts of the red fluid escape into the texture of
the part, rendering it more compact, but more friable or capable of
laceration. As inflammation progresses the tissues pass from a dense
but friable state to that of softening, proceeding to a pulpy condition
as more and more of the fluid parts of the blood are infiltrated into
inflamed substance ; soon the molecules of the tissues become com-
bined with the infiltrated fluid, and all distinct traces of a proper or-
ganization are lost. The fluid poured out from the extreme capillaries
gradually distends the surrounding parts, partially dissolving the tissues
in which it is effused. A limit is set to the extension of the cavity,
now forming, by effusion of coagulable lymph from the vessels, which,
being less highly involved in the disease, retain more of their vital
energy. The lymph thus thrown out presents a barrier to the wider
diffusion of the fluid forming within the cavity. In cachectic or debili-
tated subjects the vital powers of the adjoining parts are too feeble to
permit this effusion of coagulable lymph, and the jpus or fluid matter

ABSCESS. 653

formed in the abscess may diffuse itself in, the cellular membrane, like
water in anasarca.

The formation of pus is effected by the collection in the central
point of the inflamed structure of minute portions of sero-albuminous
or sero-sanguinous matter. These minute collections become more
abundant, approach each other, the intervening tissue becomes soft-
ened, and the small cells unite in one cavity ; the effused fluid changes
from thin albuminous lymph to pus ; having lost its coloring matter,
and dissolved the fragments of the disorganized tissues, it forms a ho-
mogeneous whitish fluid, which produces little irritating effect on the
tender surface of the cavity containing it. This surface becomes co-
vered with a grayish pellicle, presenting all the appearance of a true
membrane, which in dense structures becomes very dense, forming
thick cysts. It acts as a secreting and absorbing surface, and through
it the more fluid parts of the pus are absorbed, and further modifica-
tions of its character effected.

Second Form of Abscess / Spreading or Diffuse Abscess. — In de-
bilitated or cachectic constitutions the regular course of abscess is
modified by the operation of certain noxious causes, which entirely
change its course and termination. These causes are : the presence
of various animal poisons ; animal and vegetable matter in a state of
putrefaction, which produce a septic effect on the living textures. The
eflect of these influences is that the inflammatory action, and the for-
mation of pus is not circumscribed by the boundary of coagulable
lymph which is poured out by vessels around an abscess in a healthier
subject, and the pus formed may be widely diffused in the cellular
membrane. In these imperfectly formed abscesses we see inflamma-
tion in the ataxic or asthenic form; it is conspicuous in some kinds
of erysipelas, or after wounds inoculated with animal poisons, and
characterized by want of vital resistance, and a speedy solution of vital
cohesion in the affected tissues. The influence of the nerves is rapidly
destroyed, and the fluid parts of the blood are effused into the relaxed
tissues in the form of a watery or puriform sanies.

Diffusive abscess may commence in the cellular tissue, and moie
rarely in the liver, lungs, or other internal viscera. As it progresses
the nervous powers presiding over the organic and assimilating func-
tions are much depressed ; the watery or putrid sero-sanguinous or
albuminous effusion commences very early ; the whole process of
the formation of pus is rapidly completed ; the sanious fluid flows ex-
tensively through the feeble resisting force of the debilitated cellular
membrane and adjoining textures, which become gangrenous and are
dissolved in the effused fluid.

The pus secreted in this form of abscess is sometimes limpid, red
dened, and highly fluid ; sometimes white, again more highly colored^

654 DISEASES OF THE SAITGUINOUS EUNCTIOK.

brownish, and sometimes of a green color, becoming more offensive in
odor in proportion as air is admitted to tbe diseased surface.

Third Form of Abscess,— In lymphatic temperaments and scrofu-
lous constitutions deep-seated or superficial and fluctuating tumors
and purulent collections are formed without much appearance of active
inflammation. In chronic cases the appearance of the pus formed is
frequently yellowish, serous, and transparent, containing albuminous
or fibrinous flocculi ; and the external skin remains free, moveable, and
unaltered.

Fotorth Form of Abscess. — The pus formed in indolent abscesses
frequently finds its way through the interstices of the cellular mem-
brane to distinct parts. This is common in diseases of the hip-joint,
and in abscesses formed in the vertebra or their fibro-cartilages. In
these cases it may travel beneath the pleura to a more depending posi-
tion, or descend behind the peritoneum, under the crural arch, and
sometimes through the inguinal ring. Many other forms are often seen.

ConsecAitive Abscess,- — Sometimes the pus formed by suppuration
in ofie part is absorbed, and the absorption is followed by a deposition
of similar matter in some other organ. In puerpural cases inflamma-
tion of the uterus and its veins is sometimes fatal ; and, on dissection,
collections of pus are found in various remote organs. After injuries
of the head abscesses are found in the liver or lungs. In many other
diseases similar collections of pus are found. In all of these cases the
energies and vital powers of the system are impaired by previous ill
health, and the prostration is increased by the inflammation and sub-
sequent suppuration, and by the poisonous influence of the putrid
matter absorbed.

The process by which a deep-seated abscess progresses towards the
surface of the body is highly interesting and important in a practical
point of view. As the inflammatory action and the secretion of puru-
lent matter proceed, the extension of morbid action advances most
rapidly on that side on which the structures are most distended and
and stretched by the accumulating fluid. The inflammatory action
thus induced in the adjoining texture leads to the pouring out of lymph
which, with the pressure of the swelling, causes adhesion of the abscess
to the adjoining part, the absorption of the solid elements, with attenua-
tion, and lastly ulceration. When the morbid process is approaching
the surface we see marks of inflammatory irritation, and infer that the
adhesion has taken place beneath ; and that an incision may safely be
made to the centre of the abscess below, if we begin in the centre of
the inflamed integuments. In this progressive manner we see an abscess
of the liver make its way gradually through the membranes and tex-
tures of the parietes of the abdomen to the external skin ; and in some
cases taking an opposite direction, we observe its gradual extension

ABSCESS. 655

through the diaphragm, and the lungs to empty itself into the bronchii.
In its course it produces adhesion between the liver and diaphragm,
then ulceration of the diaphragm, adhesion of that membrane to the
lung adjoining, then inflammation and suppuration of that opgan. The
parts thus successively-invaded undergo the inflammatory and softening
process in succession ; the purulent matter finds its way to a distant
outlet in that direction in which the inflammatory action most readily
advances; and the successive " reddening, inflammation, adhesion, soften-
ing, and absorption of the various structures, as the tumor advances
exteriorly, are the guides to treatment in these formations." The pro-
gress and spontaneous opening of abscesses which have progressed from
the interior to the surface terminates in the erosion of the attenuated
integuments, and the discharge, at intervals of the accumulated con-
tents.

Diagnosis. — Inflammation intense in degree, rapid in its progress,
in any part in which the cellular tissue is a' prominent part maybe
presumed to be progressing towards suppuration when a throbbing,
pulsative pain has continued for some time, and is slowly diminishing.
The repulsations are isochronous with the heart's action ; wxight and
tension of the part ; diminution of febrile action, succeeded by " large,
broad, open, soft, or undulating pulse ; irregular chills or rigors, ex-
tending along the back, loins or lower extremities. If the matter,
be not now soon evacuated there are symptoms of chronic irritation ;
frequent and small pulse, heat or burning of the palms of the hands
and soles of the feet ; irregular fits of perspiration, and night sweats ;
loss of strength and all the characteristics of hectic fever; this is ul-
timately followed by colliquative diarrhoea., and other signs of permanent
irritation and constitutional contamination of the blood and rapid sink-
ing of the vital powers.

When the inflammation has terminated in suppuration the tumefied
part becomes changed in appearance. It is less diffused, smaller in
circumference, and more concentrated, elevated, prominent and softened
at the centre of the surface. The more prominent part acquires a
dark red, and afterwards, a bluish tint. A distinct fluctuation may be
felt beneath it ; though this not always very distinct. But the external
signs may be assisted in pointing out the existence, the stage and the
serious character of an abscess, by the constitutional predisposition to
form purulent collections of matter in many persons whose vital energies
are depressed. In patients of the lymphatic temperament, pale visage,
who have been debilitated by previous disease, in those in whom the
suppurative has continued for some time and been suddenly checked
by an operation, the tendency to form abscesses is strong. A sudden
suppression of any secretion predisposes to abscess as the drying up

666 DISEASES OF THE SANaUINOUS FUNOTIOlSr.

of the mammary secretion often originates an abscess without any other
perceptible cause.

PROGNOSIS. — The danger from abscesses is in proportion to their
size, and the severity of the disease by which they have been occa-
sioned ; the extent of their internal surface ; depth at which they are
seated ; the indolence of their action ; deficiency of vital powers of the
constitution; the intensity of the symptoms accompanying or produced
by them ; importance of the viscera in which they are seated ; the di-
rection they take, the chances of their evacuation ; and the means of
renovation and repair possessed by the constitution. Consecutive ab-
scesses are always dangerous from the exhaustion dependent on the
primary disease.

Treatment. — Indications of Cure, — First, to remove the purulent
collection. Second, to procure the obliteration of the cavity in which
it was lodged.

1. Matter may be absorbed from the interior surface of an abscess,
conveyed through the^circulation and eliminated from the system by
the various excretory organs. The means usually resorted to to promote
this object are : Frictions with stimulating substances, as Ammoniacum,
Iodine, Iodide of Potassium, cold, warm, or tepid affusions on the part.
A great variety of stimulating, discutient liniments, &c., are in common
use ; but their powers are only applicable to a small proportion of the
cases that commonly occur. Abscesses preceded by acute or active
inflammation can very seldom be removed by any local excitants, and
the opening of them is therefore inevitable. The subsidence of inflam
matory action does not generally follow the formation of pus, and gene-
ral and local treatment must still be directed to its more complete
removal. So long as pain, redness, heat, tension of the skin remain,
leeches, or other modes of capillary depletion may be useful. Emollient
and astringent applications may also be necessary to reduce the inflam-
mation of t\e surrounding tissue, favor the resolution of the parts not
yet suppurated, limit the quantity of the morbid secretion, and prepare
the abscess for being opened with the best prospect of success. Even
sthese measures sometimes favor the absorption of pus; and this sooth-
ing course will promote the favorable suppuration and lessen the general
irritation till the thinning of the skin at the most prominent part of the
tumor indicates the necessity of opening it.

Consecutive and spreading abscesses arising in unhealthy constitu-
tions enfeebled by previous disease, ataxic inflammation from a specific
cause, inflammation of the veins or morbid secretions of purulent matter
absorbed into the circulation, require a restorative treatment, combined
with all the means that promote the healthy action of the digestive
organs. •

When the puriform matter is not likely to be immediately absorbed

ABSCESS. 657

the abscess should be opened by an incision of the necessary size and
depth. The operation should be more promptly performed in propor-
tion to the irritation produced by the accumulating pus ; its deleterious
eifects on the general health ; its depth, and the danger of discharging
itself internally; and the vicinity of important organs, blood-vessels
or nerves, which are injuriously affected by the increasing pressure of
the abscess. In many cases it is necessaiy to exercise the greatest
care in opening large collections of puriform matter, as in lumbar ab-
scess and some others. When large incisions are at once made, and
large evacuations encouraged, the vacuity left is immediately filled by
atmospheric air, and an increased state of irritation of the lining mem-
brane of the abscess is produced. To avert this injurious effect of the
admission of air, Dupuytren advised that abscesses of this character
should be opened " by successive punctures, the margins of which
should be immediately closed, upon the evacuation of that part of the
contents which are first expelled by the reaction of their parietes."

2. Abscess, Secondary. — Secondary abscesses of a severe and even
fatal character often follow injuries and surgical operations which were
not dangerous of themselves. These secondary collections of pus take
place in distant parts of the body, and often in organs essential to life ;
they seem not to be necessarily connected with any previous external
injury, and are sometimes induced spontaneously, and independent of
any injury or operation. It has been shown that the usual pathologi-
cal appearances found after death, in these cases, consist '' in deposits
of purulent matter, inflammatory congestions, effusions of coagulable
lymph, sero-purulent effusions, effusions of sanies or bloody serum, ad-
hesions of contiguous surfaces, ulcerations and disorganizations of dif-
ferent structures, as of the eye and of the tissues about the joints."
(Dr, Lee^s Note to Go^lanWs Dictionary, Vol. L, p. 26.) The or-
gans most frequently affected are the lungs, liver, brain, spleen, the
knee and shoulder-joints. In such cases the inner coats of the veins
in the neighborhood of the primary injury are found inflamed, and
purulent matter is generally found within the cavity of the veins.
There is, therefore, reason to believe that phlebitis is always attended
with secondary local affections. The secondary abscesses are known
to occur in connection with phlebitis, whether the pus in the veins is
free to enter the circulation or is circumscribed by a barrier of lymph,
thrown out to prevent the pus from contaminating the blood. Dr. Wat-
son, in the American Journal of Med, Sciences (Vol. XXI., pp. 87,
74), has shown that the existence of pus within the free cavity of. the
veins does not necessarily lead to the formation of secondary abscesses
elsewhere ; and that the secondary disorders of a difi'erenfc character
which often follow operations, the high inflammatory excitement, and
the exhausting influence of hectic fever, may result in consequences in

658 DISEASES OF THE SANGUINOUS FUNCTION.

no way connected with the disease of the veins. He shows that the
secondary depositions of pus are not always, if they ever are, the re-
sult of the absorption of matter from one place and its transportation
to another locality; "and that, as they occur in all parts of the body
without any definite relation to the part primarily affected, they cannot
be attributed to any special sympathies between the parts first diseased
and those subsequently involved." He therefore believes secondary
abscesses can only arise from the effects of "a vitiated condition of
the blood, induced by the purulent matter, or other morbid exhalations
of inflamed veins, mixing with the blood, and thus exciting local inflam-
mation in the parts secondarily diseased."

Treatment of Abscesses in GenerA:L. — Foe Acute Abscesses.: —
^r5^m'(?'i^m.—Intolera.ble burning pains during the fever ; or, the ab-
scess threatens to become gangrenous, or is accompanied by great de-
bility.

Asarum, — -Abscesses discharging a colorless serous pus ; violent
pains on contact, and great sensitiveness, of the surrounding parts.

Bell. — Pressure, burning, and stinging in the abscess ; cheesy and
flocculent pus. Hepatic abscess following inflammatioxi.

Bryonia.— ThQ tumor is either very red or very pale, with tensive
pain.

J/^s^^^t^m.-— Abscesses of Jlhroics parts and tendms/ or following
the abuse of Mercury.

Pulsatilla. — The abscess bleeds readily, with stinging or cutting
pains ;^ or thei-e are itohing yhMvnmgj and stinging in the surrounding
parts. Abscess originating in varices.

^A^^5-^Jo9^,— Abscesses of the axillary or parotid glands; the swell-
ing is painful to the touch, or discharges a bloody serous pus.

Chronic A.mcis.^m>^.— Remedies : Asarum, Aurum, Calc, Carb.-veg.,
Con., Hep., lod,, Laur,, Lycopod,, Mangan., Merc.-corr., Nitr.-acid.,
Phos., Sepia^ Silicea, Sulph.

3. CELLULAR INFLAMMATION. —Inflammation op the Cellular Membrane.

That fever often excites, inflammation is well known. These se-
condary local inflammations, generally arise during the fever, and often
lead to fatal results.

In the decline of certain cases of autumnal fever, we often meet with
a form of inflammation affecting the extremities called " fever sores,"
boils, abscesses, &c. They are generally considered signs of a favor-
able termination of the fever ; but they are not caicses of recovery, and
occur generally in cases that convalesce slowly, and manifest m-uch
irritability; death may follow from extensive suppuration. We give a
<)ase by Dr. Drake of Cincinnati :

CELLULAE INFLAMMATION". 659

An engineer after ague had febrile and inflammatory symptoms
wliicli came out in furuncles and inflammations of the cellular tissue
on the head and neck, fore-arm, on the scapula, between the fifth and
sixth rib near the sternum ; some suppurated, others remained solid.
Near the heart was strong 'pulsation ; the disease then attacked the
brain. There were jactitation, headache, heat of scalp, fierce expression
of the eye, delirium, insanity, vigilance, coma, variable pulse ; later
there were spasmodic twitchings of the eyelids ; convulsions ; partial
hemiplegia ; after some suppuration took^place the vehement action of
the right carotid abated, but the left took on a similar increased action,
with contraction of the eye of that sid^ which became engorged with
blood. Under the antiphlogistic treatment he declined, though suppu-
ration was protracted; he became extremely emaciated ; cordials, tonics,
anodynes were all injurious and the patient died. On dissection, the
cellular substance from the forehead to the clavicle, from the chin and
occiput was filled with pus ; a great portion of the vessels, nerves and
muscles converted into an unorganized putrid mass, especially at the
angle of the jaw : parotid gland not distingmshable ; cellular substance
over parietal and part of the temporal bone disorganized; also over
cervical vertebra. Carotid artery had lost its cellular coat, its sub-
stance inflamed ; extremity of the maxillary bone without and within
denuded of its periosteum; other abscesses contained only pus. The
pulsating tumor near the heart was found to consist of an abscess within
the sternum and the cartilages of the ribs, resting on the pericardium,
having the pleura within and the attenuated walls of the chest without ;
the pulsation had been transmitted through the tumor from the impulse
of the heart.

Treatment. — Counter-irritation has long been regarded by old^
school physicians as an important resource ; and even the homoeopa-
thist may admit that it is to a limited extent useful. The following are
in general in use : sinapisms, rubefacients, frictions, moxas, caustics,
issues, hot baths, as well as cold ones ; and, in a wider sense, counter-
irritants may include emetics, purgatives, and even mental impressions
These agents are used to excite a powerful impression upon the system,
which in many cases- proves beneficial and removes the morbid action.

Cayenne pepper produces redness and burning pain when applied to
the healthy fauces, but acts as a sedative in the sore throat of scarlet fever.
A concentrated solution of acetate of lead, applied to the skin, denuded
of its epidermis, or to mucous membranes, creates irritation and pain
the same, when sufficiently diluted, is a soothing and sedative application,
when this state is the result of disease or injury. Kemedies, p. 658.

4. Frost Bites. — Cold when applied to a part to the extent of diminish-
ing the temperature below the common healthy standard always acts as
^ sedative or dejpressant It has been known from the earliest ages

660 DISEASES OF THE SAKGUmOUS FUKCTIOK.

that cold is capable of producing entire sensibility ; but it was not eni«
ployed for this purpose as a means of preventing the pain of surgical
operations till its power and safety in producing entire sensibility was
demonstrated by Dr. Arnott in 1848.

Excessive cold first causes extreme redness as the result of the
relaxed condition of the walls, of the blood-vessels ; this is followed by
a peculiar biting or stinging pain, induced by the pressure of the dis-
tended vessels upon the nerve branches, and also* by the influence of
the cold directly on the nerves^themselves.

After still farther exposure of the part to intense cold the extreme
redness with a portion of the congestion disappears, until =- there is
a sudden sting and the part becomes white, painless, stiff, and is
frozen. All the vital processes cease. Innervation, circulation, sen-
sation and all the usual functions of vitality are entirely obliterated.
The liquids and semi-solids become solid, crystalize and consequently
expand and press upon the more compact structures, w^hich, only when
exposed for a longer time still, will become frozen also.

The process of congelation commences on the surface, extending
from the surface and the point of exposure inwardly ; the freezing of
the plasma taking place more readily than that of the floating cor-
puscles, which are driven away from the parts frozen, thus giving the
bloodless appearance ordinarily observed in frozen tissues.

Hecovery from the Effects of great Cold, — As the freezing com-
menced on the surface, driving the floating solids of the blood towards
the heart, the thawing should commence from within and progress
toward the surface, so that the part last frozen should be first thawed,
else there may be a stratum of unthawed structure between the surface
and the actively vital structures, thus cutting off all innervation and
allowing chemical changes to commence uncontrolled by vital force,
which chemical changes occur speedily in animal structures whenever
the vital force is withdrawn. When the thaiving takes place from
within, innervation follows, and the parts are under the influence of the
vital force, as fast as they can thaw ; the nerve aura can then penetrate
by degrees through the reviving portion of the member which may be
restored to a healthy condition with far less injury than might be anti-
cipated.

Treatment.— -Rub the part for a few minutes with snow just in the
process of thawing, or which is light and feathery, having recently
fallen ; but this only when the patient has been brought into a room
in which the temperature is above the freezing point ; and .it must be
continued for only a short time, as the frozen part must become warmer
than snow bpfore vital action can be restored in it. When the snow is
too cold it rather increases and perpetuates the injury. When it is
less than tJie freezing temperature it may be applied with advantage,

CELLULAR INFLAMMATION. 661

as it retards the thawing of the surface till the natural heat of the
body within can slowly penetrate the frozen structures, bringing
warmth and vitality toward the surface. But even melting snow
should not be applied by friction; and any other substance which can,
without freezing more deeply, just retard the process of thawing on
the surface, will be quite as good, often better and safer than snow.
When the nose, cheeks, forehead, or ears are frozen, a shawl, coat
collar, or the cap drawn over the part will usually protect it till it
gradually thaws. The foot or hand, when frozen, should remain co-
vered with some woolen fabric, and no more heat should be applied to
them than the rest of the system requires. They should be kept near
the freezing point, and the circulation gradually and cautiously per-
mitted to reestablish itself. The nibbing of frozen parts with snow, as
commonly practiced, is uniformly injurious. Rubbing with the warm
hand may restore the heat of the frozen surface^ but cannot cause
blood to flow through vessels that are congealed and closed with frozen
crystals further inward.

Frost-bites should be treated without mechanical pressure, friction,
or manipulation ; and protected from rapid elevation of temperature
of the surface by enveloping the part in soft and melting snow enclosed
in a piece of flannel, silk, or linen. Moisture itself does no good,
though a cloth wet with cold water may be better than the warmer air
of the room.

The temperature must be gradually permitted to rise to that of
health, but without any friction or unnecessary disturbance. Usually,
if a part has been frozen quite solid, when vitality is established the
epidermis becomes separated from the dermis, and blebs or blisters are
formed by the exudation of th^ serum of the blood through the injured
vessels. These blisters may be treated as blisters formed by scalds
and burns.

When a frost-bite has been very severe and deep, unless the utmost
care is taken to have it thaw properly and slowly, the parts are quite
apt to slough. Such slough must be managed according to the gene-
ral principles of surgery. If a bone or a part of a bone has been
frozen it is quite likely to die, although the frozen portion may never
be detached from that which remains alive, but it may become diapho-
nous, and require amputation or removal.

5. Panaris, Whitlow^. — The remedies hitherto found most effica-
nous in checking the progress of whitlow are r

Hepar : Arsenicum, Calc, Phos.-ac, Nitr.-ac, Petrol., Sepia, Cans.

Lachesis: Panaritia under the nail; between the tendons.

Silicea : Inflammation of the tendons and their sheaths.

Sulphur, alternated with Silicea every eight days, to prevent recur-
rence of the disease.

662 DISEASES or the SANQUmOUS rUNOTIOK.

Merc.-cor., followed by Hepar.

Alum, if abscess forms.

Dispensary Case. — A lady, aged forty-one, has felon on the right
fore-finger. The deep-seated, excriiciating, and long-persistent pain
shows that the inflammation is seated heneath the jperiosteum. I
already involves the first joint, and is extending upwards ; the paiu
runs up to the shoulder. No sleep last night. Incision half an inch
long, with the bistoury, penetrating to the bone. Poultice. Next
day discharging slowly. Slept last night. Poultice continued. Reco-
very rapid.

A groom at a livery stable has whitlow, involving first and second
joint of right middle finger. Pain has prevented quiet sleep for two
or three days. Whole finger largely swollen. Inflammation would
continue to extend along the bone, and could not for two or three
. wrecks relieve itself by perforating the periosteum. Incision to the
bone, from near the first joint, a half inch, reaching the bone. Poul-
tice continued two or three days more. Recovery rapid.

6. CoNTUSiOKS. Arnica, — -Persons who have received a Mow or con-
tusion feel pains in the side, a desire to vomit, lancinating and burning
pains in the hypochondria, all of which are accompanied with anxiety,
tremors, and involuntary starts, similar to those produced by an elec-
tric shock, formication in the parts that have received the injury, &Gi

As Arnica-mfhontana produces similar symptoms, according to the
observations of Meza, Vicat, Crichton, Collins, A-nsh-ow, .Stoll, and
J. C. Lange,,^^ it may be easily conceived that this plant will cure the
effects of a blow, fall, or contusion, as is familiar to the experience of
a host of physicians, and even of whole nations, for centuries past.

7. Sprains. — A limb after a fall or other violence is painful, does
not admit of being moved, swells, and turns red.

Treatment. — Apply a lotion of cold water containing Arnica, arid
give it internally. Bryonia or Rhus may be used after the more
acute symptoms have subsided.

Dislocations, Luxations.— The removal of the head of a bone from
its corresponding articular cayity. It is characterized by violent pain,
loss of motion, swelling, alteration in the shape, length, and direction
of the limb. There is an unnatural depression or prominence in the
vicinity of the injured joint, and a peculiar rigidity of the limb. The
deformity is apparent on comparing the injured with the sound limb.

The treatment consists in setting the limb ; then giving Arnica, or
Aconite if the injured part be becoming red and inflamed. Apply
cold water or diluted Arnica. This will be occasionally repeated till
the inflammation has subsided ; after this the limb must be occasion-
ally moved to ensure against the joint growing stifil
* Hahnemann, Mat. MecL, I.

CELLULAIl INFLAMMATION.

663

8. PERIOSTOSIS.

Diagnosis.

Acute Periostosis.
Inflammatory fever ; the swell-
ing, if the disease be in the tibia
or femur, is diffused: not limited
to the larger joints— ankle or knee ;
but it occupies a wider range, and
is oedematous in its character.

Acute Rheumatism.
High inflammatory fever, with
swelling of the limb and grea.
pain, increased by pressure, s)
that the patient is nearly helpless,
and shrinks from the touch of the
surgeon, in dread of the torture to
be inflicted by an examination.

Pain.

Pressure over the bone, as the
tibia or the muscles of the thigh,
or around the femur, in rheuina-
tism, rarely causes much paiii, but
moving the limb causes intense
pain.

The aittack not caused by injury.

The chief diagnostic mark is
found in the seat of the fain. In
this disease little or no pain is
caused by pressure, unless it be
made over the seat of the disease
in the course of the infected bone.
In the early stage you may move
the limb, at the knee or the ankle,
and press the ligarments and ten-
dons without producing pain ; but
the slightest pressure on the bone
excites intense suffering, and the
pain cannot be borne for a moment.

The attack usually succeeds to
injury.

Treatment. — The hospital surgeons content themselves at the onset
of the disease, when the bone affected lies near the suirface (as the
tibia), with local applications. These, however, cannot be relied on
when the affected bone is deep seated.

Incisions.— The only reliance of unquestionable power in true peri-
ostosis, by which the extension of the ulceration along the boiie can be
arrested and furthei' mischief averted, is a free incisicmy extending
through the periosteum to the bone. In a case in which no ftuGtica-
tion is perceptible it is 'best to cut down boldly, through the thick
vastus externus to tTie boiie, if there is full evidence that the pe-
riosteum of the femur is acutely inflamed. In such a case, Dr. Cur-
ling says, "the incision revealed a small quantity of pus- confined be-
neath the muscle. The membrane was partly detached,, and in a few
hours extensive mischief would have ensued. This was arrested by
the incision, the pain and inflammatory fever rapidly subsided, and
health was speedily restored."

In another case the periosteum was extensively ietached, and so

664^ DISEASES OF THE SAKGUHSTOUS FUNCTION

distended by the pus effused beneath it that, when an opening was
made, the matter gushed out with force over the surgeon's clothes.
The necrosis in this case was very extensive, the inflammation had
affected the cancellous structure in the lower end of the tibia, jeopar-
dizing the safety of the ankle-joint ; additional incisions were required,
after which the inflammation in the periosteum and the necrosis ceased
to extend, and the work of restoration was set up.

Periostosis consequent on injury is a common cause of necrosis in
the long bones. When only a small portion of the bone is denuded
by the injury and the subsequent inflammation, and the wound, after
discharging pus a few days, gradually fills up till a small sinus is left,
no further treatment is generally directed, even if a small portion of
the bone remain denuded. But such treatment generally ends in fur-
ther trouble. When more permanent treatment is demanded, the fol-
lowing may be necessary : cut down to the bone, and chisel away a
small portion, so as to enlarge the aperture, extract any loose pieces
of bone, and chisel away such parts of the bone as are unsound.

JRuta-grav, — It is the distinguishing, and perhaps peculiar feature
of Ruta, that it produces, in an eminent degree, pains of a pressive and
bruised character in the muscles, and especially in the periosteum and
bones. Many drugs produce pain in the back and limbs, apparently
in the periosteum or bones. But these pains from other drugs seem
not to be directly upon the periosteum or bones, but indirectly through
the spinal column and nervous system. The pains are sympathetic,
are attended by different trains of concomitant symptoms, and are of
quite a different pathological character. But the pains of E-uta seem
to be the direct effect of the drug upon the periosteum and bones.
Thus the pain of the os coccygis, as if bruised.

Stone Beuise.^^— A disease of the feet, usually caused by walking
or jumping on the stones, and occurring in young persons who go with-
out shoes during the warm season. Persons liable to this disease
acquire generally, by going barefooted, a thick sole to the foot, on
which slight pressure, even blows, can make but small impressioua
But severe pressure, or the bruise caused by jumping on stones, though
not injuring the skin, may bruise the parts beneath, even the perios-
teum, and cause deep-seated inflammation and suppuration in the
plantar fascia, or in the cushion of the under surface of the toes or of
the bed of the foot. Such an abscess progressed slowly, may be less
painful than a boil or carbuncle, and less liable to produce constitu-
tional disturbance, and yet it may demand surgical treatment

If a deep-seated inflammation commences in the toes, the plantar
jsurfaoe of the foot, or the heel, the foot should be soaked for a long

* Jour, of Rational Medicine. Cincinnati, March, 1862. p. 83.

CELLULAR INFLAMMATION." 665

time in a quite warm and weak solution of alkali, as saleratus. This will
partially dissolve or soften the thickened cuticle, which may then be
scraped off, and the skin shaved over the central portion of the inflam-
mation. The persistent use of a hot alkaline foot-bath, with due efforts
to scrape off the hardened skin, will put a stop to the inflammation ; at
least we may thus diminish the extent of it.

The limB should be now kept in a horizontal position, foot enveloped
in water slightly warm and alkaline. If, in spite of this treatment, an
abscess form, the pus must be let out by the abscess lancet or bistou-
ry. After this some cauterize the abscess by inserting to its bottom a
stick of Nitrate of Silver, evacuating the pus by repeated injections
of warm water, warm infusion of Arnica leaves, or, still better, of Ca-
lendula. Some inject into the cavity Lugol's solution of Iodide of Po-
tassium, to start a new action in its interior surface.

Uloeeation of the Cartilages of the Joints.- — This formidable
disease does not always reveal in its outward symptoms its real char-
acter. It may at first be only regarded as an ordinary abscess, with
little inflammatory excitement, heat, or local tenderness ; but it excites
suspicion by the degree of lameness of the foot, and by some of the
common phenomena of stone bruise or of ordinary abscess.

It may be caused by the extension to the cartilages of the inflam-
mation of a bunion, ganglion, an abscess, or constitutional derange-
ment. When it involves the cartilages of the foot it is often very ob-
stinate and difiicult to cure.

Anatomy. — Four distinct varieties of cartilage are recognized : 1,
That of ossification of the bones of the cranium; 2. That which pre-
cedes the ossification of the long and short bones, the patellar, and the
bones of the tarsus ; 3. The cartilage of adults, as over the nasal bones,
at the ends of the ribs, joining them to the sternum, and between the
vertebrae of the spine ; and, 4. The fibroid variety, into which that at
the end of the ribs changes in old persons, and in the canaliculi which
are analogous to the haversian canals in bones.

The first and second varieties contain a few blood-vessels, but
neither the third nor fourth varieties, while in a healthy condition,
ever contain any blood-vessels.

The cartilages that enter into the structure of the feet are of the
second variety, which may be found in children, even after the second
dentition. If from direct injury or constitutional cause the cartilages
of the foot of a child less than ten years old become diseased and ulce-
rate, the minute blood-vessels will swell, and the foot manifest the usual
symptoms of inflammation ; and being difficult of access, as well as liable
to constant irritation and injury, the disease will be liable to be of long
standing, and at the best to result in a permanent deformity of the foot,
and anchylosis of the bones.

666 DISEASES OF THE SANGUINOUS FUNCTION.

Treatment. — This must be directed to the correction of the psoric
or scrofulous condition of the constitution. The foot must be kept at
rest ; pus when it forms must be removed by incision ; and then local
treatment can be employed to wash out and excite to healthy action in
the interior of the abscess. If some part, as a tendon, cartilage, or
bone, is apparently dying or dead, it may be touched with a minute
quantity of strong Nitric-acid, applied by a probe or stick. ' If a broken
blood-vessel is inclined to bleed, the Perchloride of Iron may be ap-
plied to restrain it.

Internally we endeavor to meet the constitutional condition by anti-
psoric remedies. After some trial of these, hoiiiGeopathic attenua-
tions of Hypophosphate of Lime, or Hypophosphate of Iron, will keep
up the strength, promote the digestive power, and produce some specific
effect in promoting ossification and curing the periostosis, which in-
clines to extend along the bones. A firm bony union of the cartilagi-
nous surfaces is often the best thing the case admits of; and it is best
to promote this result by good and pure diet, perfect rest, and invigo-
rating internal treatment.

10. Poisoned Wounds, Bite of the Rattlesnake.-— -^^omm^, Bi-
hron^s Antidote, — The composition was thus given to Prince Paul of
Wirtemburg, in his travels in 1854 :

R. — Potassii-iodidi, 4 grs.
Hydrar.-chloi'., 2 grs.
^ Brominii, 4 drachms.

Give ten drops of this mixture, diluted with a table-spoonful of
brandy or wine, to be repeated if necessary. It must be kept in glass
stoppered vials, well secured. Prince Paul says^ Prof. Bibron allowed
a rattlesnake to bite him in the lips and cheeks ; and then, by taking
his antidote, he prevented all unpleasant or alarming symptoms :

In 1857, in the course of an expedition to' the Rocky Mountains,
some experiments were made with this remedy, afterwards reported by
Dr. W. A. Hammond, since Surgeon General U. S* Army.

1. July 2, the Hospital Steward was bitten by a large rattlesnake
(crotalus confluentus) which inflicted a deep wound, and hung by his
fangs to the .finger for a second or two before he could be detached.
Four minutes afterwalrds a dose of the antidote was given. The symp-
toms almost immediately disappeared. After forty minutes the pain
and swelling returned, attended with much throbbing. Repeated the
antidote. In less than five minutes the finger regained its natural ap-
pearance, and all pain and pulsation had vanished. The man resumed
his duties an hour from the accident.

2. A large rattlesnake was made to bite a wolf (canis occidentalis)
about three months old, wounding the animal severely in the left flank
In fifteen minutes the leg was much swollen ; the wolf showed sign?

CELLTJLAJ^ INFLAMMATION. 667

of great uneasiness, yawning, stretching, and looking about in an
anxious manner. The symptoms increased in intensity ; it became
unable to stand, drows}^, slightly convulsed. Thirty minutes from, the
infliction of the wound gave six drops of the antidote. Almost instan-
taneously the symptoms disappeared. In a few minutes the animal ate
a large piece of meat.

3. The following day the same snake was made to bite the wolf three
times in the space of five minutes, in the flank, neck, and cheek. In
two minutes the wolf was unable to stand ; gasping respiration, a fixed
expression of the countenance showed the offect of the poison. Some
delay in getting the antidote ready ; before it was given all signs of
life had apparently ceased. Nevertheless six drops were placed far
down the throat, where it apparently remained, as there was no effort
to swallow. In one minute respiration again commenced, and the heart
could be felt to pulsate. But the wolf lived twenty-seven minutes, and
then died comatose.

4. A large crotalus confluentus brought from the Eocky Mountains
was made to bite a dog, five months old, in the right shoulder. In ten
minutes the poison caused gasping respiration, inability to stand. Be-
fore the antidote could be given the dog became unable to swallow
and he wag perfectly senseless, dying in forty-five minutes after the
infliction of the bite; very slight swelling observed in the wounded part.

5. Only forty-five minutes after the last experiment the same snake
was made to bite another dog, of the same age as the last, in the lower
jaw, near the mouth. At the end of three minutes, and before any vio-
lent symptoms ensued, a dose of the antidote was given. The dog
swallowed it readily. In five minutes he seemed uneasy. Respiration
was accelerated ; he preferred to lie down in the shade. At the end
of fifteen minutes he could stand with difficulty, and the effect of the
poison seemed to incr>ease. Another dose was given, nearly half of
which was lost. Slight swelling of the face and neck ; when roused
he would walk a few yards, though with difficulty ; he preferred to
rest. In an hour from the bite he seemed better; took some milk; in
two hours he appeared well, a small swelling remaining under the jaw,
which disappeared by next morning. (See Brit, and Fonu, Med.
Chir. Beview^ 1858, p. 4cO^»—Gen. Marcy^s Prairie Traweller^ &c.)

Dissection" Wounds.— C(:3^5<3 hy Dr, O. Dunham,-— -LaGhesis. — Dis-
section wound in the index finger, received in making autopsy of a woman
who died of puerpural peritonitis. In a week the finger had quadrupled
in size ; hand and forearm much swollen and oedematous ; a hard and red
line extends from the wrist to the axilla ; axillary glands swollen ; arm
and hand intensely painful ; whole left side partially paralyzed. Ex-
treme prostration causes the disease to be mistaken for typhus ; low mut-
tering delirium at night ; marked aggravation, suffering, and prostration

668 DISEASES OF THE SANGTJINOUS FUNCTION.

on awaking from sleep. General condition growing steadily worse ;
abscesses forming under the deep fibrous tissues of the finger and
hand. Allopathic surgeons in attendance advised Calomel and Opium,
and gave a discouraging prognosis. Dr. Dunham refused their ad-
vice ; took Lachesis, 12, the first dose on the third day, and repeated
it thrice daily for five days. The constitutional symptoms had now
vanished. The recovery of the finger was slow but complete.

Bites of Insects. — Collodion. — This is the best application to the
poisoned wounds made by insects. It gives perfect relief to the bites
of mosquitoes, and is also the best application to the stings of bees.
Arnicated Collod, is the best. Other remedies are : Brom., Amm., Caust.

One of the very best local applications for the bites of insects is the
tincture of Apis-mellifica. It usually affords prompt relief.

11. Malignant Pustule, Chaebon. — In addition to a peculiar pre-
disposition on the part of the patient, Larrey thought the disease was
caused by "the general or partial absorption of certain deleterious
gaseous effluvia, very abundant in some marshy districts in the middle
of France. These mephitic emanations are formed more frequently
when the first heats of summer open the pores of the earth, and' cause
the decomposition of the animal and vegetable substances." "The
places most exposed to these emanations are the sewers or cemeteries
which remain covered with snow during the winter, the neighborhood
of stagnant waters, or those temporary ponds formed by the melting
snows or rains of winter, in which are engendered a great quantity of
reptiles. These ponds, in drying up, leave a prodigious number of ani-
malculse, which putrefying, generate these pernicious exhalations."
Persons exposed to the impure atmosphere of such localities ; or
butchers, tanners, cooks, &c., who come in contact with the flesh or
skins of animals that have died from malignant diseases are liable to
be attacked with this disease. There have been instances of the in-
fection being conveyed by flies from diseased animals to the human
race.

A symptomatic variety attacks persons who are predisposed to such
diseases and are then exposed to malaria which excites this pustule or
some%nalogous disease.

Symptoms. — The disease commences with a disagreeable itching,
with shooting pains in the place where the tumor was forming, and
following the course of the nerves. This point becomes red and
slightly swollen ; the patient thinks he has been bitten by some poi-
sonous insect. Soon yellow vesicles appear on the spot, filled with
lemon-colored serum. An areola forms around it, at first red, then
livid, and producing vesicles like the first. The swelling extends to
surrounding parts ; the vesicles burst, and the fluid escapes. The der-
moid tissue in the centre now becomes black, dried up, and hard like

CELLULAR INFLAMMATION. 669

a piece of black leather, it is sunken, and adheres strongly to the parts
beneath, while the areola enlarges, assumes a livid color, and becomes
gangrenous. It often attacks the genitals of children.

The itching with which the affection begins is followed by tension,
numbness, and slight throbbing pains; and there is general uneasiness
pains follow in the head ; vertigo and disposition to vomit ; no appe-
tite ; disturbed sleep, dreams and delirium. Pulse at first weak and
slow, and lessening as the disease advances; respiration labored ; urine
deficient; constipation; hiccough; moral faculties disordered. In
malignant cases the symptoms rapidly increase ; the slough spreads ;
the vesicles break and discharge a green or reddish fluid.

The tumor is elevated ; the general functions disordered. When the
vital powers are too much depressed to form the circumscribing of true
inflammation around the tumor, and confine the disease to one spot, the
dry form of gangrene extends rapidly in depth and breadth ; the gan-
grenous matter is absorbed by the lymphatics ; the patient becomes
prostrated, having frequent faintings, hiccough, oppressed respiration ;
palpitation of the heart, and greater depression of the pulse ; then fol-
low drowsiness, vertigo, suspension of the intellectual faculties, and
finally death.

Pathology. — In the fatal cases the carbuncle is found "gangre-
nous, the stomach and intestines filled with tainted gas, and spotted
with points of gangrene ; epiploon yellow and flabby ; whole venous
system gorged with liquid blood." [La/rrey.)

Diagnosis,

Malignant Pustule.

The skin is primarily, and the
cellular tissue secondarily involved.
May occur on any part of the body,
but always in relation to the epi-
thelium, whether on the skin or
mucous membrane.

Generally young or middle-aged
persons.

Commences in forming a vesicle.

Not many openings ; there is
one^ but it is larger, and without
defined edge.

Carbuncle.
Generally appears on the back
of the neck or in the loins, where
there is a dense fibrous fascia ; and
it arises in connection with 'the
areolar tissue beneath such fascia.

Commonly old persons, seldom
middle-aged.

No vesicle is formed.
Small pin-hole openings commu-
nicate with the gangrene beneath,
and discharging drops of matter.
Carbuncle. — Anthrax. — A painful, hard, flattened, circumscribed
tumor, but slightly elevated above the skin, extending through the en-
tire cuticle, and even beneath it, so as at times to be an inch or more
deep. The surface is red, of a mahogany tint, then purple, then livid ,
and after the parts heal up the skin still remains red or of a deep
brown, and the discoloration remains for some weeks.

670 DISEASES OF THE SANGUINOUS FUNCTION.

The pain is peculiar, throbbing, and burning ; wlien the carbuncle
is fully formed the surface is livid or purple, the cuticle becomes raised
into blisters, there are numerous^ points of pustulation, and as the pus
escapes the cuticle appears to be pierced with small perforations,
through which a core beneath may be seen. The core is made up of
a slough of the fibrous tissue of the inner part of the skin, and as it
loses its vitality that tissue appears to be converted into a grayish or
whitish pulp, apparently soft and mixed with an ichorous purulent
fluid. The entire surface of the carbuncle is filled with the perfora-
tions through which this fluid oozes. Or a considerable space of the
skin may lose its vitality, turn black, slough, and leave a large opemng
in the core. Carbuncles vary in size from an inch to several inches
in diameter, and are from an inch to an inch and a half in depth.
They are always attended with more or less danger from the great and
long-continued pain they cause, from the exhaustion of the sloughing
process, from the febrile excitement, from its aptitude to excite erysipe-
las, and from the fact that the disease usually occurs in those already
in feeble health."^'

Causes.— The Eegistrar-General of Scotland, in his Report for
1862, says that from the breaking out of pleuro-pneumonia among the
cattle in that country a few years ago, carbuncle, a disease formerly
very rare, has become comparatively common. Dr. Livingston observed
in Africa that, if the flesh of animals that die of disease be eaten it
causes carbuncle in the persons- who eat it ; and that neither boiling
nor roasting the flesh, nor cooking it in any way, gets rid of the poison.
Though the cattle aifected by the disease be killed before they die of
it, ** still the poison is in them." The Report suggests the possibility
of the origin of diphtheria from the use of diseased flesh.

TREATMENT. — The most prompt and certain relief is given by mak-
ing a crucial incision quite through the diseased structure, and even
extending a little beyond its boundary into the sound part. The pa»
tient is generally relieved almost instantaneously from the distressing
shooting pains. In dividing the tumor it seems as if the knife passed
through a honeycomb. A soothing poultice should be applied to pro-
mote the full discharge.

Medical Treatment. — The remedies are: BhuS'tox,, Arnica.
Arseniciwi: Carbuncle taken from cattle. Bell., Hyos., Nitr.-ac.
CalGarea-muriatica : Silicea, Sulph.
Chloride of Lhne : Calendula.

Dr. Helmuth says, he treated three severe cases, in one of which
* the disease extended over the whole forehead, and required crucial
incisions three or four inches in length. In the second case a large

* Jour. Rational Med. March, 1862. p. 83.

CELLULAR INFLAMMATION. 671

and extremely painful anthrax appeared just above the tendon of the
quadriceps extensor, and involved the tissues beneath to such a degree
that an abscess formed, underneath and threatened the joint. And, in
the third, three large and painful tumors developed themselves on the
neck. The internal treatment was Arsenicum for the intense burning,
and, in an early stage, free incisions, the parts being constantly co-
vered with a thick compress, saturated with a hot solution of Galen-
dula and water. The effect of the remedy in hastening the generally
tardy separation of the slough, in allaying the pain, and more pai ticu-
larly in bringing the disease to a speedy termination, was surprising.
Moreover the aqueous solution of Calendula can be poured into deep
wounds with great benefit, and with much alleviation of pain."

Galcarea-muriatica was recommended by Rademacher in 1832.
Dr. Kallenbach of Utrecht says that he had been for near twenty
years afflicted with boils every three or four years, which, under the
use of " Arnica, Hepar and poultices," tormented him " ten or fourteen
days before the so-called core" could be extracted. On a late occasion
" a boil the size of an apple formed in the perinaeum, and after eight
days" In spite of the usual remedies he was confined to bed and unable
to move. " The formation of matter (my age being 66) went on slowly,
and the fluctuations were barely perceptible, so that from past experi-
ence I counted on another eight days delay. Then came into my me-
mory Rademachers recommendation, and I began to apply a solution
of Muriate of Lime, two drachms to three ounces of water. The same
night was- quiet and almost free from pain. In twelve hours the boil
opened of itself, and discharged about one-third of its volume of thin
bloody pus. Under the continuance of the same application the open-
ing closed in a few hours, and the remainder of the swelling was dis-
persed by resolution in a few days, instead of passing into suppuration."
(IIo7no30p. Kliiiilc. May, 1861.)

Chloroform, — Dr. Hardy reports some interesting cases of prompt
relief to most violent pain in carbuncle, haemorrhoids, irritable bladder,
difficult menstruation, ulceration of the os uteri, cancer of the rectum,
&c., by the topical application of the vapor of chloroform. Intense
pain, even when it does not cause death, may interfere with the action
of remedies ; and it is proper to relieve or remove it by any reasonable
means in our power.

Carbonate of Lead, — White Lead.. — As an external application, in: a
case of a huge carbuncle on the loins of a man rapidly extending in
spite of free incisions, linseed poultices, and common general treat-
ment, a thick wide circle of white lead in linseed oil was applied.
From that time there was no advance of the disease ; the centre ra-
pidly broke np, and recovery followed. Warm poultices often increase
the inflammation of carbuncles.

672 DISEASES OF THE SAI^TGUESTOUS FUNCTION.

The white lead seems to act in two ways : 1. It effectually excludes
the air which is a great irritant ; 2. It is a direct homoeopathic sedative
to the sentient nerve filaments, rendering them less disposed to become
involved in the progressive inflammation.

12. ERYSIPELAS.-ST. ANTHONY'S FIRE.

Erysipelas presents itself under so many different aspects, and so
often makes its appearance in connection with other morbid conditions
of the system, that any description which shall cover all its various
phases, is scarcely possible. The structures upon which it seizes are
the skin, the cellular tissue, and the internal organs, especially the
brain and the lungs. It may exist in a cTironiG form, unattended by
febrile, or other constitutional disturbance, and persist for a long period
— ^displaying itself at intervals, upon the surface, in the form of slight
superficial inflammations ; or sometimes passing to an internal organ,
and producing temporary derangement of function; while at other
times it will remain latent and inactive. But it very frequently appears
in an acute form, either as an idiopathio or a sym^ptomaiio affection.
It is in this active condition that erysipelas has proved so formidable
to the old-school physician and surgeon. It was in this form of the
malady, that the late celebrated Listen, conscious of the inefficiency of
allopathic remedies, was induced to adopt homoeopathic treatment in
the numerous symptomatic cases from surgical operations, wounds, &c.,
which came under his care, the results of which were so satisfactory
to Mr. Listen and the friends of homoeopathy. (See B&ports of Worth
London Ilosfital^ 1836. — 7 and 8.)

Erysipelas prevails most commonly in the spring and autumn, and
not unfrequently it assumes an epidemic character. Females are like-
wise more subject to its attacks than males.

The circumstances which operate to modify the character and course
of the malady are very numerous. In some instances a peculiar state
of the atmosphere exists, which serves to develop the affection in a highly
malignant form, in those who are predisposed to its influence. At other
times, the effluvia arising from those who are suffering from the disease,
appears to possess contagious qualities, and to be capable of communi-
catino: the morbid influence to those who came within its reach. Cases
of this kind are usually severe and malignant — attacking the cellular
tissue with a low grade of inflammation, which is exceedingly prone to
terminate in gangrene, and not unfrequently to extend its ravages to
the brain and lungs. The habits and constitution of the individual
likewise exercise an important influence in determining the character
of the disease. Excessive indulgence in malt-liquors and impure spi-
rits and the exclusive use of fresh meat, reduce the system to a con-

EEYSIPELAS.

673

dition peculiarly favorable to tke development of malignant erysipelas,
whenever slight exciting causes operate. So also general debility, a
dropsical tendency, a scrofulous or scorbutic habit, or any other dys-
crasia, will be likely to determine a dangerous form of the complaint.

J)iAGii08is»—JS'rysij}elas is sometimes preceded by general lassitude,
depression of spirits, and protracted rigors, followed by accelerated
circulation, hot skin, thirst, headache, wandering pains in the back and
limbs, and general restlessness ; or it may make its appearance with-
out any premonitory symptoms, excppt perhaps slight chills, succeeded
in a few days by fever ; or it may occur during an attack of pneumo-
nia, typhus, bilious or gastric fever; or after wounds, or other injuries,
in difierent parts of the body, especially of the scalp ; or it may arise
suddenly from violent mental emotions, as terror, joy, anger, &c. When
the inflammation is confined to the skin, the malady runs its course in
a mild and simple manner, and the accompanying symptoms will be
merely stiff, heavy, burning, or pungent sensation in the part affected,
impaired appetite, slight febrile disturbance, and noctural restlessness.
The inflammation generally comes out in blotches, which sometimes run
together, and after a few days, are covered with vesicles filled with a
limpid or yellowish fluid. These blotches vary from a light red to a
dark red, or purplish color, becoming white under pressure, but again
resuming their original appearance as soon as the pressure is removed
As the disease is about subsiding, the color of these spots changes to
a pale or dirty yellow, after which desquamation of the cuticle takes
place.

When the malady is complicated by gastric or biliary derangement,
we may have a high grade of febrile excitement, and the other phe-
nomena which usually attend affections of this kind. In these instances,
the erysipelatous inflammation is apt to be more violent, and to extend
deeper, than when no complications exist. The tumefaction is more
extensive and deep-seated, the inflammation is more intense, the hard-
ness greater, and the pain more profound, in this variety, than in that
first described. Some authors have designated this variety the erysipe-
las jphlegmonodes. The most common seat of this phlegmon is in the
face and head, although it occasionally attacks other parts of the body,

Another and highly malignant variety of erysipelas prevails at cer-
tain seasons, and attacking more particularly females after confine-
ment, and individuals who have already been enfeebled by other dis-
eases. The tumefaction in these instances is more soft and spongy
than in the preceding varieties — often pitting on pressure; the skin
assumes a pale, waxen, or sallow color; the temperature of the parts
is sometimes above and at other times below the natural standard ; the
skin of the affected parts presents a smooth and glossy appearance ;
vesicles containing a limpid or yellowish serum, are diffused over the

VoL.1.— i3.

674 DISEASES OF THE SAITGUINOUS PUJSrCTIOK".

swelling; sensations of stiffness, weiglitj and deep-seated burning pains
are experienced ; followed, if the disease advances, by nausea, vomiting,
obtusion of the senses, rapid and feeble, or slow and full pulse ; con-
stant inclination to sleep, and finally profound coma; stertorous respi-
ration; contracted or dilated pupils, either partially or wholly insensible
to light; protrusion of the lips at each expiration; frothing at the
mouth ; diminished temperature of the skin ; livid and inactive appear-
ance of the diseased part, and general and rapid abasement of the
energies of the system. This form, of the disease has been recognized
under the term erysijpelas oedewiatodes^ from the resemblance of the
affected parts to dropsical swellings.

Erysipelas gangrenosui7i.-—hi this form of the disease there is
evinced a strong disposition, from the commencement, to terminate in
gangrenous degeneration. The inflammation is confined principally to
the sub-cutaneous cellular tissue ; the swelling is hard and inelastic ;
the color of the skin is dark red or purple ; large vesicles filled with
an acrid fluid form on the surface, presenting a sluggish and gangre-
nous tendencv ; the accompanying fever is of a low typhoid character ;
the muscular and nervous energies are below the natural standard : de-
lirium or coma are for the most part present, and suppuration, gan-
grene and sloughing soon supervene.

Erysijpelas ^^^znato^i^m.— Erysipelas of this form attacks new-born
children. The inflammation is generally confined to the lower part of
the body in the first instance, but sometimes extends over the whole
surftice. The character of the attack depends much upon the consti-
tution and predisposition of the child ; although, commonly, the inflam-
mation is of a high grade, the swollen parts very painful and tender,
and disposed to suppurate and slough. The course of the complaint
varies from two to four weeks.

Another, and very common kind of erysipelas is observed in old
people and in cachectic and intemperate persons. It is unattended
with febrile disturbance, or much pain ; but it is apt to make its appear-
ance from very slight exciting causes, it becomes a constant annoyance.
When the inflammation is upon the surface, the subject feels well; but
on its disappearance there often occur internal pains, congestions, and
numerous unpleasant symptoms, which lead to the inference that the
disorder is dependent on some internal miasm. Frank terms this form
habitual erysipelas,

A number of other varieties have been described, founded upon the
disease as it has prevailed in different localities and climates, and as
modified by various forms of disease which may have accompanied it.
We only aim to give a general outline of the complaint with its charac-
teristic phenomena.

Ej?id6mio Erysijpelas, — This formidable disease invaded various

ERYSIPELAS. 675

parts of the United States and Canada about 1841. In 1842, 48, 44,
45, it prevailed, at one time or another, in almost every Western state*
It afterwards gradually diminished in virulence, losing its most striking
characteristics. A single case "VYill furnish a sufficient history of the
epidemic as we often saw it during those years.

Mrs. M., aged 25, was in good health on the evening of the 19th of
March, 1844, felt some pain and soreness in one nostril and' through
the head. During the night the pain increased, the nose swelled and
the eyes could not be opened. In the morning erysipelatous inflam-
mation was extending along the angle of the right jaw. At 9 p.m. the
pulse was 100 in frequency; arterial action not strong; skiii moist;
but the inflamed surface fiery red ; pain burning and confined to the
skin ; heat of the surface generally not great. The swelling and red-
ness, however, continued to extend, assuming a deep dark-red color. At
4 A.M. on the 21st the pulse was 120 ; pain in the head ; much worse
among the parotids and salivary glands. During the morning the pulse
130, in the afternoon 140. The face largely swollen over the right
side and red on the left. Pain in the head continued. The tongue,
from the beginning coated, now dry and red. Appearances continue
the same through the evening. Pulse constantly 135 to 140. Swelling
extending upwards through the hair. The swelling closes the right
eye.

March 22d, 8 a.m. The pain is now scarcely felt, though the swell-
ing of the face is such as would be made by adding two inches in thick-
ness at the middle of the cheek and extending it down the neck and up
to the top of the head. Color dark mahogany color; pulse 136. The
throat collects full of thick mucus which seems coming off. The patient
thinks she is better. The pain in the back and legs is gone ; intellect
little disturbed, mammary secretion increasing, though the pulse is still
too frequent to assure her safety.

At 6 P.M. the swelling was slightly diminished on the points first in-
vaded, but is increasing on the top of the head and on the other side
of the face ; some discharge from the nostrils ; pulse improving (120) ;
superficial inflammation still slowly spreading, but with less swelling.
From this time the disease declined. 23d, pulse 120 in the evening;
face and head still very large ; skin dark ; nose running bloody serum ;
slight pain in the head. Skin thickened and red quite 'down to the
neck, front and back. Itching of the skin and subsidence of the swell-
ing and pain give assurance of resolution in the parts first invaded.
24th free from pain; pulse at 6 a.m. 110. Swelling slowly subsiding,
though the eruption spreads down the neck ; both eyes still out of sight
from the swelling of the lids.

25th. Slowly improving ; pulse 104. The eruption has ceased to

676 DISEASES OF THE SAlS-aUINOTJS FUNCTION.

extend; appetite good; little perspiration; tongue moist and of natural
appearance. Full recovery about the seventli day.

Causes. — There is much difference of opinion respecting the causes
of erysipelas. Some attribute it to a local cutaneous vice; some to a
degeneration of the blood in consequence of improper food, abuse of
stimulants, &c.; some to a derangement of the biliary organs ; some to
atmospheric influences ; "vyhile others entertain the opinion that it is
dependent upon a peculiar dyscrasia which is constantly present as a
predisposing cause. This opinion appears to us reasonable ; but
whether this dyscrasia is in all instances hereditary, or whether it may
be acquired by intemperance, unwholesome food, or from contaminated
air, we are not as yet always able to determine.

The more common excitmg causes of erysipelas are, debility and
loss of resisting power from disease, abuse of stimulants, violent emo-
tions of the mind, undue exposure to cold, certain states of the atmos-
phere, accouchment, disordered stomach and bowels, confinement in
close and crowded apartments, and wounds.

Eberle says, "the inflammation which is produced by the recent
leaves of ih^ Ehus-toxiGodendron^ is- strictly of an erysipelatous cha-
racter." ' This, however, is an error, for although a close similarity
exists between the two inflammations, the careful observer will be able
to distinguish decided marks of diiference.

Treatment. — The important medicines in the treatment of erysipe-
las MQ^Bhus-tox.^ Belladonna^ AconiteySid2jMir^ Opium, GraphiteSj
Arsenicicm, Carlo-veg., Merc,^ Bhosphorics^ Pulsatilla, Acid-jphos.,
Acid-nitriG., SiliGea, China, Hepav-suljpJi,, Lachesis, Bryonia,
Chamomilla, Clematis, Eujpliorbia^vA Ajpis,

BhuS'toxiGodendron. — External indications. — Inflammation con-
fined to the skin, numerous vesicular blotches, attended with itching
and burning sensation ; swelling and redness of the face, worse in the
eyelids, around the eyes,' and in the lobules of the ears, attended with
burning and itching ; swelling in the scalp ; erysipelatous inflammation
of the scrotum in new-born children ; distinct or confluent vesicles,
containing an acrid, limpid, or yellowish fluid, with redness of the skin
over the whole surface of the body ; partial or entire closure of the
eyelids; swelling and hardness of the alm-nasi ; gangrenous ulcers ; hot
and dry skin ; rapid and full pulse ; urine small in quantity, dark and
turbid.

Physical Sensations.— Burning, itching, and stinging of the afiected
parts, aggravated by scratching ; irritation and sometimes excoriation
of the skin from contact of the vesicular discharge ; the itching and
burning sensations worse in the evening; stiffness and sense of immo-
bility in the swollen parts ; bruised feeling in the limbs and back,
general sensation of heat, both externally and internally, occasionally

ERYSIPELAS. 677

interrupted by slight rigors ; mouth filled with saliva, or dry, with or
without thirst; dryness and obstruction of the nose, relieved by
draughts of cold air, or by being fanned; painful pulsations in the
internal ears, when resting on the aifected side; scalp swollen and
painful to the touch*; eyes painful on motion; dull, heavy pain in- the
head, aggravated by motion or stooping.

Mental and Moeal Symptoms. — Obtuseness of intellect, stupefac- ^
tion, and weakness of memory; sadness, anxiety, and despondency
towards evening, and during the night ; nightly delirium.

Administration.— A drop of the second or third dilution in water,
once in two to four hours.

Remakes. — -Ruoff and Schroen consider ^Ai^5 particularly appli-
cable in vesicular erysipelas, which is confined to the skin ; but if
symptoms indicative of serious cerebral disorder are present, they pre-
fer Belladonna, It has been used with success in infantile erysipelas.

Symptoms produced by Mhus-toxicodendron, — Blistering of the
skin. The head swells to a very large size. Fontana thus poisoned
himself three times when experimenting.

Inhalation of the atmosphere of Rhus-toxicodendron produces in a
few days or even hours: itching; swelling, redness ; pain, pustules,
which are more or less vesicular; there is fever, malaise, oppression,
lasting several days ; death has resulted.

In 1825 Lavini experimenting with Rhus juice inoculated the first
phalanx of the index-finger with two drops of the juice, leaving it only
in contact for two minutes. In twenty-five days the following symp-
toms arose suddenly : great heat in the mouth and throat; rapid and
large swelling of the cheek, upper lips and eyelids; in the night fol-
lowing, swelling of the fore-arms to double the natural size ; dry, tense
and burning skin ; intolerable itching.

Rhus afiects the integuments and membranes rather than the cellu-
lar tissue and the muscles, which are more under the influence of Ar-
nica. It differs from Ledum-palustre by its tendency to spread instead
of confining itself to a narrow space.

PatJiological Conditions curable l)y Rhxis-tox. — ^Sense of fullness
about the head; worse when stooping; sensation in the brain as if
bruised, or fluctuating; stupefying hciadache, such as exists in acute
fevers, or that caused by intoxication with Brandy.

Redness or paleness of the face ; margins around the eyes ; pointed
nose; comatous drowsiness, occasionally delirium; coldness of the
surface; numbness of the limbs ; general sinking of strength ; frequent
but oppressed pulse. It is employed successfully in many diseases,
among which are the following. Acute hydrocephalus; serous and
sanguinous apoplexy, erysipelas ; paralysis; epistaxis. {Teste.)

Symptoms. — Tingling in the hairy scalp, forehead, nose, or the

678 DISEASES OF THE SANGUmOUS FUNCTION.

whole face ; cracking and ulceration of the red border of the lips ; hot
swelling of the upper lip; burning pustules around the mouth, fol-
lowed by dry, brownish crusts ; heat and smarting over the face ; paro-
titis. Enormous swelling of the whole head (erysipelas); itching of
trunk and extremities, burning, itching made Worse by scratching
burns, chilblains; consequences of sun-stroke; it has even cured me
ningitis from this cause. It has cured erysipelas, pemphigus, zon?^
eczema, hot and painful engorgements of the sub-cutaneous glands ;
rheumatic pains which are very violent and always spread over a large
surface, as at the nape of the neck, loins and extremities ; gout, espe-
cially when characterized by cutaneous symptoms ; hydarthrus ; warts
on the hands ; red or colorless infiltrations of the extremities with
burning pains ; erythematous gastritis and gastro-enteritis, with the
mouth hot as if burnt; strong desire for cold drinks ; red and dry
tongue, covered with a sort of false membrane^ vesicles being visible
beneath ; burning at the stomach.

(Edematous Erysipelas of the Face.—Dr. E. A. Guilbert, Dubuque,
Iowa, advises the topical application of remedies. He gives cases
illustrating the treatment, in one of which he applied Arsenic for twelve
hours, followed by Rhus. Improvement within the first twelve hourSg
and in thirty-six hours the case was out of danger.

In a second case Aeon., Rhus-tox., Rhus-rad., Iodine, and Belladonna
were used.

Third case. Arsenic and Rhus-rad. internally and the sa,me "reme
dies externally ; impression made on the disease in twenty-four hours.
Attenuations, first to sixth, tincture, twenty drops to a pint of water.

A vigorous and plethoric man, blind from cataract of both eyes,
had erysipelas, involving the face, scalp, neck, and upper third of the
chest "erratically leaping thence to the dorsal surface of the hands,
and the plantar surface of the head," features hideously disfigured ;
eyes closed, lower maxilla almost immoveable, owing to the extraordi-
nary tumefaction of the tissues involved ; color of the affected parts
bluish-red, and the heat thereof most pungent ; dangerous cerebral
sjmiptoms from the second day to the subsidence of the disease. In
this case, no topical application was used but strong tincture of Iodine,
to create a barrier, by w^hich the march of the inflammation might be
arrested ; and when that barrier was reached, the disease Was suddenly
translated to the hands and feet. He recovered slowly under Aeon.,
Bell., Arson., Rhus-tox.

In another case remedies were used topically. A boy of nine
years was treated internally for several days by Arson, and Bell. The
same remedies were used topically; beginning at nine o'clock on one
evening, they produced evident amendment by next morning. In an-
other case a boy, aged nineteen, had been under treatment severa]

EJRYSIPELAS. 679

days ; " the disease was still extending its ravages, and the cerebral
symptoms were particularly ominous." Arsen, and Ulnts-rad. were
used internally, and the same (twenty drops of the tincture to a pint
of water,) locally applied ; " an impression was made on the disease
within twenty-four hours, and the patient rapidly convalesced."

Belladonna. — External Indications.— Skin swollen, red, hot, and
painful; cheeks, eyelids, nose, lips, and forehead, swollen, tense, shin
ing and painful to the touch ; eyes red, prominent, and glistening, or
dull and cloudy; pupils dilated or contracted; whole head swollen and
painful ; obstruction of the nostrils ; inflammation and enlargement of
the parotid glands ; hardness of hearing ; redness and swelling of the
tonsils and throat ; urine scanty, dark, yellow, or reddish, clear or tur-
bid ; vesicular inflammation, with intense febrile excitement; tongue
and lips dry ; sordes upon the teeth ; occasionally spasms, tremblings
and rigidity of the limbs ; pulse generally full and quick*

Physical Sensations. — Tension and pressure, or sharp, throbbing
pains in the head ; scalp very painful, especially on pressure ; violent
heat and burning of the inflamed parts ; dryness, smarting, or burning
of the eyes; disordered vision; stitching and throbbing pains in the
€ars, both externally and internally; roaring and humming in the ears,
mouth, and throat, dry, hot, and painful; sticking and burning sensa-
tion in the throat when swallowing; aversion to food and drinks, or
violent thirst for cold drinks ; bad taste in the mouth, bitter eructations,
and other signs showing biliary and gastric derangement ; short,
anxious, and difficult inspirations; great weariness and uneasiness;
pains worse in the afternoon and at night, and aggravated by contact
or movement.

Mental and Mosal Symptoms.— Vertigo, confusion of ideas, or
loss of consciousness, or delirium, violent at night, but moderate during
the day ; or melancholy, despondent, and apathetic.

Administeation.— -A drop of the third dilution in water every two
or three hours, according to the severity of the symptoms.

Remakes.— It was chiefly from the employment of Belladonna and
Aconite that Listen produced the successful results in the North Lon-
don Hospital, and in private practice, to which we have already alluded.
It is applicable when we believe it to have been excited by intemperance
and violent emotions of the mind. Also in nearly all cases of erysi-
pelas where there- exists prominent cerebral disorder. In these cases,
should it not cover all the important symptoms, we may give some
other appropriate medicine in alternation.

Whenever febrile symptoms are strongly pronounced, and there
exists a decidedly augmented action of the circulatory vessels. Aconite
will be rec[uiredj either alone or in alternation with some other remedyf

680 DISEASES OF THE SANGUINOUS FUNCTIOIT.

It should be used in the first, second, or third dilutions— a drop in
water as often as the exigencies of the case may demand.

Opiunfh is indicated in those cases which supervene during jpneu-
monia^ typhoid, and other fevers, and present the following signs : pro-
found coma ; stertorous respiration ; eyes dull and watery ; pupils dilated
and immovable ; general appearance stupid and besotted ; spasmodic
motions in difierent parts of the body ; pulse slow and feeble, or slow,
intermittent and full ; inability to rouse the patient. The second or
third dilution may be employed — a drop every half hour until an
impression is produced.

When ulcers have formed, and there is a disposition to gangrenous
degeneration, we must refer to Arsen,^ Cari^-veg.^ Siil^li,^ LachesiSy
EiijpJio7''b,^ Sil., Clematis y Acid-nitr,, and Aoid-phos,

In erysipelas phlegmonodeSjy^^iQB. the inflammation is extending into
the cellular tissue, our best remedies are Bell.^ Graph,^ Hej^ar^sril.^
MeTG.^ Phos,^ /Sil. and Sulph.

If the inflammation exhibits a tendency to shift from place to place,
and is attended with gastric or intestinal derangement, and constantly
shifting pains, Pulsatilla will prove specific.

Bryonia has been strongly recommended when the inflammation
takes place about the joints, and is accompanied by rheumatic pains.

China will often prove serviceable during convalescence from severe
and protracted attacks, when the energies of the system have been ex-
hausted, and there is great irritability of the nervous system. Some
of the signs which point to this medicine, are emaciation, oedema of
the limbs, deficiency of the animal heat, pale countenance, great de-
bility, ringing in the ears, disturbed sleep.

Tarta^r-emetio, — In bilious erysipelas, or in the form that originates
in strongly marked gastric disorder, T6^^r25(^r-^m^((^^ often diminishes
the inflammation, increases the perspiration and urine. Dr. Welsh
thinks it acts specifically on erysipelas of every form, whether of high
inflammation, low fever, vomiting or purging. It does not appear, how-
ever, to be so "generally useful as Rhus and Bell. It succeeds best in
cases accompanied with constant nausea, bilious vomiting, watery or
brownish diarrhoea, cold sweats and great prostration of the vital
forces.

External applications to the affected surfaces, in the form of blis-
ters, and of nitrate of silver, have sometimes been supplied with
success ; though they are in accordance with our principle of cure, it be-
comes us to give them attention only as subordinate to internal remedies.-

M. Velpeau, of Paris, says, he treated one thousand cases of erysi-
pelas and recorded the history of four hundred of them. He relied
only on external remedies, some of these were : blisters, nitrate of sil-
ver, Mercurial-ointment, hog's lard, white precipitate ointment, Sul-

BRAm AND NERVOUS SYSTEM. 681

phuric-acid, HydrocUoric, Citric, Tartaric, and dilute Acetous-acid ;
common salt and water, liquid Nitrate of Mercury, bird-peck punctures,
and Camphor; and found no benefit from any of them. He then re-
nounced them all in despair, till he came to think the disease might
consist in a blood poison, to be corrected by iron. He tried nine drops
of the Sulph.-ferri in forty ounces of water. He found that this, when lo-
cally applied cured the disease where it existed, but would not prevent
its spreading.

Carhonate of Lead. — This is far superior to the common lead lotions,
hot fomentations, Nitrate of Silver, Collodion. After painting the skin
with white lead paint, the tight shining skin soon becomes wrinkled
and shrunken ; the inflammation rarely extends after the second or
third painting. Apply it by means of a feather over the affected part,
and a little beyond the margin. But no local treatment must be de-
pended on in any form of erysipelas. Rhus and Belladonna are the
true specifics. Let them be given alternately, followed by Rhus in
vesicular cases.

Respecting the administration of the remedies above enumerated,
we suggest, as a general rule, the employment of first, second, and
third attenuations ; but in cases of infants and young children, we may
go up to the tenth, or twelfth dilution. In acute cases, the dose should
be repeated once in two to four hours; but in the chronic varieties,
two or three times daily will -suffice.

Acetum. — Cleghorn, a brewer of Edinburgh, recommended the ap-
plication of vinegar to burnt surfaces, continuing it till the pain
abated. The eschars to be covered with poultices, and afterwards
sprinkled with finely pulverized chalk.

DISEASES OP THE BBAIN AND NEEVOUS SYSTExM.

Geneeal Obseeyations.— If the soul of man manifests itself through
the healthy organism in a certain definite manner, and if these mani-
festations are modified precisely in accordance with the abnormal con-
ditions which the organs and tissues may acquire, the importance of a
correct understanding of the exact healthy functions of all the struc-
tures, and of their alterations during disease, will be truly appreciated.
Unfortunately for science, the profusion of hypotheses, the arbitrary
assumption of ancient ideas for facts, as well as the inherent diffici^l-
ties attending the pathology of diseases of the cerebro-spinal system,
have until recently retarded the onward progress relative to their na-
ture and treatment, until Sir Charles Bell demonstrated that the
nerves which arise from \hQ posterior column of the spinal marrow
were devoted to sensation * those of the anterior column to musGular
contraGtion y while the middle column gives origin to the respiratory

682 DISFASES OE THE SANGUINOUS FUNCTION.

nerves^ the most erroneous and contradictory notions were entertained
respecting the functions of the nervous system.

Magendie, Flourens, Abercrombie, Hall, Solly, Serres, Bennett, and
Andral have also thrown much light upon the functions of particular
portions of the brain, but much remains to be done in this important
field of discovery. And it is only by banishing from our medical voca-
bulary all vague and obscure expressions, and contemplating the body
as a complicated machine, actuated and kept in operation by an in-
telligence that pervades every part, and in conjunction with its ma-
terial stimuli, giving rise to sight in the organ of sight, — -hearing, taste,
smell, digestion, assimilation, calorification, motion, &c., in their several
organs,— and perceptions, memory, comparisons and ratiocination, by
their operation upon a combination of organs, that we can arrive at
accurate conclusions.

The cerebral organs may be affected throughout their whole extent,
or in isolated parts alone; but whatever condition obtains, diseases of
certain sections of the brain usually give rise to peculiar and well de-
fined symptoms. Thus, GOinpression of the brain, whether from effused
blood, serum or pus, depression of a portion of the cranium, or a con-
gested and relaxed condition of the cerebral vessels, give rise to coma^
with slow pulse and stertorous respiration; orgdnio lesions of the
brain, to jparalysis of one or more parts of the body, depending upon
the extent of the lesion and the part a,ffected ; irritation of the brain
to Gonvulsions\ disease of the cortical substance or hemispherical
ganglia^ to delirium and mania / of the QnechtZlary or tubular struc-
ture^ to convidsions y eflPusion within the ventricles, to dementia /
effusion upon the surface of the brain, to lethargy ; inflammation of
either lateral lobe of the cerebellmn^ to paralysis of the lower ex-
tremity of the opposite side., inflammation of the m/iddle lobe to saty-
riasis (Hall,) of the arachnoid Sbudpia mater, to delirium; ramollis-
sement, to torpor of the intellectual faculties and loss of muscidar
power.

So strongly marked are these signs, that pathologists have made
somewhat minute classifications of the diseases of the brain, as of the
nrachnoid, of the pia-mater, of the corticcd, or the medullary part,
the base^ the tuber-anmdare^ the hemispheres^ and the cerebellum, —
But it is to be observed in most cerebral affections, that inflamma-
tions of particular structures rarely exist uncomplicated with more or
less disease of the surrounding parts, and on this account we meet
with a great diversity of symptoms during their progress. For this
reason, if no other, it is more consistent to prescribe for the totality
of the symptoms than for the mere name of the disease. By the former
course we pursue a definite object and apply our remedies with a,n as-
surance of success, even if we are in error respecting the patholog;^

BRAIN AND NERYOUS SYSTEM. 683

of the case ; while by the latter method, we are liable to mistake the
location and nature of the. malady, and thus adopt a pernicious mode
ot practice. Eor example, by mistaking the cerebral symptoms of a
typhus fever for encephalitis, or the ancemio condition of the brain
which obtains in true delirium tremens, in some cases of apoplexy, in
epilepsy, and in ramollissement, for acute infiammation, and resort-
ing to the old remedies for the cure of the latter, viz : copious vene-
sections, the most disastrous results might be apprehended. It is now
a well-ascertained fact, that delirium, coma, hydrocephalus, and even
ramollissement, may result from an cmcemio, as well as an inflamma'
^(?ry condition of the brain. Drs. Abercrombie and Marshall Hall recog-
nize still another comatose condition independent of disease of the brain,
and arising from exhaustion of the general system, occurring during
the last stages of certain diseases ; but from the fact that this coma
generally occurs after prostrated bowel complaints where Opium has
been used as the principal remedy, we are of opinion that a real cere-
bral disease has been superinduced by the remedy.

For the cure of the symptoms above named, arising from an ancemio
condition of the brain, tonics, stimulants, and a nutritious regimen are
deemed essential by the practitioners of the old school. Blood-let-
ting and antiphlogistic s in these cases are fatal. Eut when the
same symptoms arise from an inflammatory condition of the ence-
phalon, a treatment directly the reverse is supposed to be necessary
to save life, like venesection, leeching, purging, blisters, &c. Now,
when we contemplate the great uncertainty attending the diagnosis in
the^e two forms of disease, and the danger which must attend mis-
takes in treatment originating from errors, respecting the peculiar con-
dition of the brain, is it strange that people have no more confidence
in allopathy ?

We have before remarked, that morbific substances, in order to de-
velop diseased action in the organism, must be taken into the blood and
conveyed to those tissues upon which they exert a specific morbific
influence, there producing those alterations, (probably upon the sen-
tient extremities of the nerves,) which constitute disease. It is only
necessary to refer to the examples to which we have alluded in an-
other part of this work to render this supposition entirely probable.

It is also equally evident, from the multitude of experiments by
Miiller, Magendie, Orfila, Pereira, Hahnemann, Trinks, Philips, Plou-
rens, and Bichat, that poisonous drugs and all medicinal substances
operate in the same manner in. producing their specific poisonous or
medicinal efi'ects.

There are other causes constantly operating upon the system, of a
character entirely different from those to which allusion has just been
made, and which may with propriety be termed spiritual or dynamic*

DISEASES OF THE SANGUIJSTOUS EUIfCTIOISr.

Thus violent mental disturbance may cause epilepsy or apoplexy-
chagrin and grief, biliary derangements, jaundice, and dyspepsia,-—
sudden news, whether good or bad, diarrhoea,— anger, fear, disappoint-
ment, and ill news, sometimes instantly destroy the appetite; fear and
apprehension predispose to contagious disorders; the sight of blood
induces syncope; and of human suffering, pain and disorder in the
stomach. In these cases, the unusual mental excitemO'nt determines an
unnatural amount of blood to certain parts, the blood-vessels and nerves
of such parts are oppressed, and disease results.

But it is of vast importance that these spiritual or dynamic causes
be not confounded with those that are merely material^ or those mani-
festations of the physical usually designated as im/ponderable.

Although cerebral affections may arise under favoring circumstances,
from the absorption of morbific and medicinal substances, and from
spiritual or dynamic influences, yet the latter rank first in importance,
especially in what are termed chronio cerebral maladies. In the
treatment of brain diseases, therefore, too much importance cannot be
attached to an accurate knowledge of these causes; for it is only by
their prompt removal, together with a judicious application of remedial
agents, that we can expect complete success.

The curious reader will find much to amuse, if not instruct, by
tracing the medical history of cerebral maladies from Hippocrates to
the present time. Throughout all of this period, notwithstanding the
numerous changes of opinion respecting their nature, causes, &c., one
striking fact will alwayfe be observed, viz. : that the treatment for all of
these complaints has remained almost the same as that first instituted by
the very respectable heathen j)hilosopher, Hippocrates, until the time
of Hahnemann.

« Up to the time of Sydenham no advance in the knowledge of cerebral
affections had been made. This celebrated author supposed the cause
of many brain diseases, as lethargy, coma, paralysis, &c., to consist in a
" viscid condition of the Hood and lyiivph^ which obstructed the pores
of the hrain^ and dulled the anivial spirits. While the viscid Hood
forces its way into the hrain^ through the two carotids ^ it leaves in
its passage a slimy matter ^ through which the aovlmal spirits pass-
ing^ stich by the way^ and so the pores of the brain are obstructed.^^
{Sydenham 2,Tidi Salmon, Pract. Phys.y^. 20'i>)

Their indications of cure were : First, ''to evacuate the redundancy
of phlegm and choler, or to carry off that vicious acid which has
created the viscosity of the blood. Second, to alte'i the present dys-
crasia of the blood. Third, z56> open the pores of the brain now ob-
structed, and give a free passage to the spirits. Fourth, to strengthen
th^^ weakened parts, quichen the dull spirits y and increase their store
01 ^toc'kP {ibid.)

BRAIN AND NERVOUS SYSTEM. 685

To fulfill these indications of cure the fathers of allopathy adopted
almost precisely the same treatment as that which prevails with their
brethren of the present day, viz. : blood-lettiDg, emetics, cathartics, " to
'purge off the jphlegQn (Mid oholerr Antimonials and alteratives " to
cut up the gross phlegm^ dissolve the coagulums of the Mood and
humors^ and excite the animal spirits to a brisker and more lively
air.^^ Paracelsus and Van Helmont particularly commended opiates
and narcotics in chronic affections of the brain. If we refer to the
most recent writers on insanity and other cerebral affections, we shall
find not only the same remedies retained, but the same diversity of
opinions respecting the application of these remedies ; some trusting to
venesection and purges, some to tonics, while others depend upon
opiates and narcotics.

In a book which is now before us, published in 1587 by " Andrew
Boord, Doctor of Physic — -an Englishman," the opinion is given that
maniacs are possessed of devils, and he advises for their cure, in addition
to blood-letting, cathartics, &c., that they should be sent to Rome to
be made whole. He says that " within the precincts of St Peter's
church, without St. Peter's chapel, standeth a pillar of white marble,
grated round about with iron ;" that this pillar is one to which our
Lord " did lie in himself at his delivery unto Pontius Pilate ; and that
the Romans say that all persons possessed of the devil from divers
countries" who were brought thither " were made whole."

The same writer supposes the cause of phrenitis to consist of "water
or wind enclosed in the head ;" and the remedies were " to purge the
head with sternutatories and the bowels with physic."

Modern pathologists do not attribute mania to demoniacal possession,
or phrenitis to " wind being enclosed in the head ;"— -coma,, lethargy and
paralysis are not supposed to be caused by " viscid blood rushing into
the brain through the two carotids, and leaving in its passage a slimy
matter, through which the animal spirits passing, stick by the way,"
but they have demonstrated that inflammation, irritation, organic
lesion, and compression give rise to the phenomena which characterize
the different diseases of the brain. But, notwithstanding this change
of opinion in a. pathological. point of view, the therapeutical doctrines
reniain the same as formerly, with the single exception of advising ma-
niacs to be sent to the marble pillar at Rome.

Blood-letting, probably to let out the " slimy" part of the blood ;
emetics and purgatives to " purge off the phlegm and choler ;" irritating
and inflaming the intestinal canal in order to cure a disease located in
the brain, and now and then an opiate to cover up symptoms when too
troublesome, are still resorted to by gentlemen of the old school.

It is to be hoped that the time is not far distant when all such indi-
rect and unreasonable practices for the cure of diseases, will be entirely

6S6 DISEASES OF THE SAJ^GTJmOUS FUNCTION.

superseded bj the more direct, and philosophical method of treat-
ment which has been instituted by the father of homoeopathy and his
disciples.

Probably in no class of maladies has allopathy been so much at
fault as in her classification of cerebral affections. Each author who
has written upon the subject, has taken upon himself to promulgate
pathological views different from those of his predecessors, and from
these views to form new classifications and new modes of treatment.
While some nosologists recognize inflammation of the arachnoid, of the
pia mater, of the cineritious or cortical substance, of the medullary, or
tubular structure, of the different lobes of the cerebellum, of the tuber
annulare, &c., as distinct diseases requiring different modes of treat-
ment ; others, as Frank, describe inflammation of the hemispheres of
the brain, the cerebellum, and their common envelops, as a single dis-
ease under the general term, encephalitis^ and demanding for its cure
a definite course of treatment. Thus : " JO injlairtifnation die cerveaiv^
du cerveld^ de leitr enveloppes communes Qie presente pas, selon la
difference deson siege^ des symptomes distinctifs' surs- et GonstantsP
So also Solly in his work on the human brain at page 822 remarks,
"I have long felt convinced that there is no such thing as inflammation
of the pia mater, independent of the brain, and that much mischief has
accrued from our systematic writers treating of inflammation of the
membranes of the brain as distinct from inflammation of the brain it-
self" The same writer lays down the following broad principles, viz. :
" That inflammation of the brain is a depressing disease, and that, as a
general rule, general blood-letting is not often admissible. That, al-
though, blood-letting may sometimes be attended with relief, at the same
time, the gbod derived from it is seldom permanent." Again, "ZZ n^existe
pas de signes certains qui annoncent le siege de Tencephalite, qui
caracterisent la phlogose superficielle et I'inflammation phlegmoneuse
avec tendance a la suppuration. Ces varietes n'offrent pas des carac-
teres differentiels assez constants pour distinguer la frenesie de la
cephalite. L'invasion soubite de la douieur, la violence de la fievre la
stupeur des organes des sens et de Tentendement, bientot suive de
I'extinction de leurs facutes, ne prouvent pas I'inflammation de la pulpe
cerebrale." (Frank.) .fn

In view of these radical differences of opinion, and from the gene-
rally acknowledged fact, that no single structure within the cranium can
become inflamed without involving to a greater or less extent other
portions of the cerebral region, we shall adopt the following classi-
fication :

A, Injuries and transient diseases of the brain.

B. Encephalitis, embracing acute inflammation of the hemispheres,
the cerebellum and their membranes ; under which head we shall point

tiONCUSSIOjSr OF THE BEAIK. 687

out, as clearly as possible, the peculiar symptoms which are supposed
to characterize affections of the different parts.

C, The diseases which occasionally result from encephalitis, as ra-
moliissement and hydrocephalus.

Genus III.— INJURIES AND TRANSIENT AFFECTIONS OF THE

BRAIN.

1. CONCUSSION OF THE BRAIN.

Pathology. — In concussion of <^he brain, as soon as the blow
which strikes the skull has caused the symptoms of concussion,
the physical disturbance of the brain, whatever it may be, has been
produced, and the continuance of the symptoms must depend on the
continuance of the structural or molecular disturbance. But the actual
condition of the brain is not known, and has received no explanation.

Symptoms. — The patient who in a state of perfect health receives a
violent blow on the head in an instant loses his consciousness, and lies
dead to the world around him. In some cases this insensibility lasts
only a few minutes, in others for days : the patient remaining in a kind
of sleep insensible to ordinary stimuli. He may perceive an extra-
ordinary bright light, or may take some notice of his name loudly called
near him; but ordinary noises he does not notice. As he recovers, he
begins to answer questions, but incoherently. These symptoms dis-
appear by degrees, after lasting from some days to as many weeks.

The pathological condition of the brain in a state of concussion has
been little understood. It can hardly be that a long continuance of
the usual symptoms of concussion can be caused by any temporary
disturbance of the vascular system of the brain. It is more probable
that they " depend upon something more intimately associated with the
structure of the brain itself. The most appropriate physiological term
for concussion of the brain is, perhaps, ^collapse' or * shock;"' and
" that the function of the part is rendered very imperfect, is evident by
the insensibility of the bruised skin, and its coldness or diminished
temperature." {Hilton)

If inflammation supervene, another group of symptoms follows. This
inflammation is rather of the substance and lining membrane of the
ventricles than of the cortical substance, and all the symptoms are
decided and clear from the first ; but often the effect of the concus-
sion passes over quickly and the patient is considered out of danger ;
but after a few days, meningitis supervenes in such a form as to be
overlooked by the friends.

A boy, aged fourteen, fell from a scaffold seventy feet, first striking
the lower part of the abdomen and afterwards the head ; was seen in a

DISEASES OF THE SANGUINOUS FUNCTIOK.

few minutes afterwards. He was pale, cold, insensible, and almost
pulseless. Received at the hospital he was partially sensible only ;
he became wildly delirious. The pulse rising to 100, then to 144,
afterwards falling to 100. It must ever be kept in mind that when once
the delicate texture of the ganglion is in a state of acute inflammation,
it soon becomes disorganized, and all medical treatment is un-
availing.

Treatment.— As in external bruises and shocks to parts of the sur-
face, we rely chiefly on rest^ giving the best opportunity for the favor-
able employment of nature's own efforts, the same means are our best
reliance in concussions of the brain. " Grive the brain absolute rest ;
rely on nature's reaction," only aiding it by such homoeopathic remedies
as have been proved to have power to aid the reactive powers of nature.
One system long ago tried consisted in depletion, which has been now
fully abandoned ; another equally bad, more recently in fashion con-
sists in " hurrying on reaction by excessive stimulation with brandy or
ammonia." The brain which has been violently shocked by concussion
is " defective, if not in structure, certainly in its vital endowments, and is
therefore unequal to its ordinary duties. It recovers itself slowly; it
then soon becomes fatigued from use," over-stimulations lead to in-
flammation.

The brain requires absolute r^?^^, absence of occupation, for its com-
plete recovery ; as external parts that have suffered from severe con-
tusion and have apparently recovered from the immediate effect, if too
early or too much used, will become painful and assume a chronic in-
flammatory condition resulting in local thickening or ulceration, so the
brain, though it may not manifest its disturbance by pain, is still more
liable to go into some more serious condition of disease from excite-
ment, stimulation or want of due rest.

Many of the chronic affections of the brain we meet with in practice
are the result of concussion, perhaps trifling, as, a transient shake of
the brain, slight or severe blows, or a fall upon the head. The im-
mediate effects of the shock having passed off" quickly, may have al-
most been forgotten. A sudden bound or recoil of the brain may in-
stantly follow a railway collision, and may produce only a temporary
confusion of thought to be remembered for a short time only. But we
often hear of sudden deaths following at a long interval after a concus-
sion of the brain. We may then consider that the brain that has been
subjected to concussion or bruising, is not necessarily injured to the
extent of laceration or extravasation of blood, but as having suffered
molecular disturbance in its exquisitely delicate structure, this struc-
ture having a function belonging to it which requires molecular per-
fection to enable its fine endowments to be made manifest. Now, since
we know that other parts of coarser texture require weeks or even

CONCUSSION OF THE BEAIN.

montlis of rest after injuries before tlieir functions can be fully per-
formedj we must not deny to tlie delicate texture of the brain a period
of Test as long or longer before we again impose upon it the perform-
ance of its ordinary functions. Rest is the chief nurse employed by
nature in restoring to health the body after injuries.

Causes,— A blow on the head, a fail, or a violent shaking of the body ,
when the violence is not very severe there will be some mental dis-
order, vertigo, dimness of vision, trembling of the limbs, sickness of
stomach.

Symptoms of moee severe Cases.— The accident is immediately
followed by insensibility, relaxation of the extremities, coldness of the
skin, feebleness and irregularity of pulse, difficulty of breathing, dila-
tation of the pupil, sometimes nausea and vomiting; breathing, though
weak and laborious, usually free from stertor or snoring. These symp-
toms are followed by gradual return of warmth of the body, the breath-
ing more natural, the pulse rises, sensibility is partially restored, the
patient is capable of being roused out of sleep or lethargy in which
he was found, and can answer questions concerning his injury.

When the stupor and other primary symptoms have passed away,
inflammation of the brain of an active character begins to be deve-
loped ; and, if not arrested, it proceeds to a termination in eifusion.

Concussion of other parts of the body may injure the brain*
sometimes internal parts are distended or torn ; pains arise which in-
crease the following day; violent headache, giddiness, pains in the
chest, asthma, hacking cough, spitting of blood, pain in the back, pains
in the abdomen are common symptoms.

Teeatment.— As soon as reaction has taken place after the injury,
the circulation will become accelerated, and symptoms of approaching
inflammation will obtain. The more common phenomena of this re-
active stage are, headache, more or less mental perversion, flushed
face, hot head, and moderate febrile symptoms. For this condition^
Belladonna, first dilution in water, is the appropriate remedy.

Should the fever become quite active, a few doses of Aconite may
be administered.

For other effects of concussions of the brain we suggest the follow-
ing medicines a.s likely to be required : Calendula, Stramonium, Can-
nabis-ind., Rhus-tox., Opium, Hyosciamus.

Arnica is the chief remedy. The patient should keep quiet, drink
plenty of water ; wash the parts bruised with cold water containing a
few drops of Arnica. Allow the simplest food, no stimulants, spices,,
salt or acids.

2. Inficmirtiation from Injicry of the Brain.—K^iOiV injuries of the
head the membranes are liable to become inflamed. The symptoms
are nearly the same as those of inflammation of the brain itself: great

Vol. I.— 44.

690 DISEASES OE THE SANaTJlHOtJS EUHOTIOlsr.

pain ; the scalp becomes oedematous ; the edges of the -wound become
glossy, or shining; there is discharge of serum and blood; sometimes
the parts have a sloughy appearance; the countenance is much flushed;
the carotid arteries beat with great force ; frequent rigors, sometimes
followed by hemiplegia ; and the patient quickly becomes comatose.
The inflammation of the brain or its membranes does not generally be-
gin immediately after the injury. Sometimes a week or two elapse
before it attracts attention. When the dura mater alone is wounded,
there is generally a high degree of inflammation; when it and the pia
mater are injured, there is generally fungus cerebri, and the consequent
inflammation is less severe.

Treatment. — The first question that arises in the mind of the sur-
geon is the necessity of an operation to remove or elevate depressed or
broken fragments of bone. The circumstances which render trephin'
ing necessary are : 1. When there is extravasation of blood between
the dura mater and the craniuni ; 2. In compound fracture, when a
portion of the skull is depressed, with symptoms of compression of the
brain ; 8. In simple fracture, with depression of bone, when symptom.s
of compression continue after depletion and early efforts to remove it
have failed ; 4. In some cases when there is purulent matter collected
between the dura mater and cranium.

In the early part of this century it was the practice to trepan and
raise the bone wherever there was suspicion that it was depressed; more
recently these cases have been treated very differently. Abernethy
published some cases that recovered without trephining, that would
have needed it, according to the old rule. Lawrence, in a lecture,
(Medical Gazette^ Vol. 21, p. 345,) gave a case of a boy who recovered
without an operation, in whom the skull was fractured and depressed,
the brain wounded, and portions of it extravasated through the lacera-
tion of the scalp.

The medical treatment is the same as that of inflammation of the
brain.

Fungus CerehrL — After injury of the brain, accompanied by removal
of a small portion of the cranium, there often arises a fungous excres-
cent growth from the substance of the brain, which grows luxuriantly
and presses outward through the aperture of the skull.

Treatment. — Its growth must be prevented or repressed as soon as
it is discovered, and the growth restrained until the dura mater covers
it. Wet a piece of lint with Aqua-calcis and apply it to the fungus
with adhesive plaster placed over it. Next day the fungus will be
lessened. Take now a large piece of lint, and strap it as before with
adhesive plaster, to compress slightly the protruding growth. Continue
this process till the fungus is restrained within the dura mater, where
it must be steadily maintained until the membrane heals over it.

DULLNESS OF BLOOD TO THE HEAD.

691

Apparent Death from a Fall.—V\^(iQ the patient carefully on a
bed, with the head elevated, and put a few globules of Arnica dissolved
in water upon his tongue. The old practice of bleeding is highly in-
jurious, though the drawing of a minute quantity of blood may accele-
rate restoration. The Arnica may be repeated at short intervals till
there are signs of life. If he partially recovers after any quantity of
blood has been drawn, or if he have lost blood from the injury, give
China, a few drops of wine at a time, and afterwards Arnica.

3. Fullness of Blood to the Head, — Symptoms. — Great heat of head;
flushes of heat ; sensation of fullness in the head ; confusion in the
head; loss of memory; vertigo ; noise in the ears ; deafness ; spots before
the eyes ; oppression at the chest ; faintness ; constipation generally
present ; numbness of the extremities also.

Pathology. — There could be little seen by inspection of the brain
in this state. " A little extra pressure on the brain from increased
heart's action, or the reverse ; a delay of blood in the vessels ; a sort
of atonic congestion ; an over-distention or an exsanguinated state, so
well represented in Dr. Burrow's plate, representing the brain of an
animal dead from haemorrhage ; an impoverished state of the blood"
may any of them produce similar conditions.

- ExciTESTG Causes. — 1. Disease of the Heart. —-^'hi^ organ may be
feeble, hypertrophied, be in a state of " fatty degeneration,""^ or other-
wise structurally diseased. This is one of the most common causes of
apoplexy.

2. Debility^ from naturally feeble physical development, or from
recent illness, haemorrhages following labor, profuse menstruation,
haemorrhoids.

^.'Indigestion gives rise to faintness, vertigo and congestive head-
aches.

4. Mental labor causes many forms of headache, amongst others
congestive spots before the eyes, vertigo, confusion of sight, inability
to think, and in some cases to paralysis, which when not gone too far
may be averted by relaxing mental efforts.

5. A diseased state of the brain or vessels.

6. Irregularity in eating and drinking ; swallowing the food without
properly masticating it, or not allowing sufficient time for meals ; fast-
ing too long, as men in offices too often do. The habit of taking
stimulants.

7. Suppression of natural discharges, drying up of old sores, the
sudden recession of eruptive disease of the skin, particularly after ex-
ternal lotions or unguents have been applied.

* Drury, British Homceop. Soc. Anuals, No. 2,

692 DISEASES OF THE SAlNraUINOUS EUKCTIOK.

TBMATM-E-NT.—Acomte.—The arteries of the head are felt to throb
as the pulse beats ; the veins of the head and neck swell ; the head
feels full ; the patient feels dizzy, especially when stooping or walk-
ing in the sun ; feels as if the head over the eyes would burst ; worse
when stooping or coughing. There is sparkling, flickering before the
eyes ; seeing double, buzzing in the ears, frequent fainting, stunning,
heavy sleep. Cold applications are al^o 'beneficial. Abstain from
coffee, wane, and ardent spirits ; drink freely of cold water, and wash the
head and neck frequently with it.

JVux-vomiccL — Aconite has been tried, with little benefit; the pa-
tient is very irritable and passionate ; has been much constipated ; is
of sedentary habits, and uses ardent spirits.

4. Coup de Soleil, Sun-Steoke. — Aconite is generally sufficient to
correct the effect of direct exposure to the sun. A dose every fifteen
minutes till better ; or, in alternation with Bell.

£elladoQina.-'—'^eYevQ jerking, burning, shooting pains on one side
of the head, or violent pressure in the forehead, increased by motion,
stoopingj noisCj or a glare of light. It follows Aconite well in children
teething, amenorrhoea in young "females, and generally where there is
febrile excitement, with determination of blood to the brain. The head
feels full, and aches as if it would split ; worse when stooping or walk-
ing, or from slight agitation of mind ; hot fever, thirst, restlessnesSj
anxiety, rage or great irritation, fear of surrounding objectSj lamenta-
tion, weeping.

Bryonia.— 1l\iq patient is very peevish in the morning, cannot bear
his clothes, is more passionate and cross than plaintive and despond-
ing, is apprehensive of future evil ; heat from great exertion, heat of
the sun or a hot fire ; head too full, loss of appetite, especially in the
morning ; thirst, fever; trembling, nausea, vomiting, or diarrhoea.

C^if^T'S^?-?;^^.— Headache and heaviness from overheating ; heavinesSp
throbbing, and pressure over the eyes, pains in the eyes, aggravated
by looking fixedly at any object.

Glonoine.'—DY,'WTii, Payne, of Maine,^^ refers to three cases re-
ported by Dr. John Fox in the Phila. Jour, of Homoeop,^ Vol. III.,
p. 356, in which is shown the prompt action of this remedy over this
fearful and hitherto unmanageable disease. It is believed that Glo-
noine, or Mtro-glycerine, is homoeopathic to such diseases only as have
their origin in the brain, and which exhibit primary and consecutive
symptoms similar to those produced by the drug in the healthy organ-
ism."

" The primary impression of the Glonoine is upon the Gerebro-spin<d
organs. The pain, dizziness, whirling, pressure, throbbing, fullness,

* Proceedings of the 17th Annual Meeting of the Amer. Inst, of Homoeop,

COUP DE SOLEIL.

693

confusion of ideas, shocks, undulation, sensation of balancing, impaired
sight and hearing, &c., all point to the encephalic mass as the seat of
the primary impression ; whilst the rapid varying of the pulse, throb-
bing of the carotids, diminished appetite, deathlike sinking at the epi-
gastrium, nausea and vomiting, muscular trembling, spasms, weakness,
&c., as strongly indicate the consecutive effects of the drug upon other
organs through the great sympathetic.

" All the provings of this drug, that have come under my own obser-
vation, point directly to the nerve-mass as the seat of attack." In all
but two of the twenty-six observations published in the British Joior-
Qial of Sommopathy^ by Dr. Dudgeon, on the pathogenesy of Glonoine,
we find the first development of symptoms in the encephalic mass.
"The throbbing headache has been first exhibited in nearly every
prover." " The character of the headache shows that its origin is in
the encephalic mass, and not in a remote organ or tissue. A Glonoine
headache is throbbing, with fullness and upward pressure, and a sensa-
tion as if a ligature were drawn tightly around the neck ; and there is
often connected with the above symptoms disturbance of the circula-
tion, throbbing of the carotids, rapidity of pulse, palpitation of the
heart, nausea, perhaps vomiting ; but these latter symptoms seem to be
consecutive effects, indicating a more general implication of the organ-
ism. They occur after the throbbing headache, or the lightness and
dizziness of the head which precede the throbbing headache." In
cases in which we find the symptoms developed in the order above
given we may administer Glonoine Avith implicit confidence. In no
other form of palpitation of the heart, in no idiopathic affection of the
stomach, indicated by deathlike sinking, or nausea and vomiting; in no
case of disturbed circulation, dependent on a primary affection of the
circulatory system, or any tissue other than the nerve -mass, do we re-
gard it as homoeopathic.

Dr. Colby, of Concord, New-Hampshire, took (June 17, 1856, at ten
A. M.,) two drops of the first decimal dilution. First and immediate
effect, confusion of ideas and loss of strength. Sight and hearing both
affected, indistinct. Fullness and pressure in forepart and top of head,
with throbbing, pulsation, and confusion of all the senses. Sensation
of balancing, requiring a constant effort to keep the head erect, which
inclined to drop as on going to sleep ; undulating sensation, increased
by every turn of the head. Sick, faint, deathlike sinking at the epigas-
trium, with nausea, such as results from excessive dizziness, induced
by rapid whirling of the body. Great weakness in middle portions of
the thighs and arms. All the symptoms continued two hours without
abatement, when the inhalation of Camphor seemed to mitigate some
of the symptoms, but the more prominent ones remained uninfluenced.
At the expiration of four hoijirs fullness and throbbing of head con-

694 DISEASES OF THE SANaUINOUS FUNCTION.

tinned unabated, together with dull headache, which appeared rather
to increase till retiring for the night. Awoke on the following morn*
ing with the same fullness and throbbing, which occupied the whole
forepart of the head, and appeared to be deep-seated "

Spheke of Action. — Meyer says,^' Glonoine attacks first the organ
of circulation — the heart. The symptoms are : painful feeling of
fullness and constriction in the cardiac region, which sometimes ex-
tends to the throat, and simultaneously with which the pulse decreases
in frequency. Soon after this comes a feeling of heat in the heart, as
the spasmodic constriction subsides ; its activity is increased, the im-
pulse of the heart is perceived by means of the stethoscope to be loud,
stronger, and irregular. This increased force of circulation is ob-
served in all the larger arteries ; and the jugular veins are sensibly
distended ; pulse increases rapidly in frequency and fullness (some-
times from sixty beats to one hundred and twenty per minute), some-
times irregular or intermittent ; feeling of anxiety and restlessness.

Painful sensations in the heart ; sharp pains extending through to
the supra-scapular muscle.

Congestion of the brain follows soon on the vascular excitement ;
fullness and heaviness of the head as if from weight, extending as far
as the eyes and ears ; then comes a feeling as if all the blood of the
body had ascended to the head ; constriction as if from a band, or as
if the brain were distended in all directions ; as if the cranium were
too small ; as if the brain would burst ; as if the brain moved when the
head was shaken ; constant heat of the face, with throbbing ; head
confused, as if from drunkenness ; squeezing pain and pressure, espe-
cially feeling as from helow iLjpwards^ and from within outwards ;
sticking, cutting, jerking, soreness, bruised sensation in the head with
soreness, very severe, causing a feeling of desperation, and the pressive
pain in the occiput to cause failure of the senses ; sometimes the pain
causes syncope and loss of consciousness, with sweat. Aggravated by
gentle shaking, not hy violent shahing / ^ain worse on expiration.

The pain is generally in the temples, vertex, and occiput, beginning
in the occiput, and with wavelike motion ascending from the heart.

Vertigo, arising on stooping, shaking the head, or inclining it back-
wards ; sensation like that of stepping ashore after a long voyage on a
boat ; the headache accompanied by heat of the face, hard pulse ;
nausea and vomiting ; usual severe cephalalgia wanting in these cases.
Headache relieved by rest, or sleep, in the open air, or compression of
the head.

Eyes. — Feeling of heat and confusion ; balls injected and protrude,
pupils dilated ; the lower lids are reddened, puffed, and have some-

* Allgemeine Horn. Zeitung, 64, 49.

ENCEPHALITIS. 695

times a darkened appearance, or a blue ring under tliem ; eye unsteady
and trembling ; occasionally it is staring. Sparks and flashes of light ;
a cloud appears before the eyes and affects the sight. Heaviness^
pressure, sticking, and soreness in the eyes and the orbits.

Genus III.— CERE BR. VL INFLAMMATIONS.
1. ENCEPHALITIS.

Diagnosis.— There are certain symptoms which are common to the
first stages of all acute inflammations of the cerebral organs ; and
which, taken by themselves, afford no indication of the actual seat of
the disorder. These symptoms are : a vague sensation of coldness in
the first instance, perhaps succeeded by occasional flushes of heat, las-
situde, anxiety, sadness, irritability, often alternating with great exal-
tation of the intellectual faculties ; hilarity, sudden bursts of laughter,
petulance, unwonted impudence and vulgarity ; redness of the skin,
heat ; pain, pressure, or tension in the head ; strong pulsations of the
carotids and temporal arteries ; singing noises in the head, vertigo,
weakness of memory, frightful dreams, fantastic visions when awake ;
trembling of the limbs, nausea, vomiting ; eyes bloodshot, great sensi-
bility to light ; constant wakefulness ; acuteness or dullness of hear-
ing ; mouth and tongue dry ; urine copious, yellow, and thin a-s water.

The symptoms which usually obtain in the second stages of these
affections are : stupidity, coma, paralysis, eyes suffused and dull, be-
sotted expression of countenance, strabismus, position upon the back,
pupils dilated ; suppression of urine, and general loss of muscular power.

The signs which are supposed to be peculiar to the first stage of in-
flammation of the GOTtical substance, or hemispherical ganglion, and
the membranes of the brain, are : early derangement of the intellectual
faculties ; fixed pain in the upper part of the head ; hot and dry skin ;
conjunctiva injected and red ; eyes brilliant, ferocious, fixed, and into-
lerant of light ; tone rough, violent, and defiant ; face red and swollen ;
inclination to do himself and others injury ; great exaltation of muscu-
lar strength ; strong pulsations of the carotid and temporal arteries ;
constant watchfulness; continued and rapid motions of the head;, im-
patience, irritability, and constant agitation.

Infiammation of the Medullary Sicbstance. — The first stage is re-
cognized by the following symptoms : vague chills, deep-seated head-
ache or vertigo ; vomiting, lassitude, trembling of the limbs ; convul-
sions before any signs of mental disorder, anxiety, sadness,, great
agitation, arms continually raised towards the head, position, mostly
on the back, noises in the head. This disease is so insidious in its
approach that convulsions may occur as the very first symptom.. In
instances like this it is probable that infl.ammation exists- in. the me-

696 DISEASES OF THE SANGUmOUS FUNCTIOIT.

dullary substance alone, "without involving in tlie slightest degree the
gray matter of the convolutions surrounding this part, or the envelops
of the brain. We are forced to this conclusion if we adopt the opinions
of Bouillaudj Golly, Duchatelet, Hall, and Bennett, who suppose the
cineritious, or cortical substance of the brain to be "immediately con-
nected with the intellectual powers,'' while the medullary portion pre ■
sides over the muscular powders of the organism. Therefore, after an
injury to the head, if the intellect is only impaired, we may be certain
that the hemispherical ganglion is the seat of the injury ; while if, in
addition, there are involuntary convulsive motions soon after the acci-
dent, we may be equally sure that the medullary substance has also
received detriment

Inflammation of the medullary structure is more prone than either
of the other cerebral inflammations to terminate rapidly in softeningg
and for this reason it is incumbent upon physicians to exercise the
greatest care in their investigations of this class of maladies, and to
apply their remedial measures with due promptness.

The most prominent secondary symptoms of disease of this portion
of the brain are muscular paralysis, and loss of sensation in the parts
affected.

According to Marshall Hall, " disease of a lateral lobe of the cere-
bellum induces paralysis of the opposite side, and chiefly of the lower
extremity. Disease of the middle lobe of the cerebellum is denoted
by erection of the penis. Disease of the medulla oblongata induces
paralysis of the respiratory muscles, and consequently, when complete,
instant death,"

We have now enumerated those symptoms which are supposed to
characterize the inflammations of the difl'erent cerebral structures, and
in this connection, we call the attention of homoeopathic practitioners
especially to this subject, with reference to the therapeutic application
of medicines. Flourens has demonstrated, by experiments upon birds,
that Belladonna^ Ofhim^ and Alcohol mn.hTm\^ exercise a specific
action upon certain portions of the brain. Hahnemann and his dis-
ci|)les have also proved that large doses of these articles taken in
health, uniformly give rise to those physical and mental manifestations
which pathologists have shown to proceed from disease of these same
parts. When therefore, in our provings of drugs, it is observed that
the prominent symptoms are derangement of the intellectual faculties,
exaltation of the mental and muscular powers, eyes bloodshot, and ex-
pression furious and defiant, manner violent and overbearing, voice
loud and rough, throbbing pain in the head, face red and swollen, we
may be certain that a specific eifect has been produced upon the eor-
tical substance of the brain. If, instead of these symptoms, we are
presented with convulsions, paralysis, and general depression of the

ENCEPHALITIS. 697

powers of the system, Y,^e may infer that the drug has acted specifically
upon the QnediiUary portion of the brain. The same law obtains in rela-
tion to those symptoms, which characterize diseases of the different lobes
of the cerebellum, of the medulla oblongata, of the different portions of
the spinal marrow, of the nerves, and indeed of all other parts of the
organism.

Causes. — " There is no single cause," says Solly, " which so fre-
quently produces inflammation of the hemispherical ganglion, or me-
ningitis as sudden emotion, whether of joy or fear. The latter is, how-
ever, much more common." Other causes are, fractures and contu-
sions of the cranium ; insufficient sleep ; intense protracted thought
upon a particular subject, disappointed love or ambition, repelled erup-
tions, whether by natural causes or by the abuse of ointments ; expo-
sure to cold, or to a burning sun ; abuse of Opium and spirituous
liquors ; metastasis of rheumatism, gout, or erysipelas, suppression of
the lochial and other habitual discharges. It often arises during the
progress of pneumonia, scarlatina, erysipelas, otitis, and intestinal
affections.

The most common predisposing causes are, plethora, a passionate
and excitable disposition, want of exercise, high living and abuse of
stimulants.

VATiioj.oaY.-—InJlammatio7i of the JEfemispherical Ganglion.—
One of the most important laws of vital action which pathology has
yet unfolded is, " that the first effect of the first stage of inflammation
of neurine is to excite and to exalt to an unnatural degree exactly the
same kind of power, which we have reason to believe resides in it in
the normal state. The first effect of inflammation of the surface of
the brain is to excite the faculties to produce great irritability of tem-
per, and constant restlessness and desire for action. If the inflamma-
tion be arrested at this point, the patient recovers his reason ; but if
it pursues its ravages undisturbed, limiting its destructive effect to the
spot where it commenced, without extending to that portion of the
brain which is beneath, it annihilates the intellect, but does not affect
the muscular system. If the inflammation travels farther, reaching
the instruments by which the will travels to the muscles, it first pro-
duces Gonviilswe action in those muscles which afterwards become
perfectly paralytic. In this case the integrity of the neurine, through
which volition traivels to call these muscles into action is compromised,
and its power therefore as an instrument for the production of'voluntary
motion is destroyed.

The first symptom of inflammation of the tract of sensation is the
exaltation of sensibility of the part, both where the nerves of sensa-
tion originate, and also in the brain itself where they terminate.

The first effect of increased arterial action of the hemispherical

DISEASES OE THE SANGUINOUS EUNOTIOK.

ganglion is to exalt the intellect; it may not last long and maybe
unnoticed ; but to a certain point, the person who takes Alcohol, feels
more lively ; his ideas come more rapidly and clearly ; he expresses
them in better language, with greater facility and more rapidly. This
passes off speedily. If the stimulus be continued, the brain becomes
oppressed ; the muscles of the tongue sluggish ; the speech thick and
indistinct; ideas confused; language incoherent; he loses conscious-
ness and becomes insensible to the external world.
These views are based on the following positions :

1. The hemispherical ganglia are intimately connected with the in-
tellectual powers ; and it is in them peculiarly, and not in the whole
cerebral mass that these powers reside.

2. The medullary substance beneath is in all probability merely the
passive servant of the cineritious substance, as the conductor of its
commands to the muscles, or of the various impressions made on the pe-
ripheral extremities of the nerves of the senses, which the central
power receives, and with which it works. (See Works of M. Foville^
Finely GmndGhamp^ and Bouillaitd)

The gray substance of the brain presides over intellectual pheno-
mena, and the white over movements.

M. Bouillaud says : " Those physicians, who have recently employed
themselves in the study of mental alienation, have remarked, that it
was always accompanied with a disorganization, more or less deep, of
the cortical substance of the superior convolutions of the brain; audit
has been truly observed by MM. Parent and Martinet, that delirium is
connected with inflammation of that portion of the arachnoid that covers
the convexity of the brain." The seat of the intelligence therefore
" is in the cortical substance of the superior part of the brain."

It seems not possible to separate, in diagnosis or treatment, the in-
flammation of the arachnoid and pia mater, and it is also impossible to
separate between these membranes and inflammation of the hemisphe-
rical ganglion, or cortical substance of the brain.

ABEjBEATioisr OF MiND WITHOUT OoMPLAHSTT OF Pain.- "There is a
remarkable restlessness, quick and impatient manner ; obstinate watch-
fulness ; incessant, rapid talking ; rambling from one subject to another
with little connection, and without actual hallucination. He knows
those about him ; answers questions distinctly ; the pulse rapid, but
without other symptoms of fever ; case often mistaken for mania and
hence lightly treated; but it is an affection of very great danger, and
often rapidly fatal."

Pathology. — Its nature is obscure ; on dissection little is observed
but a highly vascular state of the pia mater, without any actual result
of inflammation.

Effects of Inflammation of the Substance of the Hemispheres

CEEEBRAL mFLAMMATIOK. 699

^^The Tubular Neurine, — Its sensibility may be exalted first and
impaired afterward, and muscular contraction may be excited first and
destroyed afterwards, without the intellectual powers being affected,
when the inflammation is confined to that portion of the cerebral sub-
stance which is within the gray matter of the convolutions, that matter
remaining itself unaffected. Important conclusions may be drawn
from these facts.

Inflammation of the substance of the hemispheres, or rather the tu-
bular portion is characterized by the appearance of convulsions pre-
vious to any sign of mental excitement. It frequently terminates ra-
pidly in ramolissement, after having commenced very insidiously.

Sometimes a peculiar lieMache described as " most uncomfortable,"
is followed by vomiting, a symptom that should never be neglected.
The convulsions are sometimes followed by coma, which may be re-
garded as a sign of danger, though some recover after a few hours ;
and the patient feels better after some days. But convulsions return
without any warning and in fatal coma.

These cerebral diseases are often intermittent, but Quinine and all
stimulants have been found deleterious. The pupil of one eye, at
least, is at first contracted and then dilated.

When any injury of the head is immediately followed by convul
sions, it is generally a sign of very serious injury to the substance of
the brain, usually a laceration.

When convulsions after a few days follow a blow on the head they
must be promptly treated, as they denote inflammatory mischief in the
tubular structure or under surface of' the ganglion.

Meningitis. — This term was employed by Abercrombie to express
the disease of these two membranes, to distinguish from that of the
dura mater.

Andral says, most of the lesions described under arachnitis, have
been in the pia mater rather than in the arachnoid. Abercrombie and
others describe this under the name phrenitis.

Symptoms. — Watchfulness, acute headache, impatience of light,
suffusion of the eyes and maniacal delirium. This affection is, how-
ever, seldom met with as an idiopathic disease, except in few cases in
which it is brought on by abuse of strong liquors, and in warm climates
by exposure to the intense heat of the sun.

As a symptomatic affection is often seen as a phenomenon belong-
uig to fever, and in mania; a condition resembling it occurs after in-
juries.

It is probable, that in this form of the disease the inflammation i&
primarily seated in the membranes of the brain. When fatal, it is
generally by a rapid sinking of the vital powers supervening upon the
high excitement without producing much disorganization of the parts

100 DISEASES OF THE SANGUINOTJS EUNOTION.

wMch appear to have been the seat of the disease ; for the cases which
are referrible to this class, when they terminate fatally, are generally
rapid in their progress."

Inflammation" of the Dtjea Matee.-— -The dura mater may be in-
flamed without afi'ecting the pia mater ; and the arachnoid is said to
be inflamed without involving the subjacent pia mater. But, says
Watson, " it seems scarcely possible, that inflammation of the pia
mater should take place without implicating also the surface of the
convolutions."

Case by Watson.- — A man with a small incised wound of the scalp
had it dressed, and it was considered trivial. In a few days he came
to the hospital, perfectly paralytic of one^'side of the body. The skull
was trepanned ; he was perfectly calm. The dura mater at the point
under the wound was inflamed, and there was pus effused over the
arachnoid covering the cerebral convolutions on the same side. He
sank quietly into a state of coma without the slightest incoherency or
delirium; no convulsions ; and no other morbid appearances were found
within the cranium.

6^z^^fe— Inflammation of the dura mater sometimes occurs continu-
ously from the petrous portion of the temporal bone and the lining
membrane of the internal ear. Sometimes without any disease of the
bone it extends along the path of the auditory nerve. This is common
among the poor of scrofulous diathesis, more frequent in childhood
than in adult age.

This inflammation of the dura mater from otitis or inflammation of
the internal ear should make us guarded in our diagnosis of it.

Treatment. — Mild, unstimulating lotions may be carefully used in
the ear, but not farther than is necessary for cleanliness ; but the chief
reliance must be upon internal remedies. See Otitis Sbiid ScrofiilcL

Case by Mr. Solly. — A case is given of inflammation of the lining
membrane of the ear, extending along the neurilemma of the nerve to
the cerebrum.' A child, five years old, had otitis and discharge from
the ear from birth. Complained of ear-ache seven days ago, when the
discharge stopped ; face pale ; skin not discolored ; head violently
drawn back ; found deep-seated abscess, pus very offensive. She was
in great pain till twenty hours before death, she became comatose.
Post mortem revealed abscess in the cerebellum ; thickening of the
neurilemma of the auditory nerve, the whole sheath filled with pus ;
surface of the bone denuded, not carious.

Osseous Deposits, — The dura mater is a nutritive membrane of bone,
sometimes its vessels over-do their work and deposit bone in small
patches, sometimes in the dura mater lining the skull, sometimes on
the falx and tentorium. It always acts as an irritant body.

Case.-^Au extremely irritable, violent- tempered man cut his throat

ATKOPHY OF THE BEAIN. 701

in a watcli-lioiise. - Mr. Solly founds on post-mortem examinationj some
" rough bony deposits on tlie falx-major. The same is frequently re-
marked in cases of mental irritability amounting to insanity.

One man was peculiarly irritable all his life ; and latterly he became
so passionate, that his outbursts of passion were beyond his control^
and were excited by the merest trifle. He died rather from intestinal
than from cerebral disease. The bones of the head were found thinner
than natural, especially in the frontal and temporal regions. The ex-
ternal surface of the dura mater was healthy, on its internal surface
were bony deposits, three in number. Some softening of the brain in
the neighborhood of the diseased deposits. The bony deposits had ir-
regular pointed edges, very rough.

" The extreme thickness of skull, which are frequently found in insane
patients, must be regarded a^ the result of .long-continued and general
hypersemia of the dura mater. We have seen a case in which entire de-
mentia was conspicuously marked in a middle-aged man, who wandered
about the shore of Lake Michigan. His skull was not originally well-
developed ; it was extraordinarily thicks and, at various points on its
inner surface, there were stiff .^ Uach liairs^ projecting from the bone
against the membrane.

Spicula of bone, shooting from the surface of the skull, internally
are generally abnormal projections of normal growths. In some cases,
after a severe blow on the head, they lacerate the brain, which has
been moved and shaken. Enlarged projections of the clinoid pro-.
cesses sometimes attend epilepsy. A woman, aged thirty-two, had epi-
lepsy at the age of twelve years, following a fall and blow on the back
of the head ; latterly the fits occur sometimes four or five times in a
night, then missing four or 'mQ days. Temper exceedingly irritable ;
the mind became imbecile.

In the right temporal sphenoidal fissure was found a projection of
bone one-sixth of an inch long, sharp and at its point, wide and broad
at the base, projecting like a spine from the squamous portion of the
temporal bone ; and in the- middle lobe of the brain corresponding was
a distinct softening of the cortical substance.

Atkopiiy of the Beain.— The brain in whole or in part may be
atrophied ; partial atrophy is most common. It may arise from arrest
of development in the foetal state. The acephalous foetus is the most
complete illustration of this. Sometimes the arrest of development
is confined to the hemispherical ganglion and then the brain retains
the same condition permanently, which in a normal state would be merely
one of its stages of growth. Cruveilhier describes another form of
atrophy, as resulting from the pressure of serous effusion into the ven-
tricles in childhood ; this, however, is simply a case of chronic hydro-
cephalus in childhood, which causing dilatati m of the left ventricle at

702 DISEASES OF THE SAl^TGUIISfOUS FUKOTION.

the expense of the tubular portion of the hemispheres, has been par-
tially absorbed, and hence the paralysis.

The hemispherical ganglion or cortical substance was neither atro-
phied nor absorbed, but in normal quantity, as demonstrated by the
section ; and the rugae on the surface were much more numerous on
that side, and hence the preservation of the intellect.

Third Form. — This follows chronic inflammation of the hemisphe-
rical ganglion; we often see it in the brain of old-standing cases of
insanity, where the patient has sunk into complete fatuity. The con-
volutions are then narrow and pinched, almost sharp, instead of being
flat and rounded, full and plump. In some cases the ganglion is ac-
tually thinner, as may be seen on section.

4. Senile Atrophy of the Braik. — -In very old age, the brain,
like other organs, is less perfectly nourished, and, like other organs, it
shrinks in bulk. The wide fissures between the convolutions are
filled with that beautiful protector, the cerebro-spinal fluid ; this is now
in excess, but it is not to be considered as morbid ; it is a cushion which
nature has provided to supply the deficiency of the brain.

Nevertheless the brain of old persons is more easily injured than
that of the adult, from its being "more easily shaken in its case." We
meet cases, where the brain is lacerated by a blow on the skull,
without fracture, — an accident seldom seen in the younger subject.

Case. — -A woman, aged sixty-nine, on going down-stairs, fell and re-
ceived a contused wound, which exposed the bone over the right eye,
but without any fracture or further injury visible ; she was in a state
of insensibility till death ; she was actively treated, but died on the
evening of the next day. On dissection, the brain did not fill the skull
completely, and there was extensive effusion of blood into the left ven-
tricle, some on the right from laceration of the left corpus striatum
and thalamus.

Thus it is not strange that mental imbecility should become a cha-
racteristic feature of extreme age. It has been thus described :

*' On his staff
Bending he leaned ; and from his weary eye,
Distressing sight ! a single tear-drop wept.
None followed, for the fount of tears was dry.
Alone and last, it fell from wrinkle down
To wrinkle, till it lost itself, drunk by
The withered cheek, on which again no smile
Should come, or drop of tenderness be seen."

Induration of the Brain. — This structural change is believed to
be the result of hypereemia of the part, perhaps that state which pre-
cedes softening of the brain. It is often found in insane persons.
Pinel saw it in one woman who died in a state of insanity.

IKFLAMMATIO:tT OP THE BRAIK. 703

M. Payen saw it in a girl, six years old, of melancholy temperament,
though intelligent ; she had from her birth contraction of the right
wrist and foot, together with slight atrophy, and incomplete hemiplegia
of the same side. Andral thought the induration the result of a slow
inflammation. (Pathol, Anat p. 75.)

General induration of the brain, says Copland, generally occasions
loss of memory, confusion of thought, derangement of mental mani-
festations, causing insanity without lucid intervals. Towards the last
of life insanity is complete.

The signs of the partial induration of the brain are : progressive
defect of memory; inattention or inability to pursue a long train of
ideas ; indifference to momentary impressions and to present or future
occurrences ; difficulty of articulation ; derangement of the ideas, with
partial loss of the affections, appetites and desires ; ultimately increased
defect of speech, palsy, convulsions, or want of power of the muscles ;
fatuity, generalor partial wasting, and death. {Copland, Y oh I, 221.)

General Principles of Treatment op Inflammation op the Brain.
— 1. The disease is always serious and should be judiciously treated
from the commencement.

2. It does not in any case call for blood-letting, and, when depletion
appears to do good at the time, it is only fallacious and temporary.

3. The best resources against the delirium are Opium, Hyoscyamus,
Stramonium, Cannabis-ind., Belladonna, or other remedies homoeo-
pathic to that state. Cooling applications to the head are only ad-
juvants, not primary remedial agents.

4. Aconite is the great specific for cases purely inflammatory.

5. Mercury long continued and in minute doses has cured bad cases
even in allopathic hands. It is partially homoeopathic to cerebral and
meningeal inflammation and may be employed with safety as low as
the third attenuation, in which form its best effects may be attained.

6. Moral influence is indispensible in the homoeopathic management
of all diseases, in proportion as they effect the intellect.

7. Never lose patience in a chronic case, nor try to hasten the cure
by increasing doses.

The ti^me has been, when nobgdy thought of treating any inflamma-
tion without bleeding from the arm; and of all diseases inflammation
of the brain would be the last in which this powerful resource would
be neglected. It is useless to deny the dangerous power of the
lancet.

When cerebral disease has supervened upon the suppression of hae-
morrhoids, it is highly necessary to restore the hsemorrhoidal flow.

Cold A2?jpUcatio7is to the Head.- — We prefer cool water to the ice
that is commonly directed, let the water be so applied as to cool the
head gently and permanently ; evaporating lotions are beneficial when

704 DISEASES OF THE S AI^ aUINOUS EUNCTION".

kept np. in a regular and judicious manner. The cold dash is tlie
most powerful refrigerator, but it must be used with caution. Aber-
crombie says, he has seen a strong man thrown into a state approach-
ing asphyxia, who, but a few minutes before was in such a state of
maniacal excitement that four men could not hold him.

Though the good effects of the cold dash appear real when they are
applied with care, they are only temporary ; and then the following re«
action is only an exasperation of the original disease. Its best effects
need to be watched. Cold is homoeopathic to these conditions, but it
must not be applied on allopathic or antipathic principles. The feel-
ings of the patient may be employed as a safe-guide, but can not al-
ways be ascertained.

In our selection of remedies, therefore, we should always endeavor
to choose those of which the action has been shown h^ pathological
facts, as well as by provings, to be positively specific upon the struc-
ture affected. It is of especial importance that due regard be paid to
the causes which may have conduced to the attack. An encephalitis
which has followed immediately upon the suppression of a lochial dis-
charge, a habitual nasal hsemorrhage, or the retrocession of an eruption
by improper external applications, not only requires a remedy which
shall cover all the manifest symptoms, but one which at the same time
shall operate in such a manner as to bring back the original discharge,
or eruption. If disappointment, pecuniary embarrassments, fright, or
political or religious excitement has been the exciting cause, the mind
of the patient should be soothed and attracted into new and agreeable
trains of thought. By these means we shall prepare the organism to
receive our remedies in the most favorable manner.

The principal remedies employed in encephalitis, are : for inflamma-
tion of the medullary substance alone : Belladonna^ Aconite^ Ojjiimi^
HyoscyamuSy Stramoniwn^ Gannahis-indica^ Moschus^ Chamo-
milla^ LaiLTOcerasxis^ 2JiA Ignatia,

For paralysis : Moschnj^s^ Plimibiim^ Acid-oxalic^ Nux-vomica^
Opitom^ Oleander^ Gannahis-indiocu

For metastasis, or extension of rheumatism to the brain : Rhus-rad,^
Rh%is4ox.^ Bryonia^ and Belladonna.

When the disease has arisen in consequence of repelled eniptions :
S^pigelia, Gupriim-acetat,^ Tccrtar-emetic^ Bryonia^ SuVphur^ Tahac.^
and Belladonna,

Belladonna.— The disease presents itself with febrile symptoms,
accompanied with dryness of the mouth, tongue, and throat ; difficult
deglutition, nausea, vomiting; confusion of the head; giddiness ; dila-
tation of the pupils ; injection of the conjunctiva ; eyes suffused,
brilliant, furious, and protruded, imperfect vision ; gay delirium; in-
creased secretion of urine, and frequent desire to evacuate the bladder ;

INFLAMMATION OF THE BRAIN. 705

heaviness, pressure, or throbbing pain in the head ; roaring in the ears ;
vertigo, with nausea.

Dr. Bigel gives the following indications for Belladonna^ when chil-
dren are the subjects of this disease. The children constantly press
their heads into their pillows, they are startled by the least noise or
light, there are : snoring sleep, great heat of the head, face red and
puffed, with visible beating of the arteries of the head and neck,
swollen veins, and occasionally hydrophobic phenomena.

During the period of dentition, and directly after being weaned, chil-
dren are particularly prone to attacks of inflammation of the brain. At
this age the child is exceedingly sensitive, and there is an unusual
tendency of blood towards the brain ; but if the signs of cerebral dis-
turbance be closely watched, we shall find no difficulty in combating
them successfully at the onset with Belladonna.

Symptoms: Pace hot, red, and swollen; eyes red, sparkling, and fixed,
or half open and distorted ; pupils contracted ; visible throbbing of the
carotid and temporal arteries; veins of the head distended; constant
boring with the head into the pillow; paralysis of one or more parts ; con-
vulsive movements ; rapid, small, or intermittent pulse ; subsultus ten-
dinum ; distortion of the features ; grinding of the teeth ; tongue bright
red, and cracked ; urine scanty and suppressed.

Sharp, throbbing, or confused pain in the head ; great restlessness
and agitation; intolerance to sound and light; thirst; head and face
very hot ; limbs cold with internal burning heat ; roaring or humming
in the ears;, deafness; inability to speaker to swallow; nausea and
vomiting during the course of the disease ; sparks, flashes, or visions
before the eyes.

Great sensitiveness of the nervous system ; violent delirium at night ;
profound sleep ; mania ; hydrophobic symptoms.

Belladonna is likewise especially necessary in inflammations of the
brain proceeding from metastases of scarlatina, measles, erysipelas,
and small-pox.

Its, specific action is upon the cortical substance, the tubercula qua-
drigemina, and the membranes of the brain. When febrile symptoms
are strongly pronounced, it should be preceded by Aconite, or given in
alternation with it.

Boenninghausen says, a girl, eight years of age, with violent cere-
bral inflammation of a high grade, was cured by a single dose of Bella-
donna, 2000 (Jenichen), the child having been given up as incurable by a
previous attendant, and neither the 30th nor the 200th of Belladonna
had succeeded. '

Administration. — We advise from the first to the third attenuation,
for adults, and from the third to the sixth or thirtieth for children. As-

Vol. I.— 45

706 DISEASES OF THE SANGUIlSrOUS FUNCTION.

a general rule, the dose may be repeated every two hours until the re-
quired impression is produced upon the inflamed structure.

Aconite, — There is no proof that Aconite affects specifically either
the brain or its investing membranes. In autopsical examinations of
those„who have died from the effects of poisonous doses, no traces of
inflammation have been found in the cortical substance, or the mem-
branes of the brain, and but slight marks of action in the medullary
structure. The prominent symptoms to which largo doses give rise,
are : numbness and tingling of the parts about the mouth and throat,
and of the extremities, vomiting, contracted pupil, and failure of the
circulation. The intellectual powers remain unaffected, and neither
convulsions nor stupor usually occur.

Dr. Lombard, of Geneva, in his clinical practice, and in his experi-
ments on animals, found that the internal exhibition of Aconite gene-
rally had the effect of "rendering the pulsations less frequent, with-
out irregularity, and consequently, that it exerted a decidedly sedative
effect upon the heart ; whence he infers that it is a proper remedy in
inflammatory affections in general." See opinions on the powers of
Aconite given at page 650, 651.

Others have observed that its jpTimary effect was to stimulate the
action of the heart and arteries, and cause a universal glow over the
surface ; while the secondary effect was decidedly sedative upon the
circulatory vessels.

Its effects are so manifest upon the action of the heart and arteries,
that its use will be of eminent service in all those cases of encephalitis,
or congestion, dependent upon a plethoric state of the system, or organic
disease of the heart. It should also be given during the existence of
active febrile symptoms, in all cerebral affections, and generally in al-
ternation with some positive specific, in order that the malady may be
met at all points. Attenuation and repetition of doses the same as
JBelladonna,

Opiti7n.—lt is conceded by both schools that Opium^ when exhi-
bited in moderate doses, exercises upon the human constitution two
different effects- — a primary and a 5^(^6>7i<^ary— which are of directly
opposite characters. The first of these effects is invariably stimu-
lant, as is evinced by such phenomena as increased force and fre-
quency of the pulse, dryness of the mouth and throat, a pleasant glow
upon the skin, exaltation of the mental faculties and of the muscular
system, a sense of intoxication, and temporary retention of the stools.

The secondary manifestations are, general diminution of sensibility
throughout the body, a feeling of relaxation and calmness, tremulous-
ness in the limbs, disinclination to exercise, pulse full and slow, drow-
siness, dryness of the mouth and throat, thirst, nausea, and finally, if
a large dose has been taken, slow and laborious respiration, spasmodic

INFLAMMATION OF THE BBAIN. 707

contractions of the muscles, eyes half closed, pnpils dilated or con-
tracted, and insensible to the light ; bloated, suffused and besotted ex-
pression of countenance, cold and clammy extremities ; respiration,
gasping, rattling, stertorous, face pale, sunken, and death-like, rigidity
of the jaws, entire insensibility to external impressions, pulse thready,
and almost entirely imperceptible.

It is supposed " that the active principle of Opium is conveyed into
the circulation, and operates upon the " brain, and probably upon the
nervous system at large by hninediate Gontaot with their interior
striiGtureP ( U, S, Dispens, p. 476.)

Opium is generally supposed to cause death by suspending the " ce-
rebral influence necessary to sustain the respiratory function ; and it is
supposed also, that the heart ceases to act in consequence of the ces-
sation of the respiration." {Brodie)

Erom these facts we infer that the specific action of Opium is prin-
ts ipally upon the Qned'ulla oblongata'^ although the other symptoms in-
(^'leiJ:te that there has been some action upon other parts of the brain,
and also upon the skin and lungs.

In autopsical examinations of those who have died from the effects
of this substance, extravasated blood has been found in the brain, dis-
tention of the sinuses, and of all the cerebral vessels ; but it is pro^
bable that many of these appearances are results of the impeded res-
piration, the imperfect decarbonization of the blood, and the impaired
circulation which have arisen from a paralysis of that portion of the
cerebral mass which presides over the respiratory functions, rather
than from any specific operation of the Opium upon these different
structures.

Opium in small doses has always been observed to excite the vene-
real propensities, and has been used for this purpose for a long period
by the Turks, Chinese, and Egyptians. This fact viewed phrenologi-
cally, affords another proof of its specific action upon the cerebellum.

In proof that the active principle of Opium is ahsorhed^ and ope-
rates by actual contact in producing its specific effects, we quote the
follovying from Pereira and Barbier: "The odor of Oj^^i^m -is frequent-
ly recognisable in the secretions, exhalations and breaths of persons
poisoned by it, and the secretions, in some cases, appear to possess
narcotic properties."

Our own opinion derived from post-mortem examinations of those
who have been poisoned by Opium, and from the effects, to which it
usually gives rise, is, that it exercises, first, a specific action upon the
cerebellum and medulla oblongata. If the drug be taken in moderate
doses, this action is in the first instance excitant^ producing venereal
desires, erections, accelerated respirations ; circulation, and augmented
musculicr force ; and secondarily, sedative^ as is shown by the languid,

708 DISEASES OF THE SANGUINOUS FUNCTION.

relaxed and calm state of tlie whole system, tlie diminution in tlie
number of respirations, and in the action of the circulatory vessels.
If taken in very large doses, the parts appear to be paralyzed at once,
and all those organs the functions of which are dependent upon the
integrity of this part of the brain, cease to act.

Another specific effect of Opium is upon the skin, as is evinced by
the perspiration and its odor, and the eruption to which it occasionally
gives rise. Nor is it at all improbable that it may operate somewhat
upon the par-vagum, or the lungs themselves.

The most prominent indications, therefore, for the use of Opium, are :
exaltation of the physical and mental powers, succeeded by depression
and calmness, dry throat and mouth ; agreeable reveries ; dreams ;
pulse at first rapid and full, afterwards slow and feeble ; drowsiness ;
disinclination to muscular exertion, slow, irregular, and stertorous res-
piration, profound coma ; pallid, sunken and ghastly face ; immovable,
contracted or dilated pupils ; rigidity of the jaws, cold and clammy ex-
tremities ; complete insensibility to external impressions, and some-
times convulsive twitchings, extinction of the pulse; interrupted and
gasping respiration ; and finally death. It may be administered in
the same manner as Belladonna,

Alcohol, — Spirituous Wines in small doses have cured, homoeopa-
thically, fevers that were purely infiammatory. Of this several au-
thors have published cases. Asclepiades cured iiifiammation of the
h'ain by administering a small quantity of Wine. A case of fever-
ish delirium, attended with stertorous breathing, similar to that state
of deep intoxication which Wine produces, was cured by Rademacher
in a single night. (II%if eland] s Journal^ XVI. p. 92.) " Can any one
deny the power of a medicinal irritation analogous to the disease itself
in either of these cases?"

iJ^K^&c^r^.— In the last stage, when serous exudation has already oc*
curred ; especially in cases where there are stupor, paleness of the face ;
suspension of the dominion of the mind over the body. Dr. Roth says,
he treated one child with inflammation of the brain with Helleborus,
800, where Bell, had failed.

Tartar 'emetic,' — Disease of the Neeyous Centkes.— Dr. Ohris-
tison {^^ On Poisons^^ p. 479), gives the following fata! case: The pa-
tient had been ill two days before seen by a medical man, and was
suffering " from vomiting, excessive purging and convulsions. On the
third day he had great pain and tension in the region of the stomach,
and appeared like a man in a state of intoxication. In the course of
the day the whole belly became swelled, and at night delirium super-
vened. Next day all the symptoms were aggravated ; towards evening
the delirium became furious, convulsions followed, and he died during
the night." {Christison, p. 480.)

INFLAMMATION OF THE DUEA MATEE. 709

On dissection, Mr. Hartley's cases presented tlie following appear-
ances : " On opening the cranium of tlie boy, the dura mater was found
very vascular, the " longitudinal sinus contained a coagulum of lymph,
and but very little blood. The vessels of the surface of the brain
were very much injected with dark blood, the whole surface having a
deep purple color. Every portion of the brain, when cut, presented
many bloody points, the medulla oblongata and cerebellum were also
extremely vascular. In the body of the girl, the arachnoid membrane
was more opaque than usual."

In the symptoms observed during life, we have an appearance of in-
toxication, delirium eventually becoming furious, and convulsions. The
morbid appearances present us with a complete picture of inflammation
of the brain and its membranes. The congestion of the medulla
oblongata and cerebellum^ with the convulsions observed during life,
point to epilepsy, which Yan der Kolk believes to depend, in many
cases on this cause. Dr. Wood recommends Tartar-emetic in doses
of from one-fourth to one-eighfch of a grain, every two hours in the treat-
ment of inflam^mation of the hrain. {Principles and Practice of
Medicine: Vol. IL) Dr. Graves witnessed beneficial results from
Tartar-emetic in the advanced stages of typhus fever accompanied
with intense cerebral excitement, manifested by loss of sleep, delirium,
&c. {Med, Gazette^ XX., p. 538.) Dr. Greenwood says, he cured a
case of deliriunn tremens with Tartar-emetic, commencing with small
doses, which he increased till he wound up the treatment with four
doses of injuriously large size. [Lancet,^ 1835 and 1836. Vol. III. p.
142.) In epilepsy Van der Kolk has "found the greatest benefit from
Tartar-emetic alone, in powders or pills, in which form, on account of
its slower absorption, it is less likely to produce nausea and vomiting
(in these cases to be avoided) than in solution." (Spinal Cor d^ <&c,^
Van der Kollc^^' ]Vew Sydenham Society, ^\^. 277,) .^

Treatment of Inflammation of the Due a. Matek.— In a case
which arose from secondary syphilis, there was necrosis from nodes of
portions of the frontal and parietal bones, but without symptoms of cere-
bral irritation. Two days after admission into the hospital the patient,
became drowsy and semi-comatose. He was actively treated, but got
rapidly worse ; and in twenty-four hours he came under the specific
influence of Mercury ; " and it was most delightful to see the rapidity
with which the cloud was removed from his intellect.'' In forty-eight
hours he could answer questions; the syphilitic symptoms improved
apidly; the nodes became healthy; some large rupial sores on his
thighs and legs improved, and he rapidly recovered. {Solly.)

Case.-— A man, aged twenty-five, had iritis, and secondary eruption ;
became wild in his manner, left the hospital without hat or coat in cold
weather, and remained out all day. Next day had inflammatory rheu-

710 DISEASES OF THE SANGUINOUS FUNCTION.

matism ; this grew better, but he had headache, expression of counte-
nance vacant, wild and suspicious ; there was inflammation of the dura
mater from metastasis of the rheumatic inflammation. He was not in-
temperate and there was no hereditary insanity. Under the influence
of Mercury and Colchicum, &c., he recovered.

Inflammation of the dura mater often causes insanity, and the skul
is found thickened and vascular, and the arachnoid also. Solly found
in one case thickness of the os-frontis producing melancholia, especially
over the organs of mirthfulness, ideality, and hope; symptoms: con-
stant crying and moaning. In these cases " disease commenced with
chronic inflammation of the dura mater of the anterior part of the
brain, producing an ordinary periostosis, thickening of the bone. The
thickened bone pressed on the above organs, and partially on the re-
flective organs ; there being no inflammation of the arachnoid and pi a
mater, there was no maniacal excitement.

Inflammation of the Brain from Scaklatina.— The child is some-
times attacked with inflammation of the brain before the eruption ap-
pears and is misunderstood. Many children die in this way, and the
real cause of death is not known till other children exhibit the scarla-
tinal eruption on the skin. For the treatment proper in these cases
see Scarlatina.

Again, sometimes the subject of scarlatina when recovering from
what was called a niild attack, is suddenly seized with headache and
blindness with or without convulsions. This new attack is sometimes
preceded by anasarca which follows scarlatina. The symptoms are in-
deed those of efiusion on the brain, but they are truly inflammatory
though never curable by antiphlogistic treatment. See Scarlatina^
Dropsy after, p. 601.

Meningitis caused by Sun-Steoke.— ^^ZZ^c?o?2n<2. — Boring with
the head into the pillow; sensitiveness to light ^nA noise] violent
burning and stitching pains in the head ; red, sparkling eyes, with
furious look ; red and bloated face ; stupor with distorted, half-opened
eyes ; heat in the head^ with violent throbbing of the carotids ; swell-
ing of the veins of the head; loss of consciousness and speech, or mut-
tering, violent delirium ; convulsive movements of the limbs ; spasmo-
dic constriction of the throat with diflicult deglutition and other
hydrophobic symptoms ; vomiting ; involuntary discharge of urine and
faeces.

^C(9mi{6.— Inflammatory fever, delirium, violent burning pains through
the whole brain, especially in the forehead ; red and bloated face, red
eyes, &c.

Opium. — Lethargy^ loss of consciousness; stertorous breathing
with the eyes half-closed; and stupefaction after waking; frequent vo-

mFLAMMATION OF THE BBAIK. 711

suiting ; complete listlessness and dullness of sense, the patient not de-
siring nor complaining of any thing.

Case.- — A lady of 48 years, married but without children, had droop-
ing of the right eyelid and violent pain in the head. The lid droops
over the eyeball and she can only raise it half way. She can com-
mand the left one ; quivering motion in both eyelids and eyeballs
vision of the right eye imperfect and hazy ; shooting and pricking pair
in the ball of the right eye ; feeling of pressure and pain on the left side
of the head and face. Feels as if going delirious ; countenance wild
and anxious; eyes staring and unnatural. Nervous feeling over the
whole body ; feels pricking like pins and needles ; the eyeball flutters ;
right arm and leg numb ; the left never feels so ; passes a pint of blood
a week from haemorrhoids ; has had much mental agitation and distress
after the discharge. Six months ago the uterus was displaced, hard
and shrunken ; menstruation but once (two months ago) in that time ;
was then relieved by it. Pulse quick, irritable ; tongue rather pale,
not furred; appetite and sleep good; feels week. She took Hydrar-
gyri cum creta two grains night and morning for two and half months*
The paralysis of the eyelid was restored, and she felt nearly well.
She disappeared for two months. Returned, eyelid and general appear-
ance worse ; pain in the back of the head and top of the neck ; at times
something seems to pass over the eyes and make her blind. Sometimes
sensations so horrible that she feels as if she were going mad. Some
loss of power of the right side across the right leg — it feels numb and
heavy. Began to. feel worse as mercurial action declined, though moral
causes produced the relapse. Mercury again continued for four
months ; improvement considerable ; sight restored ; head easy ; spirits,
appetite and strength good ; mind composed ; feels comfortable.

Certain Derangerifhents of the Brain and 7iervous jSystem> aGGOiU'
paoiied hy Paralysis of the voluntary Muscles, — Mr. Colles of Dublin
gives eight cases. {Mercury in Affections of the Nervous System^
p. S28.)

Case.— A woman, aged fifty years, has for two years suffered severe
family afflictions, loss of property, and has become subject to "great
confusion in the back of the head;" it has extended to the right side
of the head also. Latterly she has avoided ail society ; there is failure
of memory, increasing for the last six months, defective memory of
words or of place where she laid things; confusion in the head when
she tries to read, do needle-work, or recollect things ; temper becoming
extremely peevish and irritable; constant sickness of the stomach like
fiea-sickness ; dizziness of the head and staggering in walking ; good
appetite ; constipation ; sleeps heavily ; no emaciation ; pulse 96. She
took Mercury in purgative doses and in four days had mercurial
dysentery and soreness of the mouth ; though she was injured in many

712 DISEASES OF THE SANGUIKOUS FUNOTIOlSr.

respects by the extent to wliicli it was carried. The Mercury should
have been attenuated and then given in small doses, producing the
specific homoeopathic eiFect -without the mercurial drug disease.

Sleeplessness, — -This is generally the result of the manner of living,
when not associated with other diseases. Some persons cannot sleep
if they eat anything in the evening before going to bed. Others only
sleep soundly by eating before gping to bed. Exercise in the open air
in the evening, when not carried too far, favors natural sleep. The
use of coffee and tea are the most common causes of nervous sleep-
lessness.

Coffea,- — Sleeplessness caused by exciting agreeable news. Bene-
ficial to children.

Aconite.— yfh-Qin caused by agitating events.

Ignatia, — Sleeplessness caused by dejection, grief, &c.

Pulsatilla, — When caused by surfeit.

Cha7ri07nilla.—^QdiVi^Qdi by abdominal symptoms, flatulence, &c.

Opium, — When various figures and visions appear before the eyes
and prevent sleep. In general Opium is suitable for old persons. The
general state of the health must be corrected; the cause of the sleep-
lessness must be studied.

HyosGyamus.—M.. Fouquier, of La Charite, gave (Archives gene-
rales de MecLy 1828,) the results of his experiments with this remedy
on 200 patients. His conclusion embraces the symptoms it produced
in massive doses. ^^ Until it be absolutely necessary to procure rend-
ing headache, with vertigo, fantastic reveries, burning thirst, loss of
sight, perversion of taste with insupportable disgust for every sort of
food without a single wink of sleep, this remedy must continue utterly
useless, and in the mean time should be banished from every Pharma-
copoeia." He denies that it ever acts as a hypnotic.

IlyoscyamuSj StramoniuTn vuYidi MusJCyd^TQ applicable in cases at-
tended with complete loss of sense; convulsive or spasmodic move-
ments ; closed eyes ; low muttering delirium ; constant movements with
the hands ; dilatation of the pupils ; rapid and anxious respiration ;
frequent sighing.

If inflammation of the brain has arisen in consequence of a sup-
pressed otorrhoea, Sulphur should be employed. In those cases which
occur in children from teething, Chamomillay Belladonna Midi Aconite
are our most relia-ble remedies.

In cases of metastasis or extensions of rheumatic inflammations to
the brain, Bhus-radicans and Hhus-tox. are our best remedies.

Ottpricm-acetat, should be given in cases which have arisen from re-
pelled eruptions.

When encephalitis threatens to run into dropsy of the brain, Mer-
euriuS'SoL is the best remedy to counteract the tendency of effusion*

SOFTENIKG OF THE BEAIN". 713

If the disease has arisen from exposure to the sun, repeated doses of
Camphor are highly recommended.

Administeation.— Our attenuations may range from the first to the
Bixth, and the doses repeated every two, three, or four hours, according
to the severity of the symptoms.

A morbid condition of the brain of ancemiG character occurs from
long-continued dyspepsia, confinement in impure atmosphere, and other
prostrating causes. This is called "London cachexy." Jt is charac-
terized by loss of appetite, confusion, giddiness, violent sickness of the
stomach, sleepless nights, horrid dreams, waking suddenly in a fright,
noises in the ears like the singing of a tea-kettle, or like something struck
close to the ear, or water thrown on hot iron, or a muffled drum at a
distance ; falling to sleep and suddenly awakened by a feeling as if a
sky-rocket had suddenly rushed through the brain; transient deafness;
headaches; black and bright spots dance before the eyes; languid,
weak, irritable pulse ; cold skin ; pale flabby tongue. Sometimes there
is a partial loss of memory, sudden startings up at night, frequent diz-
ziness and depressed spirits. [Solly, On the Brain, p. 288.)

The only treatment required in these cases, consists in a better diet,:
restricted to proper articles in reasonable quantity; change of air; eX"
ercise to the extent of slight fatigue; proper attention to the state of
the stomach, liver, bowels, &c.

2. WHITE SOFTENING OF THE BRAIN.

RamoUissement — Cerebral anaemia long continued produces white
softening of the hrain. It may be connected with hydro cephalus^
or be independent of it. It often occurs in infants, being caused
by hydrocephalus, and in old men it arises from disease of the
arteries. Mr. Abercombie says : " This peculiar softening of the
cerebral matter is analogous to gangrene in other parts of the body;
and, like gangrene, it may arise from two different causes— inflam-
mation, and failure of the circulation from disease of the arteries."
Both of these forms of gangrene are familiar to all observers, though
their origin is very different. Ossification of the arteries of the brain
is common in elderly people, and is a frequent source of apoplexy with
extravasation of blood at advanced periods of life.

It is not yet decided whether ramollissement, or softening of the
hrain, proceeds from inflammation, or is a disease 8ui generis. Many
of the French pathologists suppose it to be the result of inflammation ;
while others, as Hostan, believe it to be a disease sui generis. Aber-
crombie believes it may arise from cither inflammation or from a con-
dition of the cerebral structure analogous to those parts which have
become gangrenous in other parts of the body, while Solly supposes

714: DISEASES OF THE SA^S-aUINOUS FVNGTION.

that it, may arise from inflammation, from a total failure of tlie circu-
lation, and from local and general anemia." Dr. Burnet recognizes
two kinds of cerebral and spinal softening, an inflamTYiatory and a
non-inficmmiatory, and " wliicli may always be distinguished from each
other by the microscope."

Inflammation of the tubular structure is more prone to terminate in
softening than any other portion of the brain, and it is usually very in-
sidious in its approach.

Diagnosis. — Softening of the brain may supervene suddenly upon an
attack of acute inflammation, like hydrocephalus, or it may make its
appearance in a gradual and imperceptible manner. Some of the cha-
racteristic symptoms of ramollissement are : Insensibility, dilated pu-
pils, slight muttering delirium, paralysis, contraction of the flexor
muscles, constipation, and a urinous smell.

Those cases which have arisen from an ansemic condition of the
brain, or from an obliteration of the arteries which supply this organ,
are usually slow in their progress, and manifest themselves by a gradual
failure of the memory, drowsiness and oedematous state of the body?
occasional wandering of the mind, especially during the night, general
languor, slow, dragging and Imperfect articulation, constipation, loss of
energy and ambition, and an almost entire absence of pain or febrile
symptoms.

Dr. Todd of King's College directs us to examine in all cases of
hemiplegia the condition of the muscles of the paralysed limbs; to
"flex the fore-arm upon the arm and the leg upon the thigh ; and care-
fully ascertain which, if any, of the muscles offer , resistance to our
efforts, and the degree of resistance. Sometimes the biceps alone re-
sists, and sometimes the triceps ; flaccidity, slight resistance and ab-
solute rigidity denote different states of the brain. Thus the perfectly
flaccid condition of the muscles of the palsied limbs indicates cerebral
lesiion distinctly atrophio in its nature, the opposite of inflammatory.
The vital powers are helow ]par\ the action is of a low kind, and there
is a tendency to wasting. A resisting state of the paralysed muscles
shows that the cerebral lesion is of an irritative kind ; perhaps there is
" a small apoplectic clot with laceration by the effused blood of some
of the healthy brain-substance immediately adjoining it. When the
palsied muscles are hard and rigid, and alruost in a tetanic condition,
the brain lesion is of a more distinctly and decidedly irritative kind,"
it may be even of an inflammatory nature. These are the cases which,
when the resistance is slighter, or the muscles perfectly flaccid, may
be remedied by Aconite, Belladonna, or Mercury. But these reme-
dies are not alone suflicient. When the intellectual powers remain
perfect or nearly so, the seat of the lesion is in the part of the
brain concerned in voluntary actions — the corpus striatum and optic

EAMOLISSEMEKT.

715

thalamus, and parts adjacent. Softening of the brain is not attended
with the ^wolonged coma, which almost always follows the wpojpleGtic
effusion of blood on the brain. Consciousness is retained, though the
articulation is imperfect.

Causes. — Long-continued anxiety ; over-exertion in business ; vene-
real exhaustion ; use of stimulants and low diet ; depression. White
softening of the brain generally depends on some cause which cuts off
the normal supply of blood from the brain, or some part of it. Ligatures
placed on the common carotid artery, have speedily caused hemiplegia
of the opposite side. Dr. Todd says the^ application of the ligature was
in one case followed in two days by hemiplegia of the opposite side,
without any loss of consciousness ; dissection showed white softening
of the cerebral hemisphere of the same side as that of the carotid tied.
In another case a dissecting aneurism, formed by a stream of blood
from a slit in the aorta, extended for an inch and a half up the right
common carotid. It there coagulated and formed a plug, which com-
pletely obliterated the carotid artery. Two days after the accident the
patient became suddenly hemiplegic on the left side. Consciousness
was retained, the muscles were perfectly flaccid and reflexed, and life
continued eleven days. Dissection revealed white softening of all the
parts of the right hemisphere of the brain which are supplied with blood
by this artery.

This disease occurs most frequently in persons above fifty years of
age ; and in many of them it is preceded by a change in the coats of
the arteries, especially in those of the brain. This change consists in
the deposition of earthy and fatty matter in the walls of the vessels,
and is known by the term atheromcL These deposits impede the blood
in the capillary vessels of the brain, which, being less perfectly nour-
ished, passes into a softened state. The disease is thus seen to be
one of a purely atroj^liiG nature. It is in such cases that true apoplexy
generally occurs. This is usually preceded by unsteadiness of gait, loss
of mental and physical power, eccentricities of conduct, despondency.
(Todd, Med, Times, Pebr., 1858.)

Dr. Bennett {Edinb. Med. and Surg. Jour., Vol. 58, 59 and 60,)
has explained the process of ramollissement of the brain, and thus
sums up his conclusions (Vol. 60, p. 898.) :

1. That two kinds of cerebral and spinal softening exist, — an inflam-
matory and a non-inflammatory affection, and they may be distinguished
from each other by the microscope.

2. That inflammatory softening is characterized by the presence of
exudation, corpuscles and granules ; whilst in the non-inflammatory
these bodies are never found.

3 That the nature of inflammatory softening consists in the forma-
tion and development of nucleated cells in the exuded blood plasma

716 DISEASES OF THE SAN'GUINOUS FUNCTIOK.

whilst the nature of the non-inflammatory softening consists in the
mechanical destruction or maceration of the nervous tissues in serum,
or is the result of putrefaction.

4. That non-inflammatory softening, unaccompanied by hemorrhage,
is ususllj post 7nortem, and causes no symptoms ; whilst uncomplicated
inflammatory softening always causes marked symptoms which, however,
vary according to the seat of the lesion.

5. That the inflammatory and non-inflammatory softening have fre-
quently been confounded together by morbid anatomists, it being im-
possible to distinguish the one from the other with any certainty by the
naked eye.

6. That inflammation in the nervous centres has in several instances
been demonstrated by means of the microscope after it has escaped the
search of good morbid anatomists and been indicated by most equivocal
symptoms.

7. That very different colored softening has, at various times, been
found to be connected with inflammation; but that yellow and white
softening are most frequently inflammatory, whilst fawn-colored soften-
ing is non-inflammatory.

8. That red softening usually depends on congestion or the direct
extravasation of blood; yellow softening on the imbibition of the color-
ing matter of the blood; fawn and gray-colored softenings on the pre-
sence of gray exudation corpuscles ; and white softenings, in the great
majority of cases, are post mortem, and the result of ^maceration in
serum.

9. In no instance has softening of nervous centres been traced to
the presence or infiltration of pus. •

10. That inflammation of the central parts of the brain generally
produce well-marked lesions of sensation and motion ; whilst in inflam-
mation of the peripheral portion, lesions of intelligence are commonly
well pronounced.

11. That in idiopathic inflammatory softening of the brain, the con-
traction in one or more limbs is a common symptom.

12. That the fawn-colored spots described by Dr. Sims are no evi-
dence of the cure of inflammatory softening.

13. That inflammation accompanying haemorrhages is -consecutive.

14. The softening surrounding apoplectic clots or sangineous infil-
tration is no proof of inflammatory action.

PROGNOSIS. — Eamolissement of the brain was formerly considered as
almost inevitably fatal. Regarded as always inflammatory and treated
by depleting measures, the vital powers became rapidly more de-
pressed. In those cases of fatty and earthy degeneration of the coats
of the blood-vessels it may still be considered hopeless. But in cases
which originate from the obliteration of the arteries it may still be pos-

EAMOLISSEMENT. 717

sible to support tlie cerebral powers until a collateral circulation may
be established through other vessels which may restore and maintain
the normal nutrition ; this is often seen where the main artery of a
limb has been tied. ,By this process it seems that simple white sof-
tening may be repaired ; but in very many cases it never takes place.
In these the palsied limbs are never restored; their temperature falls
below that of health ; the paralysed parts become oedematous ; strength
gradually declines and death follows ; though existence may be pro-
longed through months and even years.

Treatment.— Begin by endeavoring to improve the state of the
blood, and uphold the patient's strength in every way consistent with
the degree of digestive power remaining. At first Ammonia and Chloric-
ether may be given every four hours or less,, after the hemiplegic at-
tack ; to these we may add wine, coiFee, Quinine and other tonics and
stimulants may be added. When the patient appears rapidly sinking,
he may be revived by stimulants, and of these strong coffee in large
quantities is one of the best. All the attendant symptoms, as the slow
pulse, fainting fits, convulsions, &c., denote extreme anaemic debility,
rather than congestion. Many of these cases occur in persons who
have lived freely and are accustomed to, stimulating food; and a fre-
quent cause of their worst symptoms is found in dietetic restrictions.
Let the generous diet to which he was formerly confined be restored,
especially the wine, the animal food, and add to it iron and other tonics.
Mr. Skey, of St. Bartholomew's Hospital, says, he has treated nine or
ten cases of ramolissement on the stimulating plan. These patients all
had a slow pulse, some had alarming syncope, both of which symptoms
depend on the state of the heart, and are always improved by tonics
In one case he gave a pint of claret a day, in place of water gruel, and
quinine and iron in place of leeches, antimony, graypowder and
mindererus.

Ramolissement, from whatever cause it may proceed, is seldom
cured. As remedies, however, we suggest Opium^ IlyosGyaTiiuSj
Ohinctj SeGale-Gornutum^ Carbo-vegetahilis^ Belladonna^ JSfux-vom,^
and Phos,

]Sfux-vomiGa.-—J), E. M. Hale gives a case {W, A, Joiir, Horn,
Vol* XL) of a physician aged 60, a man of large frame, and originally
possessing much strength and considerable power of endurance. For
some years he had occasional paroxysms of "sick headache, excruciat-
ing pain and vomiting, was affected by a certain absent-mindedness,
loss of memory, and an eccentricity of manner. His mind became
clouded at times, his speech hesitating and slow.

Two years after he had an attack similar to an apoplectic seizure.
This left him, with partial loss of motion in the lower extremities. He
recovered from this attack, so much as to be able to ride and even walk

718 DISEASES OF THE SANGUIKOUS FITNCTIOK.

over his farm, and attend to his domestic a-IFairs, but he had the head-
aches, mental obtuseness, fee, worse than before. One year from this
attack, he had another, much more serious. It came upon him while
in the barn-yard and he was found several hours^ after lying upon the
ground completely insensible, comatose, with stertorous breathing.
After three weeks of allopathic treatment, he was in a condition ap-
proaching to general paralysis of the voluntary muscles. His lower
extremities completely paralysed, they still retained sensation, but not
in a normal degree; the tendons were somewhat contracted, upper ex-
tremities partially paralysed, the face was partially distorted, power of
speech lost. Gelseminum improved the febrile condition and the passive
cerebral congestion ; he appeared much better. The case was con-
sidered to be one of ataxic or chronic softening of the brain, of the
variety denominated "red-softening" — from chronic venous congestion
and capillary haemorrhage.

Wztx-vomica^ 8. produced in a week decided amendment. The tongue
became moist and clear, breath less offensive, greater power of articu-
lation, less distortion of the features, and the return of some power of
motion in the legs. He can turn in bed with a little assistance. There
was slow but steady improvement in all except the mental condition,
which remained cloudy and idiotic as ever. Phosphorus was then alter-
nated with Nux, with decided benefit. Further improvement, followed
from Citrate of Iron and Strychnine,

A distressing headache and vomiting was prevented from returning
in regular paroxysms by Cuprum- ace tic um, 2^, given every three hours,
for the twelve hours, preceding the expected paroxysm, and until its
subsidence. Phosphate of Zino^ first dec. trit., one grain one hour before
meals, cured it entirely.

3. HYDROCEPHALUS.

WATER-BRAIN-FEVEK. DROPSY OF THE BRAIN. TUBERCULAR MENINGITIS.

General Remarks. — No satisfactory account of this disease appears
in any of the ancient authors. The first clear and full description of
it was given by Whytt, in a Dissertation published in 1768, which is
even now regarded as one of the best that has ever been written on this
subject. It may be divided into three stages : 1st, that of excitement :
2d, that of effusion ; 3d, of convulsions.

ACUTE HYDROCEPHALUS.

Diagnosis. — -This is a malady almost peculiar to infancy and child-
hood. The symptoms which indicate its approach, are neither very
uniform nor regular. Indeed, so various and uncertain are these symp-
toms, that some writers suppose the effusion to be dependent upon a

HYDROCEPHALUS. 719

debilitated condition of the membranes, analogous to dropsy, wliile others
attribute it to inflammation in all cases.

It may appear suddenly witli most of the phenomena we have de-
signated as encephalitis, viz. : febrile symptoms, quick pulse, fits of
screaming, expression bold and furious, eyes bloodshot and brilliant ;
great heat of the head, nausea, vomiting, noise and light painful ; con-
vulsions, ending in coma and death in a few days. In cases of this de-
scription there exists unquestionably acute inflammation of the meninges
of the brain ; and the effusion commences almost simultaneously with
the inflammation. „

In other instances, the disease approaches insidiously, presenting no
marked symptoms for some days. The child will perhaps be observed
to be petulent, to complain of some pain in the head, to become easily
fatigued, to have occasional flushes of heat, to be restless at night, oc-
casionally to grind the teeth, to have lost the appetite, and to prefer
the recumbent position. After these symptoms have continued for an
indefinite period, the more serious signs of eff'usion present themselves,
as; general diminution of sensibility, less frequent and more ir-
regular pulse, greater debility, constant inclination to keep the bed,
or to be held in the arms, dilatation or contraction of the pupils,
frequent sighs, strabismus, or an unnatural expression of the eyes,
turning inwards of the feet and hands, slight convulsive twitchings of
the face, upper-lip and arms, automatic movements of the hands towards
the head, rolling the head from side to side, constant motion of the lips,
convulsions, paralysis.

The jpxilse at the beginning of this disease is always slow^ in very few
cases.exceeding one hundred, in some eighty, and in a few as low as fifty-
four per minute ; but this lasts only a very short time after the head-
ache, and vomiting begin. There is then a reaction and the pulse rises
to one hundred and thirty, and in some to one hundred and sixty. It
is full, but more easily compressible than in inflammation of the brain,
called encephalitis ; it has a perceptible variation in the rythm of the
artery and in the regularity of the strokes, varying in frequency even
during the same minute. There is a distinct intermission every seven,
seventeen or twenty pulsations, and some of the pulsations may be felt
soft, weak, and fluttering. In the second stage, the pulse sinks and
becomes slow, labored, intermittent and irregular, and is easily quick-
ened by motion or mental disturbance to double the number of pulsa-
tions per minute. [WhyU^ Hennisj Green^ Smith on Ilydrocephalus^
jf>. 31. miliet and Barthez)

Abdominal Organs, — The appetite is not entirely lost : but vomiting
almost always occurs on the first day, rarely later, though sometimes
■continuing longer than the seconder third. M. Piel says of this sign:
" If in a child that has been vaccinated or had the small pox, who

720 DISEASES OF THE SAKGUmOUS FUKCTION.

digests well, and is suffering neither from bronchitis nor pertussis,
vomiting, whether simple or bilious, accompanied or preceded by a
more or less continued headache, there is every reason to fear an ap-
proaching meningitis, especially if the child is tuberculous." The
vomiting is spontaneous and unattended with nausea, and after its oc-
currence food is often taken with avidity. Constipation is generally
conjoined with vomiting, and is generally followed by diarrhoea before
the disease terminates.

Hetraotion of the walls of the Abdomen generally occurs about the
sixth day. Rilliet and Barthez say : The belly becomes depressed at
its centre and takes the form of a boat; the contraction being some-
times carried so far as to allow the beating of the aorta to be felt. It
is almost a constant symptom, and does not depend on the constipation
or the subsequent diarrhoea. It is almost exclusively in cerebral af-
fections that we have observed this symptom."

The urine is of a deep amber hue, of high specific gravity, sometimes
milky, and deposits a whitish slimy sediment, smells offensively shortly
after being passed, and occasioning strangury. It differs in color from
the dark-brown or porter-colored urine, seen in inflammation of the
brain, which contains more urea and less of iithates than that of hydro-
cephalus. {HydroGejph.^ p, 9.)

Oerebral Syonj)toms, Vertigo, stupor and coma follow the charac-
teristic headache : dilatation of the pupil, spasmodic contraction of the
eyelids, &c.

Diagnosis.- — Distinction feom Phrenitis. — The headache of hydro-
cephalus is of a lancinating, paroxysmal character, and accompanied
by voluntary ejaculations. -If the child be directed to shake the head
he tries, but suddenly he stops, utters a piercing cry, holding the head
fast between the hands. The head feels heavy and full anteriorly, and
there is a disposition to rest its frontal surface against the pillow.
Vertigo approaches more gradually and lasts longer than in phrenitis,
and is especially felt on assuming the erect posture. " The stupor is
more intense and longer continued than in other cerebral affections.
Rheumatic and colicky pains are found oftener in the abdomen, with
tenderness along the cervical and dorsal vertebrae which increase as
the disease advances. The respiration and pulse do not observe their
usual consentaneous action. The pulse may beat 140 or 160 per mi-
nute, while the respirations are only 40 or 60." But " the respiratory
effort is usually performed in a hurried convulsive manner, and there
is a marked increase in the duration of the expiratory act and the pe-
riod of repose ; deep and prolonged sighing intervenes, and consider-
ably diminishes the amount of the respiratory movements." The faecal
evacuations in this disease are more " tenaceous, gluey, and glossy in
their properties, with a more cadaverous smell, than in phrenitis or

HYDEOCEPHALUS. 721

other febrile affections. Tlie pupil is always dilated in idiopathic
hydrocephaluSj and it is only when the disease is complicated with in-
flammation of the brain or its membranes that it is permanently con-
tracted. The spasmodic contraction of the eyelids peculiar to this
affection is attributed to irritation of the filaments of the fifth pair sup-
plying the orbicularis ; and from the same cause there often exists
itching of the alae nasi, and lower lobe of the ear. The auditory nerve
is acutely sensible to impress^'ons, but the olfactory becomes obtuse.

Cerebral Auscultation" has been proposed as a means of distin- .
guishing hydrocephalus, but thus far without important results.

Causes.— -The predisposition to hydrocephalus is often inherited from
scrofulous or unhealthy parents. The latent cause most common is a
strumous or lymphatic constitution, which has most frequently origi-
nated in the highly excitable condition of a nervous and irritable
mother. A woman, whose brain and nerves are liable at all times to
be extraordinarily excited, whether by causes of great or small impor-
tance, always transmits to her child a feeble, ill-nourished, scrofulous
or otherwise unhealthy body, and an irritable weak or ill-balanced
mind. This disease may also result from the want of suitable food,
clothing, exercise in the open air. The health of children depends in
a great degree on that of the parents, their habits of life, and general
management. Let dwellings be improved; let food be selected with
greater regard to its healthful qualities ; and let children be properly
fed, clothed, and habituated to the appropriate degree of exercise in the
fresh air, and they will be less burdensome to themselves, their parents,
and the community. Hydrocephalus is often one of the tubercular forms
of disease inherited from phthisical, scrofulous or dyspeptic parents.

Pathology. — This disease is an idiopathic nervous fever with a de-
position of tubercular matter in the meninges of the brain, in its most
common and well-marked form. In some cases there is a limpid effusion
of serum, softening or slight opacity of the membranes, either on their
surface or at the base of the brain. In other cases there are signs of
tubercular deposit in various organs of the thorax and abdomen. Hy-
drocephalus, says Dr. Smith, "is not in essence an inflammation, much
less a dropsy ; but it may or may not be accompanied with inflamma-
tion in its origin," — it may or may not lead to effusion in its progress.
{On HycLrocephalus^ p. 68.)

Prognosis. — This disease once developed in that kind of constitution
which, of all others is most likely to be effected by it, has not often
been cured. In constitutions not hopelessly tubercular it can be gene-
rally treated with success.

Treatment. — -Prophylactic Measures.— In children suffering but
trifling indisposition, to outward appearance, but in whose families the
disease has already manifested itself by attacking other children, hy-

Voi.1.— 46.

722 DISEASES OF THE SANaUINOUS FUNCTION.

drocephalus may be feared, and all useful means for maintaining the
general health should be employed. Due attention should be paid to
all the secretions, the state of the skin, the physical strength and all
the indications of morbid activity of the brain, precocity of intellect,
&c. All invigorating measures should be immediately employed and
all mental excitement avoided. It is easier to criticise one mode of
treatment than to propose another that will be certainly successful.
Hitherto the most successful treatment has been directed to the pro-
ducing of a favorable crisis by the steady and uniform action of ail the
abdominal and cutaneous exhalents by means of homoeopathic remedies

A warm bath may often be found useful, though it must be employed
with great caution. And it may be useful in some bad cases if the
warm Avater be allowed to come up high enough to cover the chest at
the same time that cold, graduated to the strength of the patient, may
be applied carefully to the head. A sponge ^a^^,— formed of pieces
of thin sponge sewed together and to a leather border to secure it, may
be made to absorb any cooling mixture desired, and then, by its evapo-
ration the head may be carefully cooled ; andj in this way, the excess
of blood maybe driven from the head, at the same time that it is drawn
to the extremities and' surface of the bod}^ We have better resources.

The medicines which we would suggest in this affection are : Bella-
donna^ Digitalis^ Oannatis-ind.^ Hellebore^ Apis-mel., Wtix-vomica,
PJiospKoTus^ Stramonium^ Tartar-emetie^ Veratrum, Aconite, Ar-
nica, Arsenicum, JBry,, Cuprum-met, lod.-arsen., and Canthar.

During the first stage of the acute variety, our most reliable remedies
are Aconite and Belladonna. These should be given as often as once
in two hours, until a manifest effect has been produced, after which we
may repeat as circumstances require. '

Bryonia, — If the inflammation has not been promptly subdued by
the use of Aconite and Belladooma, but signs of effusion manifest
themselves in the form of " deep red, or almost brown face ; eyes rolling
in their orbits, sometimes closed, and at others wide open ; lips dry ;
tongue covered with a brownish yellow fur; tension and swelling of the
abdomen; constipation; generally retention of urine, or difficulty of
passing it; respiration quick, anxious and sighing; deglutition difficult;
skin of the whole body dry and burning, Bryonia acts surprisingly,"
{Bigel) . ^

Selleborus-niger has been successfully employed in many apparently
hopeless cases, which were attended with coldness and insensibility of
the surface ; rapid and feeble pulse ; convulsions and spasmodic ri-
^gidity ; face pale and swollen ; constant rolling of the head from side
to side ; moaning ; general prostration.

After decided marks of effusion obtain. Digitalis,^ Merc-sol,, Bellor
donna, Veratrum and Arnica deserve our consideration.

HYDROCEPHALUS. 723

Nux-vo'inioa M^d, Stramonuim will be required wlien great agitation,
flushed face, convulsions, strabismus, haggard and staring look, in-
volunta,ry twitchings of the muscles, dilated or contracted pupils, groan-
ing and crying, and opisthotonos are present.

PJiospliOTUS and Tartar- ewstio will be found useful in hydroce-
phalus, depending upon metastasis of some disease to the brain, and in
cases occurring in worn-out constitutions.

Administration. — The first, second and third attenuations may be
used, and the doses repeated once in from four to six hours.

jLpis-Tnel, is another remedy of importance. Several acute cases
are reported in the JBrit Jour, of HomcBopatky and elsewhere.

Kali-hydroicuni^ first decimal trituration, in grain doses, every
three hours, has often cured apparently hopeless cases.

Tartar-eQnetic—Ld^QmiQG used it to reduce the inflammatory action,
and restore the secretions of the abdominal organs. In chronic cases
Recamier used a bath of one ounce of Tartar-emetic to the pail-full of
water. He thought it reduced the size of the head and acted as a
diuretic. We can only rely upon internal remedies.

Mercury, — The treatment of inflammatory diseases by Mercurials
was commenced by Dr. Dobson in England in 1776. It was of course
used on a large scale, and the quantity sometimes employed seems in-
credible in this age. The following case treated by Dr. Kuhn of the
Pennsylvania University, in 1814, is reported by Prof. Chapman of the
same school. A child, six years of age, passed through the diiferent
stages of hydrocephalus, taking repeated and large doses of CalomeL
When the phenomena of effusion on the brain became evident, the
doctor commenced rubbing the whole surface of the body twice a day
with mercurial ointment of double strength. Long gloves made to
reach to the arm-pits, stockings extending to the groins, a wide belt
around the abdomen, and a cap on the head, were all thickly lined with
mercurial ointment. On the 14th morning, a slight ulceration of the
gums was- perceptible, and some improvement was apparent; but the
treatment was only discontinued after fourteen and a half pounds of
the strong ointment had been consumed. " Recovery" followed with-
out any perceptible inconvenience from the Mercury absorbed.

The reckless employment of Mercury has very often resulted in the
sudden development of most disastrous effects even when the quantity
given has been very small, and where a high degree of caution and com-
mon judgment have been exercised. Every physician who has precribed
much Mercury in any form knows that its action is uncertain and ca-
pricious in a great proportion of all the cases in which it is tried in a
crude form. It can only be used successfully and safely -in the ho-
moeopathic form. Mercurius-corr., or Mercurius-hydriod. employed at
the second triturations, have produced excellent effects in many cases.

724 DISEASES OF THE SANaTJINOUS FU]sroTio:Nr.

CHRONIC HYDROCEPHALUS.

Diagnosis. — Ghromo hydrooephalus is usually the result of a very
slight inflammatory action, which has progressed very slowly and insi-
diously. The characteristic indications which distinguish it from other
affections are, gradual emaciation, feebleness, unnatural enlargement
of the head, occasional giddiness, and now and then strabismus.

Teeatment. — The medicines we would suggest in this disease are :
Belladonna, Digitalis, Wux-vo^inica, PhosjpJhorus, Si/ixcmonium,
Ta/rtar-emetiG, Yeratrum, Aconite, Apis, CannAnd., Merc-cor.,
Arnica, Arsenicilm, Kali-hyd., Galcarea, Sulphur.

First Stage of the Actjte Variety. — Our most reliable remedies
here are first Aconite, followed hj Belladonna, They should be given
even singly or in alternation as often as one in two hours, until a mani-
fest effect has been produced, after which we may extend the intervals
as circumstances may require.

"We usually commence the treatment of this malady with Sulphur,
followed by Calcarea, both in the higher attenuations. These medi-
cines have the effect to modify the scrofulous dyscrasia which is often
present, and to prepare the system for the favorable reception of other
remedies.

Next to these drugs in value we should rank Kali-hyd., Digitalis,
Arsenicum-alb., and Hyd., Apis, Cannabis-ind., and Mercurius-corr.
These medicines should be prescribed in palpable doses, and repeated
often.

Case by Dr. Norton. — -Calcarea.—A. boy, aged one year, had been
previously under allopathic treatment. His appearance was scarcely
human ; the head was immense, with open fontanelles, and squinting
eyes ; his only attempt at speech or vocal sound was a distressing
grunt ; the skin was hanging in loose folds ; emaciation ; very tumid
abdomen ; diarrhoea, alternating with hard scybate, passed froni him as
from a senseless animal; periodical convulsions, amounting to opis-
thotonos; he drank milk greedil}^, through a tube, and'^till satisfied he
continued the grunting noise. After a dose of Calcarea 200°, he was
much improved. Calcarea 200*° and Sulphur 200° were given in
weekly doses, one medicine one week, the other the next week, and so
on alternately. In six months he was quite well." {Brit. Jour, of
^(?m., Vol. VIL

Dr. Liedbeck has recorded some cases of hydrocephalus success-
fully treated with Ferrum-aceticum. {Brit. Monthly Eev.y'YoloY.
p. 39.)

DISEASES OF THE EAE. 725

Genus IV.^INFLAMMATORY DISEASES OF THE EAR, MOUTH AND

THROAT.

1. Diagnosis of Diseased Condition of the Meatus Exteenus. — ■
Facility in conducting an examination of the meatus externus and
forming a correct judgment of its true condition can only be acquired
by considerable experience. To judge accurately of the nature and
extent of the disease that maybe present it is necessary to have a clear
idea of the healthy appearance of the part. This knowledge can only
be acquired by the careful inspection of the meatus in a large number
of healthy individuals.

Mode of Conducting the Examination. — Placing the patient in a
favorable condition to permit the rays of the sun to fall directly into
the ear, and then gently pull the upper portion of the auricle upwards
and backward ; and if the whole cavity can not then be well examined,
a speculum of some kind is required. " The instrument employed by
Dr. Toynbee is a modification of the cone introduced by Gruber and
Wilde. The portion which enters the meatus is of the same circum-
ference throughout, but oval, like a flattened cylinder, corresponding
to the oval shape of the outer meatus." " In order to hold the spe-
culum more firmly, it is desirable that the expanded portion should be
somewhat flattened; and this flattening should be at right angles
with that of the small extremity." The " forceps speculum," formerly
used with the design of dilating the meatus, is now rejected as unfitted
for that purpose.

When the sun is not in a favorable position for the direct falling of
its rays in the exact direction required, a mirror can be so adjusted
outside of the physician's ofiice window as to reflect the sun's rays into
the ear of a patient, sitting in any part of the room. When the sun is
obscured an artificial light may be substituted. This can best be done
by throwing the light of a good lamp or gas-burner through the spe-
culum into the ear by means of a concave reflector, having a small
opening in the centre, through which the surgeon can look. Specula
with magnifying lenses are sometimes advantageously employed.

In cases of otorrhoea, where there is a discharge from the meatus,
the ear should be gently syringed, and carefully dried by means of a
small tuft of cotton, before the inspection of the meatus is attempted.

2. Fobeion Bodies in the Eaks.— The symptoms commonly excited
are, intense pain; alarming inflammation which is propagated to deep-
eeated parts ; ulceration and granulations in the meatus, which may be-
come closed ; deafness is the common result.

Treatment. — The foreign body must be removed, but the eflbrt to
do it must be made with the greatest caution, as the offending substance
maybe thrust still further in, the membrana tympani ruptured, and

726 DISEASES OF THE sA:t;rauiNOus fujstctiok.

the body enter tlie cavity within. Forceps can scarcely be used, as
they must be insinuated between the sides of the meatus and the body.
Perhaps the best instrument is a steel-stylet, tapering from one ex-
tremity to the other, that the end in the hand may be stiff enough for
a handle. The other end like a small probe, obtusely flattened later
ally and bent at the point.— This point is to be insinuated beyond the
foreign body, and the instrument used as a lever to bring it out.

If this mode does not answer, try forceps with very large slender
blades, bent nearly at the right aDgles about an inch from their points,
which should be thin, a little convex on the outside, and slightly
curved imvard. They are bent that the hand may not exclude the light.

After removing the object the ear should be deterged by warm milk
and water. Many are mistaken about the existence of the substance
in the ear; at all events it is necessary to be careful. to avoid irritating
the external meatus in efforts to remove what is not there.

When an insect has got into the ear, place the patient on the opposite
side and pour sweet-oil in the ear. The insect will probably become
visible and may be removed by a roll of paper or small forceps.

Extraneous bodies, as gravel, shot, beads, cherry-stones, pieces of
wood, peas, beans, &c., when put by children into their ears, excite in-
flammation and swelling. They will generally be removed by slender
forceps, or by a hair-pin bent into an obtuse angle. This forms a
round smooth wire spatula so curved that it can enter far into the
external ear without injury, and, passing beyond the offending sub-
stance, withdraw it. A horse-hair bent into a spatula-form and wrapped
with a thread to form the handle, can be pushed farther into the ear
than the wire spatula, and if used with skill, will almost always bring
the extraneous matter with it.

If, before efibrt is made to extract the foreign body, inflammation and
swelling of the membrane lining the ear has proceeded so far that no-
thing can be introduced within the ear, the fever is also high, and there
is pain in the head, we begin by reducing the inflammation. Aconite
and Belladonna may be given in alternation so long as they seem to
exert an influence in allaying the inflammation. Warm fomentations
exert a homoeopathic influence by being applied directly over the ear.
Soft cloths wet in warm water may be laid so thickly over the ear as
to keep warm for considerable time. A few drops of Glycerine may
be dropped in the ear before the wet cloths are applied. A drop of
Lactucaxium in the Glycerine soothes the pain without doing any injury.
In one case a child had pushed the part of a fine comb into the ear, and
when examined the meatus was so swollen that the comb could not be
seen, and there was no room to insert any instrument. By fomenting
the ear the swelling was reduced till the comb was visible, and then
extracted with curved forceps.

DISEASES OF THE EAE. 727

3. Diseases of the Membeana Tympaki. — 1. Fungous Memhrans
covering the memhrana tympanL — This membrane in new-born infants
is over-spread in tlie external side by thick fungous membrane, which
soon disappears by suppuration. When this continues to adhere- to the
drum, instead of separating, it produces deafness. This is probably the
condition of most of the congenital deaf Tmotes. A deaf mute of
Chartres, in 1803, began to hear at twenty-four ^^ears of age ; another,
(says Riolan,) began to hear after the membrane was perforated with a
tooth-pick. At Nantes, a man deaf and dumb from his birth, at the
age of twenty-eight began to hear and speak.

The existence of this deciduous membrane has indeed hardly been
demonstrated. It is said that the suppuration is often imperceptible,
and that when the suppuration is going on the pus blends with the ce-
rumen of the ear, it is with difficulty distinguished, and must be
often and carefully examined. The wax during the suppuration is
changed in smell and color, the question of ability to hear is hardly
settled till the child is old enough to answer some questions. This
fungous membrane corresponds with the membrana pupillaris.

Diagnosis. — To ascertain whether this be the cause of deafness ; ex-
pose the ear to a strong light, directing the rays of the sun into the
external meatus. If the bottom be seen to be pearly white, smoothy
sensible to the probe, we may be certain, that there is no false mem-
brane ; but if the bottom be seen of red fungus, little or not at all
sensible to the probe, we may be assured the false membrane exists.

TREATMENT."— It has been proposed to destroy it by irritating it by
acrid medicines, or to cause it to desquamate by dry, mild corrosives.
But these measures cause unnecessary inflammation and sometimes the
inflammation thus excited only thickens the membrane ; as often hap-
pens in efibrts to destroy false membrane on the eye. Hildanus says,
a child, eight years old, had discharge from the ears. An empiric in-
jected into it an acrid fluid, which produced intolerable pain and inflam-
mation ; it was afterwards insensible to the loudest sound.

A child, aged six years, had inflammation of the ear excited by a
gla,ss-bead as large as a pea ; there was continual pain, afterwards in- ,
creased by cold and moisture. Then there began to be felt numbness,
first in the left arm, then the hand, next the leg, finally the whole side.
A dry cough and attacks of epilepsy followed ; the arm atrophied ; but
all of these symptoms ceased on the extraction of the bead. These
cases show that any substance introduced into the ear may be followed
by dangerous consequences.

Sassy prefers puncturing the membrana tympani, as "it restores
hearing more promptly than any other method ; and to prevent closure
of the pupil a small portion of a gum-elastic tube or sound may be in-

728 DISEASES OF THE SAITGUINOUS FUNCTION.

serfced in the opening, whicli should for a time be repeated every day."
{Diseases of the Ear^ This is now abandoned.

Valuable internal remedies for this form of deafness are : Kali'liy-
driod.^ Mercurius-hydriod., Sulphur. We prefer the low attenuations,
given every night for a considerable period.

4. Inflammation of the Membkana Tympani.— This inflammation
generally extends to the. adjoining parts. It may terminate by resolution,
suppuration, seldom by catarrhal effusion, though this last is the ordi-
nary termination of chronic inflammation.

Causes.— The most common cause is picking the ears ; any other ir-
ritation may produce it. Foreign bodies in the ear, retrocession of
external eruptions, as itch from the skin, or tinea capitis, are common
causes.

Symptoms. — Acute pain and fever, increased by the slightest noise
or opening the mouth, show acute inflammation. Chronic inflamma-
tion; less painful ; mucous or serous excretion; itching within the
ear ; at later stages the hearing is difiicult from the thickness of the
membrane.

Acute inflammation is generally soon cured. Chronic generally
leaves some hardness of hearing after it.

Treatment,-— 1. The measures that reduce inflammation in general

2. If the disease has been caused by the repulsion of eruptions, the
case must be treated by antipsoric remedies capable of reproducing or
curing the original eruption.

3. Some advise the softening of the secretion by emollient vapors^
washing the ears out with warm soothing liquids : lay over the ears
eotton-l)atting wet with warm oil of almonds.

Local washes injected into the ear. Cleansing the ear with mild
warm suds of Castile-soap.

External irritation to the back of the ear- has been much practiced.

Blisters have produced bad effects, as in the following case : A sol-
dier, who had passed many nights oh guard during the siege of Lyons,
had rheumatic pain in the ear. This afterwards ceased, but there re»
mained a buzzing noise in the ear and difiiculty of hearing. A blister
was applied over the mastoid region which increased the buzzing sound.
Another surgeon healed the blister, and applied another on the arm,
which cured both the buzzing and the deafness.

Madame G- , in Paris, had inflammation of the external meatus

of both ears, involving the membrana tympani. After a great many
remedies, the inflammation was apparently subdued by caustic over the
mastoid region on each side. To the inflammation now succeeded a
degree of deafness, which every day grew worse ; it having commenced
the same day that the caustic was applied. These and many similar
cases show that blisters, caustics and especially issues produce con-

DISEASES OF THE EAR. 729

gestion in the mastoid cells instead of relieving them and hence these
drains become causes of deafness. {Sassy^ on Diseases of the Ear.
Paris, p. 45.)

In the first period of the inflammation, give Aconite and Belladonna,
every four hours until the acute symptoms have subsided. After this
Hepar, Mercurius-corrosivus, Glraphites, and China will probably be in-
dicated. >

In the use of local applications extreme caution should be used, in
order that no undue irritation shall be excited or kept up, by their em-
ployment. Much injury is often produced by too frequent and too ac-
tive local appliances." In these cases, as in many others, unassisted
nature not unfrequently restores affected parts, which the efforts of art
would only have injured.

5. Ulceeations of the Meatus Exteenus.— -No membranes of the
body seem so often the seat of local diseases as the part of the tegu-
mentary system which lines the orifices of canals leading to internal
cavities. Here the skin and mucous membrane are blended into and
insensibly assuming the character of each other. Thus the muco-cuti-
cular membrane of the lips, that of the meatus, the prepuce and the nose
are characterized by the combined qualities of the skin and mucous mem-
brane, perform the offices of each other and participate also in each
other's diseases. Thus also these different membranes influence each
other by sympathy called continuous. A morbid state of the mucous
lining of the stomach diffuses itself along the membrane till it comes
to the skin, and this is also true in regard to disease located in the
skin. Thus we have cases of disease within and without. This ac»
counts for the frequency and obstinacy of ulcers of the meatus, eyelids,
lips, prepuce, &c.

In some of these regions morbific humors seek for an outlet, forming
ulcers, frequently of scrofulous or psoric character.

6. Abscess of the Meatus.— This is known by the purulent discharge
as more sanious than pus commonly is. It requires local cleansing
with fine soap and water, and protection from the cold air. And then
it needs constitutional treatment for the general psoric or scrofulous
diathesis, which is always present in patients in whom the abscess
tends to become chronic. The hearing is soon injured, the morbid
granulations grow up and overspread the membrane, excluding the un-
dulations of the air; or the ulcer spreading more slowly destroys the
membrane, the delicate small bones and extends to the accoustic nerve.

Treatment. — -If the disease is of recent origin, we may at once cure
it by cleansing the meatus with washes of water with Oastile-soap, and
treat the general condition, as it may be febrile, scrofulous or other-
wise. Other more remote irritations must be removed. Difficult den-
tition is often accompanied by abscesses within or behind the ears

730 DISEASES OF THE SANGUINOi: S FUNCTION.

Irritation from tlie stomach from noxious indigestible food, worms, &c.,
increase general fever and determinations to the head. These sources
of irritation must be sought for and removed. The constitutional
treatment and proper cleansing of the ear ought to be successful with-
out the local mineral injections recommended bj authors. In those
cases in which the abscess becomes chronic and lasts for years, we
must always succeed by internal treatment of the general dyscrasia as
has been done in many cases of which we give a few examples, p. 732.

Hepar-sulph., Calcarea-carb., Sepia, Mercurius-hydroid., Aurum-
met., and Silicea are the medicines most likely to be required in this
afiection. If the disease is recent the lower attenuations should be
employed ; but if of long standing, the higher preparations should be
prescribed at long intervals.

7. RuPTUEE OF THE Membeajsta Tympani. — Causes. — Violent use of
ear-picks, sneezing, erosion of the membrane by acrid pus. This cause
is the most common.

The accident is usually known by air proceeding from the ear with
a buzzing sound, so that a hair or the flame of a wax-candle shows the
current. If injections are thrown into the ear, the fluid comes out
through the mouth or nose ; also by injecting a fluid into the eusta-
chian tube it passes out through the ear.

Treatment. — Art has done nothing to restore the perforated mem-
brane. Nature can do with it as she does the puncture of the mem-
brane made by art. If the membrane is much injured, the hearing is
injured or lost, as the small bones of the inner ear are connected with
this membrane and it is essential to hearing. Some recommend a false
membrane to keep out the external air, but a little wad of cotton is
sufficient. The disease is incurable by art ; but a constitutional treat-
menl; with proper antipsoric remedies will greatly improve the patient's
general condition, and avert further progress of local disease.

Many cases of rupture of the membrana tympani originate in the se-
vere concussion of the air from the firing of cannon ; gunners, particu-
larly in the naval service, aware of the great danger to which the ear
is exposed, plug their ears well with wool. The wool gives only par-
tial protection. The effect of position with reference to the gun is pe-
culia.r ; those men who stand nearest the muzzle feel the report most,
and those who are to leeward suffer more than those to windward;
Some protection to the ear is said to be afforded by keeping the mouth
open when listening to heavy firing. During the French revolution a
dog, which stood near a cannon, was seen to run away and complain
loudly when it was fired. Blood ran from his ears ; he ran into a house
and died. The membrana tympani was found ruptured.

Dr. Von Mosckzisker says, the injury of the ear by loud explosions
may be obviated by " saturating a piece of cotton in a solution of Gly-

DISEASES OF THE EAK. 731

cerine and Belladonna, and placing it as far within the ear as possible.
This solution forms a coating for the surface of the membrane, and
with the addition of the cotton protects the drum of the ear to the
fullest extent. It can be afterwards washed out with warm water."

8. Polypus of the External Surface of the Membrana Tymi^ani
-—This may originate in any cause which produces irritation of the
part. Adynamic or ataxic fever frequently end in deafness, accom-
panied by long-continued suppuration and polypus of the ear.

Sassy says: "A young man, aged twenty-tAYO, had adynamic fevei
ten years before ; it left him deaf, with suppuration and buzzing sound
in the ear. Injections of the Eau de Balarac thrown into the auditory
passage caused the polypus which made these symptoms to drop off.
The polypus was like a strawberry, attached by a slender pedicle to
the membrane. Separation of this caused a slight bleeding only. The
suppuration and sound ceased and the hearing was immediately and
permanently restored." When .polypus exists, examination • quickly
shows its presence, but not the point of attachment. It can always be
removed by twisting it off, or by a cutting instrument, by ligature, or by
local applications, always duly associated with internal remedies. In
one case of polypus of the external ear, which completely filled the
cavity, a cure was effected by Scultetus in part by tearing away and
in part by the application of the actual cautery. A young girl had
an excrescence growing from the external ear implanted deeply in the
cavity, and issuing more than half an inch ; it was regarded as a true
polypus fungus and emitted a foetid purulent discharge from its surface.
It was removed by lacerations. See p. 426.

9. Relaxation of the Membrana Tympanl — The membrane pro-
trudes in the form of a pouch. It may be caused by violent coughing ;
violent inspiration; sneezing; an accumulation of mucus, pus, or rari-
fied air in the tympanum.

In the latter case it is sufficient to depress the membrane which may
easily be seen protruding. It may be effected by the end of the probe,
and the cavity stuffed gently with cotton or lint for forty-eight hours.
Removing this, a few injections of a mild astringent water occasionally
repeated for a few days. A weak solution of Sulphate of Zinc will be
sufficient.

10. Morbid Tension of the Membrana Tympani. — This may be
caused by such diseases of the brain and its appendages as produce mor«
bid acuteness of the sensations. Inflammation of the eustachian tube
sometimes causes morbid acuteness of hearing. The slightest noise
disturbs. In some persons the North or North-east wind makes some
persons peculiarly uncomfortable, with neuralgic pain and sensitive*
ness of the face, teeth and ears. The South wind relieves them.

Treatment. — Cure the fever and neuralgia with Aconite, Bell., &a

732 DISEASES OE THE SANGUmOUS EUNCTION.

Baths and vapors, emollient soothing applications to the internal ear;
fresh glycerine dropped into the ear over which cotton may be applied ;
protection from cold, removal of decayed sensitive teeth, &c.

Ot':^rh(ea. — Chronic. — The question of the propriety of suppress-
ing chronic discharges from the ears has perplexed all allopathic au-
thors. They have concluded that if we make the effort, we must blis-
ter, purge and give mercurial alternatives at the same ; and even then
the discharge must only be suppressed with slowness and extreme cau-
tion. They sometimes venture to arrest it in young persons, and also
where the disease is the result of suppressed evacuations.

Frederick Hoffmann cured cases of chronic otorrhoea by scarifying
taemorrhoids and applying leeches to them. A young girl had sup-
pression of urine and was immediately affected with discharge from
the ears. Gn restoration of the former excretion the latter im-
mediately ceased. {2£. Alard^ J)e Voreille.) A woman Jiad otorrhoea
for six months, following on suppression of the menses. When the
latter re-appeared, the purulent flow from the ears ceased sponta-
neously.

But in all ordinary cases suppression of otorrhoea has been pronoun-
ced dangerous by ancient and modern authors. The effects witnessed
of suppression have been convulsions, epilepsy, and death. A Vene-
tian who had an old discharge from his ear arrested, says Sadabert,
speedily died. A robust and sanguine man, aged sixty, had a consi-
derable otorrhoea of twenty-five years standing, though in other respects
he was well. The matter discharged was foetid and very thick. This
discharge, says Duverney, " being suddenly stopped the man died in
twenty-four hours of apoplexy." Alard says, "an attorney of Paris had
an ear discharging copiously of matter for a long time; the humor be-
ing repelled by cold, the ear became the seat of a violent inflammation,
which induced violent symptoms, followed by death." Similar events,
says the author, should instruct us to be careful to cure these dis-
charges from the ear while they are recent and not permit them to be-
come chronic. {Du^erney^ Traite de Vorgane de Vouie, p. 121.)

Dr. Richards, of N.-J., gives a case of a scrofulous girl, aged nine
years, who had been troubled for six years with constant purulent dis-
charge from the left ear. She was treated with Sulphur 80, Hepar-
sulph. 80, Calc.-carb. 80, and Lycopodium 80, for several weeks. Of
these remedies Hepar and Calc.-carb. seemed to have some effect, the
others had none. Feb. 18, 1860, gave them Aurum sixth, six pellets
three times a day. March 5th, improving. March 28th, cured. Feb,
of next year there had been no return. ( U, K Jour. Momwop, Vol.
II. p. 491.)

Ajpis-meL-^-DY, Munger cured a case with the following symp-
toms with this remedy: Hard, red, somewhat conical swellings, usually

DISEASES OF THE EAE. 733

on the lower extremities below the knees, but sometimes in the arms,
and occasionally on other parts. Some no larger than a dime, others
an inch or two in diameter ; heat, redness, extreme soreness, a burning,
smarting, stinging pain. In from two to six days the spots became
livid ; the swelling, heat and pain subside ; but new spots continue to
appear; slight general swelling of the limbs ; little febrile excitement.
{New Materia Medica.)

11. Induration of the Mem'bram.a Tymjpani. — This membrane some-
times becomes hard, as if cartilaginous or bony. This state may arise,
1. from inflammation, tumefaction of the glands of the septum, an affec-
tion which Bartholin declares very common in persons affected with
abdominal dropsy ; 2. from venereal disease ; 3. from intemperance in
drinking : 4. from age.

Symptoms.- — Deafness, diminished sensibility of the membrane if it
be only hardened ; but if it be ossified it becomes insensible to the
probe; then there is want of elasticity, and when firmly ossified the
membrane emits a sound when struck with the instrument. If the in-
duration proceed from the venereal virus the expansion of the ear is
covered with scales easily detached, leaving the organ red ; though
these scales may arise from predisposition to the tetter. A case was
seen in the Hotel Dieu in Lyon who was completely covered with the
scales. The nails, hands and feet were hard, thick and of dirty white
color ; ears red and scabby, and hearing difficult.

Treatment. — Some of these cases have been treated by surgeons
with injections, others by puncturing the membrani tympani; others
again by injections through the eustachian tube.

1. Perforation of the membrane has succeeded when this septum was
cartilaginous or ossified, the rest of the organ remaining healthy. Also
in stoppage of the eustachian tube when is is impossible to remove this
obstacle by other means at hand. Also when owing to malformation,
.chronic svf elling or polypus of the nostrils.

2. This operation is insufficient when the cavity of the drum is ob-
structed by matter which is so thick that it cannot pass through the
artificial opening.

3. It will be useless when deafness depends on paralysis of the audi-
tory nerve.

4. It will be equally so in cases of deafness which proceeds from
catarrhal affections and nervous irritation.

5. When deafness is the consequence of adynamic and ataxic fevers,
and the eustachian tube unobstructed, this operation will be in-
effectual.

6. This operation, excepting in the first-named cases above, should
be rejected from the means of treating deafness.

734 DISEASES OF THE SANGUINOUS FUNCTION.

In these cases, a long-continued course of antipsoric, or anti-venereal
remedies, will always produce good results.

Induration of the membrani tympani and consequent deafness, often
occur in scrofulous subjects who have suffered from syphilitic affections.
Such cases are alwa}^^ more or less benefitted by the high potencies
of Mercioriii^s^ Sulphur^ NitriG-acid^ Calearea'Carl).^ Hej^ar-sulpJi.^
Lycojpodhim^ and Kali-hydriod,

12. OzGENA. — Ulceration of the lining membrane of the nostrils, at-
tended with foetid discharge; and sometimes followed by destruction of
the cartilages, and by caries of the bones of the nose. In some cases
there is a large accumulation of thick mucus, or incrustations which
sometimes block up entirely the passages of the nose. Wheri not
checked, it progresses among the cartilages and bones of the nose, and
extends to the cheek, producing frightful deformity. See p. 423.

Causes.— It is generally excited by exposure of the face to cold, but
the extreme cases are connected with either a scrofulous or syphilitic
discrasia.

Treatment.— Kemedies. — Teucrium, Sulphur, Pulsatilla, Bell., La-
chesis, Lycopodium, Causticum.

Syphilitic 6>^6e^^<^.— Mercur.-sulphuret, Hepar, Aurum, Nitric-acid,
Lycopodium, Lachesis, Conium.

Scrofulous {?^c^e7^a.— Phosphorus, Silicea, Nitric-acid, Conium,

Arsenicum, — One of the best specifics. Symptoms : pains severe,
burning and throbbing.

Zy<^oj96>(^mm.— Discharge thick and yellowish.

Pseudo-ozoena from Foreign Bodies in the Wostrils.—J)v, Culbert
of Newburgh, N. Y., gives some cases'^ presenting the following symp-
toms: " At first there is merely a feeling of stuffiness and obstruction
of the nostril. The natural secretion of the nose not escaping freely,
sooner or later putrefy, and give rise to an ill odor. This putrid mass,
again, acting as a local irritant, causes increased redness and vascu-
larity,—in a few weeks or months, congestion and ulceration of the
schneiderian membrane, foul secretions, foetid smell and the symptoms
of constitutional ozoena."

' In one case a boy, aged four years and a half, had offensive discharge
from the left nostril through which he was unable to breathe. As the
family was scrofulous, one member having died of phthisis, and a son
Buffering from hip-joint disease, this nose affection was considered of
similar origin. The lining membrane of the nostril was congested,
bleeding when touched, foetid liquid oozing from it. By bringing a
strong light upon the affected spot, a grayish white substance wa.s
found, resembling a mass of concreted pus, as large as half a small

* U. States Jour, of Horn., Vol. I. p. 73.

INFLAMMATION OF THE TONGUE.

735

pea. A small string of mucus-coated substance was drawn doAvn with
forceps, and was found to be wool from a rose-blanket ; following came
a tea-spoonful of thick mucus mixed with blood. Washing with tepid
soap-suds speedily cured the ozoena.

In another case, a boy of three years had been treated several
months for ozoena with Hydriodide of Potash, Sarsaparilla, and local
use of Nitrate of Silver. A roll of paper was extracted; castile soap-
washings cured the ozoena in a few days.

A tliird child, aged four years, had been treated with Arsenicum
30^, 60^ and 100^ without effect. After a putrid pumpkin-seed had
been blown from the nostril, the child got well without treatment.

A fourth case was supposed for several weeks to be one of worms ;
showed itching of the nose, pain at its root, headache ; face swollen ;
eyes red, sensitive to light. Injecting the nostril with water excited
sneezing ; a grain of wheat was then extracted with a forceps. It had
lain so long in the upper part of the nostril that it had germinated, "hav-
ing a root and blade attached; it was one and a quarter inches long."

13. Swelling and Inflammation of the External Nose. —
Treatment.-— 'When caused by a blow, contusion, or fall, Arnioa is the
best remedy. Calendula is also useful. If caused by abuse of Mer-
cury, give ABCC7'icm, Aiir., Bell.^ Hepar^ orSulph, Redness of the
nose, caused by intemperate drinking : Arsen.j Oalc.^ Puis., Sulph,
Redness in scrofulous patients : Iodide, Merc, jSulph., jPhos.., Colo,
Copper-redness: Arsen., Gupr,

IT. INFLAMMATION OF ORGANS AND TISSUES CONNECTED WITH
THE DIGESTIVE SYSTEM.

1. glossitis.-inelammation of the tongue.

Glossitis,-— Inflammation of the 7^<9^.^i^<^.— -Inflammation of the
tongue is by no means a common affection, but cases now and then occur
in which this organ is so enormously inflamed and swollen, as to place
the sufferer in imminent danger of suffocation. It may arise spon-
taneously, with but few and slight premonitory symptoms of its ap-
proach, or it may proceed from derangements of the stomach, sudden
changes of temperature, and the application of irritating or poisonous
substances. Generally it runs its course rapidly, and if not met by
prompt and efficient measures, will so fill the mouth and throat as to
suspend respiration.

Diagnosis. — Previous to the pain and swelling of the tongue, the
patient is affected with slight chills, loss of a.ppetite, lassitude, indica-
tions of disordered stomach, dull pains in the head and back, succeeded
by throbbing and aching pains in the tonguo, heat of the skin, and
rapid pulse. The tongue now commences swelling, and often pro-

736 DISEASES OF THE SANaUDSTOUS FUNCTION.

gresses, if the inflammation is not arrested, to an alarming extent.
It is usually red and dry, but in some instances continues moist through
all the disease.

Causes. — Derangements of the stomach, exposure to strong currents
of air, mercurial salivation, small-pox, the application of irritating sub-
stances, stings of insects, certain poisons.

Treatment. — The physician is sometimes summoned to cases of
this description, where the danger of suffocation is so threatening, as
hardly to render it prudent to await the operation of remedies. In these
instances free and deep incisions should be made into tho substance
of the tongue in a parallel direction, which will afford prompt tempo-
rary relief, and thus allow us time for the action of our specific remedies.

The remedies which will apply specifically in these cases are, Mer-
curius^ Belladonna^ Plumbicm^ Aurum^ Ilej^ar^ Calendula^ Arnica,
NitriG-acid^\Kali-hyd.

J/6^c^^Wi^s-s6»Z.— -Expression of countenance anxious and terrified ;
tongue inflamed, swollen, red, dry or moist ; respiration exceedingly
difficult ; pulse rapid and full ; constant inclination to keep an upright
position ; skin hot and dry.

Febrile Symptoms. — Heat; thirst; pains in the head, back and
limbs ; throbbing, stinging, or aching pains in the tongue ; mouth and
throat filled with the swollen organ, giving rise to a dreadful sense of
suffocation; symptoms somewhat aggravated during the night; rapid
sinking of strength; respiration rather better in the air, and on gentle
motion ; deglutition partially or entirely suspended.

Excessive anguish, apprehension, and constant and insurmountable
dread of immediate suffocation.

ADMrniSTEATiON, — Divide two grains of the third trituration into six
equal parts, — -one powder, dry upon the tongue every^ half hour in
urgent cases until there is relief, or a medicihah aggravation. In less
severe cases the medicine may be given once in two, four or six hours,
according to the symptoms.

Marcus gives (Magazin ii.) a case of inflammatory swelling of the
tongue and of the pharynx, which he cured with Mercury. , The daily
experience of all old school physicians, at least, proves that Mercury
has a specific tendency to produce inflammation and tumefaoUon of
the internal farts of the mouth ; even when applied on the skin it
produces these same effects.

Belladonna. — Face red; eyes bloodshot, or suffused; tongue in-
flamed, red, dry and swollen ; violent pulsations of the carotid and
temporal arteries ; pulse rapid and bounding.

Congestion of the blood to the head ; throbbing pain in the head ;
eyes sensitive to the light; skin hot and dry; thirst; throbbing, dart-
ing or drawing pains in the tongue; difficult and anxious respiration:

APHTHA. 737

deglutition extremely difficult or entirely suspended ; sense of suffo-
.cation.

Great agitation ; fear of death. ; anxious and depressed.

Administration. — A drop of the third dilution on two grains of
sugar of milk] divide into four equal, parts, and exhibit one dry upon
the tongue once in one, two or three hours, as the urgency of tlie case
may demand.

Plumbum. — Plumbum is appropriate in cases of chronic swelling
of the tongue, with limnhiie^^ 2i:n.di ^ccrtial ;paraly sis. Convulsive trem-
ors and general muscular debility are other indications for the employ-
ment of this remedy.

In cases of glossitis proceeding from the abuse of Mercury, recourse
may be had to AuTum-muriaticuvi^ Kali-hyd.^ NitriG-aoid^ and
Ilepar-sulph. If the inflammation be owing to a wound or injury,
Arnica is the proper remedy.

Herpetic Glossitis. — -Diagnosis. Redness of the mucous inem-
brane and development of the papillae, or exfoliation of the epidermis
thelium ; at a later period, partial induration, fissures, ulcerations and
transformations of the epidermic tissue, smarting, shooting pains caused
by contact of food and drink, while the sensation of dryness is perma-
nent. There is generally also a dyspejptio state., either with or
without hmmorrhoids J and the glossitis follows in a remarhable
manner the modifications which this general herpetic state under-
goes. When the disease becomes well established, the fissures show
indurated edges, become deep and are often taken for a syphilitic
affection, even for cancer. It is often treated by cauterizations which
may cicatrize the fissure; but it soon breaks again, and every cauteri-
zation increases the inflammation or induration. Dr. Escallier {IJArt
Medical, 1861.) gives the case of a native of Yucatan, in whom the
disease commenced in 1846. He had sought a cure in Mexico, and by
a voyage to Europe ; had been five times cauterized and found himself
worse after each trial ; he had been treated with Mercury, and longer
by Iodide of Potassium. He was at last subjected to homoeopathic
treatment. He took Sulphur 10° in water, Nov. 2. There was gradual
improvement. Nov. 4, Staphysagria 6°, was directed; on. the 22d the
digestion and action of the bowels had been good ; the tongue moved
easily and was nearly healed. He continued under treatment till the
summer of next year ; and during this time took Staphysagria 12°,
Sulphur 80°. Borax for Aphthae, Orpiment and Sulphur 12°, &c,
Finally returned to Yucatan quite well.

APHTHA.-THRUSH.— Muguet.-Stomacace.

Aphtha in adults occurs most frequently in the course of other dis-
eases, and then it indicates deiility^ imperfect digestion and mal»

Vol. I.— 47.

738 DISEASES OF THE SAKGUINOUS rUN"CTIOl!T.

nutrition. The worst cases are those called stomatitis materna in
nursing females and those of infantile aphtha in children at the period
of lactation. We shall treat of them separately.

1. Aphtha Infantilis. — This disease appears in small white ulcers
upon the tongue, gums, and around the mouth and palate, resembling
small particles of curdled milk. When the disease is mild, it is con-
fined to these parts ; but when it is violent and of long standing, it
generally extends through the whole course of the alimentary canal,
at least in the oesophagus, so far as is supplied by reflected epidermis.
We have here in the mouth and upon the tongue the white, creamy,
circular spots, which are scattered buttetid to coalesce at their margins.
These spots form little islands of a matter which at first is very white,
and not easily destroyed or removed. The islands consist of a species
of small grains which are distinct and opaque, having nothing resembling
vesicles filled with liquid. On the inner surface of the cheeks these
productions bear a close resemblance to milk-curds arranged in clots.
Among patients having a continuous coating of thrush,— the exudation
having become yellowish or brownish in consequence of matters vom-
ited, of blood efi*used, or of medicines taken, the pellicles are less re-
sisting, easily broken and their adherence to the mucous membrane is
delicate. The deposit is smooth, and in consequence of its not involving
the deeper layer of epithelium, is not accompanied by ulceration.

The salivation is not extremely abundant. It is known, that in some
cases of children the milk is quickly acidulated in the mouth. In mild
cases of muguet, the saliva becomes diminished by the acidity of the
buccal mucus, as is proved by the reddening of litmus paper when it is
brought into contact with the mucous membrane.

The disease in severe cases is attended by drowsiness, sickness,
feverishness, severe purgings, flatulencies and other disagreeable symp-
toms, the surface remains brown or bluish after the loosening and sepa-
ration of the crusts ; the local afl"ection runs into a bad kind of gangre-
nous ulceration; the discharges from the bowels contain slime and shreds.

Aphtha sometimes appears as a chronic disease in warm, moist and
malarious climates. It begins with evident derangement of the stomach,
acidity and uneasy feeling or burning in the stomach, increasing gradu-
ally in violence. After some time, small pimples of the size of a pin's
head appear on the tip and edges of the tongue ; these soon spread
over the whole inside of the mouth, causing tenderness and rawness,
till the patient can not take any solid food; acid and stimulating drinks
cause pungent burning pain. There is little febrile heat ; but the skin
is dry, the countenance pale, the pulse is small, the extremities cold.

In debilitated children improperly nourished the aphthous ulcerations
become gangrenous ; the edges shrink, become flabby and ragged ; a
brownish slough forms in the centre ; and on coming ofi*, a granulated

APHTHA. 739

surface of Vermillion color remains ; the ulcers become covered with
a brown, creamy fluid, which exhales a gangrenous odor ; the parts
around the ulcers become tumid, soft, and of a violet hue* The saliva
becomes foetid, ropy, flowing from the half open mouth. Countenance
pale and pufiy ; the pulse feeble ; surface of the body pallid, deficient in
sensibility. The vomiting and diarrhoea become profuse, exhausting ;
abdomen tympanitic ; hiccough and eructations precede complete ex-
haustion and death.

Pathology.— When a portion of the pseudo-membranous layer that
spreads over the inside of the moutlj, fauces and oesophagus is minutely
examined, the following appearances are seen by aid of the microscope:
The substance is composed entirely of a collection of cryptogamic plants.
M. Gruby says, the roots are cylindrical in form, transparent, and about
:j-^-u th part of a millimetre in diameter, and implanted in the cellules
of the epithelium. During their development, projections from these
roots penetrate tl^e entire series of cellules of which the epithelium
is composed, to arrive at the free surface of the mucous membrane.

These parasitic plants have some resemblance to the cryptogamic
plant called the sporotrichium. They are fragile, easily detached by
the movements of the tongue and lips; and, by mixing with the food,
they are carried downward ; and thus they become transplanted to other
portions of the lining membrane of the oesophagus, and in some in-
stances to the lower intestines. Children in whom this extension of the
disease takes place to any great extent, fall into a state of marasmus?
and soon die. {Bee Drs, Gruby, Berg^ OesUrlein and Conclie)

2. Mekcurial Stomatitis. — In this form of aphtha, which is only a
result of mercurial poisoning, the salivation appears in advance of the
membranous formations. This salivation differs entirely from that
which accompanies other pseudo-membranous a.ffections.

The appearance of the false membranes of inerGurial stomatitis is
that of grayish concretions which are not very adherent, and which
are frequently covered by ulcerations. They have been observed upon
the tongue and upon the cheeks, with elevations which correspond to
the intervals between the teeth, and which are frequently more reddened
than the remaining mucous membrane, of which the tint is grayish or
ash-colored.

3. Ulceko-membranous Stomatitis. — The appearance here is alto-
gether different from the last. In such cases there is always some
ulceration beneath a soft and yellowish cast. This cast is sometimes
strongly adherent in its middle portion. The ulceration is frequently
covered by a simple whitish exudation, or by sanious pus. The edges
are swollen, the base ecchymosedrand sometimes of a brownish color.
The submaxillary glands are engorged. When the ulceration is located
upon the dental borders we find the alveoli occupied by a chalky pulp •

740 DISEASES OF. THE SANGUmOUS FUKCTION.

the gums are raised, fungous, of a reddish or violet red hue. {LdbouTbene
on Pseudo-membranes.)

4. Cheonio Exanthematous Eruptions of the Intestinal Canal.
Symptoms, — -Greneral indefinable debility and emaciation ; a condition
often of broken and impaired health without any very appreciable
cause; the muscular system easily fatigued and exhausted; sometimes
so much palpitation as to lead to the idea of heart-disease ; the cir-
culation weak, as shown by the coldness of the extremities, diminution
of nervous power, irritability, &c. Direct evidence of the presence of
and tendency to m-ucous eruptions in such subjects, can generally be
obtained by carefully examining the state of the mucous membrane
within sight. Spots of eruption and sometimes ulcerations left by them,
will frequently be detected on the inside of the lips and cheeks and on
the gums and tongue. The tongue, with the mucous membrane lining
the cheeks, is not unfrequently so swollen as to be marked and indented
by the impression of the teeth. Sometimes when thus enlarged, the
tongue is whiter than usual ; but in other cases we see it red and ir-
ritable, and one or more distinct and broad patches of eruption are seen
upon its surface. {Dr. Simpson of Edinburgh.)

Acute exanthematous inflammations generally form a "complementary
addition to eruptions on the general integument ;"^ sometimes they
are " vicarious with the crisis of an exanthema upon the skin, which
from various influences of which we are ignorant, is insufficiently de-
veloped ;'^ sometimes they constitute a specific eruption, arising from
a special relation between the general disease and a particular tract
of mucous membrane. The two first of these varieties appear on the
mucous membrane, where it joins the original seat of the disease, as in
the mouth, pharynx, tracheal passages, conjunctiva, or urethra. The
last kind is confined to particular parts of the mucous system, as the
ileum in typhus, or the colon in dysentery."! Chronic exanthematous
affections have as yet been little studied.

5, stomatitis MATERNA.-NURSINa SORE THEOAT,

Geneeal Symptoms. — Anwmia is seldom wanting in well-marked
cases. The complexion is less waxy and clear than in chlorosis, with
more of the sallow and cadaverous shade than is seen in other diseases.
The tint is peculiar, and is recognized at first sight. It is dependent
on the ansemia, and in common with the other symptoms is attributed
to local irritation and suffering superadded to a cachexia which is in
some cases related to scrofula, in others to scorbutus.

The Diagnosis generally turns on the general condition of the pa-

* Dr. Helmuth. U. States Jour. Horn. Vol. I,, p. 407.
fRokitansky, Path. Anat Vol. III. p. 55.

STOMATITIS MATEENA.

741

tient. The disease presents the peculiar characteristic local symp-
toms and is found in subjects who are either enciente^ or in some one
of the stages of recovery from the puerpural state. The aphthae of
advanced phthisis, with which it is often confounded, is a different and
much more fatal disease.

Treatment of Stomatitis. — ArseniGum-album, — Stomatitis oc-
curring in malarious districts, most of whom have been injured by
Quinine ; or where the water is more or less stagnant, and impreg-
nated with the common causes of malarious fever. There is a de-
praved condition of the system analogous to typhus ; the local erup-
tion is vesicular in character ; there is dryness and inflammation of
the buccal mucous surfaces. The edges of the tongue are ulcerated;
aphthse, violent burning pains ; swollen and readily bleeding gums,
looseness of the teeth; debility; sinking. .

Galcarea-GarboniGa, — Dr. Ludlam gives the following indications :
In cases where disorders of digestion, in pregnant or lying-in women
are due to a stomatitis which may be either latent, or may have already
so far localized itself that its real nature may be known ; the constitu-
tion of the patient is scrofulous or consumptive ; there is inveterate
diarrhoea, not relieved by other remedies. There is " great dryness of
the mouth and tongue, with a sense of roughness and stinging ; a dry,
bitter, sour, or metallic taste in the mouth ; great aversion to boiled
food, and to meats in particular ; inclination to salt diet, or to eat such
forbidden articles, as pickles, dirt, chalk, slate-pencils, &c., strong and
unconquerable desire to sleep after dinner or tea ; nausea, with acid
eructations ; vomiting of the ingesta ; profuse colliquative diarrhoea, the
stools being sometimes quite undigested ; faintness, with swooning, after
stool or exercise ; a sudden metastasis of the eruption from the mouth
to the alimentary mucous membrane ; acidity of the urine, with burn-
ning of the urethra, &c. The third decimal trituration, repeated thrice
daily. {Amer, Horn. Review, 1860. p. 252.)

Merourius, — Red, spongy, receding, ulcerated gums, with burning
pains at night, soreness when touched ; loose teeth, inflamed, sore, ul-
cerated tongue and mouth, covered with aphthae ; foetid cadaverous
smell of the mouth and ulcers ; saliva profuse, foetid, bloody ; ulcera-
tion of the stenonian duct ; tongue swollen, stiff, hard, or moist and co-
vered with white mucous ; face pale, chills ; burning diarrhoeic stools.
The eruption on the mucous membrane assumes the form of ulcers,
more or less corroding and destructive of the tissues, and there is pro-
fuse secretion of saliva. When the corroding tendency is manifest and
the breath has an offensive putrefactive odor it is recommended to al-
ternate the Mercurius-vivus once in four hours.

Natrum-muT, — Swollen gums, readily bleeding ; sensitiveness to
cold or hot substances , ulcers and blisters in the mouth, on the tongue

742 DISEASES OF THE SAKGUINOUS FUNCTION.

and gums, with burning pain and impeded speech ; ptyalism, rigidity
of tongue.

JVttriG'aoid,'--Bleedmg ; \Yhite swollen gums ; loose teeth ; sore
mouth with stinging pains ; foetid smell of the mouth ; ptyalism.

Mu7'iat.-aGid.—T\ns is one of the best constitutional remedies; i
is recommended where it is believed that the disease has Sb^arasitioa
character.

NuX'VOinica, — In incipient cases first manifested " through perverse
disorders of the nutritive system; suspend it when the eruption appears
in the mouth, especially after diarrhoeic symptoms begin.

Sulphiiric-acid. — Aphthge in the mouth ; swollen, ulcerated and rea-
dily bleeding gums ; profuse ptyalism.

SidphuT. — Gums bleeding and receding from the teeth, with throb-
bing pains ; blisters and aphthas in the mouth and on the tongue, with
burning and soreness when eating ; foetid and sour smell of the mouth ;
ptyalism, or bloody saliva ; tongue thickly coated, whitish or brownish ;
slimy, greenish stools, with tenesmus ; rash; restlessness at night.

Veronica-haocabiirga, — Dr, Prentice of Freeport, 111., says, he has
used this plant in the first decimal trituration with great success for
years; also applying it as a local wash.

Local Treatment. Dr. Curran, of Hannibal, Missouri, recommends
the Oleum-juglandis (Butternut- oil). All local treatment will fail ex
cept when associated with appropriate constitutional remedies.

FraseQXt-carolinensis, — Dr. Murch directs a gargle of an infusion
of this plant for the mouth, also for the nipple when very sore and sur-
rounded with vesicles. Hydrastis is a still better remedy. '

For further remedies see page 248. Also Scurvy. — Index,

Diet. — This must be that which is best calculated to promote the
general health, allowing for all peculiarities of condition and idiosyn-
cracies of the patient. It must be as nutritious as can he digested
and assimilated.

It may include, beef-tea, oyster-soup, good, dry, mealy potatoes also.

Vegetable acids, as baked apples, oranges, or weak lemonade. Many
of the cases which have baffled allopathic skill and are not promptly
cured by homoeopathists, are scorbutic in their character and can not
be cured without these grateful acids.

4. parotitis.-mumps.

This afiection is classed by writers as an epidemic. It more com-
monly attacks children, than adults, and generally makes its appear-
ance during cold and damp seasons. Its cause is a specific morbific
contagion, which may be generated during certain peculiar conditions
of the atmosphere, or it may be communicated from the bodies of those
having the disorder.

MUMPS. 743

Diagnosis. — Slight febrile disturbance, followed by swelling and
pain in one or both parotid glands. Under favorable circumstances
the local aifection continues to "progress until the end of the fourth day,
at which time the inflammation and swelling have reached their height,
then tumefaction and pain gradually subside, until at the end of about
seven or eight days from the commencement, all traces of the com«
plaint have departed. As soon as the inflammation has fairly de-
clared itself in the glands, the patient experiences much difficulty
and pain in moving his jaws, masticating, or even the sight of savory
food, especially acids.

It is highly important during its progress, that there be no exposure
on the part of the patient, either to cold or dampness, nor from any
undue mental or physical excitement. In this manner we may guard
against those troublesome metastases to the brain, mammse and testes,
which sometimes supervene from improper exposure, external applica-
cations, &c.

The pain of the swollen part is of a tensive cha<racter, combined with
pressure, rendering both chewing and swallowing difficult. When the
disease affects one side only, the face appears drawn to one side.
Often the cellular tissue and the skin overlying the gland are infla^med,
and then the patient seems to have erysipelas.

Sympathetic swellings often affect only one testicle, and then it has
been noticed only on the side opposite to the seat of the mumps. The
scrotum over the testicle is more or less swollen and red. Sometimes
after the disappearance of the mumps a metastatic inflammation of tha
testicle is developed, when there is shooting or bruised pain in it.

In mumps there is generally fever, a full tense pulse and great heat ;
head hot, aching hot feeling of the head ; shooting hard pain in the
aftected parotid; redness of the face, in some cases of the conjunctiva;
photophobia and flow of acrid tears ; thirst ; constipation.

A severe epidemic of cynanche parotidea catarrhalis is described by
Dr. Baertl. {Brit. Jour, Homoeop, 1861.) The disease was preceded
by feelings of general illness ; ill-humor ; prostration of strength, dis-
turbed restless sleep, want of appetite, shivering, alternating with heat ;
headache, extending to the neck ; coryza and uneasiness. A few days
afterwards the region in front and beneath the ear became swollen and
hard, generally also red and painful; sometimes nearly the whole neck -
swelled also, and the sub-maxillary glands a,nd tonsils were aff*ec ted.'

The fever in some epidemics afiects the chest, when there is cough
with but little expectoration of mucus ; heat and aching of the chest ;
there is also sleepiness ; restless sleep at night, starting on falling
asleep, and horrible dreams. In these severe cases the patients are
prostrated and depressed at the commencement of the disease.

Duration of the disease : about one week, at most fourteen days^;,

744: DISEASES OF THE SANGUIKOTIS FUNOTIOK.

Causes contributing to its Development — Atmospheric influences.
Suppression of the perspiration, a catarrhal predisposition.

Termination of the disease, usually in resolution on the third or
fourth day by a general warm perspiration. The sleep becomes more
tranquil, the fever declines, the swelling subsides, and other morbid
symptoms disappear.

Treatment." — But little medicinal treatment is required in this ma-
lady, provided the precautions just alluded to are heeded ; a few doses
of the sixth dilution of MercuriuS'Sol. being all that is necessary to
conduct the patient happily through the attack.

Sometimes, however, coma and other alarming symptoms of cerebral
disorder, suddenly appear from metastasis of the disease to the brain/
which require the prompt administration of Belladonna,^ Opiurn^ or
other cerebral specifics. More commonly, however, the metastasis oc-
curs to the mamm^ or testes, causing inflammation, swelling, indura-
tion, and occasionally suppuration in these glands. . The remedies in
these cases are MeTmiT.-sol,^ Bell.^ Nux^j Puls.^ and Aeon, See the
particular indications for these medicines under " Infiammation of
the Mamram and Testes^

In severe cases, keep the patient in bed, covering him with a moderate
supply of clothing ; regulate the food and drinks.

The external swelling may be covered with dry flannel ; the swollen
scrotum should be placed in an elevated position and covered with dry
cloths and supported by a suspensory bandage.

Belladonna. — In the epidemic described by Dr. Baertl, it proved a
specific, effecting rapid amendment and cure. It was generally given
in the third dilution, a few drops in several' ounces of distilled water,
a table-spoonful every three hours. On the decline of the disease the
intervals are lengthened.

Mereurius-solu'bilis, — Used with success when the inflammation is
not highly marked. It should be given as high as the third trituration^
and in the milder cases, when it will be effectual if given only once per
<iay.

GalcaTea'CarboniGa. — In cases in which the course of the disease is
slow, and almost without fever.

MerGurial Parotitis, — This form of parotitis never exists as a pri-
mary affection, but follows other diseases yi which Mercury has been
used. When the original malady has arrived at that stage in which it
seems entirely subdued, and the patient is lingering between disease
and convalescence, he suddenly complains of a pain and swelling be-
neath and in front of the ear. The affected spot soon shows a throb-
bing tumor, which is extremely tender to pressure by the finger or the
pillow ; and it increases, becoming painful, lancinating on every motion
of the jaw, spreading anteriorly with great rapidity. In a few hours,

MUMPS. 745

tbe whole side of the head becomes involved ; the eyelids, lower jaw,
side of the neck, the cellular tissue of the neighboring parts, the
periosteum, muscles and parenchyma of the glands, are all included in
one mass of inflamed tissues rapidly advancing towards suppuration*
The skin over the tumor is red, smooth, tense and glossy ; when felt
by the hand, it emits a peculiar burning heat, and the hand feels as if
pricked by needles. The surface resembles an inflamed spleen, co-
vered with serous membrane.

As the disease advances, the pain becomes more intense, burning,
and lancinating. Swallowing is now exceedingly painful. The coun-
tenance is flushed and livid, and sufibcation begins to be threatened.
When the intumescence has reached its heiglit, the pain subsides. The
head has now a feeling of dull heaviness ; the tumor becomes livid ;
there is deafness of the ear of the affected side, low muttering deli-
rium, with other symptoms of cerebral oppression and deep nervous
prostration. The tumor at this period begins to present evidences of
suppuration ; it becomes soft and fluctuating ; the abscess soon bursts
spontaneously, and discharges generally in small quantities a sero-pu-
rulent matter, from a surface which is beginning to assume a gangrenous
appearance. But the discharge is not followed by the slightest im-
provement ; the parotid gland continues hard and firm ; the cellular
tissue begins to slough off in flakes and masses resembling wet tow ;
the pulse, which in the beginning of the disease was hard, quick and
contracted, becomes now small, weak, and about one hundred and fifty
per minute ; the cerebral excitement continues to increase till the pa-
tient sinks from exhaustion, or, if the abscess makes its spontaneous
opening inwardly he suddenly dies from strangulation. The disease
usually runs its course in four or five days ; it never occurs during the
progress of active ptyalism, but follows a sudden subsidence of the or-
dinary form of mercurial action, or supersedes it in peculiar constitu-
tions. This is only one of the many disastrous results that have often
followed the use of Mercury even in small doses. The physician whose
prescription has caused one such result, as the disease above described,
has suspended his patient's life and his own reputation against the
mere dust of the apothecary's scales, and is astonished to find that he
has lost them both.

Parotid Gland, Induration of. — Case of Baron Kaczkowsky of
Yienna^ — The baron says he took cold in 1840, from exposure while
performing a difiicult surgical operation, which induced a rheumatic
attack. He was treated with various drastic remedies, cataplasms of
mustard, Russian steam-baths, &c. The swelling of the joints sub-
sided, but the parts remained very sensitive to changes of temperature,

^ Monthly Magazine of the Homooopathists of Austria.

746 DISEASES OF THE SAITGUINOUS FUNCTION.

with evident proneness to rheumatic pains and disposition to inflam-
mation of the throat. This ultimated in hypertrophy of the tonsils,
which were at length removed by excision. The throat disease termi-
nated in " an inflammation and swelling of the glands beneath the right
ear. In spite of the remedies employed it became indurated and en-
larged to the size of a man's fist, extending to the clavicle and causing
violent pain upon turning the neck." After the whole medical and
surgical therapeutics had been exhausted, and the baron in the course
of six years had undergone every variety of treatment without even
the slightest relief, the swelling was larger than ever. In April, 1851,
he was induced to try homoeopathic remedies. He took every morning
one drop of Belladonna of the sixth dynamization, alternated every
second day by one grain of Hepar^ sulphur in the evening, of the same
potency. In two days striking improvement was manifested in the in-
durated swelling of the gland, and the homogenous, hard mass began
to disperse into separate smaller and painless knots ; and in like pro-
portions the motions of the neck became easier. Before the end of
July the swelling as well as the pain and stiffness of the neck had en-
tirely disappeared. Certain hsemorrhoidal complaints that had troubled
him for a long time had also totally ceased.

TONSILITIS.-QUINSY. ^

Diagnosis.— Febrile symptoms, succeeded in a few hours by sore-
ness of the throat, painful deglutition, swelling, and smooth, shining
scarlet redness of the tonsils, uvula and soft palate. As the tonsils
continue to enlarge, deglutition and respiration become more difficult,
the voice is changed, the pains increase in severity, extending often
through the eustachian tubes into the ears, the tongue becomes covered
with a thick yellow fur ; there is an abundance of viscid saliva on the
tongue and tonsils ; the breath acquires an exceedingly ofi'ensive odor,
which, according to Mackintosh, proceeds from sebaceous matter es-
caping from the mucous follicles.

The disease may terminate in resolution^ suppuration, or in perma-
nent induration. When the appropriate remedies are administered at
the commencement, the inflammation usually resolves itself without
suppuration. If no medicines are given, or those only which are in-
appropriate, the disorder usually progresses until suppuration ensues,
when an artificial opening is made, or the tonsil bursts spontaneously,
and the swelling and inflammation gradually subside.

Not unfrequently the tonsils become affected with chronic enlarge-
ments and indurations, from frequent and partially subdued acute
attacks, which prove exceedingly troublesome by their proneness to
take an acute inflammation for the slightest exciting causes.

QUINSY. 747

There is often reason to suppose that chronic enlargements of the
tonsils often lead to cough and expectoration of purulent matter, which
are confounded with and erroneously attributed to chronic bron
chitisj &c.

Causes.- — The predisposing causes are : Inherited scrofulous dis
crasia, irritability, chronic enlargement of the tonsils from mercuria
salivations, and derangements of the stomach and bowels. The common
exciting causes are, cold, atmospheric viscissitudes, wet feet, and the
common causes of fever or inflammation.

Tkeatment.— The best remedies for tonsilitis are : Belladonna^
Mercttrius^ Aconite^ Baryta-carl).^ JSux^ Pulsatilla^ Hepar-suljpli.
and Kali'liGhro'm,

Belladonna, — Cheeks flushed ; violent pulsations of the carotids ;
enlargement of tonsils perceptible on the outside of the throat; tonsils,
uvula and soft palate, inflamed, dark, red and swollen; tongue dry, or
covered vfith a thick, transparent and tenacious mucous ; skin hot ;
pulse full, hard and frequent ; voice hoarse, stifled or suppressed.

Headache ; burning and shooting pains in the throat, when swallow-
ing; constant inclination to swallow; choking sensation ; tonsils 'pain-
ful to the touch ; putrid or bitter taste ; thirst ; eyes sensitive to the
light ; stitches extending into the ears ; deafness from obstruction of
the orifice of the eustachian tube ; burning fever.

Uneasiness and dejection ; worse at night, and occasionally delirium

ADMiNiSTEATioisr. — -Two drops of the third dilution to two grains of
sugar of milk. Divide into six parts and exhibit one dry, once in two
to four hours, as long as possible.

Mercurius, — Ofiensive, putrid odor from the mouth ; tongue covered
with a thick, yellow fur; mouth dry or filled with viscid saliva ; uvula
elongated and red; tonsils and soft palate dark red, inflamed and en-
larged; roots of the tongue red and swollen; ulcers in the mouth and
throat; enlargement of the parotid or sub-maxillary glands; pulse fre-
quent and moderately full.

Heat, alternating with chills; frequent profuse sweats; stinging and
shooting pain in the throat, particularly when swallowing; very great
difficulty in swallowing ; although frequent inclination ; glands of the
neck painful on motion of the jaws, at sight of savory food, or on
swallowing ; the pains and difficulty of deglutition worse at night ; pains
darting through the eustachian tube to the ears and parotid glands ;
loss of appetite and disgust for food ; putrid or coppery taste ; thirst
for cold drinks ; symptoms migitated during repose in bed.

Morose; dejected; uneasy; out of humor. ,

Administeation. — Divide four grains of the third trituration into six
powders, — give one dry, upon the tongue, once in four to six hours until
an impression is apparent.

748 DISEASES OF THE SAInTGUINOUS FUNCTION.

A Gonite is a suitable remedy in cases of tonsilitis attended with a
high grade of arterial reaction, painful deglutition, bright redness of
the fauces, uvula and tonsils, with pricking or burning pains when
swallowing.

Administeation. — A drop of the third dilution to two grains of sugar
of milk. Divide into four parts, and give one dry, once in two hours
until the symptoms abate.

Bao^yta-carboniGa may be given in cases of catarrhal tonsilitis,
where there is suppuration of the tonsils, swollen and elongated uvula,
raw, scraping or shooting pain on swallowing, obstruction, as if by a
plug in the throat, bad taste, offensive breath, especially in the morning,
and discharge of sebaceous matter from the follicles of the throat.

Administbation. — The same as AGonite,

NuX'Vomica, — ^When derangement of the stomach appears to be the
prime predisposing cause of the complaint, and when the symptoms of
the acute attack are, scraping pains during deglutition, or when inhaling
cold air, obstruction from the enlarged tonsils, choking and spasmodic
contractions of the throat when swallowing, Nux-voniica is the specific
remedy indicated. It may be given at the third dilution, by means of
sugar, like AGonite.

Pulsatilla will apply in cases arising from a chill by being wet, wet
feet, &c. The signs for this remedy are, burning, scraping, smarting
or shooting pains in the throat when swallowing; deglutition obstructed
by viscid mucus which adheres to the tonsils and fauces ; pains worse
in the afternoon and evening; bitter or saltish taste in the mouth, loss
of appetite; unnatural taste of food; tongue furred with a thick yellow
coat, and breath offensive.

Administeation. — A drop of the third dilution on sugar. Divide
into four parts, and let one be given dry, once in four hours until the
desired effect is produced.

Hejpar-sulphuT has been much employed in those habitual cases of
inflammation and suppuration of the tonsils, which appear to owe their
origin to a scrofulous dyscrasia. This medicine occasionally arrests
the disease and prevents suppuration, after Belladonna, MerGurius
and Aconite have entirely failed to produce an impression. It may be
given in grain doses, at the third trituration, once in two hours.

5. angina MALIGNA.-Putrid Sore Throat.

See Scarlatina Maligna^ p. 592.

6. .|»HARYNGITIS.— Inflammation of the Pharynx.

The pharynx, the muscular funnel-shaped bag at the back part of the
mouth which terminates in the oesophagus, is liable to inflammation from
cold as well as from other causes.

IKFLAMMATIOK OF THE PHAEYNX. 749

Tkeatmeitt. — Aconite. — Simple and uncomplicated inflammation or
" sore throat." Other remedies are : BelL, Canth., Lach.j Merc.

Inflammation with spasmodic constriction of the fauces : Bell., Hyos.r^
Lachesis,Stram.jVeratr.-alb., Arson., Ooccul.,Ignatiaj Laur.-cer., Lycop.,
Nux-vom., Opium.

Sensation of a foreign body in the throat: — Arson., Ign., Merc,
Nux-vom., Puis., Bell., Lach., Sulph., Lobelia.

Inflammation of the Velum palati: Ac, Coff., Merc, Cinnabar, Nux.-
vomica.

Inflammation of the uvula : Bell., CofF., Cinnabar, Nux-vom., Calc ,
Senega, Sulph., Sanguinaria.

Tartar-emetiG.'—'Vhwcjnx and oesophagus violently inflamed; sore
throat; disagreeable sensation about the palate; pustules covering the
mucous membrane of the pharynx and oesophagus ; Dysphagia, with
difficult breathing ; palate bright red, swollen and covered with tena-
ceous mucus and vesicles ; sudden swelling of the cervical glands and
tonsils; burning in the same parts. Heat in the throat; dijBficulty
of swallowing and of breathing, in consequence of the swelling of the
isthmus of the fauces ; great sensitiveness of the oesophagus.

Swelling and redness of the throat, with large secretion of mucous,
often present in epidemic catarrhs and influenzas ; pustular eruptions
in the throat, whether caused by small-pox or other cause ; convul-
sions horn tonsilitis ^* erysipelatous sore throat; mercurial ulceration
of the throat.

7. LARYNGITIS.

Laryngitis is an inflammation of the mucous membrane of the
larynx, sometimes extending to the epiglottis. It is regarded as a dan-
gerous disease not so much from the extent or severity of the inflam-
mation which constitutes it as from the situation in which it is deve-
loped. Inflammation of the larynx even of small extent is always
alarming; it is particularly so in young subjects in whom the forma-
tion of the so-called false membrane takes place. The reason for the
deposition of this plastic exudation in children only is not well
known. Dr. Williams says: "that the inflammation involves the
sub-mucous areolar tissue, which is»very abundant during youth; and
that the natural product of the phlegmonous inflammation transudes
readily through the thin- delicate mucous membrane proper to that
age." In the case of the adult, the infiltration consequent upon inflam-
mation pushes or swells oilt the mucous membrane, too thick already
to admit of serous transudation, and terminates in that frightfully fatal
disorder, oedema glottitis. On the other hand the same inflammation
produces precisely the same result with respect to the lymphatic ves-
sels, so numerous in this region, namely the secretion of lymph in ab*

750 DISEASES OF THE SAJSTGTJIN-OUS FUNCTIOK.

normal quantities ; but tte tenuity of the mucous membrane in the
young allows the lymph to ooze throughj and coming in contact with
the atmospheric air, to coagulate, and with the fibrin of the blood to
form the so-called false membrane. It will be seen that the patholo-
gical process is the same in both, only that in the one the mucous
membrane is infiltrgited — that is oedematous ; and in the other, the
mucous tissue permits the complete transudation of the lymph and
the consequent formation of an adventitious membrane on its surface.

"The explanation, therefore, would seem to be anatomical rather
than physiological. That atmospheric air is necessary to the forma-
tion of this false membrane will be readily admitted when the history
and nature of plastic lymph is understood. The lymphatic glands and
vessels are essentially skin organs, and no where exist so abundantly
as beneath the mucous tissue of the respiratory organs. Very few are
found in the brain, while the pleura is completely " gridironed" with
them. The fibrin of the lymph possesses the peculiarity that, under
ordinary circumstances, it does not coagulate within the lymphatic
vessels either before or after death ; while blood itself clots in many
cases, during life, but always after death ; so that " of all fluids of the
body^ the blood alone possesses inherently the quality of coagulation,"
Coagulated lymph is never found m the lymphatic vessels either be-
fore or after death, "but that coagulation commences as soon as the.
lymph is brought into contact with the open air." It has then been
supposed that the lymph proper contains no finished fibrin, but that it
becomes complete, either from contact with the atmospheric air, or
under abnormal relations, through the importation of altered morbid

matter.

Diagnosis.

Group^ or Traclieitis.

Croup seldom occurs in adult life.

No pain in swallowing.

The croupy symptoms set in suddenly,
or after a slight cold ; no pain on swallow-
ing ; no swelling of the epiglottis or
throat.

Treatment. — Our principal remedies for laryngitis are: Aconite^
Kali-hichrom.^ Caust.^ Spongia^ FluoT-ae.^ Nitr^-ao,^ Ilepar^ lod.^
Kali-hydriod,^ Sanguinaria^ Calory Arsen,

a CHRONIC LAEYNaiTIS.

Symptoms. — Complete loss of voice, sibilant cough, and the larynx
painful on pressure ; expectoration of a thin but a viscid mucus, occa-
sionally pus, painful deglutition, owing to an inflammation of the
epiglottis, and emaciation ; as the disease progresses it has all the
symptoms of phthisis pulmonalis, with which it is frequently connected

Laryngitis,

Is common in adults.

There is pain on swallowing.

The croupy symptoms have super-
vened upon an attack of scarlatina,
measles, smalLpox, tonsillitis or ordinary
sore throat.

CHEONING LABYNGITIS. 751

Causes. — ^Many causes have been assigned for the increasing pre-
valence of this disease. Clergymen who read their discourses are
more subject to it than lawyers and political orators ; for the reason
that reading is a purely mechanical operation, whereas extempore
speaking is both mental as well as mechanical. It is, therefore, this
mental, this vital nervous influence, which protects the lawyer and
stump-speaker, while the lack of it punishes the preacher. The ex-
tempore speaker " gives his mind" to his argument, and thus lends the
muscles of speech extra and recuperative energy; while the reading
clergymen from a colder and calmer sense of duty^ allows his organs
of speech to flag and fail. Chronic laryngitis is the result ; for it is
only when under a strong earnest desire to say something, from what-
ever exciting cause, that the vocal chords can be kept faithful to their
functions. In mere mechanical reading, there is an absence of that
vital energy which affords the power to resist the " wear and tear" of
the enunciating organs. The vocal chords were made originally to
give the means of expressing our thoughts. They were never intended
for reading merely, consequently when we have something to say, the
brain lends the requisite amount of nervous energy to protect the vocal
chords from injury in discharge of their duties. The lawyer speaks
generally from the spirit of the moment; the brain co-operates with
the vocal chords in giving expression to his thoughts, and thus saves
them from irritation and disease. {])t\ Wcwd, TI, S. Jout,^ Vol. IL;

Pathology. — OEdema glottitis, inflammation of the mucous surfaces,
ulceration, ossification, caries and necrosis of the cartilages.

Teeatment. — The topical application of Nitrate of Silver has long
been the principal dependence of physician^ Though this powerful
agent has a direct influence in modifying the condition of the mucous
membranes, we have better resources in the proper homoeopathic re-
medies. The application of Iodine to indolent ulcerations of the la-
rynx, has also been much relied upon.

Internal Remedies.- — Arsenicum^ Oalcarea, Sanguinaria,

Nitrio-aoid 30°.— -In that bad form of throat disease in which in-
flammation of the mucous membrane ends in laryngeal phthisis. When
this fails, Apis 80° ; then Fluoric-acid 10° ; in the most serious cases
the 2000° ; in more acute cases 200° in dilution, once in five days.

Tracheotoiny . — In the cases in which the inflammation originally
in the trachea extends upwards, involving the larynx, the epiglottis
and the pharynx successfully, or pass downwards into the ramifications
of the bronchia, tracheotomy can not be successful in giving relief.
But in those other cases in which the inflammation is confined to the
larynx the patient may be saved by tracheotomy. When the trachea
alone is affected it should not be tried. Still if there be doubt of the

r52 DISEASES OF THE SANaumOUS FUNCTION.

seat of inflammation the patient should have the benefit of the doubt,
as many lives have been saved by tracheotomy. M. Trousseau saved
39 out of 150 cases ; others have met with better success. If there be a
bare prospect that the patient would recover without an operation the
operation does not lessen the chance t besides, as soon as the patient
breathes through the tube in the throat, the atmospheric air which has
been shown to be the chief agent in the formation of the fibro-plastic mem-
brane, ceases to rush into the lungs through the throat ; and thus the
formation of the false membrane is arrested. When inflammation has
extended to the bronchia and lungs, tracheotomy is worse than useless.

9 DIPHTHERIA.— Laryngitis Exudativa.

In 1818 Brettonneau wrote a description of an epidemic which pre-
vailed at Tours, in France, which he considered as a new disease and
designated by the term diphtherite. He believed that the disease came
from Egypt and that it first manifests its presence in the nasal
mucous membrane. It afterwards became common in other parts of
Europe.

After having prevailed for some years in the neighborhood of Bou-
logne, in France, the disease crossed to England about 1856.

In September, 1858, diphtheria began to be regarded as an epidemic
in Albany, N.-Y., between that time and February, 1859, about two
hundred and fifty deaths occurred in the city and its immediate vici-
nity. Dr. Paine estimated that, the whole number of persons who
were in some degree afiected by the epidemic would embrace about one-
fourth of the entire population.

It was regarded as an epidemic that had crossed the Atlantic, but
nobody pretends to tell on what day it appeared.

In the autumn of 1858 it commenced in Nova Scotia, and was strongly
epidemic during the winter.

In the city of New- York the first case of diphtheria was that of an
infant, eighteen days old, reported May 3, 1857. But one other case
occurred that year ; and both of these were probably something else.

In 1858 the number of deaths reported by the physicians of this
city was five ; in 1859, the number was fifty-three ; in 1860, 422 ; in
1862,594.

Definition. — Diphtheria or diphtherite, is a word used to signify a
specific disease, which should be classed among the zymoses, and is
characterized, locally, by the formation of a false membrane upon mu-
cous or abraded cutaneous surfaces.

Vakieties, — We recognize but two varieties, the simple and malig-
nant ; though diphtheria may become complicated wdth other diseases.
These two grades of the disease are essentially the same in their nature

DIPHTHEEIA. 753

In this they resemble many other diseases ; thus we have cholera
morbus resembling in its general features the more dreaded cholera
maligna. We have different forms and grades also of scarlatina and
many other diseases.

Diphtheria, then, is not a new disease, but a modification of a disease
long known; and the two types under which it now appears, differ " in
proportion as they are modified by season, climate, epidemic constitu-
tion of the atmosphere, and other sources of propagation and develop-
ment of a specific zymotic cause, as well as in the individual organic
susceptibilities of persons who are seized."

" These contingencies make the types convertible," and cases of each
may appear in the same house. Some practitioners find nearly all
their cases curable and others find many malignant ones. " Or in a
family of children, one may have the disease in the more severe, the
others in the milder form. In this regard, as well as in the fact that chil-
dren seized with the diphtheria at a later period of its prevalence do
not have it so badly as at first, it resembles scarlatina and other epi-
demic disorders " [CliniGol Lectures on Dijjhtheria, Dr, E,Ludlam.
Chicago, 1863. p. 7.)

Nature, of the Disease. — It is always endemio^ sometimes ap-
proaching the epidemic^ but never the contagious character, affecting
in all places persons subject to glandular enlargements, or to catar-
rhal or croupal affections. Nearly all who die with it have such pre-
dispositions, and worst in syphilitic and scrofulous subjects. In 1858,
says W. H. Eddie, Esq., it appeared at Barton-upon-Humber, and for a
few weeks it was connected with scarlatina. After that period, " diph-
theria began unequivocally to show itself as a distinct disease ; appear-
ing in some who had had scarlatina and were perfectly recovered, and
in others who were grown up and remembered having had scarlatina in
their childhood."

Diphtheria is a zymotic disease. Its characteristic symptoms are
evidently the product of blood poisoning ; and its first cause must be
sought for in "a specific virus which vitiates and depraves" the blood,
and, through it, the structure and function of certain solids.

Dr. Ludlam reaches the following conclusions respecting the nature
of the disease :

^' 1. Diphtheria arises from a specific invisible cause, which in order
to produce its legitimate pathological fruits, must first be introduced
into the blood.

"2. The means for the introduction of this virus into the blood are
two in number, viz. through the respiration and by inoculation.

" 8. We can not conceive of an epidemic cause which fails to occa-
sion more or less contamination of the atmosphere. Local circum-
stances may concentrate suph a taint, and thus render susceptible per-

VoL. I.— 48.

754 DISEASES OF THE SAKGUINOUS FUISTCTION.

sons in a community more liable to contract the disease from breathing
this atmosphere.

" 4. In exceptional cases the diphtheria may spread in this manner
by a thorough poisoning of the air which is breathed ; but as a rule
it is much more feebly contagious than either of the eruptive fevers.
There is no evidence that it is ever conveyed hj for)%it6S,

" 5. The only known method of successful inoculation is that a por-
tion of the vitiated secretions from either the mucous membranes or
the skin of a diphtheritic subject be applied to an absorbent surface.

" 6. Both these methods of communicating the disease will fail un-
less the individual constitution and local habits and surroundings of the
subject afford a congenial soil in which the specific cause may develop
its specific efi'ects."

" All of these symptoms and sequelae point to the constitutional cha-
racter of diphtheria. There is no question but it is a systemic, and not
merely a local disorder which owes its essential characteristics to the
presence of a species of parasitic growth, whether it be algous or fun-
gous. It is zymotio in its origin, its characteristics, and its sequels.
It is a disease per se^ and not alone a dyscrasia. Like the typhoid
fever, it has its general and its especial lesions, the one systemic and
the other local."

Dr. Eade, of the Norwich Hospital (England), says, the specific cause
of diphtheria is a depressing poison which acts primarily on the
nervous system, as is often shown in the apparently causeless and
sudden sinking and death of patients not considered to be in danger ;
and in other cases of longer duration, in some peculiar forms of para-
lysis, occurring at some weeks from the date of the first attack of the
disease. This paralysis is not due to mere poverty of blood or to the
sjpanmniia induced by the preceding disease, but rather to the presence
in the system throughout all the stages of the disease of a specific
poison whose special affinity is for the nervous tissue. Its action on
this tissue is shown in the first instance by a general vital depression,
and, subsequently, by a more or less complete suspension of the func-
tion of particular nerves or systems of nerves and loss of power of the
limbs. [Lancet^ Oct. 1859. p. 214.)

After reviewing the facts of the question as they are presented by
observation and the published opinions of others we conclude :

That diphtheria is a specific disease dependent for its origin on

1. A peculiar TnorMfic ejndemic influence^ vfhich for an unknown
period has been recognized in a large portion, at least, of Europe and
America, and which so far affects all the inhabitants of large tracts of
country at a time, that all common forms of disease are liable to be
more or less modification by the prevailing epidemic.

2. A predisj)osition to disease consisting in a psoric, dyscrasic^ or

DIPHTHERIA. 755

Strumous constitution, liability to glandular swellings, catarrhal, cy-
nanclial, or erysipelatous disease.

3. The common exciting causes of disease conspiring with the above
conditions in individuals ; sudden changes of temperature, exposure to
severe cold, or to damp or chilly air long continued ; derangement of
the digestive organs.

General Symptoms. — In the type, which is the most common in some
localities, the patient is suddenly, (generally in the morning,) seized
with violent vomiting of a thin yellowish-white matter of a very offen-
sive character ; then purging of a fluid of similar appearance and smell.
These dejections last for an hour or more, and are followed by groat
prostration and stupor. The patient lies for many hours in a heavy
sleep, is with difficulty aroused, and immediately sleeps again. The
skin is hot, pulse 100, though in children perhaps 140 or 160, tongue
bright red ; great thirst ; drink taken with avidity to be instantly re-
turned by vomiting. In other localities the purging does not occur.

The odor of the breath is characteristic and peculiarly offensive,
and often it gives the first conclusive evidence of the danger impend-
ing, when other symptoms have revealed nothing to alarm. The breath
is infected by specific zymotic poison operating on the secretions of the
affected parts as well as on the blood generally.

The throat is sore, though it does not feel so ; the vigilant physician
examines it and finds, in the early stage, the tonsils, soft palate and
back of the pharynx, presenting a bright shining appearance ; the
small vessels are not seen individually injected as in many sore throats ;
but the part appears as if brightly painted and then varnished. Hang-
ing from the velum to the tongue is seen in this stage a transparent
film of a tenacious fluid which bursts before the expired breath and
sends its particles over the mouth and the instrument used to depress
the tongue. The next moment a similar curtain is formed.

After a period of a few hours (10 to 16) the 'condition of the patient
is changed. The stupor has passed off and delirium takes its place ;
there is high fever, quick breathing, the voice thick or shrill ; short
dry cough ; children show evidences of coming croup ; neck puffy and
flushed, tongue coated with white fur ; the parts of the throat at first
so brilliantly red are thickly coated with a whitish substance in spots,
which in a very short period conglomerate and form one thick plastic
deposit, which in time may cover the whole palate to the teeth, appear-
ing as if the whole mouth were lined with plaster-of-Paris.

The violent delirium now subsides ; the powers of life fail rapidly ;
horrible sensations of choking .and suffocation come on ; the sufferer
tears at his neck with his nails and tries to tear open his mouth, though

* Lancet, 1859. p. 306.

756 DISEASES OF THE SAKGUmOUS FUNCTION.

retaining full power of swallowing ; and greedily takes down any fluid
offered him; livid spots on the extremities show purpura; white offen-
sive diarrhoeic discharges from the bowels become incessant; there is
muttering delirium ; and, in a long tetanic convulsion, death closes the
scene. '

The cases of true diphtheria are not numerous in any locality yet
invaded by this disease. It is characterized by the peculiar wash-
leather exudation ; foetid discharge from the nostrils ; phagedenic ul-
ceration of tongue, gums and fauces, profound general adynamia, often
from the very beginning of the disease. Dr. Dake describes it as pre-
senting, in the severer cases, aphthous ulcers on the tongue, palate,
tonsils, &c., " small and rapid pulse, with moisture of the surface, and
general debility." In a still higher grade, in which two deaths occur-
red in seventy-fo^r cases, there were: "white elevated spots on the
tonsils, uvula, arches of the palate, or posterior wall of the pharynx,
appearing like the mucous membrane, raised, thickened, hardened,
and whitened, in patches varying in size from the smallest fish-scale to
that of a piece of white kid, sufficient to cover the entire throat and
buccal cavity. These patches have a border of deep red, and, when
removed, leave a raw, rough, and often bleeding surface. They some-
times form and spread very rapidly. Under successful treatment they
loosen, break, and are thrown off in fragments, with a sanious and
bloody discharge. The breath is very offensive; the pulse small, and
generally rapid, with copious perspiration, and in the later stages, ex-
treme debility."

In sixteen cases, ef whom four died, there occurred in addition to the
symptoms already given: "Constant cough, provoked by swallowing,
and worse when lying ; hoarseness and rasping respiration, such as
characterize membranous croup." In some cases " the peculiar mem-
brane is visible, covering the epiglottis." ^ In three cases this mem-
brane came away in fragments, leaving a rough and bleeding surface.
In but one case it formed a second time on the same spot. " One patch
of the membrane thrown off and preserved in Alcohol, is nearly an
inch square, of the thickness of the heaviest kid, of spongy texture,
and of yellowish white color. The under surface is rough with eleva-
tions and depressions corresponding with the granulations of the ton-
sil whence it came. Upon close examination it appears like the mu-
cous membrane thickened by an intestinal deposit of a white cheesy
substance ; it must have left the surface of the tonsil, whence it came,
completely minus a mucous membrane ' (iV. A, Jour. JSbmwqp, Feb.
1862.)

Dr. Kinch, of New-Jersey, sent to the New- York Pathological So-
ciety (Jan. 1862) "a membranous cast of the trachea, bronchii, and
larger divisions of the bronchial tubes which had been expectorated in

DIPHTHERIA.

757

a fit of coughing by a girl, aged eleven years on the fifteentli day of the
disease. The breathing was afterwards easier, but the patient refused
to swallow anything, even water, and died after two days.
Diagnosis. — ^Distinction between

DIPHTHERIA and CROUP.

1. Seat of

DiPHTHEEIA.

Its primary and essential feature con-
sists in the exudation of an albuminous
or coagulable effusion on the mucous
surface of the fauces and air passages.
This effusion almost always commences
on the tonsils and pharynx, extending
thence along the nares, velum pendu-
lum palati, and sometimes downward
to the larynx, which it seldom passes
beyond ; but it vnay proceed to the
trachea and even along the oesophagus
into the stomach. When the false mem-
brane extends into the trachea, the
distressing dyspnoea and other symp-
toms of true croup may be produced. In
unusual cases a plastic exudation re-
sembling that of diphtheria has been
seen on other parts. In one case it cov-
ered the conjunctiva of one eye ; in an-
other the surface of a burn upon the arm.
Symptoms those of diphtheria.

the Disease.

Croup.
Genuine croup is almost always seated
in the trachea and lower portion of the
larynx. It commences there and very
rarely presents any appearance of the
disease in the pharynx or any part of the
fauces. It is always so completely re-
stricted to the region of the glottis that
the general febrile disease gives . little
concern. There is no epigastric uneasi-
ness, vomiting or diarrhoea. Pseudo-
membranous croup is a very rare affec-
tionj is confined to the larynx and trachea,
and is neither malignant nor infectious.

Diphtheria.
It usually selects feeble, lymphatic
subjects, with defective vitality, who are
surrounded by unfavorable conditions.
The inflammation tends from an early
stage to assume a gangrenous and putrid
character. The accompanying fever is
typhoid. The profound adjmamia is
different from that seen in the latter
stages of croup. Under this adynamic
fever the vital powers are exhausted.
Diphtheria is essentially a zymotic dis-
ease. The specific poison is a depressing
toxic agent which acts directly on the
nervous system.

Period
Common to all ages, but most fatal
amongst children and young persons.

Croup.
Croup is essentially a sthenic disease,
it is highly inflammatory in its nature,
generally traceable to exposure, to cold
and damp air ; it is seldom epidemic and
never contagious. The symptomatic
fever is inflammatory throughout its
course. It has been caused by some
known exposure, as sudden suppression
of perspiration, wet feet, or a current of
cold damp aiSr.

of Life,

Confined to the period of infancy ; it
generally attacks the robust and well
fed.

758

DISEASES OE THE SaKCtUINOTJS FUNCTION.

Chafaoter of

DiPUTHERIA.

In very light cases there is no effu-
sion, and when there is its features
are not uniform or permanent. Some-
times the matter effused consists of a
firm lymph-like albuminous deposition,
and is the product of an active inflam-
mation of the fauces, as in cynanche
pharyngea and tonsillaris ; in other cases
it is " soft, shreddy, in patches on one
or both tonsils, the palate or fauces, re-
sembling sloughy mucous membrane ; it
is accompanied by all symptoms of ty-
phus fever, as in cynanche maligna, and
in some of the worst forms of scarlatina
or measles. In such cases the false
membrane is formed by a thin pulta-
ceous exudation which is rather mucous
than fibrinous. In other cases the de-
posit consists of a few small patches upon
one or both tonsils, the palate or fauces
only. In all cases of diphtheria the effu-
sion seems incapable of organization.

PrinGvpal
Diphtheria.

"When the disease is confined to the
upper part Of the larynx, as it usually is,
we never observe the sharp sibilation
of croup ; we do not see the spasms
with fits of suffocation, but a kind of
*'ronchus mucosus," in the course of
forty-eight hours, with marks of a slow
and progressive asphyxia, during which
discharge from the nose becomes foetid.

In no locality have we yet found all
cases presenting the peculiar diphtheritic
exudation, though we may distinctly
recognize all the other distinctive fea-
tures of the epidemic. We find the
same erysipelatous-lookin|!^patches of in-
flamed surface on the tonsils j the same
swelling of the glands of the parotid and
submaxillary region; the same disposi-
tion to a low state of the system ; and
we find these states in the same locali-
ties and in the same families in which
the more strongly-marked cases of true
diphtheria are seen. The imperfectly

the Effusion.

Oeoup.
The false membrane in laryngeal croup
is strong, dense, fibrmousy often organ-
ized ; and it often exhibits a well-marked
vascular derangement.

Symptoms.

Croup.

There is a sharp hoarse cough, which
is afterwards stifled j spasms of the la-
rynx are followed at last by asphyxia
and suffocation. The agitation and ex-
treme agony which distinguish the last
stage of croup contrast strongly with the
livid pallor of the surface, the dehrium,
profound depression, somnolent tran-
quility and adynamia which belong to
the same stage of diphtheria.

The dyspnoea is paroxysmal, invari-
ably worse at night ; in the intervals
the breathing is almost natural ; the
patient alternates between suffocation
and repose. > There is no eruption ; no
acrid coryza ; no especial liability to
hsemorrhages from the mucous mem-
branes, no alimentary disorder ] no al-
buminaria. The glands of the neck are
not swollen ; there is no after- tendency
to paralytic prostration. Croup cannot
be communicated by inoculation.

DIPHTHEEIA.

r59

developed cases are certainly cases of
.the same disease, produced by the same
morbific influence. Adults are parti-
cularly liable to the disease m this
form. Borne albuminuria is common.

Distinction hetween .Diphtheria and SoarlaUna.-

Diphtheria has been supposed by many to be only a *' suppressed
or masked scarlatina." These two diseases have some features in
common. Thus,— in both there are :

Enlargement and inflammation of the tonsils and glands of the neck;
ulceration ; a rash upon the skin which does not appear in all cases ;
similar premonitory symptoms ; general depravation of blood, shown
by a tendency to gangrene ; albuminuria is also common to both.

This resemblance of diphtheria in some of its symptoms to scarla-
tina has led many authors to believe that the two diseases were essen-
tially the same though slightly modified by some epidemic influence^
But to this it is answered that diphtheria has prevailed as an epidemic
in many localities where scarlatina was not only absent, but had not
been heard of for years.

That there is much confusion in the minds of physicians in regard to
the diagnosis between this disease and some others is evident by the
fact that consulting physicians very often disagree about the name that
should be applied to the case before them. ** From the history of the
progress of diphtheria for the last few years its existence would seem
to be in some measure connected with scarlet fever." In 1858 the
two diseases prevailed very extensively together in England. " In
New-York City, during 1860, when diphtheria had become a common
disease, we had more scarlatina than was ever before seen in this city."
Physicians, however, frequently " confound the two diseases "

DiPHTHEEIA.

The invasion is generally insidious.
The heat is slight^ and subsides early.

SCABLATINA.

The invasion is sudden and violent.
The fever continues high ; the skin hot.

Liability to a Second Attach.

Many persons have had a second at-
tack several weeks after apparent re-
covery. Dr. Dake saw nme cases each
of which had it a second'*time.

The patient recovering from this dis-
ease is not generally liable to a second
attack. His having had diphtheria does
not protect him from scarlatina.

The Eriiption,

The eruption^ or rasTi^ when there is
any, appears suddenly and disappears
as suddenly, is more like that of measles
than scarlatina, and is not followed by
desquamation.

The eruption is a prominent feature
in the disease. The rash does not come
out suddenly ; and, after remaining on
the skin for some number of days, ter«»
minates its course by desquamation.

760

DISEASES OE THE SANGUINOUS EXJiq^CTION,

TJie Angina.
Diphtheria.
Commences by patches on the tonsils,
&c. ; it shows in spreading, a great teii-
dency to invade the respiratory pas-
sages. In many cases there is no false
membrane formed, since death occurs
before there is time for it. In slight
cases there is none that attracts at-
tention.

DTopBioal Affections.

SOARLATINA,

The angina tends to localize itself in
the whole cavity of the fauces and pos-
terior nares, and rather to invade the
oesophagus than the larynx.

Dropsy after diphtheria has not been
noticed in this country.

Anasarca and other forms of dropsy
are common after scarlet fever has ap-
peared to be terminating in health.

Alhumimma,

The mucous membrane of the throat I The albumen is chiefly eliminated by
generally eliminates most of the albumen, | the kidneys.

Mode of Termination in Death.

Death takes place from the extreme
prostration j and the symptoms by
which it is preceded are those which re-
sult from the action of a malignant
septic poison. This poison, in cases of
slow recovery, still shows its power in
general vital depression ; particularly in
the peculiar form of paralysis that often

The direct cause of death from scarla-
tina may be : — 1. Suffocation ; 2. Cere-
bral congestion or effusion; or 3. Dropsy
or other sequelae of true scarlatina.

In all of these affections there is a high
degree of toxaemia, but it does not show
its effect in the general or partial para-
lysis that often follows diphtheria.

follows diphtheria.

Di^pMheria and Scarlatina Anginosa, known by the
Synonyms " ulcerous sore throat" of Fothergill, " angina putrida ma-
ligna" of the older writers ; the " pharyngite pultacee" of Valleix.

The coating on the tonsils, &c., con-
sists of an erysipelatous redness, which
is soon superseded by patches of a gray,
tenacious firm transparent membrane.

The tonsils and contiguous tissue are
covered with a thick heavy pultaceous
exudation of dull whitish or dirty look-
ing color.

Diphtheria and Syphilitic Ulcer on the Tonsils.
The diseased surface is not depressed ; ( In this last affection the surface is de-
the membrane can be separated from the pressed, except in secondary syphilis, and
tonsil. I the false membrane is adherent.

delations between Diphtheria and My sipelas.— John Hunter, who
has been generally regarded as the Newton of modern physiology, said
he thought diphtheritic angina to have " something of the erysipelatous
disposition." He believed that the erysipelatous inflammation produces
results the very opposite of those to which common inflammation gives
rise, namely, in the serous membranes suppuration, and in the mucous
membranes effusions of lymph. In many respects we find points of
resemblance between erysipelas and diphtheria. Stephenson and others

DIPHTHEEIA.

761

have considered cynanche maligna and scarlatina maligna as forms of
erysipelas. \

Points of coincidence between these diseases are:

They both depend on occult causes little understood, and are always
found in subjects who are predisposed by previous bad health to be
attacked by some' disease, and naturally fall under the sway of the pre-
vailing epidemic whatever that may be ; they both attack more readily
persons of a scrofulous diathesis ; " both prevail most in damp districts
and damp weather ;" and " both yield to the same class of remedies."

Patients who have ever been affected by either of these diseases are
afterwards good subjects for an attack by the other. Dr. Dake says
he saw four cases in which erysipelas spread over the face after the
peculiar false membrane of diphtheria had disappeared. In these cases
as in all others erysipelas affects the skin as diphtheria does the mu-
cous membrane.

The distinotion . between diphtheria and erysipelas may then be
considered as so obvious to any observer that the features by which
they may be distinguished need not here be detailed in contrast.

On the interpretation of the term false whembrane. Laboulbene
offers the following:

"^ false Qnembrane is a morbid ^roduet wMoh is rrhost frequent-
ly deposited upon a tegmnentary surface^ — -either of muGOus or
serous membrane^ sometimes adventitiously and which is formed or
exuded by that part of the body which it invests J^ {On Pseudo-
Membranes, Pari^, 1861.)

Now the diphtheritic poison, introduced into the human organism, is
held to have two especial and peculiar affinities, — -one for the nervous
centres, and the other for the mucous structures which line the internal
cavities. These remarkable predilections are everywhere recognizede

One conspicuous and characteristic feature, which is of great prac-
tical importance, is that diphtheria has an unfortunate tendency to in-
vade the respiratory passages, the nasal fossae, the larynx and the tra-
chea. Mugue-t occupies a portion of the alimentary tract, the oesopha-
gus and stomach, but does not extend to the respiratory mucous sur-
faces.

On the PATHOLoax of Diphtheria. — Dr. Wilks^ states, that in the
cases that had passed under his own observation a parasitic fungus was
always present on the affected part ; and at first he was disposed to be-
lieve this peculiar growth constituted the essential characteristic of the
disease. He then says, his attention being directed to this matter, "I
took the opportunity to examine the films which occasionally form on
the mouths of those sick with various diseases, and upon submitting

* Med. Times and Gazette, p. 354.

762 DISEASES OE THE SANOtJINOUS EUNCTIOK.

them to a microscopic test, felt some surprize in witnessing in all fun«
gous growths which I have not been able to distinguish from that of
diphtheria." He mentions the case of a woman who had died under
his care with acute cerebro-spinal meningitis ; on examining whoso
pharynx after death, a pellicle was^ found composed of the parasitic
growth. , Several other instances are recorded in which the same
growth was detected, when there was no diphtheritic disease properly
so called. Dr. Laycock found the fungus called oidium albicans in only
a single case of diphtheria.

Diphtheritic deposits according to Laboulbene, are ; 'Aplastic jpro-
d'ucts which are niorMd^ mid which are dej>osited upon a tegumen-
tary siorface^ the shin or mucous memlrane^ hy exudation iijpon those
farts which they are to invest^ and are not jpersistentP

Appearance of the Deposit.— In patients seized with diphtheria
in the mouth and pharynx, says M. Laboulbene, "we remark the exis-
tence of plastic products of a grayish or yellowish hue, and which ap-
pear to be located upon the thickened mucous membrane. At different
periods of their formation these pseudo-membranes are opaque, some-
what delicate, and thicker towards the centre; others are whitish,
grayish, or yellowish. The first, or the more delicate, are easily de-
tached ; the adhesion and tenacity of the latter being w^ell-marked,
they adhere to the mucous membrane. They form more or less ex-
tended plates or layers, and not little islands which tend to coalesce.
In some cases the plastic product envelops the whole tonsil, again the
uvula, and sometimes it forms a lardaceous coating located at the base
of the pharynx. The subjacent mucous membrane w^hich is reddened,
is bloody in little patches, but the surface is not ulcerated ; the mucous
membrane, which surrounds the cast is tumefied. The sub-maxillary
glands are congested, painful and the neck is swollen.

"If the examination is repeated at a more advanced stage of the dis-
order, we discover the false membranes in a state of putrid solution.
These detach themselves in shreds which are mingled with the saliva,
or which are attached to the posterior part of the mouth by some points
upon their surface. Below, and where the plastic product is not ad-
herent, the diphthel-itic false membrane has been reproduced. In
appearance it resembles an ulcer which has exfoliated shreds of de-
cayed mucous membrane.

Certain disorders of innervation belong as much to the natural his-
tory of diphtheria, as does the lesion of the superior alimentary and
respiratory passages.

The exceeding and immediate prostration, which is disproportionate
to the duration or the severity of the illness, the losses sustained, or
to the balance of the symptoms ; the excess of heat, and other dis-
orders of calorification; the rapid pulse, the type of the fever; the

DIPHTHEEIA. 763

character of tlie delirium ; the dilated pupil ; the anaesthesia, which is
partial or complete ; the hyperaesthesia of the surface ; a feeble uncer-
tainty of gait, stiffness and lameness of the muscles of the neck; in
continence of urine, with or without involuntary stools ; all bespeak a
more or less profound disturbance of function in the nerve centres of
animal and organic life. There is no question but these centres are
poisoned, and hence the above train of symptoms.

Prognosis. — Children below eight years of age are less likely to
survive a severe attack of diphtheria than older persons. Those who
are predisposed to croup are particularly difficult to cure, as in them
if the disease go on beyond four or five days, there is danger of the
propagation of the diphtherite process to the larynx. Dr. Willard, of
Albany, reported to theN. Y. State Med. Soc, 1859, only three deaths of
adults among 188 cases. When we hear the peculiar noise caused by
the glottis when it becomes involved in the disease a bad prognosis of
the case is necessarily formed ; also, when the violent symptoms have
subsided and yet debility remains. Dr. Cretin, of Paris, says " that in
membranous angina as in severe fevers, the Issue is rarely favorable,
unless convalescence is prompt. In all of these cases where there is
not a speedy renovation when the apparent causes of debility are re-
moved there is one sufficient cause for failure, that is '^ a poison in^
fecting the general syste7n ; it is not the local disorder^ The con
stitutional predisposition accounts for the great fatality of the disease
in certain families. Dr. Paine says in the winter of 1858 — 59, at Al-
bany, " in 15 families there were in each two deaths ; in four families, in
each 3 deaths, and in one household four children were swept away by
the pestilence." Dr. Dake, who lost 7 cases only out of 193, says :
" Those who died were all subject to glandular enlargements except
three, aged by one year. A female, aged 38, had great enlargement of
the tonsils, parotid and submaxillary glands, irritation of the nasal duct,
foetor of breath." The disease is more fatal in some localities than in
others. Though it has often appeared in places usually healthy, it is
certainly more fatal in cities and villages in which the people live
closely crowded together in damp and ill-ventilated dwellings.

Treatment oe Diphtheria. — A persistent use of the proper homoeo-
pathic remedies will cure nearly all cases of this malady. We have
treated more than 200 cases, including many of the malignant type,
and our losses have not been one per cent. We make this observation
for the purpose of impressing upon the medical man 'the vast import-
ance of selecting and of continuing the very few really specific medi
cines at our command for the cure.

The two great remedies are Kali-bichromicum, and Merc urius-hydri-
odicum. The first triturations of both drugs should be employed ; the
first, dissolved in water (so as to tinge the water yellow), and the other

764 DISEASES OF THE SANGUINOUS FUI^OTIOH.

to be taken dry on the tongue. These medicines, repeated every hour
or two, in alternation, will suffice to cure nearly every case. We have
used the Biniodide of Mercury, in place of the Hydriodate with the
same good results.

These medicines are sine qua nons in this malady, and should be
boldly and persistently given until the deposits have disappeared.

A dose or two of Aconite and Belladonna, may now and then be
required, but they should be deemed and used as quite subordinate to
the precited medicines.

From the commencement, meat-broths, wine whey, milk punch,
brandy and water, and the like should be judiciously administered, in
order to support the strength and counteract the typhoid tendency of
the disease.

Occasional inhalations of the vapor of Ammonia water, will often
aid in detaching the albuminous depositions, and thus often relieve the
sense of threatened suffocation. Ammonia is an excellent solvent of
albumen, and will often conduce materially to the comfort and safety of
the patient.

It may sometimes be used internally with advantage, when typhoid
symptoms are strongly marked, and there are indications of decompo-
sition of the blood. But it also must be secondary to the medicines
first named.

These few observations comprise our own experience, and as such
we offer it to the profession. Below we have collected the views of
many other physicians, both American and European. .

The treatment of diphtheria is necessarily based upon correct prin-
ciples of its pathology. It may be advantageous to group, the different
remedies under the various indications they are calculated to fulfil.

The Constitutional Treatment— ^For the Febrile Symptoms : — Aconite
Belladonna, Gelseminum, Rhus-toxicodendron, Baptisia, Bryonia,—
For Cerebral Disorder : — Phosphorus, Bell., Opium, Conium-maculat. —
For the Mouth and Throat Symptoms :— Mercurius, Iodine, Mercurius-
iodatus, Cantharis, Bi-chromate of Potassa, Bhus-tox., Iodide of Ar-
senic, Baptisia, Nitric-acid, Apis-mellifica, Baryta-(3arb, Belladonna.—
For the Coryza : — Do. the gastric and Alimentary Disorder ; — Nux-
vom., Bryonia, Opium, Veratrum-alb., Phosphoric-acid, Arsenicum-alb.,
Nitric-acid, Arsen.-iodatus, Merc.-iodatus, Cantharis. — -For the Erup-
tion:— Bell., Rhus-tox., Bryonia, Pulsatilla, Nitric-acid, Arsenic-alb.,
Cantharis.— -For the Urinary Disorder:— Aeon., Merc.-iodatus, Can-
tharis, Apis-mel., Ammon-acetat., Mer.-cor., Phos.-acid, Colchicum. —
For the extreme Debility :— Cantharis,^ Ferrum-aceticum, and China.

Aconite — Is one of the first remedies in the forming stage of the

* Ludlam on Diphtheria.

DIPHTHERIA. 765

disease. It lias been common to give it in tincture (two to three drops
in a glass of water,) in doses proportioned to the age or condition.
The third dilution is better in ordinary cases.

JBelladonncL — In the simplest form of diffusive inflammation in
which no marked peculiarity was observed, a few doses in solution suf-
ficed to affect a revolution in a short time. Or, if with some swelling
of the tonsils there was a bright scarlet redness, uniformly extending
over the mucous membrane, it was generally continued at intervals
during the stage of excitement, or inflammation.

Hhus-tox.-— -'When the inflammation of the fauces is of a dark red,
or if there are dark crimson patches scattered over the inflamed sur-
face, adynamic tendency.

Colchioiimy has been found speedily efficacious for the engorgeS
state of the tonsils with fever and headache.

MerGuriios~iodatus,----J)Y,Jjudln,m thus sums up the principal con-
. ditions for which this remedy is appropriate : 1. It is *^ most appro-
priate to those examples and epidemics of diphtheria in which the
deposit is located upon the mouth, tonsils, uvula, velum palati, the
pharynx or some portion of the alimentary tract.

2. To those cases in which the function of the mucous follicles is so
deranged as to produce in considerable quantity, the tough and viscid
secretion.

3. The deposit should be of limited extent, of feeble organization,
transparent, pellicular, albuminous, and easily detached.

4. To those cases in which there is but a feeble effort at re-organi-
zation of the false membrane, when it has been removed, or has dropped
off spontaneously. .

5. To such examples of diphtheria as are characterized by marked
disorder of one portion or another of the alimentary system." The
Proto-iodide of Mercury is preferred to the Bin-iodide. {Lectures on
Dij)htheHa^ p. 104.)

As soon as the least appearance of membranous deposit or any
swelling of the glands of the neck is observed, we may commence with
this remedy, and continue it till the symptoms are completely oblite-
rated. Dr. Paine says he gave it in the first trituration, and the effect
" in arresting and detaching the false membrane was in many cases
most gratifying,"

Dr. Preston says, in 1852, ho had some success with Bin-iodide of
Mercury and Bromine. {PMlad. Horn. Jour,, 1852.) He ^^xves the
following case in the U, 8, Jour, of Homoeopathy^ Yol. I. p. 226.

A boy, aged nine years, residing near a family in which four children
had recently died of diphtheria, attacked on the morning of Sept. 16th,
1859, with high fever, inclined to sleep all day ; fever increasing till
night when he had delirium; pulse 160 per minute; when aroused he

766 DISEASES OF THE SANGUINOUS FUNCTIOK.

complains of difficulty of swallowing^ headache, &c. ; desires to be
allowed to go to sleep ; refuses all food.

Give Aeon. 3° and Bell. 3°, every hour alternately.

Sept. 18. Found the whole tonsils and palate considerably swollen
and covered with false membranes, which also lay in patches on the
pharyngeal mucous membrane; he swallows with difficulty; breath
foetid ; breathing hoarse ; pulse 120 ; an eruption appearing over the
surface resembling scarlatina miliaris, but the skin rather pale than
red, as in scarlatina. Give Bell. 3^, Proto-iod.-Merc. 3°, alternately
every hour. Meat-broths as food.

Was better next day, but three days later was much worse ; hoarse-
ness ; difficulty of breathing ; refused food and drink all day ; took no
wine for two days. Weaker than Rye days before ; no ulceration ;
palate natural ; fauces still very red ; pulse 60 ; rough breathing in
the hirynx ; breath more foetid ; bloody discharge from the nostrils ;
eruption entirely gone.

" Give Bell, and Merc.-Proto-iodide alternately every hour ; insist on
the taking of the wine three times a day with as niuch nourishment as
possible.

" The next day the breathing was easier, the mucous membrane quite
clear and very red ; swallowing easier ; more appetite. Three days later
he was quite well."

Dr., Siiss Hahnemann treated a severe case successfully with Merc-
iod. internally, and T«inct.-ferri-Mur. locally.

jBi-chromate of Potassa. — -Diphtheritic effusion on the superior
portion of the pharynx, nares, larynx, trachea and bronchial tubes, even
dowii to their ultimate ramifications ; the deposit of firm texture, pearly
in appearance, elastic, fibrinous, securely attached to the subjacent in-
tegument. Cases in which a transfer of the local disorder to the larynx
or trachea is threatened ; there is soreness of the larynx when pressed
from before backwards; aphonia, croupy inspiration or cough; desire
of the patient to lie with the head thrown far backwards in order to
throw open the glottis ; tonsils enveloped by a thick and well organ-
ized deposit ; incessant cough. Tendency to ulceration and deposit
upon remote mucous surfaces, as the uterine and respiratory epithelial
surfaces. When putrid symptoms begin to be manifested the Bi-
chromate should be superseded by Iodide of Arsenic, Nitr.-acid, or
Carbo-veg. The Bi-chromate is recommended in the second decimal
trituration, to be repeated every one, three or four hours.

Dr. Lord, of Chicago, reporting a severe case to the 111. State Asso-
ciation, says it produces aggravation even when given in moderate
doses :

" When the Bi-chromate was given with intervals of an hour or more,
the patient uniformly got worse. The cough was almost constant, ex-

DIPHTHEEIA. 767

cept in the night, when asleep. It ran up from a slight hacking to
suffocation, which was only prevented by a means which I have pur-
posely omitted to mention that I might direct your attention more
particularly to it. After the 20th day, whenever the cough became
dry, and respiration, whistling and suffocation seemed imminent, in-
halations of the Bi-chromate were used with prompt relief; of course,
it was only temporary, but it was a respite. But for it death must
have ensued. It did not fail in a single instance of easing the breath-
ing and loosening the cough, and ejection of membrane or large quan-
tities of stringy mucus followed.

" The method was simple. Two or three grains of Bi-chr. 2, were put
into a small tin-teapot, and half a tea-cup of hot water poured on. The
vapor passing from the spout was inhaled. I do not think that any
medicines given in this case, but the Aeon, and Bi-chr., had any good
effect.

"I was so well satisfied of this that in all subsequent cases I. have
trusted entirely to the Bi-chr. as the specific remedy, and have had no
reason to repent it. Other remedies may be required, but that is the
Temedyr — [TransaGtions^ &c., 1862.)

Sydriodate of Potash.-— Dv, H. Robinson, Jr., of Auburn, N. Y.,
writes : " I would like to recommend to the notice of physicians the
use of the Hydriodate of Potash in diphtheria. I find nowhere in any
of our authors the mention of this drug in this disease ; but in quite an
extensive practice in this disease, I have used no remedy with such
happy results as this. Doses the same as the Bi-chromate.

Tartar-emetiG. — This remedy has, been shown by Laboulbene to be
capable of producing the false membrane in the cavity of the mouth,
especially on the tongue. They are described as " having the form of
irregularly rounded patches, whitish or grayish in color, somewhat
thick, of a marked consistence and firmly adherent. In the oesophagus
they are small, delicate, pale and easily detached from the subjacent
tissue. Beneath the pseudo-membrane the surface of the tongue is ex-
coriated, ecchymosed, wrinkled, and forms an elevated margin around
the plastic deposit which is red and somewhat extended. The oesopha-
geal mucous membrane is ulcerated ; the borders of this ulceration are
not elevated, but enclosed by a red circle, the base being softened and
grayish, and, at some points, ecchymosed.''

This remedy is advised by Dr. Ludlam for the following conditions :
Sudden swelling of the cervical glands and tonsils in scrofulous chil-
dren, who are predisposed to catarrhal or asthmatic affections ; occlu-
sion of the larynx or lower respiratory channels by excess of mucus,
of a feebly-organized plasma, with cough, dysphagia, difficulty of
breathing ; gasping which compels the patient to sit upright, or to seek
the open air; retching or obstinate vomiting of tenacious mucus, with-

768 DISEASES OF THE SANGUINOUS FUNCTION-.

out any considerable tliirst ; small circular patches, like small-pox
pustules, in and upon the mouth and tongue ; hepatization of the lungs
impending or progressing by closure of the pulmonary air-vesicles, by
solidification of effused serum. Cases in which a prevailing influenza
attacks a patient predisposed to catarrhal disorders of the respiratory
mucous membrane.

Arsenicum^ — The breath foetid ; the lining of the nostrils dis«
charging a viscid foul secretion ; great and increasing prostration of
strength. After the separation of the false membranes, it may remove
the extreme tenderness which remains, as well as keep up the vital
energies.

Iodide of Arsenic seems more efficient than any other form of Ar-
senic when there is putrid offensiveness of the breath, especially in the
later stage of the disease. i

Bryonia. — M. Curie, in a discussion in the Homoeopathic Med. Soc.
of Paris, (Febr. 20th, I860,) says, Bryonia has the "pathogenetic pro-
perty of forming false membrcmes, which the other remedies do not
possess (though Bromine, Chlor.-potashj and Chloride of iron have some
such power in lighter degree). The false membranes formed by
Bryonia are not those developed by an irritant local action as a corro-
sive poison. Teste gives a case of false membranes in the mouth de-
veloped by Bryonia. Orfila in his Toxicology mentions another in
which they appeared in the rectum, in consequence of an injection of
Bryonia. M. Curie exhibited to the Society preparations of the tongue,
the trachea and the lungs of a rabbit to, which he "had administered
Bryonia for eight months ; at first giving two drops of tincture per day,
a dose which was progressively a.ugmented to 250 drops at last.''
There was formed "a pseudo-membranous firm tube, which lines the
trachea, and on the one hand, penetrates the second and third ramifi-
cations of the bronchia ; and on the other hand lines the whole of the
larynx. Some false membrane existed also in the mouth, at the base
of the tongue ; but these not being so strongly organized have disap-
peared in the alcohol." This was not the effect of an irritant liquid
into the bronchia. The false membrane grew little by little, and per-
mitted the trachea to enlarge for the passage of air. Autopsy showed
the trachea abnormally enlarged. The rabbit died in full vigor from
an accident. The membranous tube having detached itself at the level
of the larynx by an effort, perhaps the shock of a cough, brought on by
the introduction of a drop of liquid."

This proving of Bryonia by M. Curie was declared by M. Cretin " the
most brilliant experiment that has ever been made in homoeopathy.
He has demonstrated with specimens in his hand, the homoeopathicity
in laryngo-tracheal diphtherite, of a remedy too much neglected. Put
Bell., Hepar, Iodine, Spongia, &c., to the same test, prove that each

DIPHTHEEIA. 769

of these produces peculiar functional disorders, and you will have made
a grand step in science."

GapsiGum-annuum, — Dr. Dake :* " Sensations of heat ; burning and
soreness in the mouth and throat ; congested appearance of the mucous
membrane ; pain in swallowing ; ptyalism ; contracted feeling in the
throat; heat and throbbing in the head ; vertigo; epistaxis; increased
rapidity of the pulse; fever; nausea; strangury." It has long been
regarded as an efficient remedy in Gynanohe maligna and scarlaUna
anginosa. It promotes "the separation of the sloughs, and improves
the constitutional symptoms." " Its extraordinary power to control the
capillary circulation, to bring excess of blood, and thence to scatter
more than it has brought, will enable it to remove congestions to reduce
swellings, as promptly, if not as effectually as Belladonna."

CaTb-haryta, — A case by Dr. Preston (St. Johns, K B.).f A girl,
aged eleven years. Sept. 19th, 1869. Tonsils very much enlarged,
externally and internally ; neck Very stiff and painful on motion ; mem-
branes of the tonsils, palate and fauces quite, red without much diffi-
culty of swallowing ; no exudation in the throat; no hoarseness; no
fever, but great depression and weakness.

To take strong- nutritious food, with wine, and a dose of Carb.-baryta
every two hours.

Next day, this child and another much better. Medicine continued
at longer intervals, diet the same. Recovered in a few days.

NitriG-acid, — Burning of the tongue, mouth and pharynx ; inflam
mation of the mucous membrane of those parts ; ptyalism ; ulcerated
spots ; spreading ulcers in the mouth and throat ; swelling of the sub-
maxillary and parotid glands ; obstructed nares ; fluent coryza ; epis-
taxis ; putrid-smelling breath ; frequent urging to urinate ; red and
whitish deposit in urine. Hoarseness ; dry, barking cough ; worse at
night ; ear-ache ; hardness of hearing ; pains in various parts like
rheumatism ; swelling and inflammation of the face, like erysipelas ;
loss of appetite; aversion to food; nausea; pain in the stomach;
chilliness; paleness; excessive languor; profuse sweat; extreme
debility.

Regarding diphtheria not as a local but general affection, Dr. Dake
thinks "there is no remedy more capable of meeting the disease, with-
out and within, locally and constitutionally. It not only touches the
patchwork, but also follows on through every avenue, traversed by the
destroyer, quickening the powers of gland, mucous membrane, and
stomach, for its expulsion, the repair of tissue, and the support.

Bromine, — Recommended by Dr. W. E. Payne, 1847, for membranous

* N. A. Jour, of Homceop., Vol. X. p. 431.
t U. S. Jour, of Homoeop., Vol. T. p. 227.
Vol. L- 49.

770 DISEASES OF THE SAKUUINOUS FUNCTION.

croup {Amer, Joiir, Homceojp,^ Yol. I.), by Dr. A. S. Ball, of N. Y
(Worth Am. Jour, IlornmojJ.') Vol. II.), Dr. H. C. Preston, also in 1853^
{Phil, Jour, Ilom,^ Vol. I.), Dr. Kirsch of Wiesbaden ; all of these
pbysicians succeeded in curing cases of membranous croup -with it.

Dr. J. P. Dake gives the following indications:

"Soreness and smarting in the throat; ptyalism; hoarseness; rough,
dry cough; sensation of contraction in the wind-pipe; fluent coryza;
also nasal obstruction ; epistaxis; ear-ache ; alternate chills and heats;
violent inflammation of the mucous membrane of the fauces, oesophagus^,
also of the larynx and trachea ; these parts are coated with coagulable
lymph, which obstructs almost entirely the air passage. A dingy brown-
ish, granular, firmly- adhering exudation over the mucous membrane of
the oesophagus."

The physiological provings of Brom., and its efl'ect on patients
(syphilis and scrofulosis) produce a pathological picture, correspond-
ing fully to the symptoms of diphtheria in its diflbrent stages and
forms, but it shows also the local process of exudations so character-
istic to this disease. Trinks gives us from different sources the follow-
ing symptoms : Tough yellow, or watery mucus flowing from the nose.
Salivation with increased secretion of mucus in mouth and fauces. In-
sensibility of the skin, especially of the fauces. Severe inflammation
of the fauces, oesophagus and covering of it with plastic lymph. Severe
inflammation of larynx and trachea with exudation of plastic lymph,
nearly closing those organs.

Hulte, Bames and Pluhe found after a large application of Bromine
coryza, the eyes full of tears, injection of the conjunctiva within-
creased sensibility to light. In larger doses {z\ per day) it produced
intoxication without any agitation, great malaise, vanishing of strength,
decrease of the powers of vision and hearing, loss of sexual feeling,
insensibility of the skin, even stitches were not felt ; fauces and pharynx
losing every reflex motion.

Dr. Hering, of Philadelphia, seems to have been more successful
than practitioners generally,'^ He says he treated within three months
about fifty or sixty cases with marked symptoms of diphtheria, and
about the same number of light cases. They "all recovered within
seven days, except a few of the so-called scrofulous diathesis, which
required more time." The medicine at first relied on was Belladonna.
In some cases Bryonia or Antimonium-crudum, which latter cor-
responded to the genus epidemicus particularly well. After the first
medicine Lachesis was indicated by the great sensibility to the touch
on the throat, with or without a swelling.

Every single dose of any of the medicines, even in the worst cases,

* Transactions of American Institute of Homoeopathy, 17th Annual Meeting.

DIPHTHEIilA. 771

I allowed about twenty-four hours to act before I decided to make a
change- The lowest potency given was the 200° of Jenichen ; gene-
rally I used them higher, giving always on repetition a higher de-
gree."

M. de la Pommerais, of Paris, said at a meeting of the Societe Horn,
de Prance,^ February 20, 1860, he thought we had been too much pre-
occupied with the contagious or epidemic element of the disease and
had neglected the psoricy syphilitiG or syGotio element, which consti-
tutes the hereditary predisposition. To this neglect he ascribes the
greater part of his failures. According to Hahnemann's " Treatise on
ChroniG Mctladies^'' one of these three poisons is likely, on various
occasions, either to change the nature of the existing disease, or to ag-
gravate its intensity. We ought, therefore, in some cases to ejnploy the
anti-psorie remedies. There are some cases where we shall be
obliged to recognize the appropriateness of Hepar-suL, Merc, or Brom.
where we suspect something besides the contagious or dipJdheritic
element. Besides the symptoms, proper to a given disease, we have to
consider the constitution of the subject, his predispositions, in a v/ord
his " idiosyncracy," all that makes up his individuality, physiological,
or pathological. In a case of diphtheria, if the parents have been
tainted with one of those primitive maladies to which we ascribe the
after- existence of all the various chronic affections, can we believe that
such an angina would not be more severe than one which attacked a
healthy organism. This view of the subject accounts for the failure
of remedies which are homoeopathic to the obvious symptoms. In
these cases it is necessary to give a dose or two of an anti-psoric
remedy in order to enable the proper specific to act with its full force
upon the disease. We must individualize even in great epidemics, but
the totality of the symptoms includes the idiosynGvaoy.

CantJiaris,—M.. Bretonneau has noticed the similarity between the
debility produced by this agent and that produced bylthe diphtheria
poison. In each there may be seen the following symptoms : Coldness
which resists external heat ; adynamia even to the complete extinction
of muscular power, no movements remaining but those of the heart
and of respiration; the pulse falls to fifty, thirty or twenty* five beats
per minute ; corresponding decrease in expiratory movements ; at last
extinction of life. Oantharis produces apparent death. Successive
fits of lethargy being prolonged more than twenty minutes, without
any symptoms of life; then there is a slow resuscitation until the
poisoned animals become able to stand and walk ; subsequently there
was a more prolonged relapse ending in complete extinction of life.

Dr. Williamson, of Philadelphia, says:^ — ^'The result of the adoption

* Bulletin, &c., Vol. I,

772 DISEASES OF THE SANaUINOUS FUNCTIOISr.

in my j^Tactioe of Croton^ Canth.^ and Rhus as the 2Jr^nG^]pal reme-
dies in the treatment of the throat symptoms in diphtheria^ has
heen to diminish the mortality one-half A careful study of tHe
pathogeneses of these drugs, and a full consideration of their well-
known sphere of action in the treatment of other diseases, would lead
one to anticipate important results in the treatment of diphtheria, and
after repeated trials I have found the anticipation to be be fully
justified."

" I generally administer the remedies in water, in the proportion of
ten drops of the first decimal dilution, to a common-sized tumbler half
full of water, and give by teaspoonful doses in the usual manner."

Nitrate of Silver. — The local treatment is still the chief reliance
of the old school. Dr. McDonald says, (Lancet, Oct., 1859, p. 807,)
by skillful application of strong solution of lunar caustic to the glazed
red surface, the fungoid matter may not be developed; or if it be
formed it may be separated from the surface and brought away. But
if this be effected, the constitutional disease is not subdued. The
poison is yet to be eliminated from the system and the vital powers
remain yet to be supported. The solution directed is that of one-half
drachm to the fluid ounce of water. Such was the allopathic reliance
in the treatment -of diphtheria at Albany, in 1859.

Dr. George P. May, of Edinburgh, describes the disease in three de-
grees of severity, and says he has seen several hundred cases. He
says the lighter forms of it " yielded to a few applications of a strong
solution of Nitrate or Silver, which was best applied with a soft brush,.
as this permits to be visible the point to which it is to be applied.^

AcetO'Witrate of Copper,- — This active agent operates on a similai
principle when locally applied. Internally we have used it with good
results.

It is advised to "introduce a feather into the fauces every two hours
for the purpose of absorbing the noxious mucous." This draws away
large quantities of the substance which forms into false membrane, and
is an important adjunct to other remedial measures.

Local application of Nitrate of Silver muriated tincture of Iron,
or Iodine, possess no curative virtues. In virtue of their escharotic
influence, they may remove temporarily the deposits upon the tonsils
and throat, but they speedily reform; the patient continues to fail in
strength and vitality, and sooner or later succumbs under the typhoid
symptoms consequent upon the blood-poisoning.

Let no one therefore rely at all upon local applications in the cure
of this malady ; but strike the cause and seat of the destroyer in the
blood itself by the proper specifics.

* Lancet, Nov. 1859, p. 409.

DIPHTHEBIA.. 773

III the more malignant forms lie succeeded with Tincture Sesgui-
chloride of Iron^ applied two or three times in twenty- four hours.

CounteT'lrritation to the throat should be avoided, especially in
children. Mustard produces troublesome excoriations. A piece of
folded linen, wet with tepid water, is least inconvenient ; cover it with
oiled silk or gutta percha.

Small pieces of ice may be held in the mouth.

The following mixture is proposed for local use by Dr. Meyerhoffer,
{HirscheVs Klinilc, 1863) :

Brom. 0,1 gtt. xx.
Gl3^cerini puri ^ i.

A camel's-hair pencil is moistened with the fluid and carried over all
places, covered with the exudation. To get a direct influence on the
larynx, the first trituration of the Brom.-kali may be blown quickly into
the larynx one or two grains through a flexed glass tube during an in-
spiration. In children, who refuse pertinaciously the introduction of
the probang, or where the glandular swellings render it impossible to
open the mouth, it may be blown into the mouth during sleep. Its
local effect is quickly seen in the greater facility with which the patches
dissolve, getting more friable and disconnected ; furthermore, no fresh
exudations appear any more on the cleansed mucous membrane ; except
where the exudation is very firm, it will take a little more time.

The blowing in of the Brom.-kali commonly produces severe cough-
ing spells, during which the false tubulous membranes are expecto-
rated. Local applications give temporary benefit.

AlmholiG Stimulants, — Brandy and wine, says Dr. Dake, " only
serve to quicken the circulation, hurry morbid as well as normal pro-
cesses, and thus precipitate the approaching danger. While the disease
is. yet in the system, in active progress, though far out of superficial
view, stimulants increase the safety of the patient, and favor final re-
covery in the same way, and to the same extent that a double pressure
of steam and a redoubled velocity would increase the safety and put in
sound condition, a locomotive that is defective in the boiler, weak in
cylinder, and loose at every joint. Worse than that, the stimulation
exhausts the limited vital powers, the steam necessary to propel the
engine, without the ability to furnish more."

During the entire course of the disease we have always derived un-
equivocal benefit from the use of stimulants.

Diet. — In bad cases a stimulating and nutritious diet is demanded
from the commencement. Port wine every hour, warm milk, yolk of
eggs beaten up in wine, strong cofifee, beef-tea, white wine-whey, though
it is useless to load the stomach with food that cannot be digested. A
liberal allowance of salt is permitted in every kind of food.

r74: DISEASES OF THE SANGUINOUS FUNCTION.

Earlej^-water acidulated with l^mon-juice, or mixed with honey, cui
rant jelly or blanc mange.

After the first week, animal broths, perhaps given by enema.

In the early stages of all cases of diphtheria the use of meat-broths
is actually indispensible. All cases may not absolutely require alco
holic or wine stimulants from the onset of the disorder, but du]<i»ng it
co\irse, stimulants will be useful in nearly all cases.

10. CYJSFANCHE TRACHEALTS.- CROUP.

Until the present century this disease was confounded with whoop-
ing cough, asthma and bronchitis, and the fatal cases were supposed
to be violent forms of one of these maladies.

In the hands of the allopath, croup has ever proved a most formidable
and fatal disease. Acting, in the application of their remedial mea-
sures, only indirectly upon the part affected, by venesection, leeches,
blisters, emetics, mercurial cathartics, expectorants, &C.5 it is not a
matter of surprise that they are so often baffled in subduing a malady
of so violent a character as th^. one under consideration.

It is especially in diseases of this nature, that the truth and value
of a system of pra^ctice may be satisfactorily tested ; for it is here that
a prompt, efficient and specific remedy is imperatively demanded, in
order that the progressing inflammation may be at once arrested and
the patient saved. These are the cases that try the truth and sound-
ness of a theory; which convince the _/^^^W'^^<^, — who appreciate y(26'/^5 if
they do not comprehend abstruse theories— which school possesses the
knowledge and skill that should command approbation and support.
On the result of these tests we are willing to rest the claims of homoeo-
pathy. Indeed the records of the homoeopathic practice show conclu-
sively a large balance in its favor, over the other systems in all mala-
dies of an acute as well as chronic character.

Croup rarely occurs after the age of seven years, and may therefore
be accounted a disease almost peculiar to childhood. Its seat is in the
mucous membrane of the larynx, trachea and bronchia, and sometimes
of the fauces and palate.

Diagnosis. — Croup may with propriety be divided into two principal
varieties, viz.: first, \h^ false^ jpseudo q>y non-nneinhTanoiis^ comprising,
however, under this head the spasmodic^ catarrhal and slightly in-
flammatory kinds ; and second, the true^ or memhranoiis croup.

Some recent writers have distinguished /bz^r distinct varieties, each
one forming a distinct and independent disease, and not liable to run
into either of the other forms.

It is doubtless true that these several varieties do often exist as dis-
tinct and clearly defined maladies, and that the remedies homoeopathic

CROUP.

775

to these varieties are almost entirely distinct, but we are by no means
certain that different forms do not run into each other. Be this as it
may, it is of importance that an accurate knowledge should be acquired
respecting the seat, nature and symptoms of the mafady in all its
forms, so that we can exhibit without delay a remedy which shall bd
truly specific and homoeopathic.

1. False or nooi-membranous OrouiJ. — Spasmodic croup usuall}
makes its appearance suddenly, with considerable difficulty of breath-
ing, noisy and wheezing inspirations, a short, dry^ hoarse cough, occur-
ring but rarely, and an entire absence of febrile symptoms.

Gatan^hal croitp also commences suddenly, with a " croupy cough,''
hoarse voice, shrill, wheezing and sonorous inspirations, oppression and
tightness at the chest, and sudden attacks of dyspnoea; hut in a few
days the croupy character will we<ir off of itself^ lecming simple
catarrhal symptoms only^^ ( Watson,)

In the si'inple injiamrtmatory croup, in addition to the loud, harsh
and wheezing respiration, and hoarse, croupy cough, we have usually
sore throat, some thirst, and nightly febrile exacerbations. This, like
the preceding variety, will often wear off spontaneously, leaving only
some slight symptoms behind.

An important peculiarity of all the varieties of false ^croup, consists
in the suddenness of their attacks. Children may retire to their beds
■ in the most perfect health, and yet in an hour or two be disturbed from
a sound sleep with an apparently alarming attack of croup. It is im-
portant, however^ that all should be aware that these seemingly danger-
ous cases are much less to be dreaded than those which make their
appearance in a more slow and insidious manner, as will be seen by the
following description of the true croup.

In all the varieties above described, although there may be difficult,
labored, anxious, and wheezing respiration, hoarse, harsh and croupy
cough, hoarse voice, and the patient may seem to be in imminent dan-
ger of suffocation, yet the fact that the attack has occurred suddenly ^
and that the cough bears no resemblance to the dreadful mstalUc
cough oi real GYOw^j will affiord us sure indications of its nature, and
enable us to assure those interested that the attack will speedily be
subdued.

2. True or memh'anous croup^ is usually ushered in with the or-
dinary symptoms of catarrh, as chilliness, sneezing, some soreness of
the throat, hot skin, thirst, slightly accelerated pulse, hoarse voice, and
some little impediment in respiration. At this period a whistling or
" buzzing sound may be heard at the rima glottidis by placing the ear
upon the back of the neck, or over the larynx," ( Ware) Even at this
early period the commencement of the false membrane may be observed
upon the tonsils, and sometimes upon the uvula and pharynx, which

776 DISEASES OF THE SANGTJINOUS FUNCTION.

gradually increases in thickness and strength, unless the- peculiar in-
flammation be arrested.

As the disease advances, the febrile symptoms increase, the respi-
ration gradually becomes more labored and diflScult, the inspirations,
particularly after coughing, being slow, sawing, sonorous or ringing,
while the expirations are quick ; the cough is dry and gives forth a
metallic sound ; the voice becomes more shrill, the pulse is frequent
and small, the expression of countenance swollen and anxious ; the
head is thrown back ; the extremities are cold, while the rest of the
body retains its exalted temperature; there is often a profuse perspi-
ration^ until finally the respiration is so much impeded that the blood
is but slightly oxygenated ; the cheeks and lips become livid, the eyes
red and sunken, the pulse extremely small and frequent, the whole
organism prostrated, and the child expires in a state of asphyxia or
suffocation.

In membranous croup the inflammation is of a peculiar character;
for from the very commencement of the attack, the mucous membrane
continues to pour out coagulable lymph, which becomes adherent to the
parts affected, forming the tough artificial tube known as false mem-
brane. We believe that the progress of this fictitious formation is
never entirely arrested until a healthy medicinal inflammation is made
to supercede the peculiar morbid action.

" The false membrane which so frequently forms on blisters, is, of
itself, sufficient to prove that it is much less to the degree than to the
nature of the inflammation, that we are to attribute this concretion or
coagulation of pus in certain cases." (Zaennec.)

Causes. — A cold and damp atmosphere, wet feet, and exposure to
the air which blows from seas and lakes. It appears to be necessary
also that there should be a certain predisposition on the part of the
patient, in order to contract the disease, since ail of the children of
some families are constantly liable to its attacks, while those of other
families, constantly exposed to precisely the same influences, are
exempted. This predisposition may frequently be traced back through
several generations, while in other families the reverse is true, no in-
stances of the malady having ever been known to exist in them. Croup
sometimes follows as a sequence of scarlatina, measles, &c., and has
by some writers been confounded with the former disease, and from this
circumstance has originated the idea of its contagious natul*e.

Treatment.— Spasmodic Ceoup. — Aconite, Spongia, HyoscyamuSy
Belladonna^ Nux, Musk, Cuprum, Ipecac, Camphor and Lobelia
infiata.

Cataeehal Ceoup. — Aconite, Tartar-emetic, Spongia, Hepar-
sidphn, Drossera, Lachesis, Samhucus, Chamomilla and Nux.

cEoup. 777

Simple IisTFLAMMATORY Croup. — Aconite^ Spongia, Hepar^ Tartar-
erfietic^ Phosph,^ Iodine and Belladonna, *

Teue or Membranous Croup. — Kali-tiGhrom, Bromine^ Ammo-
nia-Gaustio^ He^ar-suVph.^ Argentum-nitr,^ Samhuous^ Sjpongia^
Iodine^ Senega^ Tartar-emetic,

Aconite Croup. — Invasion in the evening, after first sleep, preceded
by restlessness, accelerated pulse and dryness of the skin. The patient
usually rouses from sleep, with restless, impatient movements, tosses
from side to side, cannot be calmed, and, on attempting to swallow,
cries as if from soreness and pain in the throat, followed immediately
by a shrill, barking cough. The cough is frequent, following every
empiratory effort^ hut absent during inspiration. This seems to result
from a tickling sensation, excited by the rush of air from the lungs,
through the over-sensitive and irritated larynx. The sibilant, stridulous,
or sawing respiratory sound is also heard only during the expiratory
ac% and not during inspiration^ as in some other forms of croup.
The stridulous respiratory sound and cough, are concurrent and pre-
sent only during expiration^ which appears to be characteristic of
aconite croup. The cough is more or less paroxymal, but the stridulous
breathing continuous, till after midnight, when both gradually remit,
and towards morning nearly or wholly disappear, but often to return
on the following night.

Some five years since our attention was first attracted to the above
peculiar concurrence of the stridulous respiratory sound, and barking
cough, in the case of a boy about four years old. The disease resisted
all our efforts for four days. No remedy touched it, but we gave
Aconite^ when the whole trouble vanished as. if by enchantment.
(Dr. Paine, 0^ Bath, Me.)

The following excellent indications for the employment of Spongia,
Hepa/r-sulph., Bromine, Caustic-ammonia, Kali-hichrom, and Pot-
ash, were arranged by several homoeopathic physicians of Pressburgh,
and translated for the Homoeopathic Examiner by Dr. Hempel.

SpoNaiA Croup. — "Hollow cough, with expectoration, and pain in
the chest and trachea; roughness in the throat (night cough with
weeping expression) ; breathing aggravated, as from a plug in the
throat, slow or quick; panting; larynx painful, as if from pressure —
worse when touched; scratching, burning and constrictive sensation
in the larynx ; painful feeling of swelling in the cervical glands near
the larynx and trachea ; stinging in the throat and sensation in the
outer parts of the neck, as if something were pressing out, morning and
evening ; painful tension on the left side of and near the pomum Adami,
when turning the head to the right side; the eyes are sunken; the
urine deposits a thick, grayish-white sediment; general morning sweat;
pulse quick and hard ; drowsiness ; lassitude of the whole body ; out

778 DISEASES OF THE SAlS'GUmOUS FUNCTION.

of humor ; every thing puts him out of humor, even talking a,nd answer-
ing questions."

Dr. Paine says :* " It seems that Spongia covers nearly the same
symptoms as Aconite, with this difference and addition : in Spongia
croup, the stridulous respiratory sound is always during inspiratio7i,
and the cough less constant, and excited only by the inspiratory act;
and the cough and sibilant respiratory sound are not so constantly
concurrent as in Aconite croup. There is also, in Spongia croup,
fluent coryza, and sometimes sneezing, with saliva drivelling from the
mouth, which we do not see in Aconite croup. Neither of these re-
medies have any homoeopathic relation with membranous croup, either
in their symptomatic or pathologic bearing ; and, in such cases, the
t|me expended in their use, is, in our judgment, so much time lost."

Teste says, this remedy is, in general, only applicable in the second
stage of croup, though he does not hesitate to place it in the first rank
in the treatment of acute and chronic affections of the serous mem-
branes, (pleurisy, pericarditis, peritonitis, &c.).

Hepae Ckoup. — " Violent fits of cough, as if he would suffocate or
vomit ; deep distress, occasioned by the tightness of breathing ; husky,
accompanied with painful soreness of the chest at every turn of cough,
which is violent, the air rushing violently against the larynx, occasion-
ing a pain in that part; sensation of scraping ; scratching, with mucous
expectoration ; the cough being caused by tittilation in the throat,
or by a scraping in the trachea, and increased unto vomiting by a deep
inspiration ; weakness of the organs of speech and chest, which prevents
talking aloud ; short breathing, pressure in the throat, occasioning a
constrictive feeling as if he should be suffocated ; urine pale, clear
while being emitted, afterwards becoming turbid and thick, depositing a
white sediment, or flocculent, turbid, while being emitted, or dark
yellow; burning during emission; great unconquerable drowsiness;
profuse sweat, day and night ; viscid profuse night sweat ; sweat before
midnight ; sad, apprehensive and inclined to weep.

Bromine Ckoup. — Formation of pseudo-membrane in the larynx and
trachea ; spasm in the larynx occasioning suffocation ; cough with croup
sound, hoarse, wheezing, fatiguing, not permitting one to utter a word ;
sneezing, with violent suffocative fits ; respiration characterized by
mucous rattling ; wheezing ; alternately slow and suffocative, and hur-
ried and superficial ; breathing painful, oppressed, gasping for air ; heat
in the face ; increased secretion of urine ; pulse rather hard, slow at
first, afterwards accelerated."

Caustic Ammonia Croup.—" Deep, weak voice ; fatiguing, inter-
rupted speech; increased secretion of mucus in the bronchia; violent

* U. States Jour, of Horn., Vol, I.

CROUP.

779

cough, Nwitli copious expectoration of mucus, especially after drinking ;
difficult, rattling, labored breathing ; stertorous breathing ; suffocative
fits ; spasm of the chest."

B1-GHR0MA.TE OF Potash Ceoup. — " Symptoms approach gradually
and insidiously ; at first, slight difficulty of breathing when the mouth
is closed ; slight elevations of temperature ; pulse irregular and inter-
mittent, or frequent and small ; , as the disease progresses, the difficulty
of breathing increases ; the sound of the air as it passes through the
trachea is shrill, whistling, as if it passed through a metallic tube ;
voice hoarse ; cough not frequent, but hoarse, dry, barking and Qiie-
tallio / deglutition painful ; tonsils and larynx red, swollen and covered
with an appearance of false membrane ; after a time, breathing affected
in part by the action of the abdominal muscles, and those of the n^ck
and shoulder-blades ; head inclined backwards ; breath offensive ;
finally diminished temperature of the skin ; prostration ; stupor."

The medicines, of which the pathogenetic symptoms are here de-
tailed, are those which are most completely specific against croup. It
is true that the other articles alluded to, as Aconite, Iodine, Bella-
donna, N'lix, Hyoseyamus, Samlueus, Tartaf-emetio, Laehesis^
Phosphorus, Drossera, Arsenicum, kc, cover many of the symptoms
usually present, especially in non-membranous croup, but they canno
be considered positive and reliable specifics against the disease fullj
developed. So far, however, as certain special indications are con
cerned, these medicines may often be employed with great advantage

The following is Dr. Bosh's method of treating croup: "If the dis-
ease begins, as it frequently does, with an inflammatory fever, then I
give first, according to the circumstances, every quarter of an hour,
one or two drops of Aconite (the dilution, second or third, depending
upon the age), and then I let the child rest from one to two hours,
when I give the remedy, which I found in my practice to be the main
YGmeij, Spongia, first, second, or third dilutions, according to the se-
verity of the disease ; eight drops, in four ounces of water, — of this
every quarter to a half hour, or, in less intense cases, only every hour,
half a table-spoonful. If the disease has proceeded further, and para-
lytic signs are perceptible (by continued obstruction of the respiration,
congestions of the brain, &c.),.then I give Spongia alternately Avith
Phosphorus, If, notwithstanding these means, the disease increases,
I give Spongia in alternation with Tartar-emetic."

Tartar 'emetic. — Feeble voice, burning under the sternum, cough
and sneezing. Tittilation in the larynx, inducing cough ; cough with
vomiting. Mucous rale in the bronchia with oppression. Eating ex-
cites cough and vomiting of food, and glairy mucous. Short, hoarse
cough caused by tickling in the middle of the larynx, heat and sweats
on the forehead when coughing, which is very fatiguing.

780 DISEASES OF THE SANGUINOUS FUNCTIOl^.

Tartar-e^netiG is not only useful in the early stage of croup, but it
is also indicated when there are signs indicative of partial paralysis of
the pneumogastric nerve; viz.: face livid and cold; cold sweat on the
forehead or body ; respiration exceedingly difficult, short, hoarse, shrill,
or whistling; head thrown back; pulse small and rapid, or feeble and
slow ; great weakness, anxiety and uneasiness ; difficulty in swallowing ;
short, hoarse and barking cough ; disposition to sleep. The remedy
should be given in the first attenuation, and the dose repeated every
twenty or thirty minutes, until relief is obtained.

Pathology. — Larynx and trachea covered with large pustules de-
pressed in the centre. Mucous membrane of the larynx and trachea red
and injected.

«The indications for this, remedy in croup are based on the predomi-
nating symptoms of partial paralysis of the pneumogastric nerve. The
short, hoarse, nearly suffocative breathing is accompanied by a whist-
ling noise heard even at a distance, whilst the thorax expands only with
the greatest muscular effort, and the greatest anxiety, uneasiness and
prostration are manifested. The head is thrown backward; the face
livid and cold ; the forehead and sometimes, the whole body are covered
with a cold sweat; the pulse small and very much accelerated, or de-
pressed and slow ; the patient drinks with great difficulty, owing to the
spasm and complete contraction of the muscles of the throat.

The remedy must be given at short intervals and generally succeeds
best in a low dilution. If given every fifteen or thirty minutes the
symptoms often diminish rapidly without inducing vomiting, purging, or
profuse sweat. The child falls into a gentle sleep ; the cough soon be-
comes loose and expectoration begins to be more free : it consists some-
times of a thick lumpy, greenish mucus ; the skin becomes moderately
warm, the pulse more natural. In cases in which the deposition of
plastic lymph in the form of false membrane has not yet commenced,
Tartar-emetic is one of the most efficient remedies: and is generally
more applicable than any other remedy in all the ordinary inflammatory
and spasmodic varieties of the disease. It has been very effectual in
the first stages of inflammatory croup, with hoarse, barking cough,
rough and hoarse voice, great painfulness of the larynx, with danger of
suffocation when touching or turning the throat, when talking or taking
breath ; bright redness of the throat, spasmodic constriction of the
throat, whistling, laborious respiration, wheezing and rattling in the
larynx and bronchial tubes, the use of this drug in alternation with
Belladonna is our most reliable remedy. In cases of this kind Bella-
donna has not received due appreciation. It is homoeopathic to a ma-
jority of the cases that occur, and we believe that a prompt and reason-
able employment of these two drugs will speedily break up fifty per

CROUP. 781

cent, of all the cases that occur in practice. {Dr, Ma/rey. New
Materia Medioa, p. 436.)

In spasmodic croup Dr. Dunford relies upon Aoonite, Hyoseyamus^
and Belladonna.

When in addition to high febrile excitement, the local croupy symp-
toms are urgent, we must alternate the proper local specific with
Aconite, In this way we may often give Spongia, or HejpaT-sulpli,^
and Aconite, When the disease obstinately resists Aconite^ Sjpongia^
SepaT'Sulph,^ Tartar-emetic^ both alone and in alternation, we may
consult Phosphorus^ Lachesis, Sambucus^ Senega-pol.^ &c.

As we progress in the knowledge of medicinal substances, a still
greater number of pui;e specifies will undoubtedly be added to our ma-
teria medica. Before taking leave of this subject, we ask attention par-
ticularly to the employment of one remedy, previously named, for the
cure of membranous croup. We refer to the Nitrate of Silver as a
direct application to the affected membrane. For some years we have
been in the habit of employing a strong solution of this salt, by means
nra sponge moistened with it, and introduced into the larynx; and in
several instances the most satisfactory results have followed. This
remedy has been used to a considerable extent by French as well as
American physicians, and in many cases they have saved life when
every other means had failed. The principle on which it cures, how-
ever, is strictly homoeopathic, for it is due solely to the medicinal or
artificial action of the remedy^ that the morbid croupy inflammation
is superseded, and the false membrane gradually destroyed and ex-
pelled.

It may be used in any stage of true croup, and will sometimes effect
a cure when every internal remedy has failed.

A little tact will enable the physician to apply the solution to the
larynx, or trachea, in an efficient manner and with perfect safety.

Admhstisteation.— In the treatment of croup we generally employ
the lower potencies. In regard to the repetition of doses, no definite
rules can be given, but the practitioner must be guided by the variety
of the disease, the severity of the symptoms and the effects of his re-
medies.

Boeninghausenh Treatment of Croup. — ^He gives five powders.
Thus: No. 1 and 2, Aconite 200°; 3 and 5, Hepar-sulphur 200°;
4, Spongia 200°.

He says, the true symptoms of croup nearly always disappear after
the first powder, if no other remedies have been given. One hour
should always pass between 1 and 2. If there be improvement after
No. 1, the next, No. 2, should only be given after twelve or eighteen
hours. No. 1 and 2 remove the inflammatory symptoms, No. 3 removes
the cough and prevents the return.

782 DISEASES OF THE SANGUINOUS FUKCTIOIT.

Hahnemann experimented with the thirtieth dilution for twenty
years and then decided that remedies at that potency were efficient in
curing disease.

Eoeninghausen says, he began trying high potencies in 1843 on a
more extensive scale. At the end of seventeen years he says, that the
result has been so satisfactory, that he prefers them decidedly to all
lower dynamizations, and he shall never return to the lower attenua-
tions. He has treated many cases as usual, and when the two-hundreth
power failed, he only succeeded by using Jenichen's high potencies.
He understands that these latter were prepared on Hahnemann's scale
of one-hundred, potentizing each dilution with thirty shakes of an un-
usually powerful arm.

Jenichen commenced his high potentization January 1st, 1846, in
trying to bring Arsenic up to the 8000°, and he finally carried it to the
40,000^, and found it to surpass all other potencies of Arsenic.

Dr. Wolf thinks, that " Croup has become more frequent and un-
manageable through the influence of vaccination. He says, Boening-
hausen's five powders have become famous against croup, and that he
has often used the same remedies in the second or third potency gene-
rally with success, though now and then a child will die of paralysis.
He can not decide whether the high potencies have been more suc-
cessful in his hands than the lower. Where" it is possible, he would
give a dose of Thuya at the beginning, and afterwards nothing but
Aconite 2°, 3°, or 200°. Apis appears also to be an excellent remedy
in alternation with Aconite, and afterwards one dose of Thuya, 30°.

Case by Dt. Kenyon of Buffalo. — A child three years old had
croup. In the night the mother gave Aconite, Spongia, Tartar-
emetic, Mercurius-iodatus. The child grew worse. They tried hive-
syrup till vomiting gave temporary relief. The symptoms returned.
Cold compresses applied to the neck; mustard to the" feet and
wrists; used hot mustard-bath, then gave hive-syrup the third time.
Five minutes after, Dr. Kenyon found the cough dry and shrill, breath-
ing whistling with violent heaving of the chest, contortions of the
face; skin dry and hot, pulse nothing but a tremulous motion. He
feared, the Aconite could not succeed, if given in five minutes after
the large dessert-spoonful of hive-syrup: but the case was growing
worse. Aconite 200° was given, the child wrapped in a dry, warm
blanket, the cold compress being left on the throat. Relief was mani-
fest in less than half an hour. Aconite 200° repeated. Then Hepar
200°. After the last the child slept quietly two hours. Two hours
later there was hoarseness, for which Aconite 200° was given.

Ipecacicanha. — Dr. Teste {Materia Medica, p. 364) says, he has
seen Ipecacuanha arrest the following symptoms with such marked
rapidity that he ^' can not help believing it capable of producing similai

CEoup. 783

symptoms, if not in full-grown persons, at any rate in healthy children:

" Rapid bloating of the mucous membrane of the pharynx, and very
probably also of the larynx and trachea,

"Secretion, on the inflamed surface of this membrane, of a thick,
plastic, whitish, mother of pearl humor, looking at first like small white
or grayish points, either on the tonsils, or on the pillars of the palate,
or even in the pharynx.

" If we unite these symptoms to those mentioned before, we shall
have as complete an image of croup as possible."

Teste relies upon Bryonia and Tpeoac, to a large extent in oroup^
employing them in the attenuations and in alternation.

At the same time he admits that croup may be cured by many other
remedies, and also that " all the analogues of Ipecac, are capable of
producing, each in its own degree, not only the general croup, but even
the pseudo-membranous exudation which constitutes the pathognomonic
sign of croup, and that they must therefore be capable of curing this
disease." Peculiar constitutions may require other remedies. In the
sub-acute form there maybe occasion for ^'Pulsat^ jSilic, Spong,,
Ilepar, &c., in preference to Jpecac, or Bryon, But I maintain that
these cases are rare, and that, as a general rule, Ipecac, iini Bry on,
constitute the specific remedies for croup."

"Ipecac, is almost the only remedy that is indicated in all cases of
very acute inflammation of the throat, wind-pipe, bronchia, and even
the parenchyma oi the lungs, no matter what the cause of* the infiam-
m>ation may have teen^ when the patient is from six to ten months old,
with blond hair, of a sanguine and lively disposition, and if it is more
particularly at night that the disease reaches its acme, or first
breaks out."

Dr. Holcombe says, he never lost a case of croup, out , of a large
number, ftis treatment consists in : 1. Applying a cold water bandage
to the throat at an early period. This is imperative ; and he would not
take the responsibility of a case, when this was objected to.

2. Aconite and'Spongia alternately every 15 minutes or half hour til]
better or evidently worse. If growing worse. Iodine or Bromine in
such doses as leave a sensible taste to the solution, every fifteen minute,-',
or half hour, the intervals to be lengthened as amelioration is perceptible.

If the disease progresses, give Kali-bichrom. Hepar, Phosphorus
and Tartar-emetic are best adapted to pulmonary irritation which re-
mains after the exudative stage is arrested.

Teste's plan of Bryon. and Ipecac, he thinks better adapted to bron-
chitis than to laryngitis or tracheitis. Dr. Hering gives Tartar-emet. in
nauseating doses, but this is antipathic, not homoeopathic treatment:
the pathogenesis of Tartar-emetic does not resemble the early stage
of true croup.

784 DISEASES OF THE SANGUINOUS FUNOTIOlir.

Genus V.--INFLAMMATORY AFFECTIONS OF THE ORGANS WITHIN

THE THORAX.

These diseases may be divided into the following groups : 1. Those
affecting the bronchial tubes ; 2. Those more immediately connected
with the air-cells and pulmonary parenchyma; 3. Those seated in the
pleura ; 4. Diseases affecting the trachea.

1. BRONCHITIS

This appears in two forms : 1. Common acute 'bronchitis consists in
inflammation confined to the larger subdivisions of the bronchi ; 2. Ca-
pillary ironchitis consists in inflammation restricted to the minute
branches, or extending from them to include the larger divisions also ;
here the smaller ramifications are affected, but not the proper capillary
tubes or terminal twigs of the bronchial tree. Bronchitis may also
exist as an idiopathic affection, or co-exist with other diseases of the
lungs or other organs ; it may be general or circumscribed.

ACUTE BRONCHITIS.

This complaint is of most frequent occurrence in ol^_ age and in
childhood. Its seat is in the mucous membrane of the bronchia, but
authors assure us that the bronchial inflammation is always accom-
panied with considerable " sanguineous congestion of the lungs."
Effusion into the substance of the lungs, is peculiarly apt to occur in this
disease, and it is to this circumstance that its danger is to be attri-
buted.

Diagnosis. — Constriction and aching sensation, extending over the
whole chest ; breathing very much oppressed, quick, anxious, irregular,
labored ; the voluntary muscles of respiration often called* into play;
expectoration is at first dry, but it soon becomes viscid and frothy, and
sometimes streaked with blood; more or less cough, hoarse and pain-
ful in children ; throbbing pain in the forehead and aching pain in the
eyes, aggravated on coughing ; face red or pallid ; tongue moist and
covered with a white fur ; bowels costive ; temperature of the skin
nearly natural, but sometimes hot and dry ; pulse at first but little in-
creased in frequency, becoming, as the disease advances, very rapid ;
urine scanty and high colored ; vertigo ; rattling in the throat and
chest; wheezing respiration. As the malady approaches towards a
fatal termination, the skin becomes suffused with a cold perspiration;
the cheeks and lips pale and livid ; the extremities cold ; rattling and
sense of suffocation in the throat ; extreme prostration and complete
insensibility.

The peculiar respiration (the mucous rale or rattle of Laennec) which

BEoisrcHiTis. 785

is so apparent is owing to the " passage of air through the diseased se-
cretion of the air passages, and may be heard by placing the ear to
the chest, long before it becomes so severe as to be distinguished by
any other me^ns." [Mackintosh.)

The inflammation of bronchitis is of a much more intense character
fchan that which is present in cata/rrh or infiuenza^ and there is always
more or less sanguineous congestion of the lungs. Many of the more
m-gent symptoms of the complaint are due to this last circumstance,
like the great dij05culty of breathing ; the painful sense of tightness ;
stricture and oppression in the chest; wheezing respiration; severe
cough; pallid countenance; vertigo; pain in the head, &c. During
the progress of this disease, the substance of the lungs often becomes
hepatized.

Summary of Physical Signs. — In acute Bronchitis,— VoYGussion-
resonance clear on both sides of the chest. In the early stage, before
liquid secretion ta,kes place, the dry rales, especially the sonorous,
irregularly present in a certain proportion of cases. After secretion,
the moist rales frequently commingled with the dry. The rales heard
on both sides. The respiratory murmur at the upper portion of the
chest in front exaggerated and harsh in the early stage, subsequently
liable to be diminished or suppressed over a part or the whole of the
chest. Sometimes reproduced suddenly after an act of coughing. In
some mild cases preserving its normal intensity and characters. A
ronchal fremitus occasionally present.

2. Gapillary Bronchitis, — This disease was formerly known by the
title of peri-pneumonia notha, or suffocative catarrh. It consists
anatomically in an irregular contraction of the calibre of the minute
tubes, the presence of liquid within these tubes, and obstruction to the
passage of air to and from the vesicles. This obstruction causes the
principal physical signs.

DiAaNOSis.

Capillary Bronchitis.
The reverse obtains in this disease.

Difficulty of respiration, although in-
creasing at times, is persisting.
Vol. 1.-50.

(Edema Glottidis.

The seat of the obstruction is indicated
by the sudden arrest of the inspiration,
the expiration remaining free ; when
there is no pulmonary complication,
auscultation discovers only diminution
or abolition of the vesicular murmur;
not the rales of capillary bronchitis.
The finger carried to the top of the
larynx proves the existence of oedema
by the touch.

Spasm of the^Glottis. — Common in;
early life, rare in adults. It is parox-
ysmal, the respiration in the intervals-
being either free, or but slightly em-

786

DISEASES OF THE SAKGUIKOUS PUHCTIOIT.

Capillary Bronchitis a

Pulse increased m frequency.

Voice unaffected.

Auscultation shows signs of inflam-
mation.

Orthopnoea and defective hsemalosis
in minute bronchial branches, and physi-
cal signs nearly the same as in asthma.

Sonorous and sibilant rales.

The affection is inflammatory, and not
habitual nor paroxysmal.

Pulse greatly accelerated.

These symptoms are the same as in
acute bronchial inflammation extending
to, but not beyond the smaller branches.
But the symptoms all more serious, pulse
more frequent, indicating inflammation.

Peculiar to young subjects.

Inflammation extends from the larger
to the minute bronchial tubes through-
out the lungs, perhaps the air-cells, the
lobules, in parts, become implicated.

Ordinary bronchitis exists in both
these diseases.

Dyspnoea and hurried respirations in
both. But in capillary bronchitis is a
serious disease. Respirations frequent ;
asphyxiating symptoms strongly marked

(Ederfia Glottidis.
barrassed. It is characterized by a
sonorous crowing inspiration, distinctiTt)
of its laryngeal origin. .

Pulse not increased in frequency.

No positive signs of inflammation.

Laryngitis m the Adult and Ceoup
IN Childeen.-— Voice hoarse, husky,
or extinguished. In croup the soronous
tubular breathing and cough are diagnos-
tic.

No signs of inflammation.

Asthma, orthopnoea and defective hae-
matosis evident.

Sonorous and sibilant rales well mark-
ed. But here the chief element is
spasm. The affection is paroxysmal,
though often of long duration. The
patient is known to be subject to them.
Previous signs denote emphysema.
The pulse may remain unaffected, and
is never greatly accelerated.

Acute Bronchial Inflammation in
A Person affected with Emphysema.
— When the inflammation extends be-
yond the larger, but not to the minute
branches, there is suffering and laborious
respiration, impaired oxygenation of
blood. "When there is emphysema, the
sonorous and sibilant rales are present
with mucous rales, but not the sub-
crepitant. The case is less dangerous
than acute bronchitis, as is shown by the
less excited pulse.

The dyspnoea is great in proportion
to the obstruction. Spasm of the mus-
cular fibres of the bronchial tubes.

Lobular Pneumonitis. Broncho-
Pneumonia. — Peculiar to young sub-
jects.

Inflammation extends from the larger
tubes to a certain number of the air-
cells of the lobules on each side, limited
only to the minute, to the intermediate
minute branches leading to the inflamed
lobules. '

A less grave disease.

BEONCHITIS.

787

Gai?illary Bronchitis.
by dyspnoea, restlessness, lividity; ca-
reer more rapid.

Sab-crepitant rale throughout the
lungs, diffused over the surfaee of the
chest.

Asthma.
Sub- crepitant rale belongs to both
affections, but here it is limited in its
seat to the minute tubes in immediate
relation to the inflamed lobules. Thus
it is confined to certain portions.

" Summary of Physical Signs of Acute Capillary Bronchitis. —
Percussion resonance on both sides not diminished, but often exagge-
rated ; sonorous and sibilant rales diffused over the chest, the latter
more prominent and abundant than in ordinary bronchitis ; the sub-
crepitant rale on both sides, and observed especially at the inferior
posterior portion of the chest; coarse and fine mucous rales inter-
mingled to a greater or less extent." — -{Flint)

3. Pseudo-Menibranoiis of Plastic Bronoliitis. — Characterized by
the exudation of fibrin on the mucous surface of the smaller bronchial
tubes, forming what is termed false membrane, identical with the de-
posit which takes place within the larynx and trachea in croup. It
commences not in the trachea as in croup, to extend downwards, but
in the minute branches, and extends upwards towards the trachea.

Symptoms. — Cough, preceded by dyspnoea, is followed by expecto-
ration of croupal matter. These characteristic sputa are expectorated
at intervals varying greatly in different cases, days, weeks, months and
sometimes years intervening ; the remaining symptoms in these attacks
are those of acute or subacute bronchitis. The expectoration of false
membrane may be followed by relief more or less perfect ; collapse of
pulmonary lobules or solidification from an extension of the inflam-
mation to the air-cells will add to the gravity of the symptoms and the
danger. When the exudation is general throughout the lungs, the
symptoms of acute bronchitis are urgent, and the disease may prove
rapidly fatal. When but limited portions of the lungs are affected, re-
covery takes place after the expectoration of the membranous products.

This disease is rare. It is more common in males than females ;
is most common between the ages of twenty and fifty. It affects per-
sons debilitated by previous ill health ; may be acute or chronic.

Diagnosis. — SiiTnmary of Physioal Signs, — In addition to the
physical phenomena, positive and negative incident to other varieties
of bronchitis, " a peculiar valvular or flapping sound {bruit de sowpape)
has been observed, the sub-crepitant rale, if present, less diffused than
in most cases of capillary bronchitis."

Causes. — Protracted exposure to cold ; alternations from heat to
cold ; inhalations of dust and other irritative substances ; insufficient
clothing, and improper exposure of the throat and neck, after much
talking, public speaking, or singing

It is now generally believed that one great cause of the very frequent

788 DISEASES OF THE sInGUINOUS FUNCTION.

occurrence of chronic bronchitis maj^ be found in the reprehensible
fashion of shaving the beard. Tiiat this ornament was given by the
Creator for some useful purpose, there can be no doubt, for in fashion-
ing the human body, he gave nothing unbecoming a perfect man, nothing
useless, nothing superfluous. Hair being an imperfect conductor of
caloric, is admirably calculated to retain the animal warmth of that
part of the body which is so constantly and necessarily exposed to the
weather, and thus to protect this important portion of the respiratory
passage from the injurious effects of sudden checks of perspiration.

When one exercises for hours his vocal organs, with the unremitted
activity of a public declamation, the pores of the skin in the vicinity of
the throat and chest become relaxed, so that when he enters the open
air, the whole force of the atmosphere bears upon these parts, and he
sooner or later contracts a bronchitis ; while, had he the flowing beard
with which his Maker has endowed him, uncut, to protect these im-
portant parts he would escape any degree of exposure unharpied.

The fact that the Jews and other people who wear their beard long,
are but rarely afflicted with bronchitis and analogous disorders, is now
generally considered a forcible argument in support of these views.

CHRONIC BRONCHITIS.

Chronic bronchitis is at present an exceedingly common and fashion-
able disease. From the fact of its occurring for the most part in
clergymen, lawyers and other public speakers, is has acquired " caste^''
and, therefore, it may be that every slight affection of the respiratory
apparatus is now denominated ironehitis. It occurs at all periods of
life, and, in general, is insidious in its approach, though it occasionally
succeeds to acute bronchitis.

When the disease follows an acute attack, the patient will be left
with some cough ; expectoration of viscid or puriform sputa ; dyspnoea
on the slightest exertion; noctural exacerbations of fever; emaciation,
and in some Instances hectic symptoms.

The stethoscope usually gives us the sound of the crepitous ronchus
at certain points, and now and then over the whole chest, while at the
same time the respiratory murmur may often be heard.

Those cases which come on more insidiously, will be often found
complicated with chronic laryngitis, indicated by hoarseness of the
voice; raw or scraping sensation in the larynx, and extending over
the chest ; copious expectoration of opaque or purulent sputa, which
affords relief to the patient ; hoarse, hollow and painful cough ; in-
creased susceptibility to changes of temperature ; night sweats, and
general debility.

When the expectoration is copious, we shall have the crepitous

BEONCHITIS.

789

ronclius, either at isolated points or over the whole chest ; but if there
is no expectoration, then the sound which will be elicited by auscul-
tation, resembles snoring, and has been termed " dry sonorous rattle /"
or in some instances, the ^' sibilous rattle^^ like the chirping of birds.
Laennec also mentions a clicking sound, which he compares to the
action of a valve.

Percussion affords us no aid in our investigations of bronchitis, but
pressure with the hand upon the chest, will often enable us to detect
the naucous rattle without difficulty.

Complications of BEOJsrcHriTS. — -Bronchitis is frequently associated
with laryngitis, and with infiammation of the fauces extending downward
from the pharynx. This complication is often attendant on scarlatina,
or follows that disease after it had appeared to be terminating favor-
ably. Bronchitis often follows measles, continued fevers, tracheitis,
whooping cough, catarrh of the stomach and chronic hepatitis.

Dilatation of the Bronchi.— This is one of the sequelae of
chronic bronchitis, or of whooping cough complicated with this disease.
The expectoration is copious and puriform, and according to M. Louis
it is foetid.

Ulcekation of the Beonchi.-— This alteration of structure is fre-
quently attendant on the advanced stages of chronic bronchitis, more
frequently however when complicated with tubercular phthisis. It is
often found in cases m which bronchitis has been caused by the me-
chanical irritation of mineral, vegetable or animal molecules. The exis-
tence of ulceration of the bronchi is not always suspected, as the signs
accompanying it are the same as those which accompany the most
chronic states of bronchitis or tubercular consumption.

Treatment of Bronchitis. — The medicines most worthy of con-
sideration in the treatment of acute bronchitis, are Aconite^ Tartar-
emetic^ Belladonna^ Bryonia^ Hepar-siilph^^ Gario-vegetabilis^
SpongiayAmmonia-Garl).^Bhus-tox., Mercurncs, Sulphur, Sambucus,
Arsenieicm^ Digitalis^ Hyoscyamus, Pulsatilla, Sangtdnaria,

Aconite, — As in other inflammatory diseases, Aconite is also in-
dicated in acute bronchitis, whenever there is a rapid and full pulse,
hot skin, and other symptoms indicative of a high state of febrile ex-
citement. It may be given at the second or third, potency, and re-
peated every hour, till a decided amendment ensues.

Tartar-emetic is indicated when there are severe paroxysms of
coughing, with suffocative obstruction of respiration ; wheezing respira^
tion ; mucous ronchus ; very great shortness of breath, with anxious
oppression at the chest; great anxiety and agitation ; palpitation of the
heart ; pain in the back and loins ; pressure on the eyes ; pains in the
head; thirst.

During the progress of acute and chronic bronchial-affections : severe

790 DISEASES OF THE SAKGUINOUS FUNOTIOiT.

paroxysms of cougliing, with rattling of mucus in the bronchia, difficult
respiration, palpitation of the heart, nausea, vomiting, hoarseness, weak-
ness ; easy perspiration, cough aggravated by eating, speaking, inhaling
cold air, or lying down. Repeated doses of the first trituration rarely
fail to aiFord prompt relief in such cases.

Administration. — A grain of the first trituration of Tartar-emeti
to four ounces of water, — -a tea-spoonful every one, two, three, or four
hours, as the urgency of the symptoms may demand.

Belladonna, — Cases of acute bronchitis, in which the predominant
symptoms are : oppression and weight at the chest ; short anxious and
rapid respiration ; shaking, spasmodic cough, and decided cerebral dis-
turbance from the commencement of the attack.

Administration. — Same as jffr^6>m<^.

Hhii^s-toxicodendron. — Worse in the evening, at night, and with per-
fect rest. Symptoms lessened by rising from the bed and walking
about, on the other hand they are aggravated by external cold, while
frictions, warm applications alleviate them. Though gentle exercise
relieves them, they are aggravated by all rough movements or severe
exertions.

In a case of violent cough accompanied by convulsive paroxysms^
with considerable oppression and mucous rale continued through the
day, but redoubling its violence toward evening, after all treatment
had failed, Rhus 5th was given. The patient slept eight hours, and
the cough diminished daily. It returned in subsequent winters, but
was always relieved by the same remedy.

Another case in which fatigue paroxysms came on worse in the eve-
ning toward eight o'clock. Rhus 12th produced aggravation the first eve-
ning ; but there was great improvement the same night. Hepar-sulph.
was given for the catarrhal cough remaining.

Bryonia, — Headache aggravated by movement ; pressure in the eyes ;
dryness in the throat; respiration difficult, short and anxious ; pressure on
the chest as if from a weight; stingingsin the chest; cough with stingings
in the chest, or with severe aching pains in the head. In the acute at-
tacks of children with sufibcative cough, very great oppression at the
chest, exceedingly difficult, rapid and anxious, or sighing respiration,
loud mucous ronchus, ra.pid pulse, hot skin, thirst, great agitation and
anxiety, this remedy is also especially called for.

The marked characteristics are : aggravation upon movements in the
open air, after eating, and towards midnight.

It may be exhibited at the first to the sixth potency, and frequently
repeated until the disease subsides. The practitioner may sometimes
alternate it with Aconite with benefit.

NuX'Vomica, — Symptoms analogous to those of Bryonia : like them,
they are aggravated by motion, after eating and in the open air ; but

BEONCHITIS. 791

tliey display their full strength about two, p. m., Rhus about midnight,
and upon waking in the morning. They are also strongly marked at the
beginning of the motion, by continuance of which they are diminished.

Pulsatilla, — Eifects particularly discernible in the afternoon and
evening, and in the recumbent posture ; they are lessened by motion
this not so decidedly as under Rhus-tox : but unlike the latter they are
aggravated by local heat and relieved by cooling applications.

Pulsatilla is specially indicated in bronchitis in which the cough is
dry in the first part of the complaint, but soon 'becomes ,moist, "with
easy expectoration of abundant yellow matter ; sometimes with nausea,
or retching, or a sensation of reversion in the stomach, as if about to
vomit. The cough occurs principally at night, on lying down ; pro-
ceeds from a tickling or itching in the larynx, or by scraping and dry-
ness in the trachea, accompanied with fatiguing pains in the abdomen,
and stitches in the back, shoulders, sides, or chest, and relieved on
rising up in the bed.'' {Croserio) It may be given in the same man-
ner as Bryonia,

In chroniG ironchitis^ Hepar-Sulpli, is an important specific for the
following characteristic symptoms: anxious, hoarse, and wheezing
respiration, much aggravated on lying down ; attacks of sufibcation
which force the patient to throw the head back, in order to take breath
dyspnoea ; dry cough and hollow cough ; cough with expectoration of
mucus ; hoarseness of voice; exacerbations of fever in the afterpart of
the day, succeeded by night-sweats. In cases which seem to have been
connected with suppression o^ salt-rheum, or other eruptive disease, or
metastasis of arthritic inflammations, this remedy is frequently appli-
cable. It is also useful in those cases which threaten to terminate in
tubercular consumption.

The third trituration may be used : a dose from two to four times in
twenty-four hours.

Sanguinaria-canadensis, — This plant was first noticed by Cornuti
in 1635, in Canada, and was cultivated in England before 1640. Lin-
naeus first settled the name. It belongs to the class Polyandria order
monognia, in the sexual system, and the natural order Papaveracese.

Analysis shows it to contain : 1. Sanguinarine ; '2. Porphoxin ; 3.
Puccine ; 4. Chelidonic acid ; 5. Fecula ; 6. Saccharine matter ; 7,
Vegetable albumen ; 8. Orange-colored resin ; 9. Fixed oil ; 10. Ex-
tractive matter ; 11. Lignin ; 12. Gum.

Sanguinarine, discovered by Dr. Dana, constitutes the active prin
ciple of the plant. Experiments, performed on animals by Dr. Penwick,
of Montreal, show that in its concentrated form, Sanguinaria is ex-
tremely irritating to man and animals, affecting principally the stomach
and bowels. An excessive quantity produces : Violent vomiting, a
burning sensation in the stomach, tormenting thirst, faintness, vertigo^^.

792 DISEASES OF THE sA:N'Gtjmous FUNCTIO:iSr.

indistinct vision, alarming prostration of strength. In more moderate
doses its effects are emetic-nauseant, expectorant, diaphoretic; also, in
a lighter degree it acts as a narcotic, sedative stimulant, and alterant. It
has long been known as an emmenagogue, escharotic and errhine. It
has been employed in pneumonia, phthisis, bronchitis, catarrh, asthma,
croup, diphtheria, cynanche-maligna and pertussis.

Sanguinaria stands at the head of the class of remedies known in
the books as Deobstruents. They are supposed to produce a general
change of action or condition in the whole secernent and absorbent
system ; more especially they remove torpor and occasion improved and
increased secretions from the liver and from all the glandular viscera.
In this way it has been supposed, they relieve various dysthetic or
cachectic diseases, and certain affections of the skin ; induce a direct
resolution of many atonic, acute, and sub-acute, or chronic inflammations
of the viscera, muscles and joints. These effects are entirely indepen-
dent of any direct change in the degree of vital energies of the arterial
system, or any material evacuations of any sort as necessary accom-
paniments.' In short, when curative effects are obtained, they are ob-
tained through the. homoeopathic action of the remedy.

In the concentrated form Sanguinaria is extremely irritating, affect-
ing principally the mucous membrane of the stomach and bowels. A
dose of from eight to twenty grains produces : violent vomiting with
quickly-diffused, transient nervous thrill ; burning sensation in the
stomach ; faintness extending to the whole system, the thrill extending
to the fingers and toes; tormenting thirst ; faintness ; vertigo ; indis-
tinct vision; alarming prostration. {Dr. Tully. Amer, Medical
HecordeT. 18270 In moderate doses it causes vomiting, nausea, ex-
pectoration, diaphoresis. It has also some narcotic, sedative stimulant
and alterative properties ; it diminishes the frequency of the pulse,
and is used as an emmenogogue, escharotic and errhine. It is used in
affections of the chest and throat ; pneumonia, phthisis, bronchitis, ca-
tarrh, asthma, croup, diphtheria, cynanche maligna and pertussis. It
has also been used with success in rheumatism, jaundice, dyspepsia,
hydrothorax. It rarely diminishes the frequency of the pulse, till it
has been continued for a week or ten days.

It has been successful in protracted and distressing affections of the
chest with repeated attacks of pneumonia, haemorrhage from the lungs,
constitutional debility, habitual returns of spasmodic obstructions of
respiration, in plethoric persons who suffer with extreme difficulty of
respiration, the cheeks and hands becoming livid, pulse full, soft vibrat-
ing, easily compressed. In protracted catarrhal affections, assumnig the
appearance of incipient consumption, it often gives complete relief;
though in many cases no amendment is perceptible till the remedy ha^
been employed for about two weeks. After ten days or more the cough

BRONCHITIS. 793

begins to abate, tbe pulse dimmishes- in frequency, and tliis abatement
goes on slowly and regularly till all symptoms of irritation disappear.
At tbe same time, tbe appetite improves, digestion and the pulse are
improved. The action of the mucous membrane of the bronchia is in-
creased or diminished according to the condition; it is sj>6Gifically af-
fected beneficially. When emetic doses are given, the quantity of
fluids evacuated is small ; the nausea is of short duration ; there is no
refrigerant, diaphoretic, diuretic, or purgative power.— It differs from
other emetics in the peculiar shock or nervous thrill that it sends
throughout the system; and its beneficial effects are more specially ob-
tained through the sedative and nauseating property it shows in large
doses in acute cases, and the deobstruent power displayed by small
doses in chronic cases.

It is specially adapted to the pretubercular stage in phthisis also in
the second or third stages ; it renders expectoration easier, breathing
cleairer, lessens the spasmodic efforts to cough ; it acts here as an ex-
pectorant and mild stimulant. ..

In chronic bronchitis it allays the cough and irritation of the folli-
cular inflammation of the throat. In chronic catarrh associated with
emphysema, in coryza and cold in the head it has been much em-
ployed ; also in membranous croup.

In GTOupal diphtheria it acts with energy, producing a thrilling
effect upon the whole mucous membrane of the fauces and respiratory
tract, with a feeling of warmth. In t}ie form of decoction it seems to
give vitality to the suffering throat.

An acetous decoction of Sanguinaria as a gargle is invaluable.

Lobelia, — Cough, sneezing, with gaping and flatulent eructation.
Short, dry cough.

. C%6«§^.— General' tightness of the chest with short and somewhat
laborious breathing. Involuntary disposition to keep the mouth open
to breathe ; oppression of the chest, tightness of the chest, with heat in
the forehead. Sensation of* fullness of the chest; breathing short and
superficial; 24 respirations in a minute. Oppression causing deep
breaths to be taken ; deep inspirations to relieve oppressive pain in the
epigastrium ; accelerated breathing ; breath seems insufficient ; inclina-
tion to sigh ; short inspiration ; slow expiration ; difficulty in holding
the breath; tickling, smarting sensation in the larynx; irritation to
cough; feels oppressed; tickling, on taking deep breath, under lower
part of the sternum. Feeling of a lump in the throat, impeding deglu-
tition and respiration. Chronic dyspnoea, with feeling of a lump in the
throat above the sternum, impeding deglutition and respiration ; par-
oxysmal asthma ; pain in chest increased by deep inspiration ; burning
feeling in the breast, passing upward.

Senega.-— ThQ Polygala-senega, Seneca-snake-root, is a popular re

Jd4: DISEASES OF THE SANaUINOUS FUNCTION.

medy for croup ; given in a weak infusion it sometimes cures by causing
free expectoration. There is a proving by Stapf. {Additions^ <&o,)

Larynx and Traohea, — Scraping and dry contractive irritation in
the throat ; roughness and dryness with cough ; dryness in the throat,
impeding speech ; dry cough with oppression of the chest and rough-
ness in the throat; disagreeable, long-continued cough; increased short,
hacking cough in the open air ; increased secretion of mucous inflam-
matory swelling of the fauces.

Chest. — Frequent and deep inspirations ; oppression of the chest
when going up-stairs ; oppression of the chest with slight shooting
pains; tightness and dull pressure on the chest; pain under the right
scapula when coughing or drawing deep breath; aching pain in the
chest, as if forcibly compressed ; dull stitches in the left side when ly-
ing down or sitting ; burning sensation under the sternum. Sore and
violent pain in the chest on sneezing ; congestions of blood in the chest
oppression in the chest with flushes of heat in the face ; frequent pulse,
worse in the afternoon ; pain in the region of the heart during deep in-
spiration; general sensitiveness and pain in the walls of the thorax.

Urine. — Frequent emission of urine with greenish tinge, depositing
a cloudy sediment. Urine at first mixed with mucous filaments, after-
wards it becomes thick and cloudy, or cloudy immediately after its
emission ; burning in the urethra before and after micturition ; burning
in the urethra in the morning in urinating.

Mouth. — Smarting burning in the region of the palate ; dryness of
the mouth ; prickling and stinging in the mouth, with accumulation of
saliva; ptyalism ; putrid smell from the mouth ; white-coated tongue ;
burning at the tip of the tongue ; bad taste in the mouth; metallic
taste ; increased thirst ; loss of appetite ; eructations ; deranged di-
gestion ; nausea ; retching ; vomiting of watery mucus ; painful and
gnawing sensation in the stomach ; feeling of ^emptiness ; aching or
spasm of stomach; burning followed by retching and vomiting; feeling
of hunger and gnawing below the pit of the stomach ; pressure on the
pit of the stomach ; shifting boring pain in the umbilical region ; stools
increased in frequency and fluidity.

Apis-mel. — Chronic tendency to inflammation of the upper part of
the alimentary and respiratory organs, popularly comprised under the
name of bronchitis. It is characterized by recurrence of the troubles
after every cold, particularly exposure to wet ; highly inflamed or
mottled appearance of the fauces and contiguous parts ; constant dis-
charge of a tough, stringy, clear phlegm, which produces a tendency
to hawk frequently; hoarseness and huskiness of the voice, and re-
turning after every cold, even if repeatedly cauterized. In a case of a
minister who complained of cold, sore throat, great horseness, pain
from talking. Apis 3°, a few doses restored him so thoroughly that he

BRONGHITIS. 795

was able to fulfill his clerical duties only two days afterwards. Many
months afterwards a similar attack was cured by the same remedy.

Cedron. — Dr. Casanova gives a case of a gentleman in whom chronic
bronchitis had lasted fourteen years. Predominant symptom: a trouble
some cough which came regularly every morning about six o'clock and
lasted two or three hours, after which he remained perfectly free from
it during the rest of the day. It was at first dry, with oppressed rat-
tling respiration, becoming easier when expectoration became free ;
expectoration viscous, frothy, w^ith some streaks of blood. Inhalation
of tincture of Belladonna in hot water gave some temporary relief.
Cedron 3° in solution was given at night ; it was so efficacious that it
checked the troublesome periodical cough at once. Cedron is no spe-
cific for bronchitis. " The specificity lies in the relationship which
exists between the period^ producing powers of the remedy and the
periodicity of the disease, no matter what the other symptoms may be.

ArseniGitm. — In one case of chronic bronchitis, the face was bluish
and the expression anxious; the eyes were injected; the intercostal
spaces prominent ; percussion clear ; the heart displaced, and the beat
of the apex felt in the scrobiculus cordis ; fine rales in some parts and
coarse in other parts throughout the chest; respiration short and quick.
He was obliged to sit up constantly and grasp the side of the bed
pulse 90, small and intermittent ; liver one inch below the ribs ; the
diaphragm also depressed; oedema of the feet; constant dyspnoea.
Immediate relief after the first dose of Arsenicum, and almost well in
four days. Cured.

Arsenic Inhalation. — M. Trousseau orders the inhalation of the
fumes of Arsenious-acid, by means of cigarettes, each charged with
one-fifth of a grain of Arsenic, and three or four of them being used
during the day, the smoke being inspired as deeply as possible. It is
said to give much temporary relief.

When bronchitis is complicated wdth angina trachealis^ we may
resort to Spongia with confidence, either alone or in alternation with
IIepar-s%iljph, If febrile symptoms run high, these remedies should
be preceded by Aconite.

When suffocation is threatened from loss of tone and power of the
respiratory organs, rendering them incapable of expelling the morbid
secretions which obstruct the free entrance of air into the pulmonary
structure, Ammoniiiin-carh.^ MMos-tox.^ Samhucus^ Arsenicum^ Digi-
talis^ Hyosciamus and Stannum are worthy of careful examination.
In making our selection from these medicines, regard should not only
be had to the actual symptoms present, but to the temperament, here-
ditary predisposition, and the remote cause of the disease. For exam-
ple, if in any given case, the indications actually present point equally
to HepaT'Sulph. and Ehus-tox.^ but if the attack was found to be con-

796 DISEASES OF THE SANGTJINOUS FUNCTION.

nected with a repelled eruption, our choice would evidently rest upon
the former medicine ; while if the disease was found to be dependent
upon an arthritic habit j5Ai^<9 would be the appropriate remedy.

In the last stages of acute bronchitis, when there is danger tha,t the
malady will run into the chronic form, >&Z;pAi^r has been highly lauded
by many eminent practitioners. If the disease occurs in persons of
lymphatic constitutions, and subject to eruptions, swelling of the glands,
&c., this remedy can scarcely be dispensed with during the progress
of the attack.

For the profuse and debilitating sweats which now and then occur
during the continuance of the symptoms, valuable specifics will be found
in Merourius, Acid-nitr,, Acid-phos, Many physicians have com-
mended CafpbO'Veg,^ in the strongest terms, in chroniG hronohitis, and
it has doubtless effected many excellent cures. It may be used at the
third attenuation, one grain once or twice daily.

Mercury . — Aggravation occurs at night, and in bed ; but this aggra-
vation begins and ends with the night strictly so called ; its pains are
increased by the warmth of the bed and are not increased by cold, and
are rendered more acute by motion. Compare this remedy with Rhus-
tox., Bry. and Pulsatilla.

5. (EDEMA OF THE LUNGS. -PULMONAEY OEDEMA.

The serous effusion takes place primarily and chiefly within the air-
cells, but the infiltration extends to the intervesicular areolar tissue.
The volume of the affected lungs is slightly augmented ; it does not
collapse or crepitate on pressure. A yellowish limpid fluid,^ somewhat
frothy^ oozes in abundance on cutting the lungs, showing that some
air finds access to the cells ; the texture is solid, resisting, non-elastic,
pitting on pressure as in sub-cutaneous oedema.

(Edema of the lungs may in some degree be found in most of the
lung diseases which terminate in c^eath; in the congestion which is
found in the latter stage of fevers, and may even be developed after
death. As a separate disease it is always dependent oil some previous
malady; as scarlatina, organic disease of the heart with mitral re-
gurgitation or obstruction, or hypertrophy a,ffecting the left ventricle ;
Bright's disease, or morbid blood conditions, such as give rise to drop-
sies elsewhere. It may progress rapidly and be speedily fatal ; then
called serous apoplexy of the lungs.

Physical Signs.— There is dullness .on percussion over the affected
part. When the lung is made deiise by serous infiltration, as when
solidified from inflammatory exudation or tubercle the sound may be
tympanitic over the lung. The resistance of the thoracic wall over the
lung becomes notably increased. A subcrepitant rale is caused in the

PULMOKARY (EDEMA. 797

air-cells and minute bronchial tubes, and discovered by auscultation.
In other respects the respiratory sound is broncho-vesicular, though
not so strongly marked as in inflammatory or tuberculous solidification ;
the high-pitched metallic sound often heard in the latter is wanting.
Great feebleness and suppression of the respiratory sound belong to
oedema rather than to pneumonitis or tuberculosis.

If the above given physical signs are found in a case in which
there is evident organic affection of the heart, obstruction of the pul-
monary circulation, such as belong to diseases which affect the mitral
oitfice, or in conjunction with general dropsy, the oedema may be con-
sidered as established with considerable certainty ; provided, we have
evidenpe against pneumonitis ; such as the absence of pain, of the rust-
colored sputa of fever, " and of the physical signs, which denote solidi-
fication of the lung from the deposit of inflammatory exudation, viz.,
a well-marked and intense bronchial respiration, broncophony and the
true crepitant rale. The latter sign, however, may be present in cases
of oedema." Hypostatic congestion always affects the lower and pos-
terior portion of the lungs. (Edema is also more common in the same
parts. If oedema should occur in the superior and anterior portion of
the chest, this mark becomes a diagnostic. Hydrothorax may be dis-
tinguished by the change of level of the liquid on the change of posi-
tion by the patient. (See that article.) •

" Summary of Physical SiaNS.— Absence of vesicular resonance
on percussion, with increased parietal resistance ; sub-crepitant andj
occasionally, crepitant rale ; broncho-vesicular, or the bronchial respi-
ration, never intense or metallic; absence of respiratory sound; in-
creased vocal resonance and fremitus uncertain, and rarely, if ever pre-
sent, in a marked degree." {Flinty Bespiratory Organs, p. 515.)

Treatment. — When pulmonary oedema follows scarlatina it is always
accompanied by congestion of the kidneys. The chief remedies for
this condition are : Apis and Arsenicum.

Apis, — ^First dilution. (Edematous and erysipelatous appearance
in the throat; rapid and laborious breathing, worse usually at night;
face and lips livid ; puffed face and eyelids.

ArseniGum.—^^eGondi dilution.) General and rapid sinking of
strength ; oedema of the face ; bleeding from the nose ; bluish lips,
black sores at corners of the mouth, ulcerating; foetid smell of throat,
involuntary micturition; hasmaturia; suffocative paroxysms of oppres-
sive or arrested breathing.

Other remedies are: Digitalis, (first dilution); Nitrum, (first
trituration) ; Cannabis-indica, (first dilution) ; Kali-hydriod., (first
trituration) ; Apocynum-cann. (tincture) ; Mercur.-hydriod., (first tritura-
tion.) Bry. (first dilution) ; Terebinth (first dilution).

798 DISEASES OF THE SANaUINOUS FUIiTOTIOK.

6. HEMOPTYSIS.

Seat of the Disease. — Tlie mucous membrane througliout its distri-
bution in the lungs, their appendages and the fauces, being liable to
sanguinous exhalations, we distinguish its immediate position thus :

1. When the haemorrhage is from the latter structures, there is
merely hawking without any pulmonary oppression, coughing or vas-
cular excitement. On examination of the throat, we shall in some in-
stances perceive the source from whence it comes.

2. Hsemoptysis proper. It appears in two forms :

1. From the mucous membrane of the lungs ;

2. From the tissue of the lungs.

Diagnosis. — The latter, affecting the lung itself, is generally accom-
panied with all the violent symptoms, coming on more suddenly, and
with such intense oppression as even to threaten suffocation.

External Exploration. — Th'is cannot always be trusted ; but much
may be learned by it. In hsemorrhage of the mucous membrane, the
chest on percussion is perfectly sonorous, and the stethoscope betrays
the mucous rattle proportionate to the quantity of blood contained in
the bronchia. Percussion, when pulmonary engorgement is consider-
able, elicits a dull sound over the affected paTt, and the stethoscope
sho\^s the want of the respiratory murmur in it, and the crepitus in-
stead of the mucous rattle. In ambiguous cases these resources fail,
as when the two affections are united, or the engorgement is slight, or
is seated in a portion of the lungs beyond the reach of percussion,
In any view, percussion is rather a point of curiosity than of practical
utility. But in chronic lesions, as tubercles, hepatization, &c., of which
haemoptysis may be the effect, the discussion is important and is hap-
pily easy. Skill in applying these means gives the power of decid-
ing at once with tolerable certainty.

Pathology. — The post-mortem appearances vary according to the
conditions. The appearances after death from hsemorrhage have been
seldom observed, as death seldom results from it. In the most simple
cases, caused merely by turgescence of the vessels of the tissue, little
is seen except the surface covered with blood, the congestion having
been relieved by the previous effusion. When there has been actually
phlogosis, the ordinary signs of that state are seen. And, if a chronic
case, there are changes of structure, thickened, and either softer or
more indurated or condensed than natural, with occasional fibrinous
concretions in the form of polypi.

Extravasations in the parenchyma are rare and resemble much those
appearances in cerebral apoplexy. Looking at the lung thus affected,
we shall discover such portions of it circumscribed from one to two or
three inches, of a deep dark-red color and of a density equal to the

HEMOPTYSIS.

799

completest hepatization. Cutting into these portions, they are found
to consist of the concrete blood, — the surrounding tissue being crepitant
and of the usual color, or reddish, as if tinged with blood.

In more complicated forms, there are discoverable in difierent in-
stances, besides tubercles in their several stages of development, all
those organic lesions to which the lungs are exposed. Extending our
researches further, we may find the heart, liver, spleen or other viscera
variously diseased ; while the lungs shall escape in some cases and
suiFer in others. In the former case the irritation which caused the
effusion of blood is entirely of a derivative nature.

PEoaNOSis. — ^Inactive haemoptysis is generally far more intractable
than active haemorrhage. But the degree of danger is influenced by
the position whence the bleeding proceeds, and still more by the patho-
logical condition. Coming from the larynx and adjacent structures,
"it has been deemed less alarming, but it is sometimes serious even
when principally confined to the fauces. But it is presumed that the
larynx was at the time, or subsequently became involved, — and when
haemorrhage from this structure are precursory symptoms as they are
apt to be, probably the lungs were previously affected, the morbid
action ascending upwards ; or it may be the reverse, the irritation de-
scending till the whole pulmonary system became engaged. Caused by
tubercle or by any other organic lesion, an unfavorahle result is sooner
or later to be anticipated ; such as emanate from the pulmonary sub-
stance itself, are almost uniformly and speedily fatal, but these are of rare
occurrence. Belonging to the mucous membrane, there is little danger,
even when the haemorrhage is copious. Death indeed seldom happens
as an immediate consequence of haemoptysis. Heberden says, in sixty
years practice he never lost a case by it. Dr. Chapman says, his
practice of forty years supplies him with very few instances, and thinks
none of these were from the mucous membrane.

The chief source of alarm in this disease is the apprehension, fre-
quently well grounded, that it is an outward expression of disease of
the lungs, especially tubercular. Exempt from tubercles they appear
to suffer no more from haemorrhage than other parts. In many cases
we see the bleedings from the lungs repeated, year after year, and
ultimately do well. A distinguished person in a neighboring city, who
died at the age of ninety, was subject to very frequent hj^morrhages
from the lungs nearly two-thirds of his life. It is, however, always
desirable to effect a cure. The existence of haemoptysis shows an undue
afflux of blood to these organs, an undue irritation which causes their
determination ; and it is certain that this is the very state of things
that, by continuance, is so apt to lay the foundation of permanent mis-
chief.

Treatment. — -The principal remedies are: Acon,j JIamam>eUs^

800 DISEASES OF THE SANGUINOUS FUNCTION.

Millefolium^ Arnica, China, Ferrum, Ipecac, JVitric-aoid., Bry.,
Phos,, SuljpL, Arsen,, Crocus, Bell., Hyosc, Nux-vom,, Op,, Puis,,
RhuS'tox,

-4(3omi^^.— The paroxysm is preceded by fullness or congestion of
the chest, with burning pain ; palpitation of the heart, anguish, rest-
lessness, aggravation on lying down ; pale face ; expression of agony
in the countenance ; copious discharge of blood from the lungs even
when coughing a' little.

Arnica, — The haemorrhage is caused by mechanical injury, fall,
blow on the breast or back, expectoration of black and coagulated blood
with heavy breathing, stitching, burning and contraction in the chest,
palpitation of the heart ; great heat in the abdomen, and fainting fits ;
or, discharge of bright-red, frothy blood, mixed with mucus and coag-
ulated lumps ; tickling under the sternum ; stitching in the head, and
bruised pain in the region of the ribs when coughing. A dose of
Aconite may generally precede Arnica.

Ipecac, — Symptoms remaining after Aconite : Taste of blood in the
mouth; frequent hacking with expectoration of blood-streaked^ mucus ;
nausea and debility. . After Arsen. if the paroxysm recurs.

Achillea-millefolium, — Hafnie recommended this plant in 1720 as
a remedy for haemorrhoids. It has a specific power over haemorrhages'
in various forms. In the form of tincture in drop doses it has ofter
cured haemoptysis. Dr. Ruckert [Annales Horn, Allem., Vol. I. p. 114)
says : A woman, aged forty-eight years, had every evening for eigLS
days, spitting of blood, followed by a cough, bringing on a fresh ex-
pectoration of vermillion-colored blood, a pint in quantity, followed by
extreme debility. She took Millefolium only three times in the course
of three days, and was cured.

2. A young man, subject to attacks of cough with expectoration of
pure blood, was cured by a single dose. (Gross.)

Hamamelis-mrginica, Witch-hazel, — There has as yet been no
complete proving of this remedy ; but the clinical experience of many
physicians goes to establish its value in certain forms of haemorrhages,
especially haemorrhoids and haemoptysis. It was used by the surgeons
of General Wayne's army, in 1794, in the trea,tment of gunshot-wounds,
bruises, sprains and haemorrhages. Within a few years it has come
into popular use for the same purposes. Homoeopathists have em-
ployed it with success in all cases of injury accompanied by bleeding
where Arnica would otherwise be used, and attribute to Hamamelis
some of the powers also of Aconite. Its sphere of action is supposed to
embrace specially the whole field of venous congestions which result in
haemorrhage. In one case in which it was given by Dr. Davison for
haemorrhoids, (.London Horn, Review, 1859,) it produced the following
symptoms: " A peculiar pricking pain from the wrist to the shoulder.

HEMOPTYSIS. 801

whicli pain was increased by pressure along the course of the super-
ficial veins." On suspending the remedy these symptoms subsided
Further use of it cured the haemorrhoids. They, however, returned
after some months, and Hamamelis was resumed (two drops of the
tincture in six ounces df water ; one table-spoonful every three hours.)
"After taking four doses the haemorrhoids were better; but the pa-
tient became alarmed by the pricking pain in the region of the heart.
Two days later this pain had become very severe, and was renewed
in the course of the superficial veins of both arms. It continued to in-
crease in intensity for ten days, and was then cured by Arnica 12^ ;
while under this treatment a pecnlmY tight7iess of the chest which had
been felt from childhood was permanently cured.

Dr. Thomas {£rit Journ. of Homo&op.^ Jan., 1858) gives the follow-
ing synopsis of the powers of Hamamelis : Haemorrhages from all
mucous membranes; those with asthenia or anaemia. Diseases of the
veins, inflammation of the veins, varices^ haemorrhoids, circocele, varico-
cele, evil effects of loss of blood, carbuncles, boils, abscesses, and in-
iuries from falls.

^2/^5.— -Painful inflammations ; excessive congestion of the con-
junctiva.

' iV(?5^.— Bleeding from the nose ; feeling of tightness over the bridge
of the nose ; crowding pressure in the forehead between the eyes, with
a benumbed sensation over the whole forehead.

Stomach.-—^ ^m^vX vomitings of blood.

Abdomen, — Varicose veins.

Amis^—JjOBB of dark blood by stool in typhoid fever. Bleeding and
painful piles. Those characterized by burning, soreness, fullness and
rawness ; weakness and weariness in the back, or feeling as if the back
would break. Piles with profuse haemorrhage.

Kidneys, — Bloody urine.

Sexual Organs,— GircocQle and varicocele. Uterine haemorrhage^,
(bright-red blood). Milk-leg, swelling of the labia, groin and thigh ;
difficulty of moving the leg ; painful but benumbed sensation of the
limb ; swelling commencing at the ankle ; difficult motion of the limb
from stiffness and pain in the hip. Leucorrhoea; active or passive
uterine haemorrhage ; dysuria ; tenderness, of the os uteri ; agonizing
soreness over the whole abdomen after a violent blow on the ovarian
region. Ovarian inflammation.

Larynx and Trachea,— Q^yy^ and hmmoj)tysis with taste as of
sulphur in the mouth, and dull frontal headache. Tickling cough with
taste as of blood on awakening.

Chest, — Return of inflammation of the diaphragm, with labored re-
spiration, oppressive tightness of the lower part of the thorax; inability
to make a deep and full respiration ; when attempting to^ assume the

Vol. I.— 51.

802 DISEASES OF THE SANGUINOTJS FUNCTIOISr.

recumbent position, breathing impossible ; a crowding fullness of the
neck and head, and sensation that pi'events him from lying down ; in-
ability to make a deep respiration when standing up.

Lower Extremities. — Varicose ulcers, varicose veins, milk-leg, in-
flammation of the femoral vein or of all the veins of the leg ; with ery-
sipelatous spots near the groin and over the vein, spreading over half
the thigh; swelling of the entire leg and foot with tension; heat and
pale appearance of the limb; urine scanty, containing sediment; tym-
panitis; oedema of the whole body, limbs and face.

xSfc^'^.— Purpura hsemorrhagica,' with epistaxis and congestion of the
conjunctiva.

Particular Indications. — The pains are often unbearable, with
great sensitiveness to the touchy and fear of exciting new pain on

7. PNEUMORRHAGIA.— PULMONARY APOPLEXY.

DEFmiTiON.— Extravasation of blood into the parenchyma of the
lungs. This may take place primarily either into the air-cells, or into
the interlobular and intervesicular areolar tissue; the blood in both
cases, coagulating and forming a consolidated mass resembling in density
a hepatized portion of lung. The space thus solidified is generally
small, seldom exceeding four cubic inches, generally confined to one spot,
sometimes in several distinct ones. In very few cases it involves a
lobe or an entire lung. CEdema may extend around the extravasation.
It may terminate by absorption; also by suppuration, or gangrene of
the lung. When there is much laceration of the pulmonary structure
a cavity is formed containing fluid and coagulated blood. These have
been dischatged into the pleural sac. The extravasations are commonly
deep seated in the parenchyma of the lungs, near the roots of the
lungs or in the posterior portion of the lower lobes.

When the extravasation of blood takes place into the bronchial tubes
the heemorrhage is manifested externally as hasmoptysis, it occurs only
when the blood gains access to the air-ceils. In the greater number
of pulmonary apoplexies the hsemorrhage is externally displayed in
hemorrhage from the lungs.

Diagnosis, — The expectoration of blood, though it reveals extrava-
sation into the texture of the lung is not proportioned to its extent; and
then it appears only in a small proportion of cases. In others the
diagnosis is difiicult. Besides haemoptysis there will be cough expecto-
ration, and embarrassed respiration ; but they occur in other forms of
disease.' When they come on suddenly in one free from lung affection
or when the patient has had such attacks before, they may be suspected
to be dependent on pneumorrhagia. The disease is frequently seen in

PliTEUMOKIA. 803

association with heart disease, as hypertrophy of the right ventricle or
affection of the mitral valves, as contraction or patency of the mitral
orifice.

Summary of physiGol Signs.-— ^^The evidence of circumscribed scli-
dification, furnished by percussion and auscultation, present in a certain
proportion of cases only; moist bronchial rales occasionally observed;
cavernous signs succeeding those denoting solidification in some
instances"

8. CONGESTION OF THE CHEST IN CHILDEEN.

Natuee of the Disordee. — Enlargement of the capillary and other
bloodvessels of the lungs with partial stagnation of blood. The affection
may be slight and may then pass away speedily, or may become serious
and terminate in inflammation or dangerous hgemorrhage from the lungs.

Symptoms. — Oppression of the chest; palpitation of the heart; diffi-
culty of breathing; sighing; anxiety. These symptoms are often follow-
ed by spitting of blood, or confirmed inflammation involving the pleura,
heart or' other organs as well as the lungs.

PROGNOSIS.— The severity of the attack and the previous health
of patient may indicate the degree of danger. Children threatened
with phthisis are liable to have that disease developed by congestion of
the lungs ; if the attack be violent it may end in inflammation.

Causes. — Plethoric habit associated with tendency to affections of
the chest ; over-exertion ; extremes of temperature ; repression of dis-
charges, eruptions or perspiration.

General Treatment. — Belladonna. Before inflammation is estab-
lished ; when there is an irritative condition, with dry cough, and diffi-
culty of breathing.

Aconite.— When the congestion is accompanied with chill which
may be expected to be followed by fever, it generally arrests the con-
gestion and prevents the development of fever or inflammsSlion.

9. PNEUMONIA—PNEUMONITIS.— PERIPNEUMONIA— LUNG-FEVER.

It has been estimated that in the cities of New- York and Brooklyn
pneumonia causes nearly one-tenth of the deaths from all diseases;
and that probably this proportion may hold good in other portions of
our country. It has been claimed by the advocates of homoeopathy
that that system of practice where tried has reduced this mortality to
only one-half what the old mode of treatment has been obliged to per-
mit, or to five per cent, on the whole number of deaths.

Inflammation of the lungs begins with chilliness, in some cases in-
creasing to a shaking chill followed by heat. During the heat the

804 . DISEASES OF THE SANGUINOUS ETJNCTIOK.

patient experiences a pressure deep in the chest, which soon increases
to an intense and seated pain. The pain may vary in degree, and
may be described as acute, burning, cutting, sticking, aching, dull, op-
pressive, constrictive, and is accompanied by deep anxiety.

In this pain we observe the commencement of inflammation which
extends from the seat of pain to the surrounding parts of the lungs
and pleura; and it may involve one or both lungs. The respiration is
impeded, painful, anxious, superficial, and is carried on only with the
uninflamed portions of the lungs; and when inflammation occupies both
lungs the motion of respiration is only visible in the labored action of
the abdominal muscles and diaphragm, the thorax not expanding and
rising as in health.

In some cases of pneumonia the pain is wanting and then othei '
symptoms must be depended on.

DiAGiTosis.-— The symptoms of lung fever vary so much in different
cases, that an exact portrait, which shall be recognisable in all instances,
can hardty be given. The signs, how^ever, which are more particularly
characteristic may be enumerated as follows : dull or deep-seated pain,
or tightness in the chest; frequent short cough, witt expectoration of
a viscid, tenacious matter of a yellow green, or pale color, sometimes
tinged with blood; rapid and difficult respiration; inclination for the
most part to lie upon the affected side, or the back; great heat of the
skin ; headache ; thirst ; rapid and full pulse (though this symptom is not
uniformly present, as the disease sometimes runs on to a fatal termina-
tion without any material change in the pulse) ; general restlessness ;
urine scanty, very red ; and sometimes scalding. The character of the
expectoration during the first stage of pneumonia is supposed by many
to afford a characteristic mark of the malady: and it is from this cir-
cumstance thatLaennec has denominated the sputa expectorated, ^ng'i^,
monic, or glutinous. During the stage of hepatization, the sputa di-
minish in quantity, become lighter in color and less transparent, until
finally, when the third stage supervenes, expectoration of almost a
mucous character occurs.

Pneumonia is characterized by: deep cough, at times dry, at times
accompanied by expectoration ; sometimes spontaneous and frequent,
again excited by deep breatliing, talking, or swallowing; expectoration
tenacious, sticky, at first semi-transparent, slimy, afterwards bloody,
saffron or rust color. The patient generally lies on the back.

The fever is acute, not intermittent, though almost disappearing in
the morning, and increasing in the evening. The pulse is soft in the
morning, becomes in the evening hard and bounding. The cough be-
comes also more 'violent. When the disease continues long the fever
takes a typhoid form; and after it has reached its climax it manifests
its effect on the brain and its membranes by delirium.

PNEUMONIA.

805

The face is intensely red; the head feels dull and painful, there is
intense thirst; the urine diminished in quantity, and dark red.

All of these symptoms show inflammation of the lungs, but this is
more decidedly proved by percussion: by which means it can be deter-
mined whether the inflammation is still confined to the stage of inflam-
matory engorgement or has passed to the stage of hepatization.

Percussion, — When the organic tension of the pulmonary cells is
diminished in consequence of the exudation of bloody serum, percussion
yields a tympanitic sound, which is at first clear and full, but becomes
much less so as the condensation of the pulmonary tissue, in consequence
of the congestion, increases. As soon as the process of hepatization be-
gins the percussion sound becomes dull, insonorous and hollow. When
exudation has set in, the so-called crepitant rattle is heard during an
inspiration, and during cough. When a portion of the lungs into which
one of the larger bronchial tubes opens, hepatizes, communication be-
tween the air in the lungs and the column of air in the trachea and
larynx is interrupted: this gives rise to peculiar sounds, termed hronchiol
respiration, bronchophony and consonant rattle. These three sounds
are not heard when the bronchus is stopped up, or when the voice and
respiration of the patient are feeble. Over the hepatized portion we
always hear a peculiar whiffing, bronchial respiration, but never the vesi-
cular murmur.

Sometimes pneumonia is complicated by more or less derangement
of the biliary organs, when we shall have superadded to the lung affec-
tion the symptoms indicative of such derangement. This variety of the
complaint is termed: hilious pneumonia.

Latent Pneumonia.— -This modification of the disease depends upon
a certain peculiarity of constitution and is entirely unlike ordinary
pneumonia. It seems to commence by the second stage, or that of he-
patization. M. Saucerotte describes it as follows : '^Premonitory symp*
toTTis^ either entirely absent, or of slight importance, consisting of las-
situde, with shivering, loss of appetite, and but little fever."

General Symptoms, — The temperature of the skin is not sensibly
augmented; the pungent heat of ordinary pneumonia seldom present;
pulse usually but little affected ; respiration natural, and no pain in the
chest. Percussion ahvays elicits a dull sound over a considerable ex-
tent, and bronchial respiration is audible over the same locality. In
some cases slight crepitation may be heard around the hepatized spot."

"Progress and duration variable. In some cases we have seen the
disease linger for six or seven weeks. When the case terminates favor-
ably the dullness gradually disappears, and the bronchial souffle is re-
placed by crepitation; respiration becomes more free, and the general
aspect of the patient improves."

Diagnosis, — -Pleurisy is the affection with which latent pneumonia

806 DISEASES OF THE SAITGUmoUS FUNCTION.

is apt to be confounded. In chronic pleurisy, however, there is more
constantly a pain in the side, and the region of the dullness varies with
the position of the patient. Apoplexy, and the bulging of the inter-
costal spaces, shortly clear up the diagnosis. The history of the case
distinguishes it from phthisis.

" Causes.— For the most part, exposure to cold." Dr. Saucerotte'
sole internal remedy in this affection is Ta7'tar-emetic^ which is the
homoeopathic specific in similar cases.

Causes of Pneumonia, — This disease is peculiar to temperate and
cold latitudes, and usually occurs during the winter^months. The usual
causes are: undue exposure to intense cold; sudden suppression of
perspiration ; epidemic influences, and the inhalation of noxious vapors
or gases. Laennec and Forbes assert, that pneumonia is frequently
induced by the bite of the rattlesnake {Crotalus-hoTTidics\ and of other
venomous serpents ; and that it may also arise from the ^' injection of
various medicinal substances into the veins." These assertions go far
to prove a specific action of these substances upon the respiratory
organs, and may afford a valuable hint respecting their homoeopathic
application in pneumonia. Pneumonia is most frequent between the
ages of 17 and 50 years. The predisposing causes are :

Tuberculous Diathesis] previous pneumonia; suppressed dis-
charges of blood.

Exciting Causes, — Atmospheric influences ; North-east winds ; more
frequent at the end of winter and the commencement of spring. In
summer when the air suddenly becomes cool after sultry heat ; taking
cold after being heated by dancing or other severe exercise; the
breathing of mechanical or chemical irritants ; strong vapors of various
kinds; vapors of muriatic or nitric acid; arsenious vapors; inhaling
plaster, lime, coal-dust, flour or wool-dust ; fracture of the rib, or pene-
trating stab, or gun-shot wound.

Viewed anatomically, inflammation of the substance of the lungs
prese;;:S, according to Laennec three different degrees or stages, which
he designates, ^x^i^ engorgement ^^"s: congestion^ second, hejpatization j
third, jpurulent infiltration.

In the first degree, the lung loses in a measure its crepitous feel, is
of a livid color, and more solid than natural.

In the second degree, the lung presents the appearance of liver; it
is ilot crepitous, is heavier than in the first degree, and shows a granular
appearance when cut into, or lorn asunder. Laennec, Andral and Louis
suppose this hepatization to be owing to the conversion of the air-cells
into solid grains, by the hardening of a concrete fluid, which is poured
out during the inflammation; while Dr. Williams supposes, that "these
granulations contain no viscid mucus, but consist of little bunches of

PNEUMONIA. 807

vesicles, which have been obliterated by the swelling of their mem-
branous tunics, and the enlargement of their blood-vessels.

In the third degree, the external appearance of the lung is similar to
that of the second degree, but of a lighter color. The same heavy
hard, and granular character obtains, but when the lung is cut into, a
yellowish and purulent matter makes its appearance. As the disease
advances, the granular condition disappears, and purulent abscesses
take its place.

The phenomena elicited by auscultation and percussion during the
stage of engorgement are the Grepitoics ronchiis^ the respiratory sound
being yet audible, and the ordinai-y healthy sound on percussion.

As soon as hepatization has occurred, percussion over the affected
part yields a dull sound, and neither the respiratory murmur, nor the
crepitous rhonchus can longer be heard. There are other sounds, like
bronchophony, a kind of blowing, &c., which may exist in certain cases
of hepatization, but these are so vague and uncertain, that immense
practice is requisite to enable the physician to form an accurate judg-
ment respecting them.

After the first stage has existed a little time, and the pus begins to
soften, the mucous rhonchus may be heard in the bronchia. In some
instances the pus is not expectorated or absorbed, but forms an abscess
in some parts of the pulmonary tissue* We shall then have a mucous
rhonchus over the seat of the abscess, also pectoriloquy, and what is
termed a "bronchial cavernous cough.

Pbogwstosts.— Pneumonia is a serious, but not necessarily a fatal dis-
ease in any case. When the general and local symptoms subside
gradually ; the fever, pain and cough abate ; the matters expectorated
become normal; the respiration becomes easy and regular, it may be
decided that the patient is on the road to recovery ; though auscultation
and percussion show that there is still morbid condition remaining, it
may be predicted that prudent management may provide against a re-
lapse.

Unfavorable Terminations. - — 1. The plastic exudations change,
taking a tubercular character. 2. An abscess forms in the lungs. 8.
When the hepatization has lasted too long to admit of resolution, death
may take place by excessive congestion or complication with an affec-
tion of the heart, or in consequence of some secondary disease. Re-
covery may be expected in young and vigorous subjects, and in persons
who are attacked for the first time. It is more favorable in simple
than in compound pneumonia, or when the inflamed lung was previously
partially hepatized, or otherwise changed in structure.

When the disease terminates favorably, and resolution takes place,
it will be found that the lungs gradually and by successive degrees re-
turn to their original state, as is indicated by the diminution of the

808 DISEASES OF THE SANGUINOUS FUNCTIOJST.

crepitous rhonchus, and tlie return to the natural respiratory sound
when the inflammation had ceased at the first stage ; also by the re-
appearance of the crepitous rhonchus, &c., when the malady had pro-
gressed to the second and third stages.

Teeatment. — The prominent medicines for the treatment of pneu-
monia are : Aconite^ Bryonia^ Belladonna^ TartaT-emetiG^ Plios-
phoTus^ Ipeoao,^ Saonbucus^ Sulphur^ Laohesis^ Bhus-tox,^ Arsenicum^
MeTGuri'iis, Acid-jphosph,^ Arnica. It is remarked of auscultation and
percussion, that they may furnish us with a hnowledge of the con-
dition of the lungs, and they thus become helps., but not an authority in
selecting the remedy. This knowledge may " direct us to the class of
remedies.^ from which the proper one may be chosen. The individuali-
zation of the remedy must be reached by the comparison of the symp-
toms with the drug." (Dr, P, P. Wells.)

Aconite.- — Synochal sthenic fever, with pulse hard, quick and full,
face red, chilliness and heat expressive ; pains in the chest violent ;
respiration oppressed and accompanied with anxiety.

In the first stage of the disease, when symptoms indicative of a high
grade of febrile excitement are present, as hot and dry skin, great
thirst, rapid and hard pulse, scanty and high-colored urine, &c., Aconite
and Belladonna may be given in alternation, until the inflammatory
symptoms subside. These remedies are often alone sufiicient to break
up the disease in this stage ; and even when they fail to efi'ect a com-
plete cure, they generally moderate most essentially the fever and
mitigate all the other symptoms.

If, after the subsidence of these symptoms, stitches in the side, difii-
cult and anxious respirations, and troublesome cough continue to harass
the patient, recourse must be had io Bryonia.

Bryonia. — The inflammation occasioned by exposure to dry and cold
weather ; by straining, or other violent muscular exertions ; when the
fever is not very violent or fully developed. The pains are moderate ;
the sputa white, slimy, streaked with blood, the cough loose and the
oppression is not excessive, attended with constant desire to draw breath.
Rheumatic or bruised pains in the muscles of the chest and extremities.

When, however, the second stage, or hepatization^ has occurred, in-
dicated by dull sound on percussion, bronchial respiration, &c.,we should
d.t once have recourse to Tartar-emetic or Phosphoriis.

Tartar 'emetic. — The external indications which point to this remedy
are : dull sound on percussion ; absence of the respiratory murmur, or
bronchophony ; skin cold, and covered with a clammy sweat ; consider-
able expectoration of a yellowish or brownish color, and mixed with
blood ; pulse small, soft and frequent ; tongue covered with a dry and
dark fur, and perhaps red at the edges.

Great oppression and difliculty of breathing; cough loose^ and ac-

PNEUMONIA. 809

companied witli rattling of mucus {Muller)\ burning under the sternum,
and sometimes as high, up as the throat ; sensation as if the chest were
lined with velvet ; want of air and want of breath previous to the
paroxysms of coughing ; also ■pneumonia hiliosa^ with gastric and
bilious symptoms, as yellow tinge of the skin ; yellow or brownish fur
upon the tongue; bitter taste; nausea and bilious vomiting; yellow
or dark urine ; headache ; general sensation of lassitude and debility.

Mental and moral Symptoms. — Anxiety; restlessness; confusion
of ideas ; sometimes furious delirium.

Pathology of Pneumonia caused iy Tartar -eTnetic. — The lungs,
says Magendie,' are of an orange color, or violet ; the tissue hepatizedj
gorged with blood at some parts, or resembling the substance of the
spleen ; lungs infiamed or hepatized. Dyspnoea followed by hepatiza-
tion of the lung, produced and also removed by Tartar-emetic. In ani-
mals poisoned by it, the action on the lungs is more strongly marked
when they are slowly poisoned. It also produces intense tracheo-
bronchitis, developed along with the pneumonia, which shows its great
efficiency in these forms of disease.

The specific Tartar-emetic treatment against inflammation of the
lungs was commenced by Rasori in 1808. It was adopted and recom-
mended by Laennec, who appears to have been more successful than
was common in that day. It has been largely followed in this coun-
try, but not generally, to the extent recommended by the Prench
and Italian practitioners. Even when it partially subdues the pulmon-
ary inflammation, the remedy in these large doses shows its poisonous
powers in developing abdominal symptoms, when the patient is con-
sidered as doing well under the remedy. Dr. Billing says, in some
cases the patient becomes restless, thirst is augmented ; discharges
from the bowels are increasing in quantity ; then the abdomen becomes
tympanitic and tender. The patient, who had acquired the power of
retaining in the stomach large doses of the drug, now vomits, or makes
efforts to do so; the tongue is dry and pointed; there are jactitations,
anxiety of countenance, delirium,, stupor and death. Sometimes there
is jaundice; pulse frequent, hard and thready ; the matters vomited
have the appearance of those in yellow fever. While these things are
progressing, the original disease subsides rapidly. This, with the oc-
currence of the slightest tympanitis, shows that the remedy is pro-
ducing gastro-intestinal irritation and inflammation.

If Tartar-eKYietic be given according to the contra-stimulant theory
in massive doses, the aim is to produce a drug-disease of such intensity
tha.t it will throw the original disease entirely into the shade. The
doses given are so large, that direct vomiting and purging might be ex-
pected to result; but by persisting in its use "toleration" of the
remedy is attained, and it is for a time retained in the^ stomach. Eut

810 DISEASES OF THE SANGUINOUS FUNCTION.

even then it can never be predicted with certainty, that this tolerance
Virill long continue. It is claimed, that in some cases the pneunomic
symptoms subside under the remedy, but it is certain that in many
other cases fatal purging, vomiting and prostration ensue.

Sywyptoms of TaTtar-emetiG in JPneiomonia.—'Bhovt, diiBS cult and
oppressed breathing ; frequent short, dry and painful cough with ex-
pectoration of frothy, sanguineus sputa (rusty expectoration) ; dull
sound on percussion, mucous and crepitant rale; pressure and con-
striction of the chest ; rapid and strong, or rapid and feeble pulse ;
febrile symptoms, hepatization.

This remedy seems to be specially suitable during the decline of the
disease, when the bronchia or pulmonary vessels are full of a thick
viscid secretion, which the patient finds it difficult to expel, when this
substance is no longer tinged with blood. It is most appropriate during
the resolution of the hepatization and in bronchitis, when the breath-
ing is difficult and when there is a sub-crepitant or mucous rattle in the
lungs, often accompanied by fits of suffi)cation with spasmodic cough.
Tartar-emetic, in a low trituration given in such cases, affords prompt
relief. In pneumonia it does not cause vomiting in children ; but, if
given for simple bronchial catarrh, every spoonful of a solution of one
grain of the first trituration to four ounces of water may cause vomiting.
In such cases dilute still farther.

Dr. CI. Miilier says : "It is indicated by : little or no stinging pain,
great oppression and difficulty of breathing ; loose cough with mucous
rattling, and alleviation of the oppression by expectoration which is
very profuse ; the sputa contain little or no blood, but a quantity of
mucus ; a portion of the lungs is hepatized (stage of splenization as
well as of red hepatization), the percussion-sound over a larger or
smaller portion of the thorax is dull, with increased resonance ; a por-
tion of the thoracic walls adjoining the before-mentioned region has
either tympanitic or normal sound. Auscultation reveals broncophony,
the bronchial respiration and consequent rattle."

In bilious pneumonia Tartar-emetic is indicated by the following
symptoms: slight bilious tinge of the skin, albuginea, alae-nasi, and
corners of the mouth ; yellow, brownish coating of the tongue ; bitter
taste, disposition to vomit, nausea, vomiting; saffron-colored urine;
stinging pain under the right false ribs, or pain in the pit ot the
stomach; frequent eructations and hiccough; violent aching, boring
pain in the frontal region ; sometimes increasing to furious delirium to-
wards evening; the cough is frequently attended with vomiting, with
scanty expectoration of somewhat blood-streaked frothy saffron-colored
mucus.

Case.-— A man, aged 73, intemperate and suffering from fieart-dis-
ease, had double pneumonia ; he took one grain of Tarrar-emetic in

PNEUMONIA. 811

four ounces of water, a dessert spoonful every two hours. He continued
delirious during eight days, but recovered and could walk on the six-
teenth day, {Brit, Journ, Uomoeop)

"Magendie ascribes to emetic Tartar a specific power of causing en
gorgement or inflammation of the lungs ; for he found on opening the
bodies of animals killed by it, that the lungs were of an orange-red oi
violet color, incapable of crepitating, gorged with blood, and here and
there hepatized." " It has also been assumed that the same effects are
produced in human pulmonary organs." Jules Cloquet says, a man
died of apoplexy, who within five days of his death had taken 40 grains
of Tartar-emetic. On examining "the lungs very irregular, blackish
spots which extended more or less deeply into the parenchyma of
this organ were observed." Pereira says, he can not understand how
Tartar-emetic can have a tendency to inflame the lungs, since it is
known to prove particularly useful in the treatment of such cases.
{Materia Med. YoL I., p. 698.) A homoeopathist is not much perplexed
by this question.

Case by Mr. Hartley : A boy aged three and a girl aged five, were
poisoned by Tartar-emetic. After death It Is recorded, that In the boy
the lower lobe of the right lung was redder than natural, and serum
was effused in the pleura ; the girl presented similar appearances
{La/ncet^ April, 1846, p. 460.) "Painful respiration" is a symptom of
poisoning by this article. (See Taylor, Med, Jurisjpr%idenG6^ p. 118.)

It is proved by the pathogenesis of this remedy that it is capable of
causing as well as of curing the following symptoms and conditions :
Short, difficult and^ oppressed respiration ; frequent, short, dry and
painful cough, with expectoration of frothy, sanguineous sputa (rusty
expectoration) ; dull sound on percussion, mucous and sub-crepitant
rale; pressure and constriction of the chest; rapid and strong, or rapid
and feeble pulse ; febrile symptoms and hepatization present an ex-
cellent simile to a certain form of pneumonia, and ample clinical ob-
servation has confirmed the utility of the remedy. But in order to
avail ourselves of its full benefit, it must not be employed stronger than
the first, second, and third attenuations. With these minute doses the
requisite curative impressions can be produced upon the affected lungs
with certainty, promptness and safety. {Marcy, New Mat, Med. 434.)

Dr. Ozanne, of Paris, says of this remedy : " It appears to me to be
suited to the particular state in which the bronchi or pulmonary vessels
are full of a thick viscid secretion, which the patient finds it difficult to
expel, when that substance is no longer tinged with blood. Hence it is
most appropriate in pneumonia during the resolution of hepatization,
and in bronchitis when at the same time the breathing is difficult, there
is a sub-crepitant or mucous rattle in the lungs. This condition is often
accompanied by fits of suffocation, with spasmodic cough. In snob

812 DISEASES OF THE SANGUE^OUS FUNCTION.

cases Tartar-emetic gives very rapid relief. The first trituration does
not usually cause vomiting in children ; but if given for simple bronchial
catarrh, every spoonful of a solution of one grain of the first in four
ounces of water will cause vomiting.

Phosphorus, — Phosphorus has been highly extolled also in the
second stage of pneumonia, and in certain cases of pleuro-pneumonia,
where Aconite and Bryonia have failed in effecting a cure. Dr. Fleisch-
mann has used it successfully in all the stages of lung-fever.

Symptoms.— Violent pneumonia with sticking pains in the chest,
excited or aggravated by coughing or breathing also in pleuro-pneu-
monia, when they are violent and extend over a large surface, vfhen a
large portion of the lungs is inflamed with dyspnoea, the cough is dry,
and the sputa rust-colored (a characteristic symptom of Phosphorus).
Phosphorus is in many cases the only remedy and it alfords relief in
four or eight hours. Give two or three drops of the third or fourth
dilution every tw^o or three hours. Sometimes when the attack is very
violent in the commencement. Phosphorus has to be given in alternate
doses with Aconite or Belladonna, This alternation may be neces-
sary in the second stage of pneumonia when the percussion-sound over
the affected portion of the lungs is dull, and broncophony or bronchial
respiration, or perhaps consonant rattle, is heard.

Phosphorus is also indicated when the inflammation threatens to as-
sume the typhoid character, the physical symptoms of approaching
j)aralysis of the lungs denote the passage of the inflammation into the
stage of gray hepatization or purulent infiltration of the pulmonary
parenchyma, attended with remarkable depression of the mental facul-
ties; mild delirium and grasping at flocks; subsultus tendinum ; rapid
prostration ; cold viscid sweats ; small, frequent feeble pulse ; dim eyes,
sunken countenance, dry lips and tongue ; short and difficult breathing
oppression and anguish; difficult cough and respiration.

Barchner, Griesselich, Horner, Bosch, and Schellhammer have em-
ployed it with advantage when the third stage had set in with great
prostration, livid or hippocratic countenance, sunken eyes, cold viscid
sweats, tremulous and feeble pulse, dry and dark lips and tongue, diffi-
cult expectoration of a brown or rust-color, extreme anguish, subsultus
tendinum, muttering or furious delirium, with grasping at flocks, sense
of suffocation, involuntary stools.

Miiller describes the special pathogenetic symptoms of Phosphorus
having reference to pneumonia, as follows: "Sticking and violent
stitches in various parts of the chest, left and right side, sometimes ac-
companied with burning, in rest and during motion, especially when
sitting and taking an inspiration; pain in the chest, especially during
an inspiration ; itching in the interior of the chest, with dry cough ;
feeling of heaviness in the chest; anxiety in the chest, with arrest of

PNEUMcmiA. 813

breathing, and beating in the right side of the chest ; great oppression
of breathing; great shortness of breath ; oppressive tightness, and ten-
sive sensation in the chest, as if a band w^ere encircling it ; tension and
dryness in the chest ; constrictive clawing and pressing in the upper
part of the chest ; loud rattling breathing ; dry, hollow cough, without
expectoration ; a sort of hacking cough, with huskiness of the chest,
and expectoration of some mucus; cough with expectoration of trans-
parent mucuSj accompanied with tensive pain, and afterwards with
sticking pain in the chest ; fatiguing cough, with white tenacious ex-
pectoration ; the expectorated mucus is streaked Avith blood ; bloody
expectoration, with mucus, accompanied with short, slight cough;
coughing up small clots of pus, with smarting burning behind the
sternum; sticking pain in the pit of the stomach when coughing, com-
pelling one to lay the hand upon the pit; short breath after every turn
of cough."

From the above it will be seen that Phosjpliorus includes a greater
range of symptoms than TartaT-eTnetiG, In typhoid pneumonia espe-
cially it is often of distinguished service where hepatization has occurred,
and the symptoms point to the third stage.

ADMiNiSTRATioiNr.— It may be employed at the first, second, or third
attenuation, and the dose repeated according to the severity of the
case. In typhoid pneumonia^ as well as in cases attended from the
first with great debility and prostration of the energies of the system,
.Ehus-tox, will be found a remedy of much efficiency, either alone, or in
alternation with some other specific. Should the case be complicated
with pains in the chest or side, or of a rheumatic character, Rhus-
radiccms may occasionally be employed with advantage. This medi-
cine is usually given after Acofiite and Bryonia,

J/6r<?'wW'i^5.— Allopathic writers have not yet recorded any cases in
which the symptoms or pathological conditions, characteristic of pneu-
monia or carditis, have been produced in the human subject by the
use of Mercury ; though experiments on the lower animals have shown
that pneumonia may be produced by this article. But Orfila has noticed,
*Hhe lining membrane of the heart, in one part or another, most com-
monly on the valves, invariably presenting spots of a cherry-red or al-
most black color, and on one occasion these spots were so soft, that
slight friction made little cavities." {Ohristison^ On Poisons^ p. 890.)

From experiments of M. Gaspard, made by injecting solutions of the
ichloride of Mercury into the blood, the morbid appearances presented
.n the lungs varied, but are summed up in the following words : " either
black ecchymosed spots or black tubercular masses, some inflamed,
others^angrenous, others suppurated; or finally, regular abscesses,
suppurated ; or finally, regular abscesses, separated from one another
by healthy pulmonary tissue." {Joiornal de Physiologie^ I., p. 165.)

314 DISEASES OF THE SANGUINOUS FUlS^CTIOJSr,

Symptoms. — -Orampy, tensive pain in tlie left side of tlie chest, with
violent oppression of breathing, which is sometimes increased by a
burning, lancinating pain ; there is also cough which is at first dry and
afterwards accompanied with bloody expectoration ; the pulse is hurried,
full ; much thirst ; the fever manifests symptoms of nervous irritation,
great heat, profuse foetid sweats, nightly delirium; violent pains in the
limbs ; vertigo ; dry mouth and throat ; great sensitiveness and painful-
ness of the region of the liver and epigastrium, and of the pit of the
stomach.

When the disease assumes the more typhoid character, and there
are profuse sweats and great debility; when there is congestion of
blood to the brain, slight delirium, and quick and strong beating of the
arteries; when cough is still present, with difficult, blood-tinged expec-
toration, Mercurius is to be given.

I^hosphorio-aGid. — In conditions similar to Mercurius : There is
extreme debility and diarrhoea, loss of consciousness ; strong, irregular,
frequent and intermitting pulse ; distention of the temporal arteries, &c.

Sulj^hur 30^, is an important remedy in certain protracted cases of
pneumonia, occurring in psoric or scrofulous subjects, and which
threaten to terminate in phthisis. Indeed in most of those cases of
chronic pneumonia which seem to have arrived at a fixed point, the
patient neither improving nor apparently retrograding, we should al-
ways bear in mind this powerful antipsoric.

When the disease has reduced the patient, notwithstanding our reme-
dies, to a state of extreme prostration, with a very short breath on the
slightest exertion ; dry and dark tongue and lips; extreme anguish,
stitches in the side; grea,t thirst ; diarrhoea; ringing and buzzing in
the ears,' Arsenicum is the proper remedy. In examples of this de-
scription, the remedy should be frequently repeated until a decided im-
pression is produced.

a Jnos-toxicodendr 071. -^Typhoid Stage, In persons of middle age
pneumonia often assumes a typhoid character. The symptoms of this
stage "develop themselves gradually, and the pains in the chest increase
in violence during the course of the disease. The pulse is frequent,
small, easily compressible ; the pains, which the patient never defines
or complains of very positively, are constant, without intermission. In
robust persons typhoid-pneumonia frequently appears like true pneu-
monia, with a full, strong pulse, and without any of the characteristic
typhoid- symptoms; but the sentient system is principally affected. Th
patient lies in a state of half stupefaction, is more or less delirious,
complains too little, although the disease is very violent. He is in a
state of stupor with stertorous breathing, and his eyes half open^ he is
roused with difficulty, and is scarcely conscious of any thing after
waking. In this condition Phosphoric-acid is also appropriate, particu*

PKEUMO-HYDEOTHORAX. 815

larly when the expectoration is purulent and the patient is troubled
with profuse night-sweats.

American Helleboke.— ■ Yeratru7n-mr, This drug possesses a great
power of calming nervous excitement, and reducing the force and
frequency of the heart's action ; in pneumonia, pleuritis, acute rheuma-
tism, croup, iritis, and other inflammatory diseases, when the pulse
is strong.

It has operated with great efficiency in metritis, and puerperal fever,,
alternated with Belladonha. It is never necessary to cause emesis.
One -fifth or one- tenth of a drop in water every two hours is generally
sufficient.

But it is in pneumonia, that, the Ver at.- v. shows its most specific
powers. Dr. Hale says, "it is the only remedy which will absolutely
cut short the pneumonic inflammation before the seventh day. In my
hands it has frequently arrested the progress of the disease on the
third, fourth and fifth days, and a rapid convalescence followed in every
instance."

If the pulmonary inflammation threatens to run into gangrene, as
will be indicated by foetid and greenish or dark expectoration, Arsenicum
is appropriate, as are also sometimes Carho-veg, and China,

Pneumonia occurring in old and feeble persons, and attended with
symptoms showing a low grade of inflammatory action, will require the
use of Phosphorus^ Ipecacuanha^ Sarnbucus^ Veratrum^ Nux-
vomica^ China^ Belladonna^ Lachesis^ Lycopodium and Cantharis,

Arnica is applicable in pulmonary inflammations proceeding from
mechanical injuries.

The symptoms of pneumonia and bronchitis combined, will be covered
by Tartar-emstic^ Aconite^ Mercurius^ Phosphorus^ Capsicum^
Bryonia^ Carho-veg,^ Pulsatilla^ Senega and Nux-vomica.

We usually select one of the low attenuations, and repeat the dose
once in two, three or four hours, until a marked impression is produced
upon the symptoms.

10. PNEUMO-THORAX.— PNEUMO-HYDKOTHORAX.

DEFmiTiON. — -A diseased condition consisting in the accumulation
of air or gas within the pleural sac, unaccompanied by liquid effusion.

This disease is certainly very rare; and ma,ny doubt whether "the
secretion or exhalation of air or gas from the pleural surfaces" is ever
seen. Pleural rupture over the dilated cells in vesicular emphysema,
or of the blebs which are occasionally formed in the interlobular variety
of this disease is a rare accident which may gwQ rise to an accumulation
of air in the pleura, and it may for a time be accompanied by any morbid
product ; but inflammation must soon result, and effusion must follow

816 DISEASES OF THE SANGUnTOUS FUNCTION,

PNEUMO-HYDROTHORAX.

When, by any mode, air or gas finds its way into tlie pleural cavity
effusion of liquid either precedes or follows; and the resulting condition
is QdJi\edL jpneimno-hydrotJiorax, In medical treatment it is only neces-
sary to consider the latter.

Diagnosis.— Pneumo-hydrothorax is never a primitive disease, but
is the effect of some antecedent condition. Generally it is a complica-
tion of pulmonary tuberculosis ; in this case it arises from a perforation
of the lung resulting from rupture of the pleura over a cavity or a col-
lection of softened tubercle, broken into during an act of coughing.
Pneumo-thorax is then developed, and acute pleuritis follows with liquid
•accumulation ; the symptoms vary according to the size of the per-
foration, its persistence in remaining open, and the freedom of com-
munication between the bronchial tubes and the pleural cavity. It oc-
curs more frequently on the left than the right side, on the postero-
lateral surface between the third and sixth ribs ( Walshe), It may oc-
cur in connection with circumscribed gangrene of the lung, the pleura
giving way over the eschar, inducing perforation and pleuritis ; in con-
nection with pulmonary apoplexy, tuberculous affection of bronchial
glands, abscess, cancer, and hydatids, by ulceratioli commencing in the
pleura, in cases of chronic pleuritis and empyema.

In certain cases of empyema abscesses situated in the walls of the
chest may result in an external communication with the pleural cavity.

The disease is produced traumatically by penetrating wounds of the
chest, or injuries of the lung from the fractured extremities of ribs, or
by contusions. In a few cases a fistulous communication has been
originated in some way between the oesophagus, or the stomach and
the pleural sac, and through this opening gases have found their way
into the latter cavity. In very rare cases, chemical decomposition of
the effused fluid in the pleura has caused the development of gas.

Physical Signs. — The chest yields on percussion over the space oc-
cupied by the air within "a marked degree of sonorousness, purely
tympanitic in quality, high in pitch, approaching frequently in intensity
as well as character the sound in abdominal tympanitis. This clear
hollowness is always found at or near the summit of the chest, extending
downward a greater or less distance, unless the lilng be attached at its
upper portion so as to prevent its compression and the ascent of the
gaseous fluid. The presence of the condensed lung situated usually at
the superior and posterior portion of the chest, may give rise to dullness
in that situation. If air or gas is present without liquid efiusion the
tympanitic sonorousness may be diffused over the greater part of the
affected side. But as more or less liquid is almost invariably present,
the sonorousness extends to a certain point, and below this point there

PNEUMO-HYDROTHOEAX.

817

is flatness on percussion." "The escape of fluid by expectoration, or by
external discharge, will of course efiect the quantity within the chest,
and thus occasion fluctuation in the amount." There is also variation
in the quantity of air introduced, as well as in that produced by chemi
cal changes. The tympanitic flatness of sound extends not only down
to the level of the fluid, but also some distance below it, so that the
amount of fluid contained is about twice what is indicated by percus-
sion. (Skoda,) When the quantity of gas is so large as to distend the
walls of the chest the sonorousness of the sound is diminished, becoming
duller, though still tympanitic.

Evidence fuknished by Peeoussion. — In pneumo-hydrothorax the
tympanitic sonorousness is greater the nearer we go to the summit of
the lungs. When gas exists in the stomach instead of the pleura the
tympanitic sonorousness also exists but it is greater below, diminishing
as we ascend.

The same tympanitic sonorousness is found in some cases of simple
pleui-itis, over the compressed lung, but it is less strongly marked, and
is not purely tympanitic, but vesiculo-tympanitic, and the relative de-
gree of sonorousness between the upper and lower part of the lung is
riot changed by change of posture. The walls of the chest are not so
elastic, though "auscultation shows in the one case, the lung to be in
contact with, and in the other case to be removed from the walls of the
chest above the liquid."

Over a lung solidified by inflammatory exudation, the bronchial re-
spiration and broncophony is associated with the tympanitic sonorous-
ness, and " this combination is proof against pneumo-hydrothorax, and
jf'or the existence of pulmonary solidification."

In emphysema the resonance is exaggerated, but it is vesiculo-tym-
panitic, and there is evidence that there is no liquid in the chest. In
pneumo-hydrothorax the amphoric modification of the cavernous respi-
ration is strongly marked. In general the intensity of the sound is
proportionate to the size of the fistula, and the calibre of the bronchial
tubes to which it leads.

The respiratory sound is suppressed over the space occupied by liquid
efi*usion; the bronchial respiration is discovered at the summit pos-
teriorly, above the compressed lung which is also generally solidified
by tuberculous deposit. Tuberculous cavities in the compressed lung
may sometimes be ascertained by physical signs. On the healthy side
the respiratory sound is exaggerated.

Vocal Phekomeka.— The resonance is absent below the level of the
liquid efiusion ; feeble, or more or less marked over the space occupied
by air or gas, with amphoric intonation: at the summit over the com-
pressed lung there is marked resonance, broncophony, or pectoriloquy.

Metallic tinkling is almost pathognomonic of pneumo-hydrothorax^ at

Vol. L-.52.

818 DISEASES OF THE SANGmNOUS FUNCTION".

least in cases involving perforation of the lung. It is heard nowhere
else, except rarely in large tuberculous excavations, or in the stomach
where it is unconnected with respiration, voice or cough.

Inspection and Menstjeation. — The affected side is permanently
expanded, and its movements accordingly limited. The accumulation
of air and liquid may lead to great dilatation and complete immobility,
even with forced breathing. The intercostal spaces are widened and
pushed outward, sometimes beyond the level of the ribs ; the diaphragm
is depressed, the mediastinum displaced, the heart dislocated, being
transferred, in some instances, to the right of the sternum. The signs
furnished by inspection then are the same as those presented in chronic
pleuritis or emphysema. Percussion and auscultation are necessary
to supply the information necessary to enable us to distinguish be-
tween them.

In chronic pleuritis and empyema with dilatation, the affected side
is flat on percussion, with absence of respiratory sound in the great
majority of instances, except a small space at the summit. There is
neither the tympanitic sonorousness over the affected side, cavernous,
or amphoric respiration or metallic tinkling.

Dilatation of the chest is not always visible externally in pneumo-
hydrothorax ; for liquid and air or gas may exist in the pleural sac, and
find room by compressing the lung without sensibly enlarging the
thorax. Palpitation furnishes only evidence of diminution or addition
of vocal fremitus and fluctuation in this disease, in empyema, and
chronic pleuritis.

SuccussioN. — When air and liquid are contained in the pleural
cavity, moving the trunk of the person to and fro, with the ear applied
to the chest, produces the splashing noise resembling that caused by
shaking a bottle partly filled with water. This sound is almost pathog-
nomonic of pneumo-hydrothorax, and was noticed by Hippocrates. It
occurs very rarely in pulmonary tuberculosis, where there, may be a
large excavation, partially filled with fluid. The distinction between
tubercular consumption and pneumo-hydrothorax can always be made
out by comparing the previous history of the individual case and the
other general symptoms with those of each of these diseases, which are
widely different.

General Symptoms of Pneumo-Hydeothoeax. — It generally oc-
curs in connection with tuberculosis which has resulted in the perfora-
tion of a lung, perhaps during an act of coughing. Immediately after
the rupture of the lung, there is "sudden acute pain in the chest,
speedily followed by great dyspnoea, hurried respiration, frequency of
pulse, prostration, lividity, perspiration, diminished or suppressed ex-
pectoration, occasionally loss of voice, and an expression of great
anxiety. At first and for a brief period, the affection may be simply

PLEUKISY, 819

pneumo-tliorax ; but acute pleuritis is generally quickly developed, with
more or less liquid effusion; and the disease soon eventuates in pneu-
mo-hydrothrax." There are cases, however, in which all of these
symptoms are produced in simple pleuritis, and others in which they
are not all present, though pneumo-hydrothorax has taken place. In
the latter case the perforation is small and the escape of air and morbid
products into the pleural sac, and the subsequent inflammation in the
pleura progress slowly; adhesions already existing may offer obstruction
to the rapid accumulation of air and liquid. The intense dyspnoea
which at first follows the rupture, becomes after a time diminished, and
the respiration and circulation become adjusted to the morbid condition,
and the patient suffers less, though the accumulation of air and morbid
products within the pleura becomes larger.

Peognosis. — When pneumo-hydrothorax occurs as a complication of
phthisis, it generally runs rapidly forward to a fatal termination ; but a
few patients partially recover and live several years, taking some exer-
cise, and even performing some labor.

Teeatmeistt. — See remedies, pages 808 to 815, and 824 to 827.

PLEURITIS.—PLEUKISY.

DiAGisTOSis. — This malady commences with lassitude, chills, and other
febrile symptoms, succeeded in a short time by the following local phe-
nomena : " The stitch, dyspnoea, cough and recumbency on the affected
side were given as characteristics by Laennec. Dr. Wurmbe, of Vienna,
maintains, however, that the posture of the patient is usually upon the
back." The inspirations are short and rapid, and attended with severe
sharp stitches, unless the inflammation be very slight, in which case
but little alteration will be observed in the breathing ; there is often
experienced a sense of tightness and oppression at the chest; there is
generally little or no cough unless the lungs or the bronchia are in-
volved, when there occurs a short and dry cough, with but a small
quantity of glairy expectoration, and very painful; the pulse is rapid
and full; skin hot and dry; urine scanty, and of a deep red or dark
color ; the pain is almost invariably confined to one side of the chest,
and increased by inspiration, coughing, and movement; urgent thirst;
great dyspnoea ; constant inclination to lie upon the affected side or
back ; abdominal respiration, and pain in the intercostal spaces on
pressure. These symptoms are speedily succeeded by others, which
indicate that effusion has taken place. Laennec, Johnson, and Mackin-
tosh believe, that efiusion commences as soon as the inflammation is
established ; while others, equally eminent, contend that a considerable
period elapses before it occurs. But the weight of testimony seems to
be in favor of the opinion of the former gentlemen. Amongst the

820 DISEASES OF THE SANaumOUS FUNCTION.

signs which are characteristic of pleurisy with effusion, are, increased
size of the affected part of the chest, apparent to the eye or by men-
suration ; also segophony, perceptible by the stethoscope from the com-
mencement of the inflammation, or after a moderate quantity of fluid
has been effused, disappearing when the effusion becomes very large
in quantity, and reappearing as absorption takes place, and the liquid
diminishes ; dull sound on percussion, and failure of the respiratory
murmur in the affected side.

Should the lungs happen to be involved, the sputa will be tinged or
streaked with blood, and more copious than in simple pleuritis. Other
symptoms will also obtain which characterize pleuro-pneumonia.

The effusion of pleurisy may be either of a plastic, serous, or hsemor^
rhagic character. The severity of the febrile, and other symptoms
will depend upon the rapidity of the effusion, and its quality and
quantity.

Causes. — Atmospheric vicissitudes, sudden checking of the perspira-
tion ; metastases of rheumatism, erysipelas, gout, &c., mechanical in-
juries, surgical operations upon cancerous and scrofulous parts. We
have witnessed two cases of pleurisy which supervened as a consequence
of surgical operations. One of these cases occurred after amputation
of the thigh for a malignant disease of the leg and proved speedily
fatal. The other case came on about two weeks after excising a large
fungous tumor from the breast of a female, which also proved fatal.
Both of these cases were unusually violent, and ran their course with
great rapidity. It is worthy of rema,rk, that in both, the wounds made by
the operation were progressing as favorably as usual. Whether pleurisy
in these cases is attributable, as some writers suppose, to the absorption
of pus into the system, or to some other cause we may not now be able
to determine ; but that the disease is peculiarly violent and fatal, has
been observed by all who have witnessed its occurrence.

1. acute pleuritis.

Next to bronchitis and pneumonitis in order of frequency of occurrence,
pleuritis occurs as a most common thoracic disease. When not con-
nected with tuberculosis or pneumonitis it is commonly a general disease
of the pleura of one side. When confined to one side it is called
single pleuritis, double pleuritis when it involves both sides.

Stages of Peogress. — First. ► The period from the commencement
of the inflammation to the accumulation of an appreciable quantity of
liquid effusion within the pleural sac. This is the dry period.

Second. The stage of effusion, in which liquid accumulation is pro-
gressing.

Third. Period of absorption of the liquid effusion.

Pathology of the First Stage. — The whole inner surface of the

PLEURISY. 821

pleural sac has diffused over it plastic lymph, or it appears in patches^
varying in size. It is supposed that in the initial period of this stage
there is an abnormal dryness of the membrane, which causes certain
sounds heard at this stage.

Second Stage. — Liquid effusion is poured out from the inflamed sur-
face which sinks by its weight to the bottom of the sac, compressing
the lung, and displacing it in a direction upward and backward, when
not prevented by morbid adhesions. The bulk of the lung being dimi-
nished and the air expelled from it, it becomes a condensed mass, and
is said to be carnified^ later the fluid enlarges the size of the chest,
depressing the diaphragm, stomach and liver, displacing the heart.

Third Stage. — The effused fluid diminishes in quantity and is finally
dispersed by absorption. The compressed lung then expands, and
slowly regains it former volume, except in certain cases in which that
volume is never attained. Contractions of the chest often persist, and
the relations of parts previously displaced are only restored after long
intervals, if ever. The pleural surfaces again come into contact as the
effused liquid diminishes, though .these surfaces are roughened by a
fibrinous coating more or less solidified. JPinally the surface of the lung
and costal pleura become united by adhesion through the complete or-
ganization of the intervening plastic lymph. These physical conditions
apply to both acute and chronic pleuritis, though the effects of inflam-
mation are more fully marked in the chronic form of the disease.

Diagnosis. — Physical Signs furnished iy Percussion, Before the
accumulation of liquid so far as to fill some portion of the pleural cavity
at the bottom of the chest and raise the lung above it, the sonorous-
ness on percussion is not much altered. Moderate or slight diminution
of the vesicular resonance, replaced by a tympanitic sonorousness, indi-
cates a lessening of the capacity of the lung, on account of the pain
which accompanies the act of inspiration, the exudation of plastic
lymph, on the pleural surfaces. If the patient will disregard the pain
he can inflate the lung to the full size, and then the sonorousness is re-
stored; though without this extra effort, the resonance is diminished
over the whole or the greater part of the side affected. Percussion in
this disease gives pain, unless very lightly performed.

The stage of effusion progresses rapidly, in some cases it supervenes
in a few hours from the attack; it is seldom delayed beyond the third
or fourth day ; the liquid now accumulates around the base of the lung,
and abolishes the vesicular resonance upwards over a space corres-
ponding to the amount of effusion. The percussion sound is flat, ex-
cept a gastric or intestinal tympanitic sonorousness be transmitted from
below. Vesicular resonance is invariably abolished ; the sound becomes
flat; elasticity of the thoracic wall is diminished; and the upper
boundary of the flatness is the limit below which the sense of resistance

822 DISEASES OF THE SANGOTN-OUS FUNCTION.

s increased. The boundary of flatness varies in different positions of
the patient, as the liquid changes its position when he turns another
point lower. In some cases the boundary of flatness, which marks the
level of the liquid is varied from the horizontal (though the position bb
vertical), by previous morbid adhesions, holding the lung down by an
attachment sufficient to resist the upward pressure of the fluid. " Per-
fect flatness, although not conclusive evidence of the presence of liquid,
for it may be caused by an intra-thoracic tumor, and occasionally even
by consolidation of the lung, warrants a strong presumption that effusion
exists. And this presumption is rendered still stronger by the flat-
ness being found to extend from the base of the chest upward. The
line indicating its upper limits being well defined, and pursuing a di-
rection, if the body be in a vertical position, extending horizontally,
or nearly so, around the affected side." [Flinty Resjpiratory' Organs^
p. 644.)

When the liquid is being removed by absorption, vesicular resonance
gradually returns from above downward as the level of the fluid is
lowered, but toward the base of the chest the flatness continues for a long
time. The displacement of the mediastinum toward the opposite side
is gradually changed into a displacement of the mediastinum toward the
affected side.

AusouLTATioisr reveals feeble respiration in the affected side during
the stage of liquid accumulation. The intensity of the respiratory
sound is lessened by the restrained expansion of the affected side.
Want of continuity in the respiratory movements caused by the pain
produces an interrupted or jerking murmur. During the stage of ef-
fusion the respiration is rendered more feeble in proportion as the lung
becomes compressed. When the quantity of the fluid fills two-thirds of
the chest the respiratory sound becomes very different in the upper and
lower portions. Over the condensed lung the respiratory sound is
hrouGho-vesiGular, or ironGhial^ as the degree of condensation is
greater or smaller. In some instances it is loud, in others feeble : be-
low the line of flatness on, percussion it is frequently suppressed, the
sounds of the heart being transmitted through the mass of liquid with
increased intensity. In pleuritis in young children the bronchial re-
spiration is more extensive than in adults of an equal degree of fluid
accumulation and lung condensation. In common cases the l^ronchial
respiration is more intense and seems nearer the ear over the condensed
lung ; over the liquid it is more feeble and seems more distant. When
the effusion is very copious, the respiratory sound is usually suppressed
over the greater portion of the chest, except, perhaps, at its summit,
below the clavicles and in the upper portion of the inter-scapular re-
gion. When the bronchial respiration is very loud smd jpersistenl there
is reason to suspect tbat the lung is consolidated.

PLEUKISY.

823

Diagnostic Symptoms of Acute Pleuritis.— During the first period,
pain is a prominent symptom. It is sharp and lancinating, felt most at
the moment of inspiration, shortening that act and interrupting it,
though in character it may resemble pleuralgia. In pleuritis it is com-
monly felt at the lower part of the affected side, laterally, and in front,
though sometimes extending to the back or over the whole side, even
sometimes extending to the opposite side or abdomen. As effusion
takes place the pain diminishes, and finally almost ceases.

Respirations at first frequent and short, first because of the pain,
afterwards from the encroachment of the fluid, which compresses and
diminishes the capacity of the lung. When the effusion takes place
rapidly there is dyspnoea.

Cough, almost always present; it is dry, spasmodically excited at
first, and partially suppressed to save the pain it excites. We will en-
deavor to distinguish between

ACUTE PLEURITIS

The existence of fever is always a
prominent feature, and proves the case
more inflammatory than neuralgia.

Friction sound, after the first stage.

Serous effusion gives positive evidence
of inflammation, kt first the pain may be
merely neuralgic but then inflammation
soon follows. Chill, increased pain and
fever precede the latter.

The reverse of Pneumonitis after ef-
fusion takes place.

The line showing the boundary of
dullness varies as the patient changes-
posture. The liquid accumulates rapid-
ly, and flatness on percussion extends
over a larger portion of the affected side.

When the quantity of liquid in the
pleura is large there \& flatness on per-
cussion.

AND PLEURODYNIA, OR INTERCOS'
TAL NEURALGIA.

The physical phenomena of acute pleu-
ritis are wanting, though there may be
diminished expansion of the side ; feeble-
ness of respiratory murmur, and some
relative dullness, due to restrained move-
ments from pain.

Affected side often extremely sensi-
tive.

Fever is not generally present*

Not general.
Not present.
No chill or fever.

Acute Pneumonitis.

Marked dullness on percussion over a
certain portion of the affected side begins
early. If the upper lobe is first in-
flamed, the dullness is at the summit, and
on the anterior surface, the posterior
surface below the scapula remaining re-
sonant on percussion.

But more commonly, inflammation,
begins in the lower lobe. Dullness is^
then found bounded on the chest by a
line pursuing the direction of the inter*-^
lobar fissure ; the boundary not varying -
with the change of positiou of the-
patient.

824-

DISEASES OF THE SANGUINOUS FUNCTIOK.

Acute Pleuritis.
This is usually associated with sup-
pression of respiratory sound ; if any
bronchial respiration, it is feeble, ap-
pearing distant.

These are absent when there is effu-
sion.
Sometimes jEgophony.

Vocal fremitus is abolished by liquid
effusion.

There is enlargement of the affected
side ; intercostal depressions effaced.

The heart, diaphragm and mediastinum
are displac*^d, when the effusion is large.

"Wanting.

Acute Pneumonitis.

Though an entire lung may become
solidified, a single lobe is first at-
tacked ; and the dullness extends slowly
to other parts.

Solidification of the lung produces
only dullness ; in some cases the vesicu-
lar is replaced by tympanitic sonorous-
ness. The dullness, accompanied by
bronchial respiration, often, intense, me-
tallic, as if near the ear.

There is increased vocal resonance,
broncophony, occasionally pectoriloquy.

-^^gophony is rare. Vocal fremitus
is exaggerated by solidification.

Enlargement slight; intercostal de-
pressions remain.

These are little perceptible in pneu-
monitis.

Rusty expectoration and crepitant rale
are very common, almost pathognomic

Treatment. — The most valuable remedies in the treatment of pleu-
risy are : Aconite^ Bryonia^ TaHar-emetiG^ Phosphorus^ Arsenicum^
HhuS'tox., and Arnica. During the progress of the disorder we should
also bear in mind Sulphur^ Scilla^ Bhus-rad.^ Lachesis^ Silicea^ and
China,

Aconite is eminently appropriate, either alone or in alternation with
other specifics, whenever the inflammatory action runs high, accompa-
nied with hot skin, quick and full pulse, urgent thirst, and general sus-
pension of the secretory functions. Wurrnbe and Trinks commend it in
the highest terms in that variety of pleuritis which is characterized by
the plastic nature of the effusion, and the severity of its inflammatory
fever. It should be exhibited at the very commencement of the dis-
ease, and in the lowest potencies, and repeated in urgent cases every
hour until the fever subsides.

Bryonia is a specific of great value in the malady under considera-
tion, and the power which it possesses of promptly controlling and sub-
duing the most violent cases of pleurisy, is a matter of astonishment to
us, who formerly believed copious and repeated venesections to be the
only safe means of effecting a cure. We have treated a great number
of cases, in which Bryonia has been our chief remedy, and we have
not failed in a single case, but our cures have been far more prompt,
pleasant and satisfactory, than we ever effected under the old treat-
ment. The effusion has invariably been more successfully absorbed,
and the pleura and lungs as well as the system at large have more per-
fectly recovered their original tone and vigor than in cases which have

PLEURISY. 825

been treated by the old method. Nor will this appear at all strange,
when it is remembered, that by one method the structure actually, dis-
eased is alone acted upon, while by the other the whole organism is
subjected to the influence of the most powerful medicines, impairing the
integrity and vigor of almost every part, without producing any certain
or decided effect upon the pleura, or any other pulmonary tissue.

Let the skeptical allopath prove upon his own person in health the
pure effects of Bryonia, Tartar-emetie, Phosphorus, Laehesis,
Scilla, &c., upon the respiratory organs, and then test them judiciously
in cases of disease after the homoeopathic principle, siniilia similiius,
and he will forever abandon the uncertainties and dangers of the lancet,
mercurials, counter-irritants, &c.

Bryonia may follow or alternate with Aconite advantageously. The
external indications are : cheeks flushed and hot, dry or moist ; re-
spirations short and rapid, and performed principally with the abdominal
muscles ; position upon the afl'ected side ; pulse quick and full ; tongue
dry; breath hot; urine scanty, and red or dark; dull sound on per-
cussion of the affected side ; respiratory murmur indistinct or entirely
wanting. ^

Physical Sensations, — Stinging, shooting or burning pains in the
side, aggravated on inspiration, coughing, or movement; respiration
difficult, short, anxious and rapid ; sense of tightness ; a weight or op-
pression at the chest ; painful cough, dry or with expectoration of a
glairy sputa, sometimes tinged with blood; great heat of skin, alter-
nating with frequent coldness and shivering ; urgent thirst ; pain in the
intercostal spaces on pressure ; weariness and inclination to retain the
recumbent position.

Mental and moral Symptoms, — Anxious, apprehensive, desponding ;
fear, irritability, peevishness, restlessness.

In the plastic form Aconite is more appropriate. Bryonia is the
specific for pleuritic serous effusions ; fever, with violent shooting pains
in the chest. In pleuritic effusions which follow a simple course with-
out any dyscrasia. Sulphur seems well adapted for the removal of the
effusion, especially after the fever subsides. ( Wurmie)

In pleurO'pneumonia Wurmbe and Caspar recommend Bryonia,
especially in the second stage; in cases not very extensive, but in-
volving the mucous and serous membranes; there is severe stabbing
pain in the chest, even when it does not seem to correspond with the
seat and extent of the infiltration of the lungs; the pleura is deeply
implicated, and there is moderate oedema of the lungs ; when the oedema
becomes more considerable, Tartar-emetic is to be preferred.

Administkation". — A dose of the first dilution every hour, alone or
in alternation with Aconite, until the pain, difficulty of breathing, &c.j
are relieved.

826 DISEASES OF THE SANGUINOUS FUNCTION.

TartaT'einetic, — According to Magendie this medicine possesses the
specific power of causing engorgement and inflammation of the lungs
when given in large doses. There can be no doubt, that it is an ab-
solute and decided specific over the respiratory organs, as well as the
gastro-intestinal mucous membrane. This has been demonstrated by
Cloquet, Miiller, Magendie, Gross, and others, by autopsical examina
tions and by numerous provings upon persons in health.

It is a common remedy in the old school in affections of the respira-
tory organs ; yet they are entirely ignorant of its curative action. It
is only necessary to refer to the unsatisfactory and contradictory opin-
ions of Laennec, Rasori, Broussais, Eberle, Payne, Blake, and Barbier,
upon this subject, to be convinced of the utter want of accurate know-
ledge and uncertainty of principle amongst allopathists in the admin-
istration of medicines.

The homoeopathist on the contrary, demonstrates by numerous pro-
vings in health, that it exerts a specific force upon the lungs and their
appendages, and he therefore gives it in inflammations of these organs
with confidence and success. With him there is no random and crude
speculation, — no breaking down of the organism by violence, hoping in
the general ruin to crush the malady, but, having a definite object, and
seeing his goal, he quietly, safely and surely attains it.

The indications for TartaT-emetiG are : face flushed, hot and dry,
or pale, wan and anxious, and covered with sweat ; respirations short
and obstructed ; surface burning hot and dry, or cold and bathed with
cold perspiration ; pulse quick, weak, or full ; tongue moist and clean,
or loaded with a white or brown fur; urine scalding hot, red or brown;
mucous or bloody expectoration; general appearance indicative of great
anxiety and physical prostration.

Respiration short, difficult, obstructed, and attended with stinging or
shooting pains ; cough with expectoration of mucus, sometimes tinged
with blood; violent throbbing of the heart; coldness and shivering
whenever the bed-clothes are raised, or on motion ; fever with adypsia
or moderate thirst; lassitude, debility, and disposition to syncope ;
trembling of the limbs from the slightest exertion ; sense of suffocation.

Agitation; apprehension; discouragement ; despair.

Administration.^ — Two grains of the first trituration of Tartar-emet
may be dissolved in a tumblerful of pure water, and given in teaspoon-
ful doses, every one, two, three, or four hours, as the urgency, of the
case may demand.

Phosphorus, — Countenance pale, alternating with redness; eyes
hollow and surrounded by a blue circle; respiration short, difficult and
noisy ; tongue dry ; pulse quick and hard ; expectoration slimy or
bloody.

PLEUKIST.

827

Respiration rapid, short and difficult ; lancinating pains in the chest,
mostly on the left side; sharp pains on pressing the intercostal
spaces ; anguish, fullness and tension of the chest ; palpitation of
the heart; dry, shaking cough, or cough with expectoration of th
bloody mucus ; weakness, pain, and trembling of the limbs; mouth and
throat dry ; thirst.

Uneasiness ; melancholy ; anguish ; dread of the future ; indifference
to every thing ; passionate and irritable.

Administkation. — Same as Bryonia,

After the more violent febrile symptoms have subsided, and those of
effusion into the cavity of the pleura remain, as enlargement of the af-
fected side, dull sound on percussion, absence of the respiratory mur-
mur, oppression and constriction of the chest ; difficult and short breath-
ing, with occasional attacks of suffocation ; dry cough ; coldness of the
body ; clammy sweats ; anxiety and general sense of prostration, At-
seniGum is our remedy. It may be given in these cases at the third
potency, a dose once in two to four hours, lengthening the intervals as
improvement occurs.

HhioS'tox, is sometimes useful after the febrile symptoms have sub-
sided, and there yet remain wandering pains in the chest, shortness of
breath, and general debility. In cases also which have arisen from
metastasis of rheumatism or gout, this remedy is peculiarly appropriate.
It may be administered in the same manner as Bryonia.

Arnica is our best specific when inflammation of the pleura has
arisen from contusion, bruise, or other injury. It may be used inter-
nally in one of the lower dilutions ; externally, a lotion made of a
drachm of the tincture to twelve ounces of water may be applied to the
contused part.

The other medicines which will frequently be found highly service-
able in some of the sequela of pleuritis are : /S^^^A'^^r, /Sb^7&-mar..,
Hhus-rad,^ Lachesis^ Silicea^ and China* Sulphur especially is re-
commended by Wurmbe in plastic pleurisy, and in cases complicated with
pneumonia and hepatization, after Aconite has moderated the more
active symptoms. He uses the tincture.

2. CHRONIC PLEURITIS.

This affection seldom follows or is preceded by acute pleuritis. In
general the inflammation is sub-acute from the first ; and the effusion
commonly attains to a much larger amount than is observed in the
acute variety. It is very often overlooked, and may only be detected
by physical exploration.

First period. — That of Accumulation. — This continues while the

828 DISEASES OF THE SANaUINOUS FUNCTION.

liquid is accumulating in the pleural sac or remains stationary. It is
generally of brief duration.

Second ^period, — Stage of Absor]?tion, — This may extend through a
few weeks and even several months.

Diagnosis. — Percussion gives a flat sound on the whole or greater
part of the affected side ; tympanitic resonance at the summit ; marked
want of resistance and elasticity of the thoracic parieties ; showing the
pleural sac to be filled with fluid, compressing the lung into a small
space. If any bronchial respiration is perceived, it is feeble, and sounds
as if distant, except at the summit in front, and in the inter-scapular
region. On the healthy side the respiratory murmur is intensified, but
vesicular ; greater vocal resonance in the inter-scapular space of the
affected side.

Inspection shows immobility and enlargement of the affected side,
and on the opposite respiratory movement increased. Ribs of the af-
fected side raised towards a horizontal direction ; intercostal de-
pressions effaced ; bulging between the ribs, nipple raised and removed
further from the median line. Measurements show increase of size,
perhaps to the extent of two inches.

The heart is displaced from the affected side and pulsates sometimes
far from the natural position. Mediastinum displaced laterally ;
diaphragm depressed ; this may press the liver downwards to make it
project below the ribs.

During the second stage these signs gradually change towards the
normal condition, but rarely reaching it; when the absorption is com-
pleted the contraction which began in the upper portion of the chest
becoming general, the displaced organs recede towards their natural
position. The whole process often extends through several months.

Chronic Pleueitis is not generally manifested by severe pain;
cough and expectoration are not much complained of. The cough is
more generally dry, except when there has been ulceration extending
from the pleural sac into the bronchia, causing pneumo-hydrothorax.
Other symptoms deceive superficial observers. Respirations but slightly
increased in frequency; exercise or speaking reveal want of breath,
dyspnoea and lividity of the prolabia, removed by rest. The pulse
varies from 80 to 120 per minute ; night-sweats, not always preceded
by fever; slight chills occasionally felt, even when no tuberculosis;
some indigestion common ; but often the appetite is morbidly craving,
and food digested without distress ; pallid countenance not always
present ; emaciation not generally noticed. Strength often not much
diminished ; many continue laborious occupations though the chest on
one side is filled with fluid undergoing a slow absorption.

The patient is generally supposed to suffer the efiects of a " dumb
ague," bilious fever imperfectly cured, dyspepsia, general debility, dis-

PLEURISY. 829

ease of the heart, chronic liver-complaint, or hepatization of the lung.
The distinction, which shall separate it from each of these, is perhaps
only to be drawn by physical exploration. If there be flatness over
more or less of the chest in cases of chronic pleuritis, the probabilities
are against pneumonitis. The acute inflammation of the parenchyma
of the lung would have manifested itself by pain, rusty expectoration,
fever, and confinement to bed for some days or more ; and chronic
pneumonitis, in such conditions as we find present, is not a common oc-
currence, either as a consequence of acute pneumonitis or as a primary
affection.

The diseases liable to he mista'ken for Chronic Pleuritis, — Infil-
traied-caneer of the lungs is not common. It may produce contraction
of the affected side of the chest, and may resemble the pleuritis in the
stage of absorption.

Mediastinal Tumor may lead to dilatation, and give rise to symp-
toms resembling those of pleuritis in the stage of liquid accumulation^
Cancer of the lungs is more uniformly accompanied with cough and
expectoration; the latter more abundant; it becomes purulent, re-
sembling red or black currant jelly ; haemoptysis is frequent, pain more
prominent and persisting than in pleuritis ; pulse little affected till the
disease is quite advanced. Contraction of chest not so great ; the loss of
strength, emaciation, and pallor denote the progress of a grave, serious
malady.

Cancer of the mediastinum may extend into both sides of the chesty
causing flatness on percussion, &c., not limited to one side. The
pressure of the tumor may efface intercostal depressions, and unfre-
quently, a sense of fluctuation; but these effects are more rare than
when the side is dilated by the presence of liquid. The dilatation from
a cancerous or other tumor is often partial or circumscribed, irregular,
and extends from above downward. In chronic pleuritis the dilatation
is from below upward, is general and more regular in shape. Dyspnoea
is more constant and prominent, if the tumor is considerable in size.
If a tumor cause displacement of the heart and diaphragm other
symptoms are added to those caused by accumulation of liquid: There
is also "oedema of the face, lividity, swelling of the veins, dysphagia, as
well as marked dyspnoea," which are caused by pressure on the air-
tubes, large vessels, nerves and oesophagus.

Physical Signs. — Cancer of the Lungs or Mediastinum, — Percus-
sion reveals bronchial respiration and increased vocal resonance, or
broncophony is often found over parts of the chest where the percus-
sion-sound is dull or fiat. These signs show pulmonary solidification.
In chronic pleuritis there is absence of respiratory murmur and aboli-
tion of vocal resonance below the level of the liquid. These signs with
flatness on percussion eminently show the presence of liquid ; vocal fre-

830 DISEASES OF THE SANGUINOUS FUNCTION.

mitus may be preserved or "increased in cases of cancerous infiltration
or tumor; it is uniformly abolished below the level of the fluid in
chronic pieuritis ; and flatness of the chest extends from the base more
or less upwards. In the former afi'ections percussion reveals vesicular
resonance at or near the base of the chest below the limit of flatness or
dullness.

Retbospective Diagnosis.- — Exarnination of the Ghest to deter-
mine whether Pieuritis has not existed at a former thne,^ — " Di-
minished width of the chest, apparent on inspection in the great ma-
jority of cases. Depression or flattening at the summit of the affected
side, almost invariably observed ; but occasionally enlargement, which
probably denotes abnormal dilatation of the cells or emphysema. The
reduction in size is also shown by mensuration. The shoulder
generally depressed ; but in some instances this is not apparent, and it
may be even raised above the level of that on the opposite side. The
nipple usually depressed, but not invariably, and nearer the median
line. The lower ribs converging, sometimes almost overlapping ; the
upper ribs diverging. The distance from the posterior margin of the
scapula to the spinal column lessened, often in a notable degree ; an
exception to this rule obtaining in some instances, when lateral cur-
vature of the spine takes place, the concavity looking toward the af-
fected side. Projection of the lower portion of the scapula occurring
in a certain proportion of instances; also depression of the inferior angle
below the level of that on the opposite side. The respiratory movements
almost uniformly diminished in a degree more or less marked ; the ex-
pansibility on the opposite side being at the same time exaggerated.
Comparative dullness on percussion ; the contrast rendered more strik-
ing by the great clearness of percussion-resonance on the opposite side.
A vesiculo-tympanitic resonance at the summit, conjoined with enlarge-
ment, denoting the supervention of emphysema. Feebleness of respira-
tory sound over the entire side, with few exceptions; and on the oppo-
site side, an unusually intense vesicular murmur. A bronchial respira-.
tion sometimes observed in the inter- scapular space, and in other parts
of the side. In the latter, especially associated with broncophony,
probably denoting dilatation of the bronchial tubes. The respiration in
a certain proportion of cases, broncho-vesicular. The vocal resonance
sometimes greater, but not uniformly. The same remark applicable to
vocal fremitus. Curvature of the spine in some cases, the inclination
usually lateral, the concavity toward the affected side. The position
of the heart frequently normal, but in some instances displacement cf
this organ ; it being found to the left of its natural position and ele-
vated, if the pieuritis be seated in the left side." After pieuritis of the

* Flint on the Respiratory Organs, P. 577.

EMPYEMA. 831

right side the heart is sometimes permanently drawn toward the right
side. Such are phenomena observed in persons who have formerly
suffered from chronic pleuritis, after complete recovery from the same,
except there be remaining, in some instances, emphysema and dilata-
tion of the bronchial tubes.

3. EMPYEMA.— PYOTHORAX.

A collection of pus within the cavity of the chest is one of the ter-
minations of pleuritic inflammation. The termination of pleurisy in
empyema is attended by difficulty of breathing, particularly on lying
on the side opposite the affected one; and an oedematous swelling is
generally externally perceptible.

DiAONOsis. — Purulent accumulation within the thorax, the tumor
showing itself without the ribs is regarded simply as a superficial
abscess. But the mistake of so regarding it is avoided by employing
physical exploration; if the physical signs reveal the existence of a
large collection of fluid within the pleural sac, it may be inferred that
there is a communication between the fluid within the chest and that
immediately beneath the skin. We can also by compressing the tumor,
if there be such interior communication, reduce the fluid from the out-
side of the ribs, through the perforation, making it entirely disappear
by forcing its contents into the thorax; and if the tumor contains fluid
which communicates freely with liquid in the chest, it will be observed
to rise and fall with the successive acts of inspiration. The appearance
of the tumor which belongs to empyema is not preceded by acute in-
flammation, pain, swelling, heat or redness. If the tumor be opened
under the erroneous impression that it is merely a subcutaneous abscess,
the abundance of the discharge of pus will lead to the discovery of
the error.

When the fluctuating tumor pulsates synchronously with the beating
of the heart, it might be mistaken for aneurism ; but it is developed too
rapidly, the liquid contents are too superficial, and the fluctuation of
pus is evident. The bellows' murmur and thrill of aneurism are want-
ing and the certain presence of liquid in the chest removes all doubt
as to its character.

Having discovered by physical signs that the pleural sac contains
liquid of some kind, it is desirable to determine its nature as precisely
as possible : It may be supposed to be purulent, if the quantity of
liquid be large and it remains stationary, or continues to increase in
spite of judicious treatment, calculated to cause its absorption. Serous
fluid should have been at least diminished ; but pus is more likely to
increase rather than diminish; repeated exploration may assure us
whether the quantity increases or diminishes. Positive certainty can
only be reached by ^aracetesis thoracis* Dr. Morrill Wyman, of

832 DISEASES OF THE SANGUINOUS FUNCTION.

Cambridge, Mass., proposed to perform this operation most safely by
using "a small canula which is attached by a flexible tube to a suction*
pump, so constructed that the fluid may be removed from the chest
through the canula, and discharged through the pump by another aper-
ture. {A^ner. Jour, Med. Sciences^ April, 1852.)

It is the tendency of this disease to terminate by progressing toward
the surface ; and, by means of ulceration and a fistulous communica-
tion, the contents of the pleural sac are discharged spontaneously,
either directly through the thoracic , parietes, or indirectly through
some natural outlet, as the bronchial tubes. It has resulted in dis-
charge of pus into the alimentary canal. When sudden and copious
expectoration takes place from the lungs when the pleura was known
to have been filled with pus, it may be considered certain that the ul-
ceration has commenced within the pleural sac ; speedily, however, we
have evidence of the existence of air within the thorax and the exist-
ing disease is known as pneumo-hydrothorax. (Flint.)

Perforation of the Walls of the Chest, — The purulent fluid col-
lecting beneath the thoracic integument first forms a fluctuating tumor
which is evidently situated outside of the ribs. If there has not before
been proof of the existence of an accumulation of liquid, this tumor
may be mistaken for an external abscess. If physical signs show that
liquid really exists in the chest, we may suppose the subcuta,neous
collection to be connected with that within. In this case the fluid be-
neath the skin can be pressed back into the chest through the opening
by which it found its way towards the surface ; the tumor would rise
and fall with the successive acts of inspiration and expiration; and if
opened by mistake, the large quantity of pus discharged will prove
error in diagnosis.

Treatment. — In all ordinary cases the proper use of remedies in the
earlier stages of pleuritis will prevent its proceeding to a termination
in the formation of pus. When, however, it has by neglect, or in pecu-
liar constitutions proceeded to suppuration, the treatment will be
governed by the following principles : 1. The constitutional predisposi-
tion of the patient to scrofulous or tubercular disease ; 2. the treatment
proper for abscesses in general. See the Articles Phthisis^ Scrofula^
Abscess^ Pleuritis^ Pneumonia, 8. The operation of paracentesis may
be necessary in some cases.

See an interesting case by Dr. Helmuth, U. S. Jour. Homoeop. Vol.
I. p. 489.

4. EMPHYSEMA.

Emphysema consists only of a swelling or enlargement from the ad-
mission of air into the cellular membrane. It is commonly caused by
a wound or injury of the thorax, which has afi'ected the lungs; in which

INFLUENZA. 833

case the air passes from the injured lung through the wound into the
surrounding , cellular membrane ; and from thence it spreads over the
body. In some remarkable cases it arises spontaneously immediately
after delivery without any known cause.

Emphysema is marked by an evident crackling noise ; elasticity upon
pressure; difficulty of breathing, oppression, and anxiety. The skin
over the enlarged part is tense, elastic, and crepitating.

This affection is generally without danger ; but it may be more or
less serious, according to the extent of the injury with which it is asso-
ciated. The only treatment required will be that proper for the in-
jury, and the control of the attendant inflammation and fever.

5. EPIDEMIC INFLAMMATION OF THE PULMONARY MUCOUS MEM-
BRANE.— INFLUENZA.

This disease is usually described as an aggravated form of coryza ;
but it is far more serious than that disease as it commonly appears,
and is essentially different in its nature. Arising from a specific cause,
and spreading rapidly as an epidemic, it has often been simultaneously
manifested in almost the same hour in every part of a large city ; and
in a very brief period it traversed kingdoms and crossed oceans, pre-
senting everywhere the same general features. Eor centuries it was
believed to originate in some mysterious influence of the stars ; hence
the Italian name infiuema* It was also called influence del aria^ m.
fluence of the cold.

In addition to the symptoms of simple catarrh (described at p. 423)
we find in influenza an immediate aggravation of all the febrile symp-
toms : hoarseness; severe cough, either dry and racking, or hollow and
loose; wheezing, or difficult respiration; impaired appetite ; soreness,
oppression, or stitches in the throat and chest on coughing ; inca-
pacity for mental or physical exertion ; bowels constipated or relaxed.
Sometimes the inflammation appears to extend to the membrane of
the thorax and of the bronchial tubes, giving rise to sharp, stitching
pains, or a sensation of rawness in these parts ; severe and painful
chest cough ; thick, tenacious, and semi-purulent^ expectoration ; op-
pression of the chest and difficult respiration. In these instances, the
Inflammation is of a lower grade than obtains in acute bronchitis,
pleuritis, or laryngitis, and consequently the symptoms are more slight
and less dangerous.

Treatment. — The chief remedies are, Nux.^ ArseniGum^ Mer-
curius^ Dulcamara^ Stibium^ Cejpa^ Ammoniu7)ij CarTyon^ IpecaG.^
Causticiim^ Belladonna^ Bryoniay Pulsatilla^ Chamomilla, Their
separate indications are given at p. 425. Camphor is promptly effectual.

Vol. i.~ 53.

834

DISEASES OF THE SANGUINOUS FUNCTION.

SUMMARY OF PHYSICAL SIGNS

Name

■
INSPECTION, PALPATION, MENSURATION,

PERCUSSION.

of the

Disease.

Thoeax.

Muscles.

Dia-
phragm.

LiVKK.

Heabt.

EMPHYSE-
MA.

Dilated, espe-
cially in regie
mammaria. Like
a barrel — elasti-
city wanting.
(Compare Pneu-
mo-thorax.)

Moveable, not
pushed out.

Pressed
down.

Pressed
down and to
the inside ;
not moved
over the me-
dium line.

Clear sound, not
tympanitic, even
where the sound
is dull, as over
the liver and
heart. Clear tym-
panitic sound in
limited vesicular
emphysema.

PLEURI-
TIS.

Inferior dilata-
tion with little
or no motion. In
left-sided pleuri-
tis that side wid-
er than the right
one.

Not moveable,
—pressed out.

Pushed
down.

Pushed to
the right side
over the me-
dian line,
soon in left-
sided exuda-
tions.

Empty, dull,
firstly towards
the back and be-
low.

HYDRO-
THOKAX.

As in pleuritis.

Some moveable,
but not pushed
out.

As in pleu-
rit.

As in pleurit.

PNEUMO-

Increased con-
vexity of the left
side, and enlarge-
ment of it, espe-
cially in simulta-
neous exudation.
Great elasticity
ofthe walls of the
chest

Muscles show
prominently out-
ward: nearly pa-
ralytic; increas-
ed elasticity ;
yielding in per-
cussion.

In left-sided
pneumo-tho-
rax the heart
in scrobicu-
lis cordis; or
as in pleuri-
tis, pushed
to the right
side.

Clear and tym-
panitic in front,
with metallic
second sound, es-
pecially on per-
cussion, during
auscultntion (not.
tympanitic, only
during large ten-
sion of the tho-
rax) even on the
back, where
there is fluid exu-
dation, tympani-
tic sound, mode-
rated down only
by milder per-
cussion and large
quantity of fluid.

THORAX.

Apoplexia-

Only in large
bleedings on the
periphery dull
sound, with re-
sistance of the
finger.

pulmonum.

Bleeding
from the

Lungs.

DISEASES OF THE LUKGS.

835

OF DISEASES OF THE LUNGS.

AUSCULTATION.

Brbathing.

ISTever "bronchial ;
stretched and increas-
ed expiration. Dimin-
iitioD of the sound of
respiration, but vesi-
cular in front — ^^may
be even heard on the
back in the hepatic
region.

Sounds
(Murmurs.)

Weak, bronchial
breathing in the cor^
ner of the shoulder-
blade. Breathing tri-
lling or entirely gone.
In large exudation no
breathing on the an-
terior side.

As in ph'^urit. after
exudation.

Never vesicular; on
the back of the thorax
uncertain.

Eales dry, hu-
mid, whistlin!^
surring, , hum-
ming at the ex-
piration.

Friction sound
in the beginning
and end of the
disease, (rattlin,
murmur more
seldom than in
pneumonia.)

2^0 friction
sound.

Eattling, sur-
ring, -vyhistling ;
sounds, with
ringing noise ,
sounds of falling
drops on sitting
up. Metallic
tinkling ; espe-
cially strong in
coughing and
talking.

Voice.

Yibrations visi-
ble by the hand;
not increased.

"Vibration not felt
by the hand. Bron-
cophony weak.
iEgophony near the
corners of the sca-
pula frequentij.

As in pleuritis.

Vibration want-
ing. Metallic sound
and resonance
speaking and

coughing. Ampho-
ric sound. Gurg-
ling after sound on
the back.

DIAGNOSTIC REMARKS.

Muscles of the throat hypertrophied. Dia^
meter of the chest from before backwards
increased; chest little moveable; respiratory
murmur may be wanting entirely ; rattling
murmurs more in the upper portion. On
account of bronchial mucous membrane, raw
vesicular breathing ; imperfect rattling as in
small vesicles. In larger vesicles dry vefii-
cular rattling. The interlobular emphysem
may physically not be diagnosed.

Differ &n.Ge,H from Pleurisy : Erect posi-
tion "preferred; wall of the thorax elastic;
thorax, superiorly dilated; in pleuritis the
contrary; dilatation below.

The larger circumference of the left tho-
rax (usually smaller than the right) is diag-
nostically of importance. Encysted exuda-
tions and resorption after the physical symp-
toms. Diagnostic diiferences : 1st, From
pneumonia: The hollow dull sound appears
quicker; more resistance of the thorax in
pleurisy. Pneumonia neither dislodges the
intercostal muscles nor other organs from
their position. 2d, From pneumo-thorax :
Percussion remains the same in pleurisy in
every position.

Sequela of Pletiritis : Ilydropical mixtnz*e
of blood with dilatation .of the right heart,
and great exudation. Atrophy of the lungs ;
sinking in of the thorax; friction sound is
favorable, proving a plastic exudation. In
phthisis pleuritis is circumscribed.

The surest symptom is the noise of flue-,
tuation in motion or shaking the patient.
Metallic sound may be wanting, or only be
heard at different times on the same patient.
Change of position, changing also the i^osi-
tion of the exudation, modifies also the per-
cussion sound. (Difference from pleurisy.)
Enlargement of thorax rapidly, in emphy-
sema slowly. Fluid exudation can only be
diagnosed, when in large quantity, giving a
dull sound. In pneumothorax from degene-
rate exudation the quantity of air is less.
Clear sonorous sound of the enlarged left
side witfr pulsation of the point of the heart
on the right side proves fully the existence
of pneumothorax.

Decreased vesicular
breathing, or sus-
pended breathing on
a small space in in-
farctus and crepitant
ronchus around the
part. Bronchial

breathing, when the
Infarctus extends
over a larger space.

Moist, large ve-
sicular rattling
during the

cough, especially
between the
shoulder-blades,
and in the tra-
chea. "When the
blood is fluid,
rattling, surring,
whistling noises.

Broncophony on-
ly by large extent
of infarction.

Diagnosis, — More negatively by exclusion
of concurring cases: Small bleedings and
small infarctus give no physical symptoms.
The same is the case with larger ones, going
inward and surrounded by tissue containing
air. Accumulation of mucus may be taken
for fluid blood, both giving a moist tattle.
Hemorrhage is hardly ever so extensive as
to make itself known by inspection and pal-
pation.

836

DISEASES OF THE SAUGUmOTTS FUNCTION.

Name

INSPECTION, PALPATION, MENSURATION.

PERCUSSION.

of the

Disease.

Thoeax.

Muscles.

, DlA-
PHEAGM.

LlVTlE.

Heaet.

(EDEMA-

PULMONUM.

Chest less mov-
eable, especially
in comparison to
the exertion.

Normal.

Normal.
Normal.

Normal.

Nearly normal;
in some cases
more clear, and
somewhat tym-
panitic. At the
approach of
death weakened
and deadened to-
wards the back;
in front some-
what tympanitic.

PNEUMO-
NIA.

Thorax sunk in
and flattened ;
where indurated
pieces, shrunk
in.

Muscles always
moveable, never
pushed out. Ex-
tension uneven.
The suffering
side moves rela-
tively less.

Normal.

IstStage—NoT-
mal in the begin-
ning ; in pneu-
monia near the
periphery tym-
panitic and full
resistance of the
percussing fin-
ger. ' Increasing
dullness of the
sound. The
healthy parts
around it give a
full clear sound.
2dStage.-Qo\md
dull and deaden-
ed. Resistance
increased.
Sd Stage -Siound.
full and clear •
again. Sometimes
tympanitic as in
the first stage : at
last normal.

TUBERCU-
LOSIS.
Crude Tu-
bercles.

The known
phthisical habit:
chest wider be-
low, narrower
above, (in conse-
quence of swell-
ing of the liver
and sinking in of
the tliorax.

Intercostal mus-
cles less move-
able; upper part
of the chest be-
ing less raised.
One-sided motion
of respiration ;
intercostal spa-
cesy»dilated, and
motion of the
heart visible
there.

Normal.

Position
normal, but
the stroke
stronger and
more diffus-
ed. Second
sound of pul-
monary arte-
ry increased,
pulsations of
the subja-
cent vessels
on the apex
of the lung
clearly per-
ceptible.

Normal in the
beginning, after
a while deaden-
ed in the regio
colli, over the
apex of the lung,
in regio clavicu-
lar, next to the
shoulder joint,
over the crest of
Ihe scapula, in-
creased resis-
tance, want of vi-
brations. Fuller
sound of the

neighboring
parts and in the
sides and below,
(on account of
the increased ex-
tension of the
cells.) Tympani-
tic sound next to
the sternum
(through the em-
physema of the
edges.

DISEASES OF THE LUNGS.

837

AUSCULTATION.

Breathing.

Lessened respira-
tory murmur ; cell
breathing higher,
nearly hissing ; never
bronchial breathing.
(Different from pneu-
monia.)

Sounds
(Murmurs.)

Voice.

Moist crepitant
ronchus, as in
pneumonia, espe-
cially on the
back. According
to the extent of
the bronchial
branches large
Tosicular unryth-
mical murmurs.
In simultaneous
bronchial aifec-
tion rattling

sounds (surring.
Avhistling, hiss-
ing) with the ex-
ception of the
consonant.

Never
phony.

Isi Staffe.-lncreas-
ed vesicular breath-
ing; puerile respira-
tion ; rougher breath-
ing with cell-breath-
ing.

2d Stacfe.-BTonchi&l
breathing.

S(^ Stage.-BroncMal
oreathing, receding
more and more ; for
some time rough
breathing, diminish-
ed cell-breathing.

1st Stagc—Gre-
pitant ronchus at
inspiration, or (in

simultaneous
bronchial affec-
tion); dry and
moist, but not
consonant rat-
tling noises cov-
ering the crepi-
tation.

^ Siage.-Gon-
sonant rattling
noise, surring,
whistling, pur-
ring.

Sd Stage.-Moist
rattling and cre-
pitation at inspi-
ration and expi-
ration. •

Isolated tubercles
have symptoms most-
ly belonging to bron-
chial catarrh. Ac-
cording to Stokes : in-
creased respiratory
mm-mur; dry, sharp,
long-continuing expi-
ratory sound, with
crepitant ronchus.
Weak respiration in a
circumscribed point.
Continued murmur-
ing breathing, with-
out pause, after the
expiration and stop-
ped inspiration in two
or more pauses.
Symptoms of catarrh
and pleuritis only in
the upper parts. In
conglomerated tuber-
cles in great exten-
sion bronchial breath-
ing-

bronco-

Vibrat3[on felt ev-
erywhere. In the
second stage bron-
cophony.

DIAaNOSTIC EEMABKS.

The acute circumscribed oedema shov/s
sometimes even vesicular breathing, usually
diminished and crepitation ; a.uscultation the
same in acute and chronic oedema. In chro-
nic the motion of the thorax not in propor-
tion to the exertion. The hands laid on feel
the vibrations of the internal moving tough
masses. The partial chronic oedema chooses
more the lower regions, giving a dull sound
on light percussions, or moist rattling sounds.
Simultaneous pleuritic exudation pushes the
heart away.

Sequela of ca- Yoice in solita-
tarrh: Eonchus ry tubercles not

sibilans ; dry
cracking, moist
rattling. Conso-
nant rattling
sounds over a
thickened plane.

stren ghtened. Bron-
cophony in con-
glomerated tuber-
cles in large exten-
sion.

In 1st stage, cell breathing covered by the
rattling noises, heard again at the expiration.

^ Stage-. — Emphysema on the margins or
serous infiltrations in the neighboring parts
may produce tympanitic sound. Also when
the pneumonia does not pass through the
whole thickness. Consonant rattling mur-
murs are known by their high clear^sound,
by the dull empty sound on percussion, and
by the greater resistance over the suffering
part. Palpitation increased over the hepa-
tized part. The indurated hepatization shows
the symptoms of the second stage increased
rmd continued. In abscess of the lung:
sound full tympanitic, noise of the cracked
pot, metallic sound. Breathing strongly
bronchial, churning sound as in a bottle
shaken, or rattling murmurs ; cavernous voice
with metallic sound, amphoric resonance.
Lobular pneumonia of grown persons can not
be physically diagnosed; it has only the
sjonptoms of catarrh ; lobular pneumonia of
children gives the same symptoms as tho
croupous of grown persons. Pneumonif\
differs from bronchitis in the deadened sound,
resistance of the suffering part, bronchia^
breathing, and development of stages. — Com
parison of both lungs is necessary. They
may be in different stages of pneumonia.

No safe physical symptoms for the first
stages of tuberculosis. Pneumonia in the
upper part of the lung frequently indicates
tubercular infiltraUon.

838

DISEASES OF THE SANaumOUS FUNCTION.

Name

of the

Disease.

TUBERCU-
LOUS
PHTHISIS.

INSPECTION, PALPATION, MENBUKATION.

Thoeax.

Thorax flatten-
ed; great sink-
ing in of the cla-
vicular region.
Over a vomica
the thorax sinks
in.

Muscles.

Intercostal mus-
cles sunk in ;
gion below the
clavicle immove-
able; the upper
portions do not
expand durine

breathing.
Where the vomi
careaches the pe-
riphery the inter-
mediate spaces
are pushed out.

Dia-
phragm.

Liver.

Hbaet.

Stroke of
the heart and
sounds au-
dible in
large vomica
with metal-
lic sound.

PERCUSSION.

Sound normal,
if air-holding pa-
renchyma sur-
rounds the vomi-
tympanitic
in large and su-
perficially situat-
ed caverns ; me-
tallic sound and
cracked-pot mur
murs in very
large caverns.
Large deep-seat-
ed vomica, sur-
rounded by
thickened sub-
stance, and con
taining air give a
weak tympanitic
sound.

DISEASES OE THE HEAET AOT) ITS APPENDAGES.

The heart and its appendages are subject to several kinds of morbid
action, which authors have described under the terms angina pectoris^
hypertrophy^ and dilatation of the heart, diseases cf the valves, car-
ditis^ and peri'Carditis^ ^\\^ palpitation. Many of the symptoms of
these aiFections are similar, but we shall endeavor, in the following
brief description, to point out a sufficient number of signs to enable the
physician to form a ready and accurate diagnosiSo

12. CARDITIS AND PERICARDITIS.

Diagnosis. — Inflammation of the fleshy substance of the heart, un-
complicated by disease of the pericardium, of the pleura., or of the
aorta, is an occurrence so rarely met with, that some authors have de-
scribed under one general head, the symptoms resulting from inflam-
mations of the heart and its appendages. The signs usually present
in carditis often render our diagnosis very obscure, on account of their
resemblance to aifections of the lungs, and of the pleura, and of their
frequent complication with the latter.' Frank believes that much of
the uncertainty which prevails respecting cardiac aifections, is attribut-
able to the general neglect of the profession in investigating the move-
ments of the heart during disease, and in examining its morbid ap-
pearances in those who have died in consequence of diseases of the
chest. "7? n^est pas doteux que^ si les hommes de Va/rt ohservaieni
avec la meme attention les mouvements et les viirations du coetir

CAEDITIS AND PEKIOAEDITIS.

889

AUSCULTATIOl!f.

Breathino.

Vomicae surround-
ed by air-holding pa-
renchyma, show only
cataiThal symptoms;
at the utmost un-
certain breathing;
or : small vomicoB,
through the influence
of the bronchia, or :

Larger ones (espe-
cially on inspiration
and coughing :

Extensive vomica
•with bronchial tubes
and containing a good
deal of air, give :

Bronchial breathing
and surring (churn-
ing sound as in bot-
tles shaken); metal-
lic sound, amphoric
resonance, and :

Consonant rattling
murmurs with metal-
lic sound and am-
phoric resonance.

(Murmm-s.)

YOIOB.

Vibrations of the

Rattling mur-

voice and cough

murs.

felt in superflcial

vomicae.

Increased rat-

tling murmurs.

Broncophony

Large vesicular

with metallic sound

murmurs, not

and amphoric re-

uniform.

sonance in extend-

ed Yomicas.

DIAGNOSTIC KEMAEKS.

The tuberculous infiltration shows tlie
same symptoms as the second stage of pneu-
monia. If rattling mucus appears during
their softening, it indicates vomicae. Only
Avhere the percussion sound is empty und
clear, at any rate tympanitic, do we feel jus-
tified in diagnosing excavations from the
clear and sharply consonant rattling mur-
murs over a tuberculous infiltrated portion
of the lung. In acute miliary tuberculosis:
Never bronchial breathing, always signs of
mobility, rattling murmurs, crepitations.

In subclavian artery of the suffering side
sometimes stronger pulsation by pressure
after a stoppage of the tuberculosis.

There are diseases of the heart, with &uch
influence on the lungs as to prove by their
physical signs the absence of tuberculosis.

qyie les hattem.ents des arteres^ sHls rmtltiplaient leurs reGheTcIies hut
les cada'i^res^ Us viendraient a lout dissiper les epaisses Unebves qui
enmronment les maladies de V organs central de la cirGulation^
(Frank,)

The ordinary symptoms of inflammation of the heart a,nd its envelop,
the pericardium, are acute pains in the region of the heart, increased
by motion, or on assuming the horizontal posture; sense of fullness a,nd
oppression in the chest ; palpitation from the slightest exertion, or from
mental excitement ; rapid, difficult, and irregular respiration ; short, dry
spasmodic cough ; rapid, small, irregular, and intermittent pulsations of
the heart and arteries; great anxiety, dread of suffocation; "absence of
the respiratory murmur, and dull sound on percussion." (Hall,) General
febrile disturbance almost always accompanies the inflammation,
although the heat is unequally distributed, some parts being intensely
hot, while other parts are cold. The countenance is always expressive
of anxiety and distress, the patient is desponding, irritable^ , and rest-
less, and experiences alarming palpitations, faintness on rising up iu
bed, or on talking.

Causes.— Protracted grief; anxiety, or mortification ; violent mus-
cular efforts ; external injuries ; asthmatic, and other pulmonary affec-
tions ; metastasis of rheumatism, or gout.

Injlmence of Mental Emotions on the J^^ar??,— Fear,. grief,, and
mental anxiety make the greatest depredations on the functions a,nd
Structure of the heart. It was Corvisart who first in modern times drew
especial attention to diseases of the heart, having his attention stro^gly,

840 DISEASES OF THE SAKGTJINOUS FUNCTION.

drawn to the subject by the melancholy examples of it, which were
known to have been developed by the -exciting scenes of the French
Revolution. But many of the ancients have observed similar diseases.
Chrysostom describes sorrow as a cruel torture to the soul, consuming
the body and gnawing the very heart. Agrippa alludes to the palpi-
tations of the heart and syncope induced by fear. But the most re-
markable passage in all the old authors is the following by Melancthon •
" Sorrow strikes the hecuH and makes it palpitate a,nd pine away with
great pain / and the black blood drawn from the spleen and diffused
under the ribs on the left side makes those perilous hypochondriacal
flatulences which happen to those that are troubled with sorrowP This
is a true picture of cardiac disorder from nervous irritation of grief or
sorrow. [Johnson on the Liver ^ <&g,^ p. 209.)

BroTcen Heart — The question of the possibility of rupture of the
heart by violent mental emotion has often been discussed. 1. Zimmer-
mann gives one authentic case, in that of Philip the Fifth of Spain. On
hearing, that his army had been defeated near Plaisance, he was over-
come with grief and suddenly died. The author says, on opening his
body the hea/rt was found ruptured.

2. At the Hospital de Sal Petriere in Paris, Mary Glinn, a widow,
70 years of age, and of remarkably good health previously, was as-
tounded with the horrible intelligence that her daughter with two
children in her arms had thrown herself out of a window and been
dashed in pieces. The mother was so affected that she changed to the
color of a negro in one night. The black color was permanent, and she
died in two years of pulmonic disease. {Jour. Be Med,^ 1817.)

13. ORGANIC DISEASE OF THE HEART.

Diagnosis. — The patient affected with organic disease of the heart,
in addition to other bodily sufferings, manifests habitual irritability,
melancholy, despair,* suicidal tendencies, hysteria and hypochon-
driasis.f

" Gastric, cerebral and cardiac irritation," says Dr. Forbes, constitute
in many cases such a strong chain of disease, of which every part in-
fluences and strengthens every other part, ; that, therefore, no plan of
treatment that does not embrace the whole can be attended with suc-
cess. The subjects of heart-disease are liable to haemorrhage which is
a very important symptom, as also is the change of position in bed.
**The assumption in bed of a position previously intolerable is a sign
of extremely bad omen." Syncope, epilepsy and apoplexy are com-

♦Oorvisart. fKreysig.

OEGAKIC DISEASE OF THE HEAET. 84:J

mon ; and in ma,ny cases of convulsions disease of the heart appears to
be the essential cause.*

Watson says {LeciMres^ P-74:4)j that while palpitations and functional
irregularities of the heart's action are frequently dyspeptic symptoms,
so structural change in the heart is very apt to derange the
digestive functions. Flatulence is one of the most common and
distressing symptoms; and free eructation wonderfully mitigates the
cardiac distress, by relieving the diaphragm from the upward pressure
of gas, which had embarrassed the motions of the heart : dyspnoea and
cough.

There are also in these cases an impeded and sluggish circulation
of blood from the abdominal viscera ; this causes congestions of various
parts; the liver is enlarged, grows tender, and its functions are de-
ranged.

The circulation through the brain is disturbed ; this causes head-
aches, giddiness, causeless apprehension, cowardice, and irritability
developed in men previously intrepid and of strong, firm nerves ; pro-
pensity to frightful and distressing dreams ; sudden startings from
sleep in agitation and alarm ; one or more chambers of the heart (See
page 457.) may become thicker and stronger than natural, while the
capacity of that chamber or of the others may remain natural ; in other
cases the thickening of the muscular texture is accompanied by corres-
ponding enlargement of the cavity also, constituting hypertrophy with
dilatation.

Causes. — Some mechanical obstacle prevents the free and thorough
exit of blood from the chamber, or hinders the easy play of the organ.
In the former condition there is a gradual yielding of the sides of the
afiected chamber to the continual and undue pressure of the accumu-
lated blood against them ; in the latter there is a striving action of the
muscle to overcome the hindrance, or to counterbalance the obstacle.
Thus the muscle, compelled to do extra-labor, grows in thickness while
performing it. If it could increase in strength in proportion to its in-
creased labor, it might resist the internal pressure, and there would be
no dilatation of the cavity within. In very many cases it fails to in-
crease in strength in the necessary ratio; there is therefore some dila-
tation^ and this and the hypertrophy commonly progress together for
a series of years or for life.

Sounds of the Heart in Health, — The heart may be heard by the
ear alone, or through the stethoscope, to beat within the space corres-
ponding to the lower half of the sternum and the cartilages of the fifth
and sixth left ribs; about two inches below the nipple and one inch

* Dr* J. J. 0. Moll. Dissertation on the Connection of Heart-Disease and Con-
vulsions. 1823.

342 DISEASES OF THE SANGUINOHS FUNCTIOl^.

from it towards the • sternum. When the heart is la.rger than natural,
it may be heard over a larger space. It may also be heard over a com-
paratively large space when the lung between the ear and the heart has
become hepatized, or solidified by the presence of crude tubercles or
cancerous deposits ; also when the chest contains a liquid from pleurisy

Symptoms usually present in Disease of the Heart — Pain, palpi
tation, or excessive action of the heart, perceptible to the patient ; ir-
regular, or intermittent action discovered in the pulse ; dyspnoea ;
cough; dropsical accumulations; haemorrhages; various aifections of
the nervous system, as increased and morbid sensibility or nervousness.
These symptoms, though present when there is organic disease of the
heart, often arise from other more trifling causes.

Irregular Action of the Heart consists in derangement or discord
of rythmical movements, and is discovered by the^ pulse at the wrist.
The pulse fluctuates in frequency, in strength and in regularity; some
beats succeed each other very rapidly, and are followed ' by others
more slow and full. Some beats are omitted entirely, and are made up
for by the next one being full and strong.

Treatment. Digitalis^ Aconite^ Bryonia^ Arnica^ OannaMs^
Pulsatilla^ Lachesis^ Spigelia^ Iodine^ and Arsenicum are the me-
dicines commonly employed in this malady.

Digitalis^ on account of its specific power over the sympathetic
nerve and the cardiac plexus, is especially adapted to those cases of
pericarditis which have been caused by violent emotions and protracted
grief, care and anxiety. The special indications are ; sharp stitches,
or contractive pains in the region of the heart ; uneasy sensations in
the left side of the chest, often extending to the shoulder and arm ;
palpitations, excited by talking, movement, or on lying down, particu-
larly on the left side ; pulse rapid, weak and irregular, or slow, soft,
and intermittent ; sense of oppression and anguish in the thorax ; gene-
ral weakness ; frequent attacks of faintness ; respiration slow, diffi-
cult, and unsatisfactory, or short, painful and sighing; frequent flushes
of heat in the chest, face and head, while the extremities remain cold ;
general feeling of anxiety and despondency. A drop of the second or
third dilution should be prescribed in water every two hours.

Aconite is a suitable remedy when the movements of the heart and
arteries axe more rapid and vigorous than in health, and when the con-
gestion to the heart is accompanied by an unusual degree of erethism.
The pains in the cardiac region a-re of a constrictive, oppressive or
lancinating character; the brea.thing is short, anxious, and labored ; the
pulse is rapid, strong and intermittent ; the action^ of the heart is ex-
alte'd and often irregular ; febrile symptoms are strongly pronounced ;
the patient inclines to sit with his body bent forward, in order to relax
the muscles of the thorax, and thus to obviate the liability to pain from

OEaANIO DISEASE OF THE HEART. 843

this cause. The first or second dilution of Aconite may be selected,
and a single drop administered in water every two, three or four hours,
as the nature and severity of the case may demand.

JBryonia will occasionally be required in inflammations of the heart
and its appendages, which are complica^ted by disorder of the pulmonary
structures. It will likewise prove servicable in cases which are con
nected with rheumatism or gout. The following are its indications
drawing and stitching pains in the chest, aggravated by breathing, or
by movement; rapid, anxious and painful respiration; dry, spasmodic
and painful cough; lancinating pains, extending into the shoulders and
back, between the shoulder-blades ; oppression in the chest, which
causes frequent sighing ; determinations of blood to the chest and head ;
rapid, weak, and intermittent pulse ; anxious, depressed and irritable.
Its administration is the same as Aoonite,

Arnica is chiefly useful when the inflammation has been caused by
external injuries, like contusions, wounds, &c. The special indications
are : lancinating pains in the region of the heart ; oppression at the
chest ; great difiiculty of breathing ; short, dry and irritating cough ;
sharp pains through the heart, which cause fiilntness ; Irregular action
of the heart ; pains and dyspnoea, increased by mental or physical
exertion.

It may be given in the same manner as Acofiite,

Cannabis^ Pulsatilla, Lachesis, Iodine^ and Arsenicum have been
employed with success in cardiac inflammations which have arisen
from suppression of eruptions or the drying up of old ulcers. They
may be used at the second or third attenuations, — the repetitions of
doses to be governed by the urgency of the symptoms, and the medi-
cinal or other effects produced.

Should the disease terminate in dropsy of the pericardium, our best
remedies are : Arsenicufn, A^ns-meL, and Iodine, We prefer the
first or second attenuations, — a dose once in Six hours until an im-
pression is evident.

Tartar-emetic is a powerful therapeutic agent. It controls the action
of the heart and arterial system, lowers the force and frequency of the
pulse, depresses the action of the vascular system generally, increases
the urinary secretion, and produces diaphoresis.

In pleuritis it is necessary to give it with caution, as its emetic effect
produces extreme pain. It is generally more useful in inflammations
of the mucous membranes than the serous, which are more under the
influence of Mercurius.

In palpable doses Tartar-emetic is antipathic. It isi^roper in very
small doses, when there is short, difficult and imperfect respiration ;
feeble action of the heart and arteries; nausea; diminishing animal

844 DISEASES OF THE SANGUrN-QUS PUJSrCTION.

heat ; impaired muscular and nervous force. These effects are pro-
duced by the primary action of the drug.

Sjpigelia, — Dr. Epps says, he obtained good results in carditis from
metastasis by Cannabis after Spigelia.

Caloarea, — In a case of considerable hypertrophy of the heart, which
had been treated two years allopathic ally, milk disagreeing with the
patient^ theve was considerable amendment from repeated doses of
Galcarea I and Spigelia completed the cure. {Groserio,^

14. ENDO-CARDITIS.

Treatment. — The most important remedies in the treatment of endo
carditis are, Aconite, Veratrum-viride, Digitalis, Kali-hydriodicum,
Bryonia, Mercur., Arson., Spigelia, Lactic-acid, Kalmia, Cuprum-acet

These medicines should, in most cases, be used in the lower atte»
nuations, and the doses frequently repeated until the disease begins to
yield.

The venerable Dr. Hirsch, of Prague, says, that in the course of his
twenty -four years experience he saw much mischief done by the treat-
ment of rheumatism by alcoholic embrocations; and charges that
organic diseases of the heart frequently result from this treatment.
Dr. Jaeger, of Elgin, 111., gives one severe case of rheumatism, which
was recovering well under homoeopathic treatment, when the patient
was induced by the persuasion of a friend to try the external applica-
tion of a strong solution of common salt in French brandy. The ap-
plication appeared to relieve the shoulder, but the disease took posses-
sion of the knee. The solution drove it from the knee and the patient
slept well for one night. But, in the morning he was suddenly attacked
by the most intense chill, followed by palpitation of the heart, with an
indescribable anxiety and violent dyspnoea. "I found at my visit the
countenance of the pajtient much changed ; face pale, lips cyanosic, his
looks unsteady, very restless and crying for help. The palpitation was
exceedingly strong, tumultuous and unrythmical, and was distinctly
visible in the region of the apex of the heart ; the pulse considerably
accelerated and irregular ; the tongue and extremities cold."

Aconite in solution, every five miiiutes one table-spoonful. After one
nour, ameliora.tion of symptoms, and in the afternoon the patient lay
very quiet; the palpitation and pulse better, countenance cheerful^
profuse perspiration all night and good sleep.

In the morning he was free from the endo-carditis but the pain in the
right shoulder-joint was again felt. This was removed by the alternate
use of Bryonia and Mercurius-solubilis, continued for three days. No
abnormal sound of the heart remained. ( United States Jour. Horn
VoL I., p. 424.)

Kalmia-latifolia, has the most remarkable power over the pulse of

ENDO-CAEDITIS. 845

any remedy in the materia medica, except Digitalis, and perhaps wo
shall find its best powers in diseases of the heart which alternate with
rheumatism. It is a narcotic, poisoning domestic animals, and the
honey made from its flowers is poisonous ; also the flesh of birds as
quails and pheasants. Indians killed themselves with infusion of the
leaves, which externally applied produce subsultus, startings and con-
vulsions.

Symptoms of PoisoNma : Nausea, with entire loss of sight ; conti-
nued retching, pain in the crown of the head, eijftending down the cer-
vical vertebrae ; cold extremities ; pulse imperceptible ; when the pulse
returned it was only forty per minute. Peculiar noise while breathing
like that from spasmodic affection of the glottis ; paleness of face ; ex-
cessive nausea. (Am, Inst Horn., Vol. I.)

Hering proved both with high and low dilutions.

Cuprum-acet — Dr. JTisseL — First. A patient, aged twenty-five
years, had cold and hot fits, both intense, ending in permanent high
fever. There was first pressure under the lower part of the sternum,
and oppression of the chest. After three days pain, rheumatic heat
and redness in the knee joints, with immobility ; then in the hips ;
lastly, of the elbows. Pressure on these joints is painful, and they are
all swollen. Can not move any joint, the affection beginning in the
shoulder ; obliged to lie still, quite helpless. His head is free ; skin
moderately warm ; pulse eighty-five, full, quick pulsation of the heart
and the tone feeble and dull, as if it came from a great depth ; tongue
slightly coated with white ; stool normal ; urine deep yellow, clear,
frothy, and acid. After seven days, during which time some other
treatment was tried, and at the end of which the inflammatory affection
had moved from the joints above named to the ankles, he is directed to
take Oujpri'aGet'tmcture,

The next day the pains in the ankle are gone and no new ones ap-
pearing elsewhere. Pulse sixty, soft, full; urine bright yellow, clear,
acid; heart pulsation and tone less feeble.

Two days later the patient could walk about the room. Recovered.

Second. Another case was that of a man, aged forty, who had chill,
heat, palpitation of the heart, oppression of the chest, pressure under
the sternum and in the prsecordium, had vomited.

Two days after. Auscultation revealed a bellows sound at every
other beat of the heart ; feeble pulsation of the heart ; and tongue
hickly coated. An alkaline mixture having first been tried with some
mprovement. Acet-cupri was given for five days when he was well.

Third. A lady, aged forty-five, who was first treated by bloodlet-
ting. She had at first chill, heat, palpitation of the heart, oppres-
sion of the chest, pressure under the sternum and in the prsecordium,
great feebleness and tearing pains in the limbs, not affecting the joints,

846 DISEASES OF THE SANGUIKOUS FUNCTIOIT.

Stools normal; urine reddish and turbid, with red flaky sediment, and
acid. Instead of the second beat of the heart Dr. Kissel heard a bel-
lows sound and friction sound. The pulse soft, thin, one hundred.
She lost twelve ounces of blood with no benefit.

March 1. In the night she had a paroxysm with more severe op-
pression of the chest, restlessness ; the palpitation with feeling of
anguish increased. Cured with C^i^^n

15. PERICARDITIS.

Treatment. — The principal remedies are. Aconite, Bryonia, Spige-
lia, Arsenicum, Apis, Kali-hyd., Lobelia, Gelseminum, Mercurius-hyd.,
Digitalis, Veratrum-vir., Cannabis-ind., Apocynum-cannab.

We usually prescribe these medicines in palpable doses, frequently
repeated.

Case. — By Dr, Laurie, — Bryonia, A girl, aged thirteen, com-
plained of severe darting pains in all her joints, which were swollen,
tense, shining and sensitive to touch. The face was flushed and
anxious ; tongue furred and white ; mouth parched ; great thirst ; skin
hot and dry ; pulse one hundred and thirty, full and bounding ; breathing
hurried; the heart's impulse abnormally strong; the pulsations loud,
accelerated, and re-duplicated; about the middle of the sternum a
gentle rustling sound was audible. Aconite 2>^ was prescribed.

On the second day the fever was less, but she could not lie on the
left side ; the breathing quick and laborious ; and friction sound in-
creased in extent and loudness and audible in all positions. She had
passed a restless night, and was now and then delirious ; the joints in-
flamed and painful. Belladonna 3^ was given. In the evening the
rheumatic sufferings were alleviated ; the heart sounds the same ; skin
hot and dry. Aconite 3° again given. On the third day she had per-
spired freely; pains of the joints aggravated by movement; a darting
pain through the heart in sitting up in bed ; the friction sound con-
tinued the same. Bryonia 3° was given. On the fourth day there was
improvement. On the tenth day she was convalescent.

Lobelia-infiata, — Slight deep-seated pain in the region of the heart.
Burning pain in a small spot under the right breast near the epigas-
trium ; on a quick movement of the body, deep breathing, sneezing, a
feeling as if something had fallen out of its place and went back again
with great pain. Violent boring pain through the back under the right
shoulder, becoming more painful by motion : the painful place feels as
if palsied.

Pressing pain at the left side of the lower part of the sternum. Pain
about the third, fourth and fifth dorsal vertebra.

Rheumatic pains between the scapula. Muscular stitches over the
ribs of the left side near the spine.

CHEONIO AOETITIS AND CAEDO-AOKTITIS. 847

16. CHRONIC AORTITIS AND CARDO-AORTITIS.

DiAaNosis. — Dyspnoea and anasarca are the prominent symptoms?
but a great many others are present in each case.

The patient is likely to be a man of full strength and courage, but
about the time of the turn of age he becomes suddenly undermined by
an extraordinary but obscure disease which may carry him prematurely
to the grave* He has not had apoplexy, diabetes, hypochondriasis,
nor inflammation of the urinary passages, nor visceral tumors. But a
great change has come over him, he has become ill-humored ; common
affairs of life trouble him ; he has become excessively anxious abo.ut
everything, — ^business, fortune, position, present and future conditions;
he has perhaps become miserly ; he shuns society, but fears to be alone
with himself. Restricting himself within his own family, he is
disturbed by noise, irritated by "trifles light as air ;" he excuses himself
a moment afterwards and laments that he has lost his self-control. He
now suffers from ennui, then sadness. His friends try to amuse him
and find it impossible. The crowded party or the theatre oppress him.
His food distresses him by day and with fearful dreams at night ; he
wakes in agitation. Going abroad, the walking oppresses him ; there
is contraction or pain at some point of the chest, as at the lower end of
the sternum, or lower down and towards the left side ; his head
becomes confused, there is vertigo, jolting of a carriage fatigues ; oh
moving slowly he drops to sleep ; he is easily chilled, but can not bear
the air of a close room. Stomach feels empty, hollow, no appetite, bad
taste in the mouth ; he imagines that his heart is flaccid and power-
less ; some acquire a morbid appetite, become gluttons ; but the counte-
nance becomes more sallow and the flesh falls away.

After many fluctuations between better and worse, the symptoms of
chronic aortitis are confirmed ; the dyspnoea becomes habitual, or re-
turns by spells ; the nocturnal agitation is aggravated, the skin becomes
livid and dry, sometimes cold, or cold in one part and hot in another ;
urine scanty, turbid, palpitations by spells, pulse small, irregular, un-
equal, frequent; generally the feet swell, and the oedema pro-
gresses from the ankles to the legs, the thighs, loins, and coats of the
abdomen. After some weeks, oftener months, this state passes into the
third or last period.

The patient now, says Dr. Tessier,^ becomes sleepless ; he desires to
sleep, but instantly rises and runs about the room ; he sits down, then
rises ; he shuns the fire, which increases the dyspnoea ; but his anasarca
has enfeebled his power to endure the cold ; he can not find an easy
position, and passes days and nights for weeks in torture. A time

* L'Art Medical, 1861.

84:8 DISEASES OF THE sANaumous rimOTION.

comes at last when torpor of brain predisposes to sleep. There come
moments of oblivion alternated with delirium. The dyspnoea is followed
by orthopnoea, tending to apnoea, till suffocation is threatened. There
is next, cough, expectoration, streaked or tinged with blood, then dark,
blackish ; hydrothorax on one or both sides ; oedema, congestions, even
pulmonary apoplexies ; bronchitis ; accumulations of mucus. The
countena,nce is haggard; cheeks flaccid or face puffed, pallid; anasarca
encroaching; legs almost bursting ; dropsical cushions extending up
the loins, and in front to the umbilicus, scrotum, &c., enormously dis-
tended, extreme diflBculty of micturition ; excoriations ; oedema of the
arms, hands, fingers* Constipation now insuperable ; every general
movement causes suffocation. Finally the skin becomes marbled,
ecchymosed ; phlyctense of lower limbs ; gangrenous spots, precede
death.

DISEASES OF THE ARTERIES.

1. Organisation and Structure of the Arteries. — The arterial
vessels are essentially constituted: 1. Of an external coat consisting of
a very delicate and condensed cellulo-filamentous tissue ; 2. Of a middle
coat composed of fibres, and bundles of fibres which surround the vessel
in a circular direction, but which differ in chemical and physical pro-
perties, as well as in form from muscular fibres. They resemble what
is elsewhere called the elastic tissues. The elastic tissues are dis-
tinguished from all other tissues by their yellow color and the peculiar
mode of division and anastomoses among their fibres. Like the cellu-
lar tissues they yield gelatine by boiling. The elasticity of arteries
depends on their elastic properties and not on any muscular fibres in-
terwoven in their structure. 3. The third coat is a very delicate cellu-
lar tissue or pellicle in which the minute vessels which supply the ar-
teries, and which proceed from the adjoining parts terminate. Here
also the ultimate distributions of the arterial nerves are supposed to
ramify, though they can not be clearly traced further than the proper
fibrous tunic. This is the most vascular of the arterial tunics and in it
many of the pathological states to be described first originate. 4 "An
internal membrane, presenting no linear or fibrous structure, semi-trans-
parent, more readily detached from the one next to it in the longitudi-
nal than in the transverse direction, and fragile. This delicate mem-
brane is not possessed of vessels carrying red blood in the healthy
state, but it is penetrated by minute red vessels when inflamed." It
lines the canals of the vessels conveying red blood, and the cavities of
the heart.

The arteries are surrounded by loose sheaths of cellular tissue
which permit the vessels to accommodate themselves to their varying

INFLAMMATION OF THE AETEEIES.

state of constriction or dilatation and to transmit to them tlie vessels
and nerves employed in their nutrition. During life they are considered
as in a state of distension by the blood impelled into them by the con-
traction of the heart ; when the blood ceases to distend the vessels
when the heart's action is withdrawn they contract to expel from theii
cavities the fluid already received. [Cojpland,)

The arteries are surrounded by a reticulum formed by the ganglial
nerves, and they receive minute fibrils of these nerves which convey
the nervous influence from the brain to these vessels, and perform an
important part in the changes eflected by the brain and spinal marrow
in the functions and diseases of the arteries, as well as on the patho-
logy of the blood, and assimilation of the chyle.

Diseases of the Arteries,— Nervous Affections* — 1. Neuralgia of
the arteries is "characterized by acute pain in their course, with in-
crease of their pulsations and bellows sound:" distinguished from in-
flammation by its sudden accession, and the sudden remission of the
symptoms.

2. .Violent pulsation of the arteries. A loud bellows sound heard in
some of the principal arteries, with violent pulsation but without severe
pain. It is most common after large losses of blood. (Copland^ Mar-
shal Hall,)

Causes.— Ossification of the interior of the ascending aorta, which
generally produces preternatural pulsation above the clavicles ; a pecu-
liar state of the nerves in hysterical females and nervous irritable per-
sons ; adhesions of the pericardium produce spasmodic contractions of
the heart for many months or a year or two after an attack of pericar-
ditis; pulsations may be occasioned by tumors, serous effusions, &c.,
which come in contact with the aorta and transmit to the surface its
pulsations; they may arise from the use of mercury; from spinal irrita-
tion, the excessive use of tobacco, opium, and other narcotics. (See
Cojpland^s Diet. Geddings, &c.)

17. INFLAMMATION OF THE ARTERIES.— ARTERITIS.

Arteritis is defined as characterized by "great and tumultuous vascu-
lar excitement, palpitations, sense of heat and throbbing in the course
of the principal arteries, followed by collapse of the vital energies, and;
occasionally by gangrene of the limb." {Go^pland^ Diet. Vol. I. p. 126.),

It is a disease of not unfrequent occurrence, but not always easily re-
cognized. The inflammation of a small portion of a single artery, as
that produced by the application of a ligature is attended only by a
small increase of sensibility, heat or tumefaction ; the artery may be
obliterated without exciting any perceptible general fever. When the
arteries extending to a considerable portion of the system are inflamed,
fever more or less violent always attends the inflammation. It begins

Vol. I. — 54.

850 DISEASES OF THE SAKGUINOTJS FUNCTION.

in alternation with slight chills, followed by flushes of heat ; and, as it
proceeds the pulsations of the heart and arteries become violent : " there
is red suffusion with capillary injection of the skin, burning heat, un-
quenchable thirst, extreme restlessness, jactitation and general distress,
laborious and hurried respiration, and sometimes a dry harassing
cough." [G-eddings^ Amer. Cyclop. Pract. Med., &c.)

When the inflammation embraces the aorta there is a sense of heat
beneath the sternum or in the vicinity of its upper extremity ; some-
times a sensation like that of a "hot iron, drawn along the course of the
aorta, descends as low as the crural arteries." When the arteries of the
the extremities are affected the pain may simulate rheumatism, fixing
itself upon a particular part which is tender to the touch, and the in-
flamed vessel may be felt through the integuments when it is super-
ficial. The pulsation is violent along the whole course of the artery
until the thickening of the arterial coats diminishes the size of the ca-
vity of the vessel, and the elasticity of its walls ; the throbbing and ex-
pansion of the vessel are afterwards chiefly "confined to the portion
above the principal seat of the inflammation, while lower down the
pulsation becomes feeble, and, when obliteration takes place, ceases al-
together." When 'the carotid artery is affected there is pain and
tenderness and strong pulsation along the side of the neck, and in all
the arteries of the head, flashes of light before the eyes, obscuration of
vision, or the objects seen are tinged with an unnatural color; ringing
or roaring in the ears ; in some cases delirium, convulsions or apoplexy.
The veins and capillaries of the affected part are always preternatu-
rally turgid and injected with blood from the excited arteries.

From the commencement of the disease the heart beats violently ;
there are palpitations when its lining membrane is affected; the pulse is
full, strong, and sometimes so frequent as scarcely to be counted. In
one of Frank's cases it was from 185 to 200 per minute ; the respiration
is hurried, embarrassed, amounting to distressing orthopnoea; dry
cough, sometimes hsemoptysis. The tongue is red on the edges, its pu-
pillee erect, the base and middle covered with thick yellow fur. The
thirst is intense ; the stomach irritable, bowels constipated ; urine high
colored, sometimes bloody; strangury; preternatural turgescence of the
capillary vessels ; surface deep red or mottled^

At a later stage the inflamed arteries become loaded with coagulated
blood, the coats of the vessels are thickened ; general anxiety and dis-
tress increase ; the pulse becomes quicker, small, wiry, weak, irregular,
with a peculiar sharp thrill. Tlie palpitations and dyspncBa become
more distressing ; vertigo or syncope follow the slightest exertion ; the
tongue is dry, scabrous, covered with brown sordes; intense thirst;
sunken cadaverous expression of countenance, sinking of the vital
powers, delirium, subsultus tendinum, or convulsive movements.

INFLAMMATION OF THE AETEEIES. 851

diarrhoea, and purplish hue of the skin mark the progress towards a
fatal termination. When the inflammation has invaded one of the prin-
cipal arteries of the extremities, the fibrinous concretions, formed by
the coagulation of the blood within, gradually obliterate the cavity of
the vessel, the pulsation begins to be perceptible ctbove the seat of the
inflammation, and the part below becomes at length pulseless, cold and
numb. When the obliteration is complete the limb becomes oedema-
tous, the blood accumulates in the radicles of the veins, and appears in
dark ecchymoses, the part is cold and numb ; small purplish phlycte-
nae appear ; when the anastomosing vessels are insufficient to supply the
part with blood, the affected part becomes gangrenous. The powers
of life are now more hopelessly prostrated, the pulse still more
frequent, small, sharp, and irregular; the clammy sweats more profuse,
delirium ends in profound coma; involuntary evacuations, hiccough and
coldness of the extremities mark the progress of fatal disease; and
death is ushered in by convulsions. {Geddings^ Goj)land, Franh^ cfec.)

When arteritis terminates favorably it sometimes pursues a regular
courte for a week, exacerbating twice in the twenty-four hours, and
then terminates by a free perspiration, hemorrhage or the deposit of
a copious sediment in the urine. {PxiGhelt^ System ds Med.)

Diagnosis. — There are no symptoms peculiar to this disease. It
may b<e inferred when any considerable number of the above symptoms
are present ; when the heat and pain are chiefly felt along the course
of the arteries, with strongly marked impetuosity of action propagated
from the larger to the smaller arteries ; and when anasarcous injection
of the surface or of the limbs is followed by viscations or ecchymosed
patches on the skin.

Causes. — The predisposing causes are, gouty or rheumatic diathe-
sis; middle and advanced periods of life; epidemic influences; cold and
damp climate ; stimulating food ; spirituous liquors ; plethoric habits •
sanguine and irritable temperaments; hot Aveather; effects of syphilif^
or mercury ; suppression of accustomed discharges, nervous or spasmo-
dic diseases ; defective action of the kidneys, liver, skin, &c.

Exciting causes. Great cold, and congelation of parts, followed hy
heat; excessive heat, wounds and surgical operations, amputations or
ligature of arteries, umbilical cord, &c., violent muscular action; injury
from extension of a part lacerating the internal coat of a vessel ; fits of
passion; great exhaustion; animal, vegetable or mineral poisons ab-
sorbed; suppressed exanthamatous fevers or eruptive diseases, as
measles, scarlatina, erysipelas ; absorption of sanious matter from the
uterus in paerpural fever. (^Oopland^ Portal^ Sreschet)

PATHOLoaY. — First. When arteritis arises from external causes which
are local in their operations, it is generally confined to a part only of the
arterial system; it usually affects all the coats of the vessels; and the

852 DISEASES OF THE SANaUINOUS FUNCTION.

inflammation is sthenic in its cliaracter. The common consequences
of inflammation result from it. The coagulable lymph effused on the
interior surface of the vessel forms ^fibrinous concretions and false mem-
branes which obstruct or obliterate its cavity. The vessels of the walls
of the artery are injected with red blood, thickened or softened ; and
there is occasional suppuration or ulceration of its internal membrane^

Second. When the disease oi:iginates from causes existing within
the vessels, when complicated with malignant and eruptive fevers, ery-
sipelas, or the absorption of morbid secretions into the general circula-
tion, the febrile excitement is rapidly followed by asthenic symptoms.
Inflammation extends through the whole arterial system involving in
many instances the lining membranes of the heart, as well as the veins,
In these cases dissection shows dark red or violet injection of the innei
membrane and connecting cellular tissue ; softening of these tissues and
infiltration of the parieties of the arteries. {Copland, Breschet.)

PROGNOSIS.— -The , prognosis of arteritis is more unfavorable than
most other febrile diseases of equal severity. Its immediate 'efiects in
acute cases are generally serious ; but the disease is still more danger-
ous when it is complicated with other diseases. Some of the worst
cases are those "which supervene in the progress of eruptive diseases
in which the eruption is prematurely suppressed; and when it arises in
the course of small-pox, erysipelas, phlebitis, or puerpural fever, the in-
flammation extends through the lining membranes of all the arteries and
veins ; and a morbid influence from the poisonous humors received into the
blood vessels vitiates the blood itself and prostrates the nervous powers.

Treatment. — -The general treatment of arteritis will be the same as
that of other inflammations and febrile diseases. The same specific re*
medies may be employed in subduing diseased action, supporting the
general strength; the samo, rules of diet will be necessary; and when
the disease assumes a chronic form, the same local and general treat-
ment will be continued. In every case the proper management will
depend greatly on the character of the constitution and that of the dis«
ease with which the existing malady is complicated. See the general
treatment of inflammation and inflammatory fever.

Genus VI.—INFLAMxMATION OF THE ABDOMINAL VISOERA.
1. g-astritis.-inflammation of the stomach.

When severe inflammation of the stomach results from direct local
injury, whether this be caused by mere mechanical irritation, or by the
action of heat or strong acids the fo<:?<2Z symptoons are: excruciating
pain and frequent vomiting ; heart's action depressed, which may be
BO extreme as to destroy life ; and the inability to eat or digest maj
cause death also. But if there be some restoration of the vital powers

INFLAMMATION OF THE STOMACH, 853

by wliicli the most essential functions are resumed, there may be nc
high degree of resulting fever, and no serious disorder of the functions
of the brain.

When the irritation from undigested, alcoholic dnnks, or irritating
drugs, excites only slight inflammation, there is but little constitutional
disorder, and the stomach rapidly recovers its general healthy state.
But these recuperative powers depend much on the previous state of
the stomach, nervous system, and the muscular power of the heart. The
degree of injury which in some persons would do but little harm, would
in another cause terrible irritability of the stomach, or excessive pain
or collapse. Some persons previously . in good health have died
speedily and unexpectedly after a gluttonous meal of some indigestible
substance. In such cases the immediate cause of death is faintness
or stoppage of the heart's action, under the influence of pain. The
heart has perhaps been previously in a diseased, state, or the vital
powers have been weakened by intemperate habits. {Biodd^ p. 79.)

INFLAMMATION OF THE LINING MEMBRANE OF THE STOMACH.

Inflammation is a generic term, which is applicable to a great many
specific forms of disease which may be designated by different names
according to its peculiar nature of its specific cause. Thus we have
rheumatic, gouty, syphilitic, suppurative or adhesive inflammation ac-
cording to its cause.

First. — The rheumatic inflammation of a joint may lead to the eflusion
of a fluid that does not coagulate ; it is commonly soon absorbed.

Second.— Inflammation of the pericardium and of the valves of the
heart which so frequently co-exists with the inflammation of the joints
and is excited by the same agent, leads to the effusion of coagulable
lymph, and produces lasting and permanent changes of structure.

Inflammation of the mucous membrane may produce

First.— Secretion of viscid, opaque or otherwise altered mucus.

Second.— Effusion of plastic lymph, forming a layer or coating over
the surface..

Third.— Formation of pus.

In the air-tubes the different kinds of inflammation may exist and
their products may be expectorated separately and thus examined se-
parately, and may also be examined separately in the dead body. But
in the stomach the products of secretion are blended with the contents
of the stomach; and they are all liable to be speedily changed by the
action of the gastric juice. If they pass into the intestines they be-
come still more confusedly blended with the various fluids they meet
with. Inspection of the secretions of the mucous membranes has there-
fore taught us little of the nature of the diseased surface by which they
are furnished.

854 DISEASES OF THE SANaUINOXTS FUNCTION.

Diagnosis.— Burning, pricking, or lancinating pains in the stomach ;
nausea and vomiting, great soreness, tenderness, and pain on motion or
pressure, intense tliirst for cold drinks, wliich. are ejected almost as
soon as swallowed, affording some temporary relief, pricking and sore
ness in the throat and oesophagus, tongue red at the tip and on the
edges, and covered through the centre with a white or yellowish fur
position mostly on the back or side, with the limbs drawn up and the
abdominal muscles relaxed, great depression, anxiety, and fear of death ;
pulse rapid, sharp, contracted, sometimes almost threadlike ; bowels
constipated ; disgust for food and warm drink, either of which is ex-
pelled as soon as received into the stomach ; and in severe cases there
is delirium and fever of a synochal grade ; unusual fullness in the epi-
gastric region, and often, of the abdomen. As the disease progresses
the extremities become cold, the features contracted and sunken, the
eyes glazed or suffused, and finally diarrhoea, cold sweats, coma, and
convulsions supervene. When death occurs, it is usually caused by
ulceration or spacelation of some portion of the mucous and sub-mu-
cous coats of the stomach.

Causes.— Excessive use of highly seasoned food, stimulating drinks,
the introduction of irritating substances into the stomach, poisons, in-
juries, and the use of emetics, drastic purgatives, stimulants, and other
medicinal poisons with which allopathic practice, governed by no scien-
tific knowledge, frequently induces this and other diseases, and destroys
the existence it is intended to preserve.

Case. — Maria Ladan drank by mistake a tea-spoonful of Aqua-
fortis j the most violent symptoms supervened. Under palliative
treatment these effects gradually subsided. After some time she passed
from the bowels a long membranous substance. rolled up and which re-
presented the form of the oesophagus and stomach. This was found
to be the interior membrane of those organs. From this time forward
the sensibility of the digestive organs became excessive ; and, after two
months of suffering, she experienced a sudden shock and died. {JParis
and Fonblanqiie^ p. 147.)

Treatment. — The ordinary remedies used in the treatment ol gastri-
tis are Arsenioumy Verat/ruwb^ Nux^ Pulsatilla^ Aconite^ Iodine^
Ipecacuanha,

Arsenicum, — Countenance contracted, sunken, and expressive of
anguish and anxiety ; stomach swollen and hot to the touch ; position
upon the back ; respiration short, rapid, and suppressed ; tongue red,
clean, or red on the edges with a dirty fur in the centre ; pulse con-
tracted, tense, and frequent ; voice hoarse, stifled, and suppressed ; skin
dry and hot, with perhaps cold and clammy extremities.

Burning, sharp, or shooting pain in the stomach; aggravation of the
sufferings from motion, pressure, coughing, and inspiration ; scraping

INFLAMMATION OF THE STOMACH. 855

and burning pain in the tliroat and oesopliagus ; weakness and trem-
bling of the limbs ; urgent thirst for cold drinks ; persistent nausea and
vomiting; all food and drinks speedily and violently rejected; exceed-
ing tenderness in the epigastric region on pressure ; respiration sup
pressed and painful.

Intense anxiety, anguish, depression, and despair; expectation of
speedy death; sometimes delirium.

Administration. — Two drops of the sixth dilution in an ounce of
water ; a dessert-spoonful once in two to four hours, until the proper
impression is made upon the inflammation.

Yeratru7}i. — Hippocratic countenance ; nose pointed ; e3^es sunken
and glazed; lips bMsh and dry; tongue red at the tip and on the
edges, with a dark, dry fur running through the centre ; pulse quick,
weak, and almost imperceptible ; stomach and abdomen distended ; ex-
tremities cold, and covered with a clammy sweat; position on the back,
with the knees drawn up ; hiccough ; and whole appearance indicative
of extreme prostration.

Feeling of great exhaustion ; burning pain in the stomach ; rough ;
dry, and scraping sensation in the throat, rendering deglutition difficult
and painful ; great soreness in the epigastric region ; short, trouble-
some cough ; severe and continued nausea and vomiting ; great dread
of warm food and drinks ; intense thirst for cold drinks, inability to re-
tain anything upon the stomach ; spasmodic contractions of the throat,
oesophagus, and abdominal muscles ; hiccough ; painful respiration.

Excessive dejection, discouragement, and sadness ; fear of death,
complete despair ; delirium.

Administration.— In urgent cases we may give a dose of the sixth
dilution in water, once every hour until an amendment declares itself,
or there occurs a well-pronounced medicinal aggravation. We may
then await the result, and hold ourselves in readiness to repeat this, or
whatever other medicine may more full}^ correspond with the symptoms
that may arise.

N'ux-'i^onhica.-—'¥2iQQ^ bloated ; eyelids red, weak, and watery ; stomach
distended ; tongue tremulous, red, anjd clean, or furred with a whitish
coat in the centre ; offensive breath ; frequent hiccough ; pulse frequent,
small and feeble.

Burning pain in the stomach, with pulsations and spasmodic con-
tractions in the epigastric region ; nausea and vomiting, aggravated
after eating and drinking; tenderness and pain in the pit of the
stomach when pressed, or during movement ; contraction and obstruction
in the oesophagus when attempting to swallow ; painful sensation of dis-
location of the stomach ; dizziness and confusion of the head, on rising
from the recumbent position, or in attempting to walk ; sour or bitter
eructations.

856 DISEASES OF THE SANGUINOUS FUNCTION.

Mental and moral symptoms : great uneasiness and anxiety ; morose,
peevish, sad, and often disposition to commit suicide.

Administration.— This medicine is peculiarly appropriate in those
cases, which are induced by abuse of coffee, "wine, spirits, condiments
and stimulating food. One drop of the sixth dilution to a,n ounce of
water ; a table-spoonful once in two to four hours, so long as the
symptoms remain stationary. Occasionally we shall have conjoined
with the above symptoms, cerebral disorder, indicated by delirium,
optical illusions, and great derangement of the nervous system. In
such instances an occasional dose of Belladonna will prove specific,

Piilsatilla is a valuable remedy when the inflammation is brought
on by the use of crude, indigestible, and irritating food. It covei*S the
following symptoms: pressing or shooting pains in the stomach; pulsa-
tions in the pit of the stomach ; epigastrium sensitive, and painful to
the touch, or on pressure : nausea and vomiting after eating or drink-
ing ; nausea and disagreeable feeling extending even to the oesophagus
and throat ; regurgitation of food ; eructations; hiccough; painful dis-
tention of the stomach; pulse quick and small; and bitter taste in the
mouth.

Aconite, at the third or the sixth dilution, will do good service when
the febrile symptoms run high ; to be repeated often until amendment
ensues, either alone or in alternation with the gastric specifics, as the
nature of the case may demand.

Iodine, at the third potency, has afforded relief in inflammations of
the stomach caused by abuse of Mercury and other irritating drugs.
The indications for its use are : frequent nausea ; vomitings, especially
after eating ; burning pains and pulsations in the stomach, pyrosis, sour
eructations, contraction and burning of the oesophagus ; pulse frequent,
small and hard.

" ColcJhiGum is an important remedy in cases of metastasis of rheuma-
tism to the stomach. It acts specifically as an irritant to the stomach,
even when injected into the veins.

IjpeGacuanha ; a single dose at the sixth potency, will sometimes af-
ford prompt relief in cases whe.re vomiting is violent and incessant.
It is applicable to inflammations caused by excessive doses of Tar-
tarized-antimony , Corrosive'Sitbliinate, Arsenic, c&c, for t-he pur-
pose of allaying the excessive irritation and vomiting which follow
poisonous doses of these articles.

• Gastritis from the Effect of boilinq Water.— A few years
ago M. Bretonneau poured three ounces of boiling water into the
stomach of a 'young dog. The animal uttered frightful cries and
vomited violently several times. ' The next day it appeared languid
and oppressed, drank with avidity, but refused food. Convalescence
commenced on the third day and progressed up to the seventh when

INFLAMMATION OF THE STOMACH. 857

tlie dog was killed, having the evening before caressed his master and
rolled at his feet in play. On dissection the mucous membrane, the
underlying cellular tissue, and over a large space the muscular coat of
the stomach, were found in a state of gangrene.

In another experiment he threw into the stomach eight ounces of
boiling water of each of four cats in such a manner as not to in-
jure the oesophagus. Three days afterwards they played together and
snatched food from each other. They were then killed, and in their
stomachs were found marks of injury like those observed in former ex-
periments. {Budd^ p. 78.)

Feom the Effects of Mineral Acids. — Dr. Budd says (p. 78) a
man swallowed Sulphuric- acid, which destroyed the entire lining mem-
brane of the oesophagus and charred a small portion of the lining mem-
brane of the stomach. Of the lining membrane of the oesophagus a
large portion was brought up entire, and is now preserved in the
museum of the college [King-street^ St, Jmnes^s,) The man lived
many months, and at length died from the combined eifects of stricture
of the oesophagus and tuberculous disease of the lung.

A case is given in the Medical Gazette {Sejpt 11, 1846) of a patient
who swallowed Nitric-acid and lived twenty-three days. After death
the mucous membrane was almost entirely destroyed.

These cases and others like them, show that the effects of these
poisons are mainly due to their local action. The acid chars the tissue
with which it comes in contact; coagulates the blood in its minute ves-
sels. So long then as the acid is sufficiently concentrated to have this
chemical effect it is not absorbed into the general circulating fluid ; al-
though it may continue to permeate the tissues as it would permeate
dead membranes.

Inflainm>ation of the Stomaoli from the direct irritation of hard
indigestible siibstances.

Symptoms.— Pain in the stomach, sense of heat there, occasional
vomiting of matters tinged with blood. When the injury done the
stomach is very great, the pain is severe, the pulse depressed, and as
in severe peritonitis, the pulse is small and rapid, the skin cold and
clammy, countenance shrunk. These symptoms are followed by some
degree of fever. And when no poison is retained in the stomach or ab-
sorbed into the blood, no great nervous or constitutional disturbance is
seen. The stomach possesses remarkable powers of tolerating the pre-
sence of irritating substances, accommodating its action to the necessi-
ties created by new emergencies, and recovering its original condition
after they are expelled.

In December, 1705, a- sailor, in imitation of a juggler, swallowed four-
teen clasp knives, most of which were nearly four inches long, and a
full inch in the extreme breadth. The mechanical irritation and in-

858 DISEASES OP TFE SAKaUIKOUS EUNCTION.

flammation caused severe pain in the stomaclij frequent vomiting and
loss of flesh, fragments of the knives passed into bowels ; and, though
the man eventually died in Guy's Hospital in March, 1809, there was
little fever, and not much disturbance of the nervous system at any
time. In less than two months after the knives were swallowed {Jem.
1806) he moved about, and at times performed the duties of a sweeper
In the course of the following autumn his strength and flesh improved,
he ate and drank voraciously, and performed various easy duties in the
ship {Dr> Marcet^ Med, Ohir. Transactions^ Vol. 12). Numerous
corroded blades and other fragments of the knives found in the stomach
after death are preserved in the museum of Guy's Hospital.

Inflamoraation of the Stomach frorrb si^allowing rruelted lead.—
Henry Hull, a man 94 years of age, who with two other meri had charge
of the Eddystone Lighthouse in the winter of 1755. At two o'clock
on the morning of Dec, 2d, fire broke out in the lantern, and Hull at-
tempted to extinguish the fire by throwing water four yards higher
than his head. While looking upward, a quantity of molten lead fell
in a torrent from the roof upon his head and face, over his clothes,
burning his neck and shoulders through his shirt collar. From a violent
burning sensation felt internally he thought some of the lead had passed
down into the stomach. After the fire had burned eight hours, Hull
and his comrades were found in a state of partial stupefaction in a cave
on the east side of the rock to which they had retreated to avoid the
falling of the timber, and red hot bolts upon them. They were taken
ofl" the rock by boatmen, who threw them a rope, by which they were
drawn off to the boat. Taken to Plymouth, 14 miles distant, Hull was
treated hj Dr. Spry. The patient in a hoarse voice told all who saw
him, that a mass of lead was certainly in his stomach ; but the physician •
considered the statement incredible, as he did not suppose a human
being could live in that condition, through such suffering, exposure and
fatigue ; and the symptoms were not very strongly marked, till the sixth
day, when he was thought to be better. Continuing to take his medi-
cines and food, both liquid and solid, there was little change till the tenth
or eleventh day, when he suddenly grew worse ; on the twelfth day
he was seized with cold sweats and spasms, and soon afterwards
expired.

On dissection, Dr. Spry found the cardiac portion and /orifice of the
stomach greatly inflamed and ulcerated, the coats of the lower portion
were burnt ; " and from the great cavity of it took out a great piece of
lead," weighing seven ounces, five drs*, eight grs.

The history of this case was transmitted to the Eoyal Society by
Dr. Spry, but that body regarded it as incredible and they deferred
reading it till further proof of its authenticity were received. Dr. Spry,
to establish his veracity, made further experiments on dogs and fowls

POWERFUL POISONS AND THEIK ANTIDOTES.

859

In one of tliese lie poured molten lead througli a funnel down the tliroat
of a dog tliat had fasted for twenty-four hours. The next day the dog
was very brisk, and on being killed, six drachms and one scruple o
lead AYcre found in its stomach. The internal coat was much cor
rugate d, but was not excoriated.

Dr. Spry gave to another dog a half pint of milk, and soon after
wards poured molten lead down its throat. The dog immediately after
took freely of milk as if nothing was the matter with him, and continued
to do so for three days. When quite lively he was killed, and six
ounces and two drachms of lead were taken from the stomach. " The
jDharynx and cardiac orifice of the stomach were a little inflamed and
excoriated, but the oesophagus and stomach seemed in no manner af-
fected." These experiments being attested by the oaths of Dr. Spry
and others, were reported to the Royal Society and published in its
transactions.

TABLE OF POWERFUL POISONS AND THEIR ANTIDOTES.

Poisons.

First — Gases. — Gas produced in
wells, privies, &c., deprived of fresh air.
Vapor of charcoal.

Second. — A oids.— Prussia or Mineral
Acids.

Sulphuric, Muriatic, Nitric, Phos-
phoric Acid, Spirits of Vinegar, and
strong Wine Vinegar.

Vinegar.

Tliird. — Alkaline Poisons. — Pot
and Pearl Ashes, Lapis-infernalis, Salt
and Oil of Tartar.

Fourth, — Metallic Poisons. — Ar-
senic.

Corrosive Sublimate ; Copper .• Ver-
digris.

Lead.

Lunar Caustic, Nitrate of Silver.

Tin.

Antidotes,

Chloride of Lime.

Vinegar and Vapor of Vinegar.

Spirits of Hartshorn.
Tepid Soap-suds, Magnesia.
Chalk, povs^dered and mixed with
water.

Wood-ashes mixed with water.
Potash or Soda.

Vinegar ; Lemon-juice, and other
Acids.

Sour milk ; mucilaginous drinks and
injections.

Soap-suds, White of Eggs with Wa-
ter ; Sugar- water ; milk ; Rust of Iron.
Hydrated per Oxide of L^on, in large
doses.

White of Eggs in water ; Sugar- water ;
Milk ; Starch from Wheat-flour.

Epsom Salts; Glauber's Salts.
Common Salt, dissolved in watei*.
Sugar, White of Eggs, and Milk.

Vascular Nerves of the AMominal Cavity. — Our knowledge of
the influence of the vasus on the stomach wants further confirmation

860

DISEASES OF THE SANGUINOtJS FUNOTIOI^.

and extension. CI. Bernard, on examining the fluids of tlie stomacli of
a dog by means of a gastric fistula., saw the pale rose tint, -vYliicli was
present during the absence of food in the organ, change to deep red,
under the influence of mechanical irritation, and this last give place to
complete discoloration of the mucous membrane. After section of the
great sympathetic in the neck, the discoloration persisted, even when
the membrane was irritated. In experimenting with similar conditions,
Panum observed the membrane return to its original color, four, six and
twenty-two hours after the operation.

2. CHKONIC GASTRITIS.-CHROKIC INFLAMMATION OF THE STOMACH

Diagnosis. — Many of the symptoms of this malady are similar in
character to those which occur in the acute form, but there is a mate-
rial difierence in regard to their grade of violence in the two diseases.
Sometimes chronic gastritis is the result of a partially subdued chronic
attack, which from various causes is kept up for a long period in this
State of sub-acute inflammation. At other times it comes on slowly
and insidiously, from a combination of causes operating at the same
time. Amongst the symptoms which usually attend this complaint
may be enumerated the following: pain and tenderness in some par-
ticular part of the stomach, excited by pressure or by certain kinds
of food and drinks ; frequent vomiting of food and drink soon after
they are swallowed; loss of appetite; putrid taste in the mouth;
thirst; foetid breath ; acid or bitter eructations ; acidity; distention
of the stomach with wind, which causes distressing vertigo and pains
in the epigastric and hypochondriac regions ; tongue red and clean, or
furred in the middle with a dirty fur ; melancholy; peevishness ; irri-
tability ; discouragement, and, finally, hectic fever, emaciation, sudden
prostration, and death.

The symptoms are identical with dyspepsia. There is no fever ; the
pain, flatulence, intense acidity, loss of appetite, &c., are the same in
both. If the disease has become chronic it may be considered as
most probably gastritis^ at least if it has continued long, and been
treated as dyspepsia.

The distinction between chronic gastritis and phthisis may be thus
made out :

CHRONIC GASTRITIS.
The cough and pulmonary sj^mptoms
have, perhaps, not continued long ; have
been treated as pulmonary disease with-
out success. The symptoms are not
accompanied by important lesions ; and,
if the cough, labored respiration, &c.,
have continued for a considerable time,

PHTHISIS.
Recollect that, if the symptoms be-
long to the lungs, the disease must, in
two or three days, produce lesions ca-
pable of being easily detected. If we
cannot find these we may refer the phe-
nomena to sj^mpathetic irritation, most
commonly of the stomach. In those

CHEO][SriC GASTRITIS.

861

we may set it down as belonging to the
stomach.

The gastritis may be nearly latent,
and may want the most of those symp-
toms by which it is commonly attended.

cases in which the sympathetic invita-
tion is most strongly marked the local
symptoms of the disease are most appa-
rent.

Treatment. — The medicines to which we have alluded under acute
gastritis, will be the most applicable in the ordinary forms of the
chronic form of the same disease. The following medicines will like-
wise cover many symptoms of sub-acute gastritis, namely Bismuth^
Baryta-7n'uriatis^ Bryonia^ Cicprum-'inetalliGuin^ Digitalis- fur.^
HyoseyamuSj Ignatia^ Mercicr.^ Phos;pho7ms^ Arnica.

Tartar-emetiG, - The higher attenuations are valuable in a large
class of gastric derangements; nausea and vomiting that accompany
chronic gastritis ; loss of nervous energy of the stomach; enfeebled and
irritated state of the mucous membrane ; nausea, oppression, tightness
in the epigastric region, heaviness in the head, distaste for food ; lassi-
tude, accompanying dyspeptic and bilious symptoms.

Infla7Yhm.ation of the Stomachy vomiting of maMer tinged with
Mood. Prsecordial anxiety after eating, pain in the epigastrium, burn-
ing heat in the stomach, which increases so much as to cause syncope.
Epigastric region swollen and painful rotary movement at the epigas-
trium in the evening on lying down ; with strong and rapid pulsations
at the heart. {Hahnemann)

Alcohol.— In the case of St. Martin, a Canadian, who, in conse-
quence of a gun-shot wound, had a permanent fistulous opening
through the abdominal parietes into the stomach, the rare opportunity
was afforded of seeing muGh. that went on in the stomach during diges-
tion. At one time Dr. Beaumont observed that the interior of the
stomach exhibited erythematous and aphthous patches on the mucous
surface, caused by the drinking of ardent spirits during the preceding
eight or ten days ; but there was no pain, and the patient had a good
appetite. This state continued several days ; the secretions were
vitiated, and the small quantity of gastric juice extracted by a syringe
from the stomach was vitiated and impure in appearance. At another
time the small quantity of this fluid extracted, in the morning before
eating, was mixed with an unusual proportion of vitiated mucus, saliva,
and bile, tinged lightly with blood, which appeared to exude from the
surface of the erythematous and irritable patches of aphthous inflam-
mation. On succeeding days the same morbid appearances were ob-
served. The aphthous patches grew larger and more numerous, the
mucous covering became thicker, the gastric secretions more vitiated
and purulent, resembling the discharges from the bowels in protracted
cases of chronic dysentery; yet, with all this evidence of local disease
of the stomach, there was little derangement of its functions, and n<?

862 DISEASES OF THE SANGTJINOUS FUNCTION.

pain, except an uneasy sensation in the epigastrium. There was some
vertigo, some dimness and yellowness of vision, a thin yellowish coating
on the tongue, the countenatice sallow, pulse uniform and regulai", ap-
petite good, sleep as good as usual."^^

But, during all this period, the appetite, though sufficiently craving,
was not that of health. Digestion, when the stomac^i is in this state,
is very imperfect, and under a full diet and indulgence in stimulants
there can be no recovery of the lost strength. Aft-^r being confined
for a few days to a restricted diet, avoiding stimulants entirely, an im-
provement was visible. On the sixth day of observation, at eight
o'clock in the morning, before eating, the stomach was observed to be
" empty, its coats clean and healthy as usual ; secretions less vitiated ;
extracted two ounces of gastric juice of more natura^l and healthy ap-
pearance, with the usual gastric acid flavor ; he complains of no uneasy
sensations, nor of the slightest symptoms of indisposition; says he feels
perfectly well, and has a voracious appetite."f

The accuracy of Dr. Beaumont's observations have been attested by
Professor Sewall, of Washington, D. C, and they have been more re-
cently confirmed by other experiments.^ All observations show that
large quantities of alcohol maybe taken repeatedly without exciting
the pain and sensible systems of inflammation in other delicate sur-
faces ; but that inflammation is nevertheless excited by the harsh
action of the stimulant, and digestion is deranged and health under-
mined before the cause of the insidious danger is suspected. It has
also been shown that the inflammation excited by a too free indulgence
in stimulants soon subsidy under the influence of low diet and cooling
drinks. "Such," says Dr. Budd, "is the power of reparation possessed
by the lining membrane, without which it would be unfit for the func-
tions of digestion. When, in consequence of the continuance of appe-
tite, the usual diet continues to be taken, the surface of the stomach is
long in recovering its healthy state ; in many cases it continues fretted
and sore, under an amount of food that in a healthy condition would
produce no irritation."

. When brandy is prescribed as a medicine it is quite common to
begin with doses small enough to avoid a rapid development of those
dritgsyriijptoms which are often found at last far worse than the origi-
nal disease. After repeated exhilarations, alternated with depressions,
not permitted to last long, the confidence of the patient is gained, and
Brandy becomes established in reputation as the real " staif of life."
Now, whatever the progress of the original disease, the remedy will

* Beaumont on Digestion.

t Ibid.

X See Amer. Jour. Med. Sciences. 1857.

INFLAMMATION OF THE STOMACH. 863

soon assume a conspicuous position. The chronic disease which Alco-
hol generally creates is slowly developed, and in many cases it is not
possible to refer to any serious lesion of the nervous system, appre-
ciable during life or discoverable after death. There are some men
who can drink habitually six or eight glasses of brandy daily, for seve-
ral years, without greatly deranging their health, but these are extra-
ordinary men. It is much more common to see a gradual change
come over the habitual spirit-drinker, until he finds himself in the
height of a paroxysm of delirium tremens, from which he never recovers.

The symptoms of Alcohol, habitually taken, are thus given by Dr
Huss, of Sweden : " In some cases the patient begins to find his diges-
tive powers impaired, he becomes dyspeptic, and can only eat solid
food by taking a* drink of brandy with each mouthful ; some, when
trying to keep sober, take only vinegar or spices." In other cases
there may not be intoxication at any time. In many the morbid
symptoms begin with " loss of appetite, indigestion, nausea, vomiting,
occasional diarrhoea ; emaciation and cachexia ; pustular eruptions,
eructations, and offensive breath ; there is soon serious functional
disease of the liver, kidneys, heart, and the coats of these vessels,
which finally lead to chronic structural disease of those organs. At a
later stage we have fatal serous effusions or general dropsy, haemor-
rhages, extravasations, or apoplexies. Intercurrently with these states
are sometimes seen fits of intoxication, delirium tremens, sexual de-
bility, suicidal melancholy ; and life terminates with epileptiform con-
vulsions, general paralysis, or idiocy."

Causes. — The most powerful predisposing causes of this malady are
protracted sufferings under the depressing mental emotions, and the
habitual use of irritating drugs. It often succeeds to acute gastritis
which has been but partially subdued. It may also arise from high
living, the abuse of wine, liquors, coffee, &c., repelled eruptions, metas-
tasis of rheumatism and gout, injuries, and occasionally as a conse-
quence of other diseases which have been, badly managed.

Slow Poisons. — There are instances of poisonous substances re-
tained for a considerable time in the stomach before their effects are
felt. It has been said that pulverized diamonds, or glass, enamel, &c.,
. slowly lacerate the coat of the stomach, and thus destroy life. On the
same principle it is said that human huir, chopped very fine, constitutes
the active ingredient of a slow poison employed in Turkey for the pur-
pose of inducing a chronic disease resembling cancer in the stomach.
{Paris and Fonblanque on Poisons.)

The most celebrated case of this disease recorded in the books is
that of Napoleon I, who died at St. Helena, May, 1821. The Empe-
ror had avoided medicine generally during his life, as he had no faith
in physicians. Ilis plan was, when he was unwell, to balance his con-

864 DISEASES OF THE SANGUINOIIS FUNCTION.

dition of health by running into an opposite extreme from that which
caused the disease; thus, as he said, restoring the equilibrium of
nature. If he had been long inactive he would ride about sixty miles,
or hunt a whole day. If he had ah^eady borne great fatigue he would
resign himself to rest for twenty-four hours. During the latter por-
tion of his captivity his health became more and more deranged. The
disease was called hepatitis. " The lymphatic system was deranged,
and his blood circulated with difficulty. Nature had endowed him
with two important advantages : that of sleeping whenever he needed
repose, at any time or place, and, second, that of a constitution inca-
pable of committing any excess, either in eating or drinking ; the least
excess caused his stomach to revolt immediately."

In his last illness he was only attended by Dr. Antomarchi and Mr.
Arnott. They had a consultation March 25th. The Emperor had
long been laboring under some severe derangement of the function of
digestion : he had nausea and vomiting, especially after taking food ;
obstinate constipation ; great wasting of flesh and strength. On the
17th of March he had an attack of fever, for which he was treated
with emetics, cathartics, and antimonials. On the 25th he still suf-
fered from heat, great prostration of strength, pain in the epigastrium,
most distressing vomiting, and constipation. April 1, evening. Dr. An-
tomarchi requested Dr. Arnott's aid. Passing "through a labyrinth
of passages and rooms dimly lighted they reached the Emperor's bed-
room. There was no light whatever iii it — it was perfectly dark." Dr.
Arnott was introduced by Count Montholon ; he inquired into the
symptoms in the dark, as no light was permitted. The pulse was
tranquil, the heat moderate ; moisture on the skin rather more than
natural ; much pain in the abdomen, but no tension or hardness per-
ceptible on examination ; the bowels slow ; appetite bad ; voice strong ;
some cough. Several severe fits of vomiting followed, notwithstanding
purgatives had been recently given with temporary relief. The matter
vomited on the night of April 11th was "black mucus." After this he
became quite exhausted, and expressed the opinion that medicine
would be of no avail. He took some jelly with wine, which he re-
tained. He afterwards asked: "How long does a man live who eats
so little as I do ?" He now continued better and worse till the latter
end of April, when hiccoughing came on, and all the symptoms were
aggravated. May 4th there was a total loss of muscular motion ; the
under-jaw had dropped ; the eyes were fixed ; the pulse varied from
102 to 110 per miriute, small, weak, and easily compressed.

He was now evidently dying ; but sinapisms were applied to his
feet, and blisters to the legs and sternum. They had no effect—all
the symptoms increased. At eleven minutes before six, p. m., of the
21st of May, he died, at the age of fifty-two years. His dissolution

INFLAMMATION OF THE STOMACH. 865

was SO calm that not a sigh escaped him, and his attendants had no
thought that his end was so near. His last words were " Ute arm^e^^
distinctly uttered at five o'clock, a. m. ; what associa,tion the words had
in his mind could not be known. " His countenance after death was
calm and serene, and as having in it something commanding and
noble."

Post-Mortem Examination, — The whole of the internal surface of
the stomach "was a mass of cancerous disease, or scirrhus portions
advancing to cancer. The contents of the stomach consisted only of a
large quantity of fluid, resembling coffee-grounds, or black grumous
matter mixed with some specks of blood, which he had been accus-
tomed to vomit. The remainder of the abdominal viscera were in a
healthy state.

3. acute catarrhal inflammation of the stomach.

This is an affection of frequent occurrence, attended with little dan-
ger. It is usually cured without medicine by the observance of a
regulated diet. When it originates in cold, mental emotions, night
watching, or endemic or epidemic influences, it is more severe than
when it arises from some direct affection of the stomach. It is usually
cured without difficulty by Aeon., when the fever is perceptible ; Pul
satilla, Bryonia, Nux-vom., Ipecac, Arson.

In some cases, associated with intestinal catarrh and great tympani
tis, Coloc. and Carbo-veg. See also page 515.

4. chronic catarrhal inflammation of the stomach.

The researches of Broussais and Andral have established the doc-
trine that this disease is identical with gastritis in pathology. The
patients complain of loss of appetite ; tongue coated ; taste sour or
insipid ; directly after a slight meal there is fullness or feeling of dis-
tention of the epigastrium ; this is followed by a tasteless, sourish, or
putrid eructation ; food taken is afterwards tasted ; there may be an-
noying heartburn, at times nausea and sickness; vomiting seldom
occurs ; evacuations from the bowels either normal, hard, infrequent,
or loose. General health only affected by long continuance of the dis-
order, when there comes slight weakness, emaciation, and hypochon-
driacal humor, generally no fever ; sleep little disturbed, except per-
haps by troublesome dreams or nightmare. The most frequent reflex
symptom is headache, more or less violent ; stomach somewhat dis-
tended; pain on pressure in the epigastrium very slight. See p. 515.

VoL.L-55.

DISEASES OF THE SAlfGUINOUS FUNCTION".

5. ULCER OF THE STOMACH.

General Remaeks. — -It commonly begins with obstinate vomiting,
showing either congestion or inflammation of the stomach. In some
cases the vomiting recurs almost daily for months after signs of active
inflammation have subsided. The stomach becomes distended and
feels like a large tumor, which is removed by the expulsion of a gallon
or more of fluid.

There is a greater liability to perforation in the cases of young fe-
males, contrasted with the greater frequency of the occurrence of ulcer
of the stomach in advancing life.

Diagnosis. — Pain, whether epigastric or dorsal, increased by pres-
sure ; and this symptom is considered by Brinton as an " important
test." But it may only be considered as indicating an inflammatory
irritation of the mucous surface of the stomach, rendering it tender and
irritable. It may eoncur with ulcer, but is not a sign of it. To assure
us of the existence of ulcer the numerous symptoms commonly attend-
ing it must be well marked. The pain is accompanied with vomiting
and hemorrhage at some stage of the malady in nearly all cases.
When we meet with a case of sudden profuse gastric haemorrhage we
consider the probabilities of its being connected with scirrosis of the
liver, vicarious menstruation, purpura, or heart disease. If it cannot
be attributed to any of these it may be suspected to arise from ulcera-
tion. It is true that we meet with many cases of gastric haemorrhage,
complicated with lowered nerve-power and malarious disorder, apart
from any special gastric afiection. " The gastric mucous membrane
may be flushed by reason of the paralysis of the arterial nerves, and
haemorrhage may then occur by capillary rupture, in the same way as
it does in epistaxis." {Brinton. London, 1857.) Ague is regarded
by Dr. Brinton as a cause of ulcer of the stomach ; it may rather be
regarded as a cause of haemorrhage only. And the existence of hepa-
tic scirrosis or other portal derangement should also be considered as
possible. The former may occur in perfectly temperate persons, in
those young in life, and may declare itself by haemorrhage, with or
without dropsy. A case of this kind long occupied our attention a few
years ago.

Pathology.— -There is nothing specific in the nature of ulcer of the
stomach. It may originate in various ways ; and when it terminates
fatally it is likely to be by perforation of the stomach. When this
occurs there is a violent paroxysm, attended with unusual pain in the
abdomen, ending in collapse and death in a few hours. The abdomen
is found distended with air and fluid similar to that vomited ; the
stomach greatly enlarged, its coats thickened, especially in the parts
near the ulcer, which is more common near the pylorus.

SOFTENING OF THE STOMACH. 867

Treatment. Diet — Give only bland nutriment, in small quantity
and at short intervals, to avoid distending the stomach. Dr. Brinton
then proposes to give Opium, to relieve the pain, check irritation, and
support the strength. It is regarded as possessing the most reliablo
powers for buoying up the nervous energies and checking the expendi-
ture of the tissues generally. In one case Dr. Parker, of Boston, re-
lieved the vomiting and effected temporary improvement by giving
syrup of Iodide of Iron, a fevs^ drops three times a day; though the pa-
tient died a year after on the disease progressing to perforation of the
stomach. {Trans. Sog, Med. Impr. 1850.)

Aqua-calcis^ Calcarea'CwustiGa {QuicJc-lime) , — Eructations of air;
regurgitations of food ; inflammation of the mucous membrane ; nausea
and vomiting of a sour fluid ; raising of a frothy yeasty fluid ; spasmo-
dic contraction of the stomach.

Arsenicum, — Nausea and vomiting after eating or drinking, with
great exertions, mixed with mucus and water, with bitter taste ; thick
glassy mucus, or brownish black substances, with great exhaustion.

6. GASTROMALAOIA.— Perforatio Venteiculi.
perforation of the STOMACH.-SOFTENINa OF THE STOMACH.

A softening of the membranes of the stomach always precedes the
formation of ulcers and suppurative process which takes place in tuber^*
culous and carcinomatous formations. Most common among children
of from a few weeks to two years old. (HartQuann^ vol. iv., p. S^)

Diagnosis. — The most remarkable peculiarities consist in symptoms
resembling, cholera, gastritis, hydrocephalatous fever, or slow nervous
typhus. The mild cases begin with loss of appetite, peevishnesSj low
spirits, eructations of food, aphthae, persistent diarrhoea, vomiting, the
sleep restless, and the child has a pale and distressed appearance
Fever increases, and is attended by obstinate diarrhoea— the discharges
consisting of a watery mucus with putrid odor, and mixed up with gray
green filaments and flocks ; the abdomen becomes distended, the head
and extremities cold, while the abdomen continues burning with heat ,
rapid emaciation, especially shown about' the necL There is constant
sleep, or the child is aroused with difiiculty. Sometimes the disease
breaks out suddenly w^ith violent fever, restlessness, screaming from
pain ; there is quick pulse and insatiable thirst. The abdomen is dis-
tended, the region of the stomach hot to the touch and painful when
pressed ; the lower limbs are drawn up to the abdomen. There is
repeated and persistent vomiting of greenish-slimy sour-smelling fluid ;
and diarrhoea of which the discharges consist of watery, green, acrid,
sour-smelling stools ; the breathing is oppressed, with dry cough, while

868 DISEASES OF THE SANariNOUS FUNCTIOK.

the breath and skin are cool. These symptoms are followed by ex-
tremely rapid collapse of the features and emaciation ; the screams
gradually change to a mere moaning, stupor and delirium increase, and
terminate in convulsions and death.

'Causes. — Infantile age; scrofulous or tubercular diathesis ; epidemic
influences ; the usual causes of autumnal fever ; atmospheric vicissi-
tudes ; swallowing corrosive saliva in cases of gangrenous diseases of
the mouth and adjoining parts. [Hartmann.) Disease of the brain,
as hydrocephalus and tubercular meningitis. [Hohitansky^ &c.)

Pkognosis. — ^Discouraging, but not always hopeless ; the symptoms
when most urgent often arise from a pathological condition, which may
be changed by the usual remedies.

Tbeatment. — Begin by treating the general febrile and inflamma«
tory symptoms on the general principles which are usually found suc-
cessful in other gastric afiections. For these and the cephalalgia,
Aconite, Belladonna^ or Bryonia may first be tried. After these
have subdued the fever and mitigated the local symptoms, if there be
persistent diarrhoea, give a few drops of Oalc-acet per day. It . is a
good remedy for troublesome dentition and also for scrofulous affections
in children, and is better than Calc-carh, in this disease. (Hart-
mann) Hy;po-phosphite of Lime is one of the best remedies. When
the diarrhoea becomes habitual, and the central organ of the abdomi-
nal system of nerves becomes more deeply invaded, PhospJiorie-acid
is more effectual. Tartar-emstiG, in a low attenuation, is successful
in the cases in which the head-s,jm^tom^ predominate ; when there is
evidence of actual gastromalacia^ with erosion of the coats of the
stomach, this remedy should be given in a high dilution only. Arsen?^
cuni'j Sulphuric-acid, and Argentum-nitratum have cured some cases.

Kreosoticm is said by Dr. Arnold to be the principal remedy in
this disease. He uses the second trituration, others prefer the sixth.
He says, under its use the symptoms soon abate, and finally disap-
pear— the emaciation requiring its persistence for a considerable time.
Oxalic-acid, Softening of the stomach; burning pain, hiccough,
vomiting, erosion of the mucous membrane.

7. SELF-DIGESTION OE THE STOMACH, or,

Changes in the Coats of the Stomach from the Action of the Gastric Fluid after Death

This change of the structure of the coats of the stomach is visible in
a large proportion of the bodies examined after death, though it is
usually attributed to disease. The earlier pathologists, from Morgan!
downward often observed the mucous membrane of the stomach as well
as all its tissues in a softened state ; but the real nature of the change
was not understood till John Hunter found it in a remarkable degree in
thp stomach of a man who after eating a hearty supper of cold meat,

SELF-DiaESTio:t;r of the stomach. 869

cheese, bread and ale, was suddenly killed by a single blow wbich had
fractured his skull. On dissection Hunter was perplexed on finding
the stomach so far dissolved at its greater end that part of its contents
had escaped into the cavity of the abdomen. A second case was seen,
at St. George's Hospital, in a man who died a few hours after receiving
a blow on his head which fractured his skulL He afterwards found the
same appearance in many other cases, most of whom had died from in-
juries of the cranium ; and in one man who had been hanged. In some
cases the digestive action had extended through the diaphragm, into
the spleen, and was beginning to corrode the surface of the lung. On
making an extensive series of observations, he concluded that there
were few stomachs after death which were not in some degree marked
by this post-mortem digestive action, that it was most plainly seen in
persons who had died violent deaths, and who had recently taken food.
Spallanzini was led by Hunter's observations to extend his own on the
nature of digestion and concluded as Hunter already had done that the
gastric juice was a true menstruum or dissolving fluid; and that its ac-
tion on the food might continue after death ; also that when so em-
ployed while still remaining in the stomach at a proper temperature, it
was capable of digesting the coats of the stomach itself. Later observers
have amply confirmed the truth of these opinions. Although little has
been recently said on the subject, it is well known that the fluid formed
by the stomach for the digestion of food during life becomes an agent
of destruction to the same tissue that formed it, as soon as the vital
power leaves the body.

ClECUMSTA]N'CES THAT FAYOK SELF-DiaESTION. The prOCCSS is mOSt

active when the temperature is greatest; hence Hunter, Budd and
others found it very frequently in hot weather, others looking for it in
winter have less, frequently observed it. Thus it is necessary first,
that there should be a certain quantity of active gastric fluid in the
stomach, or at least, muriatic or lactic acid. The temperature for some
hours about 98°. The stimulus of food after eating excites a full flow
of gastric fluid into the stomach, which, if death be suddenly brought
about by some external cause, goes on dissolving the contents of the
stomach and the viscus itself, particularly at its large or cardiac end,
where the fluid collects, and where the mucous membrane is thinner
and less protected by mucus. When digestion is not going on there is
no gastric juice in the stomach. QSee Digestion, p. 217.)

Action of the Gastric Juice in the Process of Digesting the Coats of the Stomach,

It first renders the mucous membrane firmer and thinner, making it
capable of removal by pressure of the fingers ; the blojod in the capil-
laries is blackened. If the capillaries are full when the action com-
mences it turns the softened membrane of a grayish brown and renders

870 DISEASES' OF THE SAKaUINOTJS FUKCTIOIT.

it paste-like and opaque; but if the minute vessels are empty, the
softened tissue is rendered gelatinous and transparent, Sim-ilar changes
are effected in albuminous structures out of the body. In a higher
degree of the digestive process, the coats of the stomach are eaten
entirely through the edges of the opening, says Hunter, " appear to be
tiaif dissolved," the fleshy parts appear " pulpy, tender and ragged," like
flesh half digested, or half dissolved by a caustic alkali. In the pylo-
ric portion .of the stomach perforation is less frequently seen, but the
edges of the folds seen on its contracted surface become softened, and
when the capillaries were empty at the beginning of the process, the
folds appear as whitish, semi-transparent lines or narrow bands, which
have a brownish tint when the capillaries have been congested. In
some cases the gastric fluid having regurgitated through the cardiac
orifice, perhaps from spasmodic action of the gastric muscular fibres in
articulo mortis, lodges in and dissolves the lower end of the oesophagus;
here, also, the projecting folds of the under or back part of the oeso-
phagus being acted on first.

It is known that irritation from other causes than the presence of
food may excite a flow of gastric fluid into the stomach. Spallanzini
obtained some from his own stomach by tickling the fauces and thus
exciting vomiting before breakfast in the morning ; and the fluid was
known to be pure from its power to dissolve meat. In one case, given
by Dr. Budd, it seemed that the flow of the gastric fluid into the stomach
was excited by irritation of the brain by an injury so severe as to frac-
ture the skull. A gentleman was thrown from his horse in the park in
London before dinner, and when the stomach was probably quite empty
and he remained insensible till his death, twenty hours after the fall.
On examination eighteen hours after death, the great end of the stomach
was completely dissolved and the digestive action was, extending to the
adjoining parts. As the stomach was supposed to be quite empty when
the accident occurred, and the power of swallowing was entirely lost by
the shock, nothing was taken afterwards ; it is therefore probable that
the gastric juice by which the stomach was dissolved after death, was
secreted under the influence of the irritation of the brain and spinal
nerves, resulting from the injury; and, being undiluted by food in the
stomach, its active powers were expended on the coats of the stomach.

When death results from ordinary diseases, the appetite having been
weakened, the power of the digestive fluid is feeble and seldom acts so
powerfully on the coats of the stomach.

Solution of the Goats of the Stomach hy the Gastric Juice after Death from excessive
Acidity discoverable during Life.

Though in health the gastric juice is only secreted when food is
taken, but in certain diseases it is secreted when the stomach is

SELF-DIGESTION OE THE STOMACH. 871

empty. In some catarrhal states of the stomach lactic acid is formed
by fermentation of the saccharine principles of the food; and this acid
forms with the mucous membrane of the stomach a digesting mixture
which continues its activity after death ; and the coats of the stomach
are more or less digested or destroyed.

First. Symptoms of the presence of free gastric juice or of a digest-
ing fluid in a stomach otherwise empty are met with during life in cases
of simple ulcer of the stomach. Pain in the epigastrium is felt when
there is no food in the stomach ; there are thirst, impaired appetite, fre-
quent sour eructations with occasional vomiting of sour food ; probably
the flow of juice is excited in the empty stomach by the irritation of
the ulcer or its secretions, as it was in Spallanzini's experiments by
the mechanical irritation of pebbles or of bits of sponge or glass.

Second. Gastric Disorder in advanced Phthisis,- — For soine weeks
or months before death there is pain and tenderness of the epigastrium;
loss of appetite, thirst, frequent nausea and vomiting of matters slightly
acid. These symptoms exhaust the strength, and often give more
distress than the diseased lung ; and are probably excited by the irrita-
tion of that organ. In persons who have died of phthisis, the mucous,
muscular and serous coats of the great end of the stomach are often
found dissolved, leaving a large aperture with ragged, flocculent edges.
Louis found this condition in about one-fifth of the consumptive cases
he dissected.

Third. Some inflammatory diseases of the brain cause gastric dis-
order ; as frequent vomiting and nausea ; pain in the stomach, thirst,
loss of appetite ; this gastric disorder is associated with increased se-
cretion of the gastric fluid or its presence in the otherwise empty
stomach. In typhoid fever the same excess of acid often accompanies
the delirium or other brain symptoms of that disease. When there has
been pain and soreness of the stomach, and vomiting for some days be-
fore death, the stomach has been found partially digested after death.
The softened tissues are of a rust color, from the presence of blood
gravitating to the lowest part of the stomach.

Fourth. Cancer of the uterus, peritonitis and other abdominal dis^
eases which lead to functional disorder of the stomach. In all these
instances the pathological change is believed to be effected after death.

Fifth. In infants during the period of dentition, the stomach aiad
parts of the intestines are often found in a softened state after death. It
is common in those who have died from hydrocephalus, phthisis, or the
exhaustion consequent on eruptive fevers or improper food after wean-
ing. Symptoms during life: frequent vomiting, loss of appetite, great
thirst, crying as from pain; diarrhoea; discharges from the bowels
green, like spinach, supposed to be caused by the presence of bile acted
on by muriatic or lactic acid from the stomach. In children the

872 DISEASES OF THE SANGUINOUS FUNCTIOIT.

functional gastric disorder rapidly exhausts the strength, causing col-
lapse and death. ^ ^

Softening of the stomach then is usually found in persons who die of
disease in some other organ, and of those diseases especially which
have long 'been Jcnown to lead to secondary functional disorder of
the stoTn^ach. This secondary disorder of the stomach is produced through
the intervention of the nervous system. The excessive secretion of
acid in the stomach in these cases is eifected through refex nervous in-
jhience from the other diseased part thrown back from the brain through
the nerves ; and the secondary disorder of the stomach thus excited af-
fects the secreting apparatus of the stomach as well as its muscular
coat. The extra gastric juice thus formed when not needed is wasted in
merely exerting an irritation on the coats of the stomach ; and when it
has passed away and more food is taken it is but imperfectly digested
and becomes a new source of offence to the mucous membrane, causing
it to secrete an unhealthy mucus ; and this acts as a ferment in forming
lactic acid from the saccharine elements of the food.

In phthisis the stomach is often found enlarged as well as softened;
being often found three or four times its usual size. It is believed to
have been caused by the enlarged fatty degeneration of the liver
which always exists in these cases. The enlarged liver compresses
the pyloric division of the stomach and prevents the wasted and
weakened muscular fibres from propelling the contents through the py-
lorus. Some of the acid then remains in the stomach and softens its
tissues after death.

Irifluences that diminish the power of the digestive fluid, —
Fi/rst Low temperature, — Spallanzini found that its powers were
only perfect when the temperature was near that of the human body
or near 100^. When cooled to 60^ the action becomes very slow and
feeble. Second. Antacids taken into the stomach render the gastric
juice inert, as was proved by the experiments of Schwann on artificial
digestion with rennet He destroyed its power by carbonate of potash,
and restored it by adding the proper quantity of hydrochloric acid.
Ammonia is sometimes given just before death to avert the sense of
sinking. If the juice be in small quantity it will be neutralized by the
Ammonia and the digestion of the stomach prevented. The same may
in som§ degree result from the transudation of the alkaline serum
of the blood after death.

Alcohol, — It is often given in large quantities in the vain hope of
relieving the sense of sinking. If not absorbed before the circulation
ceases it may prevent the action of the gastric fluid on the stomach.
Many medicines given when the stomach is full and digestion going on
arrest that process. They have often been given in large quantities
without regard to their strong deranging powers. {Budd^ p. 25, &c.)

HYPERTROPHY OF THE COATS OF THE STOMACH. 873

Diagnosis.— Varieties exhibited hy the stomach on dissection, —

1. Puljpy softening of the stomach from self-digestion,

2. ''Gelatinous softening of the stomach from self-digestion.
Cruveillier gives these distinctions, and Rokitansky specifies three

varieties ; but they both regard them as the results of disease. Dr
Budd is confident that they all result from the action of the gastric
juice. He gives the essential characters of this change :

1. Softening of the mucous membrane, over a considerable space
in the great end of the stomach and along the edges of the folds ^ ex-
tending from this towar.ds the pyloric end.

2. A blackening of the blood in the tissues so acted upon,
giving various shades of brown to the softened tissues when much
blood was contained in them at the time of death.

8. The softened tissues have an acid reaction; they putrefy less
readily than other parts, as the gastric juice exerts on them an anti-
septic power.

Gelatiniform softening appears to be nothing more than the result
of the same process occurring in a stomach, the capillaries in the
coats of which were empty of blood at death ; and they are thence
rendered more or less transparent or gelatiniform, as all albuminous
tissues are when acted upon by the gastric juice or by acetic acid.

8. HYPERTROPHY OF THE COATS OF THE STOMACH.

This has been by many writers considered as an earlier stage of
Oarcinoma of the Stomach / but Dr. Alderson of the Hull Infirmary
says, it differs materially from that affection, and is much more com-
mon. The subjects of hypertrophy of the gastric mucous membrane
are generally between the ages of forty and fifty, who have used alco-
holic drinks too freely. It has seldom been seen except in the pyloric
portion of the stomach. The disease generally commences in a state
of irritation or chronic inflammation which render the lining of the
pyloric orifice of the stomach so exquisitely sensitive that the contents
of the stomach excite it to contract spasmodically. The natural efforts
to overcome this obstruction cause a spontaneous or " instinctive" de-
position of nutritive material in these coats which thickens them and
adds to their power of resistance. The indigestion attendant on this
state of the stomach tempts the sufferer to take stimulants daily to ex-
cite the stomach to increased action ; thus keeping up for weeks or
months an unnaturally increased capillary circulation of the mucous
membrane ; the muscular coat partakes of the irritation and the hyper-
trophy extends to it. When a section of the muscular coat of the
stomach is made, the interlacing of the muscular fibres is very con-
spicuous. {Alderson, on the Stomach c&g)

874 DISEASES OF THE SANGUIISrOUS FUNCTIOi^.

Diagnosis. — The general system is not much affected till the disease
is far advanced. The most striking early symptoms are morning sick-
ness and want of appetite; and in the later stages constant retching
and nausea ; drinks are much desired ; but, whatever their quality be
they are instantly rejected, and a dark colored fluid is vomited in large
quantity. Every thing taken into the stomach gives pain, and is im
mediately thrown up, accompanied by large quantities of the vitiated
secretions from the mucous lining of the stomach. There are frequent'
alternating heats and chills ; the pulse is quick and the tongue furred ;
the pain is often felt at the pit of the stomach, but not invariably,
though it is more common in cases arising from unsubdued chronic in-
flammation than in those depending on mere obstruction of the pylo-
rus. Emaciation is not a symptom of this disease, and its absence
materially distinguishes it from carcinoma of the stomach.

Treatment. — This has not yet been genei-ally satisfactory in any of
the structural diseases of the alimentary canal, and the chief reliance
is upon palliative measures which might be successful if there was no
malignant disease, and those specific remedies which are supposed to
have some power in controlling carcinoma whether in this system of
organs or in others more external.

The first symptoms of structural disease resemble those of disordered
function, but they are really the consequence of actual change of
structure. We begin by attempting to restore healthy secretions and
to counteract the constitutional tendency to the morbid deposit. As
soon as structural disease in the pyloric portion of the stomach is sus-
pected let all stimulants and internal irritating medicines be sus-
pended ; restrict the diet to the least irritating substances : milk, beef-
tea, mucilages, and farinacious articles may be allowed, and when the
disease affects the oesophagus and cardia, but few things can be taken
and them we can not prohibit. Solids may be swallowed when fluids
can not. Rest, pure air, mental and physical quiet are indispensible.
External irritation, applied over the seat of the disease or to the spine,
has been supposed in the early stage to check local inflammation.
The celebrated Bichat employed it in his own case.

When the disease is so fully established that the mucous membrane
has given way, counter-irritants can not be useful ; and before this
stage is reached we have better resources in the homoeopathic reme-
dies already mentioned under Gastritis^ (p. 861.); Uher of the
Stomach, Oastromalacia, (p. 868,) and hereafter under Carcinoma
of the stomach in its incipient stages. Of these. Oxalic-acid, Kreo-
sote, Arsenicum, Merc.-cor., Tartar-emet, and Argentum-nitr. are most
reliable.

The internal use of water, as directed, page 297, will contribute
very much to the favorable effects of remedies.

DUODENITIS. 875

9. DUODENITIS.

Infiarnmation of the Duodenum, — The disease called jaundice
consists very generally in inflammation of the duodenum, though the
icteric hue of the skin is not a necessary attendant upon duodenitis
and is often independent of any mechanical obstruction of the biliary
ducts. In some cases the jaundice is accompanied with duodenitis
and we have the yellow skin at the same time that the bile is flowing
freely. See p. 401,

Bichat first showed that where jaundice had existed during life there
had sometimes been no obstruction in the liver or ducts ; but in such
cases there was more or less inflammation of that part of the tube into
which the bile is discharged, and this observation led ultimately to the
discovery of the connection between inflammation of the duodenum and
jaundice. In speaking of the sympathies which depend on continuity
of surface Bichat refers to the connection between the surfaces of the
mucous membrane and the ducts that open into them, and endeavors to
show that the natural mode of exciting all the secretory glands is a
stimulus applied to the surface on which their ducts open. As examples
he instances the eflect of food and other substances to the mucous
membrane of the mouth in stimulating the salivary glands ; the eflect
which stimulants applied to the conjunctiva or nose have on the lachry-
mal glands. Hence it is concluded that when the mucous membrane of
the duodenum is thrown into a state of excitement we may have a con-
sequent aff*ection of the liver, for the duodenum has the same relation
to the liver that the mouth has to the parotid gland.

It is now decided that the cause of yellowness in what is called
yellow fever, is disease of the upper part of the digestive tube, in which
the duodenum is always involved; and that the disease itself, (the
Typhus Icterodes of some nosologists), has been found to be to a
large extent connected with inflammation of the stomach and duode-
num* During the epidemic of 1826 many cases of the fever prevailing
presented a striking resemblance to yellow-fever, in intense jaundice
and inflammation of the upper part of the digestive tube. In the in-
vestigations of Rush and Lawrence on yellow fever we find that few
bodies were examined by them in which there was jaundice in connec-
tion with liver disease, but in all cases there was intense duodenitis or
enteritis.

And even where the duodenum is not inflamed, continued use of calo-
mel may cause an irritated condition of the duodenum as well as of
the whole system. The large quantities of green bile poured out by
the liver produce the greatest irritation. When this excessive flow of
bile exists as the result of febrile irritation of the liver and duodenum
allopathic doses of calomel (by causing medicinal aggravation), keep

876 DISEASES OF THE SANGUUSTOUS FUNCTION.

up this discharge and all its disastrous accompaniments. Ptyalism
can not here be induced by any quantity or repetition of doses ; and, if
it could, would not arrest the disease until the force of the fever is
broken by other means. " Calomel," says Dr. Monette, "is the Sampson
of the Materia Medica, and like him has slain its thousands when
wrongly directed. It is generally improper when the tongue is dean
and red^ whether it be dry, or smooth and moist ; also when the tongue
is dry and rough, whether brown or red. These appearances always
show different grades of mucous inflammation, and in all of these calo-
mel (as well as quinine), is injurious."

This picture by a good observer is well drawn, and fortunately so
much truth needs not to be thrown away, because it was spoken by an
author who then did not see its full value. By " turning the picture up-
side down" it becomes more true to nature and to our purposes than it
was to those of the author. The picture he gives us of the injurious
effects of calomel is that precisely which we would have tried to. draw
of the curative powers of that celebrated agent when used in an at-
tenuated form.

Causes. — Ulceration of the -duodenum has been excited by causes
acting only on the surface of the body. Mr. Carl (in Med. Chir^ Trans-
ao. Vol. 24) gives twelve cases which originated in hums. It is certain
that the burns could not by direct action produce this injury. It must
depend upon the diseased constitutional state caused by the burn. A
transfer of this diseased constitutional state, induced in the skin by a
burn must have taken place, and thus the lining membrane of the in-
testinal tube became affected.

Treatment. — See pages 410 and 574.

10. GASTRO-ENTERITIS.

Broussais, in his '^Medical Doctrines and Sym^ptoms of Nosology ^^
gives in a compact form a synopsis of the modern doctrine on this
subject.

First, — Inflammation of the mucous membrane of the stomach can
never be verified by dissection, but in connection with inflammation of
the internal membrane of the small intestines ; it should therefore be
called ^'' gastro-enteritisP

Second, — Inflammation of the internal mucous membrane of the small
intestines is sometimes seen in the dead body without any correspond-
ing state of the stomach ; but this isolated enteritis can never be posi-
tively recognized in the living body.

Third, — Gastro-enteritis presents itself in two forms, the one being
marked by the predominance of the gastric^ the other by the excess of
intestinal disease. The pain of stomach, the nausea, vomiting, and in

MILK- SICKNESS.

877

ability to bear nourishment characterize the gastritis ; the power of
satisfying the thirst, the rapid absorption of fluid swallowed, are signs
of the predominance of enteritis. The other symptoms are common
to both, with few exceptions.

Fourth. — Acute inflammation of the mucous membrane of the small
intestines, without afiection of the peritoneum, is not attended with
colic pain, in the majority of cases, but only with a sense of heat, or
malaise, or constipation of the bowels. Invaginations of this part of
the intestines seldom cause ileus, or even pain, except slight colic.

Fifth. — Colic, diarrhoea, and tenesmus are the proper signs of in-
flammation of the mucous membrane of the colon.

Treatment. — See Gastritis,

11. ENDEMIC GASTRO-ENTERITIS.— Intestinal Paealysis. Milk Sickness.

Milk-sickness is an endemic disease known only in certain localities
of the new and little cultivated parts of the Western States, unknown
to foreign authors.

The Disease in Animals. — In its active form the animal is affected
with universal tremor, lassitude and inability to make physical exertion ;
it is restless and anxious ;, the muscles are rigid and lose their power
of action, after being fixed for some time in one position. Cattle have
been mangled and torn by hogs while they lay trembling and un-
able to move. Thirst is ungovernable ; and the drinking of water only
hastens the fatal termination. The bowels are completely constipated
and there is a peculiar foetor arising from the skin. The appearances
on dissection show that the intestines have lost all vital power before
death ; and their contents are dry and parched. In animals the dis-
ease commonly runs for some time an insidious course, and its existence
is not suspected till the milk, cheese or beef is eaten. The first alarm
is often excited by the sudden seizure of the calf with the characteristic
" trembles " and vomiting immediately after it has sucked heartily.
Dogs, hogs and buzzards have been often found dead by the side of
dead bodies on which they had been feeding. Animals that recover
scarcely ever regain their former strength. We have seen dogs attacked
by the " trembles" after running, though they had been for many years
considered as fully recovered from the original diiease.

The Disease in Man, — When the quantity of the poison taken has
been small, there is at first only a feeling of weakness, stiffness of the
joints, especially the knees, trembling and anxiety, great depression of
mental and bodily powers, oppression of the stomach, nausea and con-
stipation. The pulse is slow and irregular, or excited as if by some ir-
ritating agent. In some cases the patient, by remaining quiet, may
escape the impending attack, but the slightest exertion develops the

878 DISEASES OF THE SANGUINOUS FUNCTION.

effects of the poison. Suspected animals, when offered for sale, are
tested by subjecting them to violent exercise, which speedily reveals
the presence of the poison by bringing on a paroxysm of the character-
istic ^Hrembles.''

In the more active form the patient is suddenly seized with vomitings
peculiar distress and burning at the pit of the stomach; anxiety, rest-
lessness, anxious and uneasy countenance, with great prostration.
Vomiting gives but a few minutes rest, when the same symptoms re-
turn. Unquenchable thirst calls constantly for water alone, which in
a few seconds is rejected by the stomach. All cold drinks increase
the vomiting, though it returns at regular intervals if nothing be taken.
There is a peculiar foe tor from the body which none can mistake who
have once entered a room pervaded by it. This symptom is often the
first to excite alarm, and purgatives are often resorted to, to avert the
dreaded attack. As the disease progresses, the extremities become
cold, though the heat of the chest and epigastrium is increased. There
is little apparent fever, though the skin is dry, without huskiness ; often
it is cool and natural. The face, though cold, often shows the external
appearance of high fever, with dusky purplish hue, showing want of
action in the extreme arteries, especially of the lungs. There is violent
palpitation of the heart, a peculiar burning distress, a feeling of heavy
nausea, or other extreme uneasiness at the pit of the stomach ; and this
organ being contracted into a globular mass by the spasmodic action
of its muscular fibres, is believed by the patient to contain a quantity
of some acrid substance that could be expelled by vomiting. There is
constant desire to change the posture of the body, and the limbs are
constantly thrown into new positions. The tongue is clea^n, though
slightly furred; pulse not much excited. The matters ejected from the
stomach are generally without color, sometimes dark-green, and of a
ropy consistence. In the latter stages of the disease, the symptoms
increase in severity; and though after four or five days the vomiting
ceases, the nausea still continues to be as distressing as ever. The
bowels seem to have lost all vitality ; the brain becomes implicated,
and there is a low muttering delirium, with great insensibility and
torpor of the whole system. In some cases the black or " coffee-grounds
vomiting'^ precedes the termination in death.

Diagnosis. — Milk-sickness may be distinguished from acute gastritis
by the constantly recurring vomiting, which in gastritis only takes place
when something is swallowed which irritates the stomach. The peculiar
foetor of the body and of the matters vomited is clearly characteristic ;
and the extreme torpidity of the intestines, as if from complete jpava-
lysis^i^ so different from constipation arising from deficiency of the
natural secretions, that it could hardly be mistaken in a district where
milk-sickness could be suspected. In late years congestive fever has

MILK-SICKNESS. 879

often simulated this disease, but the former is generally traceable to
the commonly-known existing causes of fever, and the manner of attack
in the two diseases is quite different

Cause. — The only cause of milk-sickness is a speoiJiG poison re-
ceived into the human system by the taking of animal food which con-
tains it. What this poison really consists of has never been definitely
settled. After reviewing many thousand pages devoted to the discussion
of the subject, I am satisfied that the cryptogamic vegetable theory is
the only one that can explain the immense mass of conflicting facts we
have collected. In 1840, Dr. Winans, of Green county, Ohio, gave the
opinion, " that the disease is produced by the Champignon, or at least
some of the mushroom tribe. It never prevails except adjacent to thick,
shady forests. When woods are cleared off, it vanishes ; and it never
prevails in prairies or open grounds of any kind." He says, he was led
to this opinion " by reading of the poisoning of some inhabitants of the
West Indies by champignons or mushrooms. Those gathered from
dense forests were poisonous, while others from open grounds were
eaten with impunity. I notice in our forests many mushrooms of small
growth and gaudy colors, some deep-red, others yellow or brown, I also
observe many growing upon beds of moss, of which animals are remark-
ably fond." '^

It is not probable indeed, that any of the large species of mushrooms,
which are common objects of botanical observation, can be proved to be
the cause of this mysterious disease; but there are vast numbers of
smaller fungi which escape the attention of naturalists, though all of
them are known to be poisonous. The localities suited to their growth,
their habits, minute size and well-established toxicological properties
indicate some species of the tribe as the probable source of this fatal
disease, which has furnished a subject of curiosity and wonder during
the whole of the present century.

Of the many supposed causes of milk-sickness it is not now necessary
to speak at length. In Eastern Ohio it has been attributed to the Galtha-
palustris^ or marsh marygold. In a part of Kentucky it was believed
to be caused by the Sympliorea-gloTnerata, On the Wabash it was
ascribed to the Eupatorixmh-ageritoides '^ and by others to the Hhus-
toxicodendron. In Tennessee Dr. Nagle recently reached the con-
clusion, that the disease could be artificially produced by feeding
animals with fungus-grass,\ But of all these plants it is sufficient to
say, that they all grow in profusion in places where tliis peculiar dis-
ease was never seen; and that they are all well-known, and have failed
to cause the disease in any authenticated case when fully tried. This

* Western Medical Journal. 1840. p. 191.
t Nashyille Journal. Oct. 1859.

880 DISEASES OF THE SANQTJINOTJS FUNCTION.

disease lias originated in places, wliere no unknown jylant^ large
enough to attract the eye of a botanist, could by any search be found.
The examination of mineral waters has led to no better results. The
sickening of some of Lewis and Clark's men on the first exploring ex-
pedition to Oregon in 1804, is referred to, as furnishing an analogous
case ; and the spring from which they drank was said to contain Cobalt
or Arsenic. More recently Dr. Evans, of Monroe county, Ky., has at-
tributed the disease to water in the vicinity of a lead-mine. But all
reasonings of this kind seem to be set aside by the fact, tha.t we have
often seen localities where milk-sickness has displayed its most fearful
powers and where no water of any kind could be found.

All observations yet published refer us at last to the poisonous
cryptogamic plants, perhaps^ those of the most minute size, for an ade-
quate cause of a disease involved in s.o much mystery.- All other
plants are better known, and, when rigidly tested, produce no disease
resembling the object of our present search, though many of them are
known to be poisonous.

Pathology, — In the most strongly marked cases, the first stage, or
that of depression, is probably one of congestion of the stomach and
large intestines, and this is followed by inflammation of these organs.
The torpor of the whole nervous system is such, that but little effect is
at^first produced by any remedy that has been tried. At a later stage,
gastritis and spasmodic or paralytic suspension of the functions of the
large intestines, especially the colon, prevents the passage through the
prima via of any thing taken into the stomach. The extension of in-
flammation to the diaphragm is pointed out by the hiccough, which,
though a symptom of gangrene in many other diseases, is not so here.
Some patients have lingered more than two weeks and then died with
the usual symptoms of gangrene, and yet on dissection there was no such
thing found, and death appeared to have resulted from complete ex-
haustion.

Pkogjstosis. — The disease is dangerous according to the violence of
the attack and the degree of influence exerted by medicines. Children
are less liable to take it, and they also recover more easily than older
persons. Intemperate persons are more susceptible than others, and
their cases are less manageable, in consequence of the impaired con-
dition of their digestive organs and the general enervation produced by
habitual stimulation.

Treatment. — The disease in its worst forms has hardly ever been
subjected to homoeopathic treatment. Nearly all who have encountered
it, have tried to restore the natural action of the stomach and bowels
by purgatives, and scarcely ever with success. Every thing given pro-
motes the persistent vomiting. Even Calomel is generally rejected,
and when retained, it produces little efiect. Enemas also fail to reach

MILK- SICKNESS. 881

tlie seat of the obstruction. When uiild purgatives and enemas have
re-excited the natural peristaltic action of the intestines, a slow re-
covery has followed ; active purgatives have always failed. Grotonr
oil has been often "tried, but it only increased the irritability of the
stomach without any purgative operation. Nux-vomioa would effec
the object by a different process.

It was long a popular and not unsuccessful practice in the Western
States to administer various animal oils, as lard, butter, goose oil, bear's
oil, &c. Another successful mode sometimes resorted to consists in
introducing into the colon, through the sigmoid flexure, a gum-elastic
tube about eighteen inches in length, and injecting through it a large
quantity of some warm oleaginous liquid. The best thing for this pur-
pose is chicken-broth. As soon as one, two or three quarts of this fluid
are thrown into the abdomen, which becomes largely distended with it,
the skin and the whole system give evidence of an immediate change
for the better. The relaxed skin is immediately covered by a gentle
perspiration ; the pulse rises in strength at the same time that it di-
minishes in frequency (from one hundred and twenty-four to eighty per
minute). All the soothing, relaxing influences of the warm bath, all
the benefits promised by the use of oils and mild purgatives, are directly
gained at the same time that the sinking powers of life are supported
by a nutritious fluid which is rapidly a.bsorbed from the whole surface
of the large intestine.

HoMGEOPATHio REMEDIES.— The most reliable will be found to be
Arsenicum^ Tahaoum^ Yeratrum, JVux-vomica and Antimoniitm.

ArseniGiiniy. — Countenance sunken, nose sha.rp, face pale, and covered
with cold sweat, expression of fear, anxiety, of utter misery ; lips and
tongue bluish, distorted by twitching movements ; tongue burning, or
cold and moist, white in the middle ; disgusting taste ; nausea extremely
distressing; appetite when returning, capricious, morbid; thirst un-
quenchable ; hard retching and persistent nausea before vomiting and
continuing constantly after it; constriction and cramp-like contraction
of the stomach ; vomiting always after drinking ; burning sensation in
the stomach with pain in the abdomen and nausea; pressure on the
epigastrium causes uneasiness ; burning heat in the intestines ; respira-
tion much oppressed, shortness of breath ; action of the heart weak and
quick ; hiccough ; hands and feet icy cold ; hands trembling ; hands and
forearms livid as in the cold stage of cholera ; coldness of the hands,
feet, face, nose and ears ; with great prostration and debility ; coldness
of the body can not be diminished by external warmth ; cold thick per-
spiration on the skin ; convulsive, small, rapid, irregular pulse, hardly
perceptible. Great physical restlessness and anguish ; eyes sunken ;
unable to lie still for a moment ; throwing himself here and there in-
cessantly, and tossing from .side to side; followed by relaxation and

Vol. I.— 56.

882 DISEASES OF THE SANGUINOUS FUNCTION.

physical apathy; sudden and involuntary muscular contractions;
paroxysms of fainting during which the coldness of the surface in-
creases ; emaciation, and rapid diminution of flesh.

12. ENTERITIS.

Under this head we shall proceed to describe two varieties of in-
testinal inflammation, the peritoneal and muscular, and that of the
mucous membrane. The older writers have confounded peritoneal en-
teritis with ordinary acute peritonitis ; but the researches of modern
pathologists have pointed out the true location and nature of these dif-
ferent maladies.

PERITONEAL ENTERITIS.

Diagnosis. — Lassitude, rigors, chills, acute pain in some part of the
abdomen, swelling and exceeding tenderness in the affected part, nau-
sea, vomiting, obstinate and persistent constipation^ urgent thirst, bit-
ter taste, loss of appetite, parched mouth, hot skin, inspirations short
and painful, position on the back with knees drawn up, and inclination
to preserve the recumbent posture, pulse frequent, tense, contracted^
and irregular, urine scanty and high colored.

The above symptoms will be modified according to the particular lo-
cation of the inflammation. If the small intestines are the principal
seat of the disorder, symptoms will obtain which simulate gastritis;
if the colon be the part affected we may expect symptoms resembling
hepatitis to be present. This form of enteritis is violent and rapid in
its course, and according to most writers is " particularly prone to ter-
minate in gangrene. When this termination is about taking place the
pain suddenly subsides, the pulse sinks rapidly, the countenance be-
comes, pale and cadaverous, the extremities cold, the surface covered
with a cold clammy sweat, and hiccough, slight delirium, and oc-
casionally convulsions close the scene. This affection is seldom pro-
tracted beyond the seventh or eighth day, without terminating either in
resolution or in death.'' {Eberle,)

Causes. — The employment of irritating cathartics like calomel, jalap,
croton-oil, aloes, scammony, colocynth, gamboge, &c., poisons, alcoholic
liquors, sudden suppression of accustomed discharges, repelled erup-
tions, worms, external injuries, persistent constipation, atmospheric
changes.

Treatment. — Arse7iioum, Yeratrum^ Aloes ^ Aconite^ J^ux-vom,^
Lyeopodium^ Opium, Ipecaoitanha, Sulphur, Plumh%im, Mhus-
iox,, Ac-Guprum,

Administration. — The principal remedies in the treatment of this-
malady are Arsenicum and Veratnim, They may be given at the

FOLLICULAR ENTERITIS. 883

third potency, at intervals of one to four ho-urs, according to the severity
of the symptoms. Should vomiting be very violent and persistent, after
the proper administration of Arseniciom or Veratrum^ recourse should
be had to Ipeoac^^ third attenuation. When the inflammation attacks
the large intestine, Aloes and Plumbicm may be given in some cases,
at the third dilution, after Yeratmim and ArseniGUTU, If the disorder
has arisen from repelled eruptions, or metastasis of rheumatism, gout,
erysipelas, &c., we may resort to 8ulphi07\ Rhus^ or AGrGuprum^ as
circumstances require. During the course of the disease AGonite will
occasionally be found useful in controlling the action of the heart and
arteries. It may be given at the second potency, either alone or in al-
ternation with another appropriate remedy, according to the symptoms.
Auxiliary to the above remedies, the employment of fomentations,
either of warm or cold water, as the case may demand, prove of eminent
service. Cloths should be wrung out, and applied over the affected
part, (care being taken to protect the body-linen and bed-clothes), re-
newing them once in fifteen or twenty minutes, when the inflammation
and pain are severe.

13. FOLLICULAR ENTERITIS.

StriiGtiire of the Gastro-Intestinal Mugous Membrane. — The
Epithelhiw, which lines the whole alimentary canal with all its ap-
pendices, even to the minutest ramifications of their tubes, also covers
the skin; it forms the surface of all the serous and synovial cavities,
and lines the heart, blood-vessels, lymphatic glands, and all other se-
creting surfaces* On the external surface of the body, it consists of
numerous layers of minute scales or laminae which are easily separated
by rubbing the skin with a flesh-brush. These scales are formed by
the drying of the vesicles or cells of which the epidermis primarily
consists. The structure of the epithelium which lines the mucous
membrane of the intestinal canal is essentially the same. It consists
of spheroid cells of very small size, each containing within it a roundish
oval nucleus, which is a hollow sphere, and sometimes encloses within
it a nucleolus more minute. They are situated on a primary membrane,
from which they appear to grow ; are bound together by a delicate tis-
sue, and are believed to perform important services in the function of
secretion. The epithelial cells are constantly undergoing the process
of further development. Those composing the outer layer burst and
discharge their contents, and the next layer of cells is pressed forwards
to supply the place of the former. '^New cells," says Sharpey, "arc
developed from germs contained in the iase^nent memhxme^ and are
formed and nourished from the blood which transudes fi'om the blood-
vessels beneath. No vessels enter the tissue of the epithelium, but the
nutrient fluid penetrates a certain way into the growing mass, and the

884 DISEASES OF THE SANGTTIlSrOTJS FUNCTION.

cells continue to assimilate this fluid, and pass through their changes
at a distance from, and independently of the blood-vessels." Even in
the finest' vascular network of mucous membrane, as well as in the mus-
cular structure, the nutrient fluid, on exuding from the vessels, has to
penetrate the adjoining mass by transudatioTij in order to reach and
yield new substance at every point where secretion or renovation is
going on.

As the mucous membrane of the alimentary canal performs the im-
portant function o^ ohsorjption^ and its covering of epithelial cells are
at the same timo the agents by which the secretion of mucous is ef-
fected, its structure must be highly complicated. The extent of its
surface is prodigiously increased by means of numerous folds and pro-
jections, as well as by the pits or follicular depressions dispersed along
its whole extent. And it is believed that the function of absorption
is, performed by the epithelial cells of the villi which cover the folds
and projections on this surface ; while that of secretion is performed by
those cells which line the follicular pits and depi-essions dispersed along
its whole extent. The villi, like the spongioles of the roots of plants,
are endowed with the peculiar property of selecting the nutritive fluid
and conveying it to the lacteals. These absorbents do not reach into
the extremity of the villi; and they do not open on the surface of the
mucous membrane by any appreciable apertures; but the end of each
villus is composed of a loose spongy tissue, in which a number oi cells
maybe seen in various stages of development, during the process of
absorbing the chyle.

In health this delicate surface of the mucous membrane is either of
a grayish-white or yellow color, from the coloring principle of the bile,
or of a darkish livid hue, from the imbibition of blood* It adheres
closely to the subjacent tissue, and can only be detached with difficulty.
The solitary glands of the small intestines and colon, as well as the
villous layer and the glands of Lieberkuhn, are invisible to the naked
eye. The patches of Peyer's glands may be distinguished at the ear-
liest period of life by their greater opacity when the membrane is held
up to the light. When distinctly seen they are always in some degree
diseased. The largest patches are situated near the ilio-csecal valve ;
the smallest are in the jejunum. They vary in number from 18 to ^Q
patches, and are referred by pathologists to atrophy of the mucous
membrane.

In the first stage of this follicular enteritis, when the disease consists
chiefly of an abnormal development of the mucous follicles of the di-
gestive organs, the fever and irritation can always be removed by
change of air, proper temperature and clothing, restricted diet with only
a few doses of Aconite and perhaps Calcarea-carb. or Merc. The
child should occupy a large airy room ; should lie on a mattrass rather

FGLLICTJLAE ENTESITIS.

885

than on a feather-bed; and cleanliness and comfort should be secured
by proper washings, bathings, &c. When there is much fever, dryness
of skin and restlessness, a warm baith procures better rest and dimin-
ishes the internal local disease. It may be repeated at intervals regu-
lated by the violence of the fever, and continued each time just long
enough to show evident relaxation. If the external heat should be in-
creased by the bath it will be found to have reduced the internal irri-
tation, and this is always a real gain which facilitates recovery.

The diet should be regulated with the greatest care. Nothing is so
good for a child in health, as the mother's milk when it is perfect; and
vy'hen her health is good it must be almost exclusively relied on, giving
reasonable care in her choice of food and attention to health in all
other respects. But there are cases in which the mother's milk acts
as a poison, even when her health is considered good. In these cases
it acts as a drastic purgative, passing off from the bowels in a curdled
state, undigested, but giving severe griping pain. Here it is necessary
to prohibit the milk entirely. Sometimes by changing the food for a
single day the cbild so far improves as to be able to bear the milk
again; but in other cases it never agrees with the child again.

Diagnosis. — -First stage, diarrhoea, succeeded about the second
day, sometimes later, by vomiting and remittent fever with evening
exacerbations. Pulse varying with the fever, small and quick, or full
and tense; slight delirium, when the brain is sympathetically affected;
there is then a fierce wild expression of the countenance, which at
other times is bright and animated; the stools are thin, watery, p^y,
or mushy, and variable in color, sometimes resembling mucus in color,
or like eggs chopped and scalded with water. The vomiting occurs
three or four times a day, the matters thrown up consist of the food
but little changedf or only mixed with mucus. The milk of the nurse
is thrown up in an acid, coagulated state. The skin is generally dry,
warmest on the head and abdomen, while the lower extremities are
cooler ; respiration little affected ; tongue moist, red at the tip and edges,
with a yellow or brownish coating toward its base ; sleep generally
quiet, except when the fever is highest; the child is then irritable and
restless. As the disease progresses the abdomen grows tense, tumid,
painful on pressure ; and the thirst becomes more intense.

CharacteristiGS of
FoLLicuLAK Enteeitis. Tubercijlar Meningitis.

Frequent discharges from the bowels.
The bowels are j?rmariZy affected. The
cerebral symptoms occur only in the
later stages of the disease ; there is then
drowsiness or stupor. The rattling- of

The bowels. are usually torpid j the
brain is the primary seat of the disease,
and it commonly occurs in delicate
scrofulous children. The pain in the
head is intermittent, and is manifested

DISEASES OF THE SANGUmOUS FUNCTION.

wiud in the stomacli and the lenticular
spots seen in typhoid fever are absent,
and there is agitation and delirium at
night.

by a peculiar cry, disturbed sleep, toss-
ing about of the hands, rolling of the
head from side to side, moaning, grinding
the teeth, delirium, and a peculiar ex
pression of countenance ; the drowsiness
and stupor often accompanied by con
vulsions.

Causes. — The heated, confined, and impure air of the city in summer
acts directly on the skin, and indirectly on the mucous membrane.
The irritation of the teeth during the process of dentition, produces in-
flammation and even ulceration in the lining membrane of the mouth ;
and since the same membrane extends throughout the whole intestinal
canal, the irritation is usually propagated along this delicate surfacej
producing indigestion, vomiting or diarrha3a; and at the same time there
is also increased development and activity of the muciperous follicles.
If this period of infantile life could be passed in a pure atmosphere of
a moderate temperature, the disturbance of the health caused by denti-
tion might not be very great; but it is always sufficiently so to strongly
predispose to disease, and to aid other agencies in exciting or perpe-
tuating diseases of the most serious character; and often such maladies
are excited by dentition alone. The other causes which originate the
fatal "summer-complaint" of cities and towns are: improper food
whether too stimulating or indigestible ; irritating drugs ; vicissitudes
of temperature ; insufficient clothing in the summer, when hot days are
succeeded by cool nights ; intestinal worms, and all other irritating
su^tances. originating in, or received into the digestive organs. But
in addition to all these causes which operate in the country as well as
the metropolis, there is certainly a zymotic or other poisonous miasm
in the air of all large cities, which conspires with bad diet, bad clothing
and inefficient medical treatment to originate this disease, as well as
render it more unmanageable when excited by other causes. A large
proportion of the cases in large cities occur in ili-ventiiated houses,
situated in courts and alleys in which bad air stagnates, and filth ac-
cumulates, where light is deficient, and where heat during the summer
months is intense.

Pathology. — Effects of Congestion. 1. In the mucous membrane.
The membrane presents a rose-red or cherry-red color, diffused in iso-
lated patches, or in arborizing trunks. It is diminished in consistency
but still adheres firmly.

2. The glands of Peyer, which occupy the free border of the intes-
tine, are rendered more red and prominent. These glands are only
mucous follicles which are not perceptible until about the fourth
month, or about the time when nature by pushing forward the teeth is
preparing the digestive organs to digest and assimilate a higher order
of food, they are found distributed over every part of the intestinal sur*

FOLLICULAB ENTEEITIS. 887

face, and each receives an artery, a vein and a nerve. These follicles
perform an active part in the process of digestion by furnishing the
surface of these organs with a fluid which assists in the elaboration of
the food. In carnivorous animals, as dogs and lions, they are largely
developed. From them is usually discharged the excess of mucous
fluids thrown ofi" by diarrhoea at the time of teething. In severer cases
of cholera infantum and follicular enteritis they are inflamed, and in
protracted cases are destroyed by ulceration.

3. Inflatnmation of the Peyerian Glands, — When this disease has
continued in the chronic form the patches sho^r gray -blue or slate-gray
color, contrasting with the mucous membrane, which is quite pale. The
tissue appears atrophied or elevated according to the stage at which
death took place. As inflammation of the Peyerian glands constitutes
the essential pathological basis o^ folliGular enteritis^ or summer com-
plaint] so a continnation of the same diseased action in the same
glands becomes the anatomical base of Tnarasmtcs or atrophy. These
inflammatory affections are extremely common ; whereas enlargement
of the mesenteric glands, aphthous formations, gastro-malacia, &c., are
comparatively rare.

4. Softening of the Intestinal Mucous Memhrane. — This patholo-
gical change of structure occurs more frequently in the small intestine
than in the colon. The adhesion* of the mucous membrane to the tis-
sue below it is lessened; it becomes oedematous, homogeneous, pulpy,
and easily lacerated. When this state continues long, the red color it
presents in earlier stages disappears, as the inflammation subsides.
The softened membrane becomes white, in the same manner as the
softened brain does in ramolissement, and from the same cause.

It is thus seen that acute inflammation of the Peyerian glands is the
most frequent and dangerous of the diseases of children during the first
and second years of life. That it is a real infiammation is proved by
the fact that tubercular disease is seldom complicated with it, inflam-
matory affections of the lungs and purulent effusion in the brain are
quite common, and frequently cause the fatal termination.

In children of a tubercular diathesis, secondary acute inflammation
of Peyer's. glands, as well as of the solitary glands, often occurs ; but it
is observed that abdominal tubercles and typhoid fever belong almost
exclusively to the second and later years of life ; whilst follicular ente-
ritis is peculiarly severe and fatal in the first year, which is to every
child, especially in the city, the most perilous of earthly existence.

" In summer complaint, resulting apparently from dental irritation,
the brain is predisposed to erethism ; it is sympathetically affected ;
the irritation of the terminal branches of the second and third divisions
of the fifth pair is transmitted through the pneumogastric and sympa-
thetic system of nerves, on the organs of assimilation, giving rise tc

DISEASES OF THE SAl^aUINOTJS FUNCTION.

the various phenomena of this disease." There are, however, cases in
which the affection of the bram is jprimary, " The fever, vomiting and
diarrhoea, together with the general malaise^ which are among the first
symptoms, seem to point unequivocally to derangement of the nervous
centres as the cause of impaired assimilation ; these symptoms always
originate from a brain lesion, whether induced by agencies operating
jprimarily upon the tissue of the brain, or secondarily from irritation
elsewhere.

PEoaNOSis.-— i^a^6>r(^5Z6.— When the pulse becomes slower, the skin
warmer ; when the vomiting ceases, the alvine discharges become more
frequent and natural ; a gentle perspiration appears ever the whole
surface.

Unfavorable, — The pulse continues quick, feeble and more ir-
regular ; the skin is cold, the discharges continue, increasing in fre-
quency and resemble the washings of meat; the uneasiness and rest-
lessness increase ; the limbs are tossed about in restless agony, or be-
come rigid and partially paralysed. Cerebral symptoms, as stupor,
and delirium increase. The pulse becomes imperceptible, the surface
cold.

Teeatment. — PrajpliylaGtiG. — When the hot weather of summer ar-
rives, examine the general condition of every child in which marks of
indisposition are noticed; and if convenient let each be removed to the
country, or at least to the most healthy situation attainable. From
the commencement to the termination of the process of dentition the
teeth should receive special attention. After the first teeth come
through, the child may be allowed a greater variety in food ; but what-
ever is used should be often prepared fresh, and never kept long enough
to permit it to undergo any change. Mucilaginous drinks, rice, barley,
farina, pure starch, toast-water, sago, tapioca, and many other articles
are in common use.

Medical Treatment.— Follicular enteritis is in its first stage an in-
cipient inflammation. As soon as all exciting causes of irritation are
removed. Aconite will be found a specific for the congestive stage of
the irritation and fever. It is indispensable when there is great heat
of the skin, thirst, sleeplessness, or agitated sleep ; fretfulness with in-
flammation of the mucous follicles imperfectly established. It may be
alternated with Belladonna when the head is the chief seat of suffer-
ing, or with Mercurius when the dysenteric symptoms are prominent,
or with Calcarea-Garlonica when the child shows imperfect develop-
ment, rickets, softness of the bones, slow ossification, or scrofula.

Second Stage, — -The disease if not arrested in its first stage advances
to the second, in which the same general features are presented, though
in an aggravated degree. The vomiting becomes less frequent, but the
alvine discharges are more painful, accompanied bv nausea and great

FOLLICULAR ENTERITIS.

prostration ; and the limbs are drawn up towards the abdomen. The
matters evacuated become more watery, stained with blood, or more
generally of a dark-green color. The abdomen now becomes tumid or
painful on pressure; its temperature increases while the extremities
are cool. As the disease progresses, the pulse increases in frequency
from one hundred and thirty to one hundred and fifty per minute, and
often intermittent, irregular or entirely imperceptible. Emaciation pro-
gresses till the skin hangs about the neck in folds ; the eyes are sunken
in the orbits, with a dark areola around each ; the nose becomes sharp,
the lips shrivelled, the feet oedematous ; the skin loses its sensibility,
and the flies are permitted to collect on the face ; petechias come out
on the skin ; the tongue is dry, encrusted and covered with aphthae ;
deglutition is painful; the mouth dry and the child thrusts its fingers
far back towards its throat. The appetite is capricious; thirst constant ;
an eruption of minute vesicles often come out on the chest. As death
approaches, the brain becomes more strongly engorged with blood;
the eyes are suffused, the lids tumid, conjunctiva injected ; the pupils
are generally dilated, though they contract on exposure to light; the
hand is frequently raised to the head ; twitchings of the mliscles, and
throwing back the head, portend convulsions, which often terminate in
death.

Pathological Appearances.'—A.Viio^^iGdX examination of children
who die of the disease at this stage, show: Inflammation and softening
of the mucous membrane; ulceration of the follicles, particularly of the
large intestine. The inner surface of the stomach is less changed,
though it is sometimes injected and softened ; the change of structure
extending to all the coats. More frequently there is found a layer of
whitish opaque mucous covering the lining membrane of the stomach;
the mucous follicles of the stomach and intestines are visible, the mu-
cous membrane of the latter being softened and pale. The duodenum
is often inflamed, presenting a shade of pink, with injection of the
minute vessels. The large intestine is generally inflamed and softened,
sometimes in bands extending longitudinally for several inches, injected
with fine arteries, and of a deeper red than the surrounding membrane.
In some cases the whole lining membrane of the colon is thickened and
of a vivid red. The follicles of the colon, having been the points first
inflamed, proceed to ulceration as the inflammation extends to the sur-
face around them. The rectum presents the deepest ulcerations ; its
lining membrane being thickened, inflamed, or covered with a thick
layer of mucus.

The brain or its membranes, in all cases after death consequent on
the above symptoms, present marks of active disease. The pia-mater is
more or less distended or injected. The arachnoid is pale and moist,
with effusion into the sub-arachnoid cellular tissue. When the brain

890 DISEASES OF THE SANGUINOUS FUNCTION".

itself has not been the seat of active inflammation, it is usually injected,
showing that congestion had existed at the time of death.

Treatment of FolliculaT Enteritis in the Third Stage,^—1. Aconite
is specific for the hot and dry skin, flushed face, tormina and tenesmus ;
pain in the head and back ; flushes of heat alternating with chills ;
burning pain in the abdomen ; eyes glistening and painful, suffused and
red ; urine high-colored ; alvine-discharges watery, frequent, attended
with nausea and exhaustion, manifested by paleness and perspiration,
followed by reaction and fever ; mourning and weeping.

Belladonna^ in alternation with Aconite, in all the periods of active
febrile excitement.

MerGurmis-solubilis, — This with other preparations of Mercury is
peculiarly applicable in cases in which the symptoms most resemble
dysentery in children that exhibit scrofulous tendencies, who are often
affected with glandular swellings of cutaneous eruptions. They are
pale, sickly ; precocious in intellect ; sufl'er much from slow and imper-
fect dentition, during which the superficial glands about the neck are
enlarged. When the intestines become slightly irritated from any
cause, the l-esulting inflammation assumes a dysenteric form. Consti-
pation is more or less complete ; and instead of natural faeces the evacu-
ations consist of bloody mucus, passed with pain, tenemus and nausea.
In other cases of cholera-infantum, in which the stools are watery and
of a dark-green color, frothy, or composed of undigested, chopped mat-
ter, mixed sometimes with dead lumbrici, Mercurius has given imme-
diate relief. When the chronic stage, usually called marasmus, com-
mences, when emaciation is progressing, and aphthous crusts begin to
form on the lining membrane of the mouth, Mercurius-sol. generally
destroys the parasites of which the crusts consist.

IpecaGuanha. — Serous diarrhoea, with vomiting of green or white
mucus, with much griping pain; nausea, eructations, flatulent colic,
faintness from excessive efforts to vomit, pain in the head relieved by
vomiting.

Bryonia. — Diarrhoea, thirst, and vomiting, caused by cold or by ex-
cessive hot weather. The heat is more internal than on the surface.
Digestion is imperfect ; all food disagrees, causing acidity, pain in the
head, pleuritic pain in the sides of the chest, constipation, dry cough
with quick, anxious breathing.

Bulcamara, — The diarrho3a is excited by exposure to cold, damp
air, and commences with cold and aching in the epigastrium.

Veratrum-album. Senna, Kreosotum, Tartar-emetic, Arsenicum^
chronic cases tending to marasmus. Iodine, emaciation, Argentum-
nitricum. Ehus-toxicodendron.

Cholera Infantum. — GrotonAiglium, Vomiting; purging; stools
watery; sunken countenance; cold extremities ; fever of remittent type

ACUTE PEEITONITIS. 891

stools light-colored, at times offensive ; emaciation ; cadaverous coun-
tenance; sunken eyes; stools resembling gray neurine and marked by
extreme and sudden debility after each evacuation, sometimes compli-
cated with dentition, and constituting that formerly called " nervous
diarrhoea," intermittent diarrhoea.^

14. ACUTE PERITONITIS.

DiAaiiTOSTS. — Three varieties of this disease have been recognized,
viz : first, acute peritonitis ; second, puerperal peritonitis ; third, chro-
nic peritonitis.

1. Acute peritonitis is usually ushered in with more or less of the
ordinary symptoms of fever, as lassitude, irregular chills, succeeded by
flushes of heat, headache, frequent pulse, uneasiness, or pressure in the
region of the stomach, nausea, and loss of appetite. These symptoms
are speedily succeeded, and occasionally accompanied by a pain and
tenderness in the abdomen, either confined to circumscribed points, or
universally diffused over its whole extent. Generally the abdomen is
exquisitely tender and painful upon pressure, often rendering the weight
of the bed-clothes intolerable ; but in some instances the pain is slight
from the commencement to the fatal termination of the malady. The
tongue is moist and covered with a white fur in the first instance, which
soon becomes dark and dry in the centre, with red edges. The bowels
are constipated, but may be readily acted upon by appropriate reme-
dies. The pulse is commonly frequent, tense, corded, wiry, though in
some instances it varies but little from the natural standard. This,
like most other inflammations of the abdominal viscera, imparts to the
countenance a contracted, sharp and anxious expression, indicative of
both acute physical and mental suffering. The patient inclines to re-
lax those muscles which operate upon the abdominal parietes, and on
this account we find him with his legs drawn up, his head and shoulders
elevated, and his respiration short, imperfect, and exercised almost en-
tirely by the muscles of the chest.

In severe cases of peritonitis we have acute pain diffused over the
whole abdomen, aggravated by movement or by pressure ; even the
weight of the bed-clothes is sometimes insupportable. The abdomen
is swollen and inflated with air ; the skin is hot and pungent ; the
pulse is frequent and small ; the stomach irritable ; the breathing hur-
ried, and the countenance expressive of acute suffering.

2. Puerperal peritonitis is that aggravated' and specific form of the
disease, which occurs in females after confinement, and is known as
puerperal fever. It differs from ordinary peritonitis in being more
gudden and violent in its attack and in having a tendena;y to run its

* 111. State Horn. Med. Association Proceedinci^s. 1860.

892 DISEASES OF THE SAKariNOUS FUNCTION.

course with greater rapidity. It occasionally rages as an epidemic,
and is by far the most agonizing and fatal disease to which women are
exposed after parturition. Among the first symptoms are pain and ten-
derness in the hypogastric region, occurring soon after delivery, and
succeeded by chills, &c. The lochia are generally entirely suppressed,
though some eminent authors assert, that they have found this dis-
charge but little affected and never entirely suspended. The secretion
of milk is also either partially or entirely suppressed ; and if the se-
cretion has not yet taken place, it does not occur at all. In many cases
of both forms of peritonitis the brain is affected at an early period and
demands special attention.

In regard to the precise character this malady may be likely to as-
sume, much will depend upon the peculiar constitution of the individual,
the season of the year, the prevalence of epidemic or contagious in-
fluences. "There is," says Dewees, "an entire extinction of the mater-
nal feeling," and this he regards as one of the most remarkable features
of the disease. There is also strangury with frequent efforts to evacuate
the bladder, producing constant burning pain.

8. Chronic peritonitis^ although often consequent upon a partially
subdued acute attack, may also arise independently from sudden chan-
ges of temperature, insufficient clothing, irritating food, external injuries,
surgical operations and chronic bowel-complaints. Many of the symp-
toms of this disease are like those of dyspepsia, as sensation of fullness,
distention, weight, and occasional pains in the region of the stomach
and bowels, constipation, loss of appetite, depression of spirits, restless-
ness at night, distress and pain, aggravated after eating, emaciation,
thirst, frequent pulse, foul tongue, &c. This form of peritonitis may
terminate in a few weeks, or it may run on for a year or more, and then
result in ulcerations opening into the intestines.

Causes. — Certain occult conditions of the atmosphere ; undue ex-
posure to cold ; excessive physical exertion ; injuries ; labor ; miscar-
riage ; over-exertion, when the organism is weakened by previous
disease; atmospheric vicissitudes; metastasis of rheumatism and gout;
suppressed discharges, &c.

Treatment. — The most important remedies in the treatment of peri-
tonitis are : Aconite^ Belladonna^ Bryonia^ Arnica, Bismuth,
Ghamomilla, Coffea, Golocynth, Ipecac, Mercurius, Nux-voin., Pul-
satilla, BhuS'tox., Sulphur, Yeratrum; Arsen,

Administration.- — We advise the employment of the first three at-
tenuations, and a repetition of the dose every one, two or three hours,
according to the urgency of the case.

In the treatment of acute peritonitis we have, in most cases, relied
upon Aconite and Belladonna in alternation, at the first dilution. We
believe that nine out of every ten cases may be cured with these two

ACUTE PEEITONITIS. 893

remedies. When the malady has made much progress, and the vitality
of the system has become much enfeebled, with weak and rapid pulse,
tympanitic abdomen, parched mouth and tongue, cold extremities, deli-
rium, and other phenomena of a typhoid character, Rhus and Arseni-
cum will be required. They may be prescribed in alternation, in the
second or third dilutions.

Should cerebral symptoms become strongly pronounced, in connec-
tion with a marked typhoid condition. Opium or Belladonna may be
required in alternation with Rhus or Arsenicum. Apis will be de-
manded in cases tending to result in dropsical effusions, and in cases
complicated with derangements of the kidneys or bladder.

Should diarrhoea ensue during the progress of the disease, we may
consult Arsenicum, Veratrum, Mercurius, and Ipecac.

Opium,-— lu some extraordinary cases of abdominal inflammation
some peculiar and little understood properties of Opium may become
highly important. The action of Opium on the cerebro-spinal-nervous
system is evident in the calmer and quieter condition of sufferers from .
peritonitis ; it renders the sensorium less impressionable and the system
less liable to be exhausted by the disease. Its action on the sympa-
thetic and vaso-motor nerves is probably similar, as it will relax con-
tracted arteries, and admit a freer transit of the blood. This is pro-
bably the rationale of its beneficial effects in the cold stage of ague,
and in similar conditions ; it does away with the . contraction of the
superficial vessels and skin. In many choleraic attacks, which , have
much resemblance at first to an attack of ague, a dose of Opium and
chloric ether is of the greatest efficiency. So in exposure to severe cold
and in gangrsena-senilis, the beneficial effect of Opium probably depends
on its preventing the arrest of the circulation in the limbs and super-
ficial parts, by keeping the arteries, especially the smaller vessels, re-
laxed a.nd patent. At the same time it protects the heart from the
.depressing, inhibitory influence of the cold, and so enables the circula-
tion to be well sustained. The latter remark will also apply to the
case of peritonitis and of the shock from burns. {Dr, (7. Handfield
Jones^ in Brit Med. Journal^ 1861.)

It is therefore a tissue sedative. If the action of the heart be in
danger of failing from asthenia, the administration of Opium in my
opinion is unsafe from this very sedative effect. Yet where the de-
pression is the result of violent irritation in another part, as for instance
in peritonitis, the action of the heart may greatly improve under the
Opium. The narcotic, by rendering the cardiac ganglia less impres-
sionable, takes off all the inhibitory effect of the peritoneal irritation.
{Jones on Tissue Sedatives. British Med. Journ. — See Symp-
toms of Opium, pages 706, 710.

In peritonitis from rupture of the gall-bladder, strangulated hernia,

894 DISEASES OF THE SAlJ^GUmOUS FUNCTION.

rupture of the uterus. Opium in tlie necessary doses to control tlie pain
furnishes the only reliance generally thought of.

In two cases of peritonitis after tapping, when the patients were in a
low state previous to the operation, large doses of Opium, without loss
of blood, removed the inflammation and saved life. — In such cases the
patient is generally cachectic, and labors under visceral obstructions ;
and collapse generally follows the operation. In one case, Dr. Graves
tapped a woman, who was apparently in the last stage of ascites. The
operation was followed by peritonitis ; there was constant vomiting,
hippocratic countenance, cold extremities, abdomen exquisitely tender,
pulse one hundred and sixty per minute and scarcely perceptible. Dr.
Graves gave one and a half drops of Laudanum, expecting only to pal-
liate the pain. The patient fell into a sleep from which she awoke
refreshed, with a warmer surface and fuller pulse. Opium in small
doses often repeated cured her.

Peritonitis from Escape of the Intestinal Contents into the
Peritoneum. — Opium, When there has been perforation of the in-
testine, by ulceration or otherwise, and escape of fecal matters into the
serous cavity of the peritoneum, or when there has been discharged into
that cavity the contents of an abscess, or when peritonitis follows the
operation of paracentesis abdominis in debilitated subjects, there is
usually no resource but Opium.

Dr. Stokes says ; " A more appalling calamity can hardly arise than
perforation of the intestine and escape of its contents among the bowels,
with the rapid and exhausting peritonitis that will follow. It generally
occurs in the course of a wasting disease, as typhoid or enteric fever."
The only indications are, to support strength and prevent further effu-
sion, so that nature may have time and opportunity to surround what
has been already extravasated with coagul able lymph. Large doses
of Opium may effect these objects. The operation of a purgative is
certain death.

14. DYSENTERY.

Perhaps no disease known to American practitioners annually causes
more deaths than dysentery. It is almost constantly present, in every
season, and almost every locality. In malarious districts it appears
as a form of remittent, typhoid, or congestive fever ; when the causes
of scurvy exist, the scorbutic affection takes the dysenteric form as the
most direct to a fatal termination; and everywhere the usual causes
of fevers and inflammations excite the common form of intestinal in-
flammation known by this name. In 1860 the number of deaths from
dysentery in the United States was 10.461.

In tropical climates the American seaman finds dysentery his most

DYSENTERY. 895

formidable enemy. At one time, in the East Indies, the U. S. Ship
Constitution had one-half of her crew afiected by dysentery ; and
scarcely a vessel returns from the tropics without bringing back a
number of dangerous cases. American seamen, accustomed to full
diet and free use of stimulants, suffer more, perhaps, than men of any
other nation from inflammatory and febrile diseases in hot climates.

Diagnosis. — This disease sometimes commences with griping ;pains
in the 'bowels^ with freguent discharges of rmteus mixed with hlood^
attended during the evacuations with m,ore or less straining am.d
burning pain. After the first two or three evacuations n'othing but
mucus or mucus and blood are passed. Occasionally the griping and
diarrhoea are preceded by lassitude, chills, weakness, and pains in the
limbs, thirst, bad taste in the mouth, furred tongue, hot and dry skin,
frequent and hard pulse, anxiety, and general restlessness. The dis-
ease is peculiarly apt to be ushered in with these last-named symptoms
when it has been caused by sudden suppression of perspiration, atmos-
pheric vicissitudes, or miasmatic influences. The appearance of the
fluids discharged will depend much upon the climate, temperament, the
exciting cause, and the particular portion of the intestinal canal af»
fected. If the small intestines are chiefly disordered the evacuations
will consist of dark watery matter with mucus and blood, while inflam-
mation of the colon and rectum will give rise to discharges of pure
onuGus and bloody preceded and attended hy distressing tormina
and inclination to remain a good part of the time at stool. These
discharges, which are highly offensive, afibrd some temporary relief to
the patient, only to be renewed with increased severity. There are
tenderness of the bowels on pressu/e, pain and burning in urinating,
inclination to lie upon the back with the knees drawn up, great de-
pression of spirits, short and painful inspirations, universal heat and
dryness of the skin, more or less derangement in the function of the
liver, indicated by a jaundiced hue of the skin, and the absence of bile
in the evacuations ; rapid emaciation, loss of strength, and increasing
disinclination to physical effort. As the disease advances towards a
fatal termination the countenance assumes a contracted and cadaverous
expression, the pulse sinks, the evacuations become more foetid, and
are discharged involuntarily, the pains abate or cease entirely, a cold
sweat occurs, hiccough, delirium, cramps, and extreme prostration ob-
tain, and then death.

Dysentery is distinguished from haemorrhoids by the fever and in-
flammation which attends dysentery ; its rapid and peculiar course ;
the character of the discharges, which, in haemorrhoids, though marked
with blood, are otherwise natural ; by the well-marked hsemorrhoidal
tumors, which are not attended by the cutting pains in the abdomen
which attends dysentery.

DISEASES OF THE SANGUINOUS EIJNOTION.

Caijses, Eem;ote. — -Sydenham says, researches after the remote
causes of disease "feed the vanity and engross the thoughts of curious
inquirers ; their discovery is impossible." In a great part of our
country the remote cause of dysentery is the same as that of bilious
fever — that poisonous miasm already treated of rnider Mal(wia,p, 4:77,
In exciting dysentery its malignant powers are exerted, mainly, on a
different set of organs ; but its nature is essentially the same. Dr.
Calhoun, in his edition of Gregory^ s PraGtice^ says dysentery is gene-
rally a form of bilious remittent fever ; and in this opinion all Ameri-
can authors agree. It is endemic in all localities where marsh fever
prevails {Hodener^ Williams^ Wagner), In places calculated to
develop malaria and diffuse it in confined air this disease is rapidly
propagated ; it is even said to become contagious in some peculiar
conditions. It spreads most rapidly in prison-ships, jails, camps, poor-
houses. It is increased by famine, hardships, and the breathing of air
contaminated with vegetable and animal effluvia ; and, under such cir-
cumstances, typhus with petechia and hospital gangrene are common.
The potent agent which is capable of communicating the disease seems
to be so highly volatile as to be carried in the atmosphere, as it is
clearly conveyed by the exhalations from the close privies used by
those suffering with the disease. The close alliance between dysen-
tery and other malarious or epidemic diseases shows that its origin is
in some way similar to theirs. Epidemic dysenteries are frequently
preceded or followed by cholera, or fever of a typhoid character, in the
same patient.

Among the predisposing causes may be mentioned : cachectic con-
dition, constipation, frequent abdo!hinal diseases, dropsies, scurvy.

Exciting Causes.— Cold, chills, exposure to cold damp air ; sleeping
in the open air and on wet ground. Some kinds of food are peculiarly
liable to excite it. Fresh pork has done it in many cases known to
us. In hot climates the exemption which the Jews are said to enjoy
from dysentery has been attributed to the dietetic prohibitions of the
Mosaic Law; and the prevalence of the disease among Negroes is
often attributable to their use of crude and indigestible food, green
fruits, melons, cucumbers, bad water, excessive quantities of strong
food, &c. Ripe fruits are generally innocent, and in some instances
curative (Tissot), In the South, where great numbers of negroes are
annually carried off by epidemic dysentery, it has often been arrested
by allowing them to eat freely of ripe blackberries. Dr. McLeod, of
the U. S. Ship Constitution^ says the French on the East India sta-
tion had to a great extent avoided dysentery, by allowing none but
distilled water to be drunk, or otherwise that which had purified itself
by spontaneous fermentation in the course of at least two months. {Dr
Harris^ Chief 'Bureau Med, and Surg.^ IT, 8, Navy,)

DYSEISrTE.EY. 897

Pathology. — The results of dissection show pathological changes
in various abdominal organs, which, according to their frequency, are
arranged under the following heads :

1. The cases in which appearances of inflammation are confined to
the internal surface of the caecum, colon, rectum, and a small portior
of the ileum.

2. Cases in which they are confined to the internal surface of the
caecum, colon, and a small portion of the termination of the ileum.

3. Cases in which these appearances are confined to the internal
surface of the csecum and colon.

4. Cases in which the internal surface of the digestive tube, through-
out its entire length, shows traces of inflammation [O'^Bierne^ p. 79).

The primitive seat of dysentery is the mucous membrane of the
intestinal canal, and its nature is strictly inflammatory. The disease
is not a mere " colitis," as given by the author of that article in the
DicL Med. Ghirur, Pratiques, Constipation is usually the first
symptom ; the contents of the lower intestines become hard, indurated,^
irritating. Nature then tries to throw off the burdensome scybalaij
and glairy mucus and bloody serum come away with pain and strain-
ing. The first morbid actions which produce it consist in the determi-
nation of blood from the surface of the body to the abdominal organs,
particularly the liver, stomach, and intestines. The small intestines
receive more arteries and veins, and they are more highly organized
than the large ; and there is perfect freedom of anastomosis between
all the arteries, and an absence of valves in all the veins of both small
and large intestines. Of the blood diverted from the surface, the
small intestines then receive more than the large ; and the acrid and
vitiated bile formed at this stage must pass along the irritated sur-
face of the small intestines, and must generally excite or exasperate
inflammation.

The nature of the disease is, first, of a congestive, secondly, of an ir-
ritative, and lastly of an inflammatory character. The general pheno-
mena presented by an ordinary attack of dysentery clearly illustrates
its pathology. Exposure to cold, or cold and damp air when the body
is overheated, repels the blood from the surface to the internal mucous
membrane, which is 'closely united with the skin by sympathy. The
congestion of the internal organs is marked by rigor, want of ap-
petite ; nausea, and paleness of the skin. This engorgement of these
organs breaks up the equilibrium between the vascular and nervous
systems, and soon the latter becomes excited in an equal degree with
the former. This is the irritative stage, which is marked by the be-
ginning of the wandering tormina, but there is as yet no effusion of
blood, but all the hepatic and intestinal secretions are arrested* When
the patient at this stage suddenly dies from some other cause, "the

You L— 57.

DISEASES OF THE BANQVTNOVB jrU^STCTION.

solitary glands in the rectum, sigmoid flexure of the colon, or the coecum
are swollen, forming round prominences on the surface of the mucbus
membrane, varying in size from a millet seed to a full-sized shot. These
prominences are of a uniform pale-red color, or have a ring of bright-
ness on their base, or present this evidence of vascular turgescenc^
only at their summit." {Baly.)

InflammatoTy Stage. — The whole mucous membrane of the entire
digestive canal, with the continuation of this membrane lining the bili-
ary and pancreatic ducts in all their ramifications, become involved
in inflammation. From this extensive surface the morbidly sensitive
secreting vessels pour out vitiated and irritating secretions. The eflu-
sion of blood from the intestinal surface might be expected to relieve
the engorged organs ; but the whole contents of the intestines are too
acrid and irritating to pass forward without adding to the general distress^
The small intestines are excited to irregular spasmodic contractions,
which cause intense cutting pains called tornhina. Thus do the origi-
nal contents of the bowels and their acrid secretions reach the large
intestines, to which they, are generally very promptly admitted by the
ileo-c9ecal valve.

The Condition of the Large Intestines in dysentery, in which the
chief characteristic feature of the disease consists, has been imper-
fectly explained by pathologists. Dr. O'Bierne of Dublin approaches
a clear exposition of the subject, and we will modify his ideas to meet
our own. {See New Views of the Process of Defecation^ Pathol.^
<&G.^ .Diseases of Stomachy Bowels^ c&c. 1884. p. 81.)

In all ordinary states of health the rectum is firmly contracted, but
easily gives way to the gentle pressure by which the bowels are eva-
cuated. . As soon as the inflammation which constitutes dysentery be-
gins the whole mucous surface of the rectum is involved in it ; and, be-
coming exquisitely sensitive, it contracts with spasmodic power, and
prevents the passage of all solid substances, permitting only fluids, as
blood, mucus, or flatus to escape. The bowels are indeed completely
constipated. The contents of the upper bowels then being passed
freely forward to the csecum and colon, arc retained within these ca-
pacious sewers of the body, being prevented by the ileo-c83cal valve
from returning into the ileum. This "principle of accumulation of
faeces in the caecum and colon" is applicable to many other diseases, but is
peculiarly important and characteristic in dysentery. Here alimentary
matters, blood, air, and vitiated secretions are propelled forward by in
creased peristaltic contractions behind. The lining membrane of the
colon is already inflamed; and it now becomes subjected to a high
degree of mechanical and chemical irritation. This irritation and dis-
tention soon arouses the abdominal muscles to frequent and violent ex-
pulsive efforts ; but they are generally ineffectual ; for the upper an-

DYSENTERY.

nulus or entrance of the rectum is inflamed in the same degree as the
surface of the colon, and is so excessively irritable that the pressure of
the harsh matters above only excite it to more violent contraction.
Even the blood and mucus which are constantly being discharged are
to a large extent poured out from the inflamed surface of this upper en-
trance of the rectum. It is the point which presents the greatest dif-
ficulty in the treatment of dysentery ; and just here ulcerations are
more frequently found after death; though they are found in every
portion of the csecum, the transverse arch and sigmoid flexure of the
colon. The ulcerations would be found much more numerous and ex-
tensive, did not nature make an efl'ort to arrest the activity .of the in-
flammatory process, first by a diminution in the activity of the secretory
functions of the small intestines, which no longer pour out such large
quantities of acrid and vitiated secretions ; and secondly : the inflam-
mation of the mucous membrane of the upper annulus of the rectum
becomes extended to the^muscular structure of the same organ. These
muscular fibres becoming weakened by disease have less power to keep
the cavity so obstinately closed ; hence some fluids, as blood, mucus,
flatus, and some fluid . faeces are permitted to escape, as the disease
progresses to a chronic form. Some solid as well as fluid fgeces and
sometimes purulent matter are permitted to pass.

Tlie Condition of the Small Intestines is very diiferent from that of
the large intestines. From the beginning of the attack they relieve them-
selves from the presence of their contents, with all the morbid secre-
tions poured out by their own vessels. The blood poured out from the
minute vessels on their inner surface relieves in some degree the en-
gorgement with which the disease commenced. And it is only in the
lower part of the ilium, when the c^cum and colon are so fully dis-
tended as to admit further accumulations reluctantly, that alimentary
matters and morbid secretions can stagnate and produce any great
degree of local irritation.

Condition of the Sectuin, In the early stage its "mucous mem-
brane is attacked by inflammation simultaneously with that of the whole
superior portion of the canal, and copiously pours out blood and a vitiat-
ed mucous secretion;" but its great muscular power enables it to pass
ofi" these fluids and discharge them, being in some degree relieved by
the efi'usion of blood from its surface. But in later stages, when the
disease advances towards a chronic form and ulceration extends to
the upper annulus of the rectum, the whole of this intestine becomes
similarly affected, and, in many chronic cases, it is extensively dis-
organized. (O^Bierne^ p. 84.)

Apjpeara7iGes of the Mucous Membrane, — Redness and swelling of
the plaits of the membrane ; infiltration of sub-mucous cellular tissue,
redness and softening, disposed to bleed ; " the epithelium of the mu-

900 DISEASES OF THE SANGUIJSTOr H FUNCTION.

cous membrane is elevated into small miliary vesicles, and is cast off in
minute portions, or is easily detached," the membrane beneath appear-
ing excoriated. The swollen solitary glands are surrounded by deep
and extensive redness, and some of the prominent points are disor-
ganized. As the disease progresses the color of the mucous membrane
becomes of a rose^ or hright red, or reddish brown. The disorganized
portions form minute yellowish sloughs, easily separated from the sur-
rounding tissue. The mucous tissue is macerated to softening ; the
layers continually extend in depth, and larger portions are excoriated
or laid bare, leaving small ulcer-like cavities in the spots previously
occupied by the enlarged glands. The softening extends over the sur
face in large stripes or in smaller circumscribed spots. [Humphreys^

P- 13-) . . \ . .

Changes in the Intestinal Follicles.'— 'Ero\^ the sixth to the tenth
day they become dilated, and form small ulcers, covered with a pseu-
do-membranous material. Numerous dark points are found along the
whole length of the large intestine, discernible with the naked eye,
surrounded by whitish plain broad elevations, which mark the m.ouths
of swelled follicles. The surrounding membrane, besides being red
and tumid, is covered with a rough layer, composed of epithelium and
fibrine. Frequently the central dark point is replaced by a small
grayish ulcerous opening which leads to the base of the krypt. Some
of these ulcers are two or three lines in diameter. {Gely,) ^' These
small ulcers," says Baly, "are produced.by a process of mortification,
and not of ulceration."

The serous infiltration penetrates by degrees into the muscular tis-
sue ; hence the intestine may become thickened to extend from three
to five lines; at the same time the muscular coat contracts and presses
the folds of the mucous coat inward, producing a hypertrophied ap-
pearance. As the disease advances, some parts of the surface become
overlaid with a dark-red or brownish scurf which adheres firmly and
degenerates into a dark substance which is thrown off in tubular patches,
called spacelated membrane. "From the destruction of the mucous
membrane the muscular and even peritoneal folds may be exposed, and
even entire perforation at times be produced." {Humphreys, 15. Ho-
Jcito/nsJcy.) If death does not occur at an early stage and the disease
assumes the chronic form, the ulcers enlarge and secrete a quantity of
transparent opaque or yellowish fluid. [Baly)

This disease, as we meet it in the malarious portions of the Western
States, is usually more fatal than any other form of febrile affection. For
at least twenty-five years it has been the disease most frequently en-
countered, and, through many years of that period, the disease most
dreaded we h>ave always found it curable by any treatment that dislodged
hardened scybalae or masses of faeces from the colon; and long ago

DYSENTEEY. 901

learned to regard tlie inflammation and ulceration of the colon at or
near its termination in the rectum as the cause of death in nearly all
fatal cases. Dr. Bowling, of Southern Kentucky, says, that after much
unsatisfactory experience, he examined the body of a negro, who had
died suddenly. ' The usual a.ppearances were found,. including the con-
gestion of the portal circle and inflammation of the colon. The celk
of this intestine contained a quantity of hardened faeces, covered with
tenacious glassy mucus, which seemed to confine the scybalse to the
cells. The tormina and tenesmus, excited by the spasmodic efforts to
expel these irritating masses, "had been distressing beyond the power
of description ; and death had seemed to result from the violence of
the pain rather than the termination of the disease. I do not now be-
lieve these scybalse to be the cause of the disease, but I do believe
that accumulations in the colon are the cause of death." ( West, Med.
Jour, 1840, p. 166—173.) .

At a late stage of the progress of a severe case, says Dr. Baly, of
the Millbank Penitentiary, " the small sloughs enclosing the solitary
glands are found to have been thrown off; the thin superficial layer of
the surrounding mucous membrane which had lost its vitality, is also
gone, leaving erosions of the surface ; and the mucous membrane with
the sub-mucus tissue is in most cases much thickened and turgid with
blood and serum. The cavities which contained the spacelated solitary
glands appear as small round ulcers with sharply cut edges, resembling
holes made with a punch, and give to the inner surface of the intestine
somewhat of the aspect of a worm-eaten piece of wood." In some
places the ulcers communicate with each other at their deepest part,
and in others they coalesce in their whole depth, after the destruction
of the septa of mucous membrane, which had previously separated
many small ulcers. When the intestine is only partially affected, the
rugge are the portions chiefly occupied by the small ulcers. The large
ulcers also are usually situated on the same prominent parts, and these
commonly extend in depth to the muscular coat, and often perforate it as
well as the serous coat. There are other cases of equal severity, in
which morbid results of a different character are found after death.
The entire mucous membrane appears in these cases to be simultane-
ously destroyed in larger or smaller tracts ; the inflammation spreads
more uniformly over the surface, the membranous folds become gan-
grenous and detached, leaving large ulcer-like excavations, (Baly^ on
Dysentery^ p. 10.) In young adults, previously healthy, the mucous
membrane around the gangrenous parts is intensely red, but in old and
feeble persons it is often pale. At an early period the sloughs are
dark-green in color and of firm consistence, but detached and leaving
irregular excavations. In all parts of the intestinal mucous membrane,
except the caecum, the disease expends its principal force on the trans-

902 DISEASES OF THE SAISTaumOUS FUITCTIO]Sr.

verse rugae and other prominent points of the surface ; but the csecum
which is nearly devoid of rugae- is frequently the seat of dysenteric
ulcers, which, "whatever their size or shape, originate by a process of
sloughing and not by simple ulceration." {^Baly)

" Two forms, then, of structural change attend cases of acute dysen-
tery of the second degree of severity. In the chronic stage they still
retain distinctive characters. In the one we have large ulcers of ir-
regular shape, chiefly occupying the situations of the rugae and longi-
tudinal bands, while in the other the predominant feature is constituted
by the small round ulcers. When the inflammatory action has con-
tinued long in a sub-acute form, the sub-mucous coat in both cases is
found thickened and, at an advanced period of the disease^ much indu-
rated in the situation of the ulcers. The contraction of these thickened
parts in the manner of the cicatrices of burns, is sometimes productive
of stricture of the intestine."

When the lower part of the intestine is the seat of the disease, "a
tolerably accurate estimate of the extent of mucous membrane affected
may be formed from the mere quantity of bloody mucus discharged.
The source of this bloody and mucous discharge in the acute stage of
dysentery is not the solitary glands, but, the tubular follicles of the
mucous membrane. The granular matter contained in the solitary
glands is composed of solid particles of flattened figure, and strongly
defined outline, resembling the nuclei of certain cells or globules ; the
contents of the cells sometimes' consist of epithelial particles; at other
times they are composed of round nucleated globules exactly resem-
bling those of mucus. " Now the bloody mucus discharged in dysentery
is composed of such nucleated globules, generally mixed with numerous
blood-discs. Sometimes the globules are seen here and there still con-
nected together in a cylindrical mass, such as they form while in the
tubular follicle ; the puriform matter occasionally discharged in dysen-
tery has probably the same source. In the'chronic stage of dysentery^
also, pus or a puriform matter is often excreted. But here this matter
seems to have a difierent source, it probably comes in the severer cases
from the' enlarged and diseased solitary glands, and in the most severe
cases from the numerous ulcers, which have been left after the destruc-
tion of the glands, and of smaller or larger portions of the mucous mem-
brane." {Baly, on Dysentery, London, 1847. p. 120.)

PnoaNOSis. — The prognosis will vary according to the climate, the
location, the season of the year, the constitution of the patient, and its
complications with typhus, cholera, or other maladies.

Hot and alluvial regions, abounding in luxuriant vegetation which is
constantly undergoing decomposition, and filling the air with miasmatic
particles, predispose the system to dysenteric affections, and serve to
render them violent and dangerous. Low, marshy, and damp situations

DYSENTERY. 903

favor the formation of the disease more than elevated and dry locations.
It is far more common, severe, and fatal in the months of July and
August in this country, than at any other season of the year ; and it is
rare that individuals who are strongly predisposed to it entirely escape
during these months. When it is succeeded or accompanied with typhoid
symptoms, or when it occurs as a symptom of typhus fever, it may be
looked on as a malady of the most dangerous character, and one which
will require the most judiciously-directed resources of our art. In
these instances w^e have to combat, not only the local intestinal dis-
order, but also constitutional symptoms of the greatest severity. During
the prevalence of Asiatic cholera, dysentery has been observed to as-
sume a more malignant form than in those years when this destruc-
tive epidemic .has not prevailed. While the cholera was destroying its
thousands weekly in our large cities, during the summer of 1849, a
malignant dysentery prevailed in most of the smaller cities and towns,
sweeping off numbers entirely unprecedented. In these last examples,
the epidemic influence was not sufficiently active to generate the actual
cholera asphyxia, but it conduced to aggravate, very materially, the
type of dysentery. The constitution and previous health of the
persons attacked often determine the degree of danger. Young
children, pregnant feAales, and very old persons are considered least
likely to recover. Abortion is very often excited by the disease ; and
in some epidemics it is generally followed by puerpural fever which is
often fatal. In those rapid cases in which gangrene speedily follows
inflammation, the mucous membrane is swollen and of a dark purple
color, its texture is disorganized, the color black, green or brown. In
these cases death results in a very short time.

Unfavorable symptoms are : extreme severity of the attack, evinced
by high inflammation progressing rapidly ; at a later stage the dis-
charges are mixed with fragments of cast-off epithelium, pseudo-mem-
brane, bloody water, and gangrenous exfoliated membrane ; dark
brown fluid with cadaverous smell, or coffee-ground deposits. An eva-
cuation recurring at regular intervals of reddish or dark-colored water,
or resembling the washings of fresh meat, indicates well-established
local inflammation kept up by hardened masses of faeces, which harsh
purgatives can not expel, and yet, which always terminate in complete
exhaustion and death, when the offending mass is permitted to remain ;
great exhaustion ; increase of the cutting pains ; distension of the ab-
domen ; vomiting in later stages ; increased agitation ; hiccough ; cold-
ness of the skin and tongue ; pulse above 120 per minute and increasing
in frequency, becoming small and irregular; delirium; paralysis or
lower extremities; sunken lead-colored face; ecchymosis; putrid aphthgej
sudden cessation of pain; increasing emaciation ; colliquative diarrhoea,
&c. When life is prolonged, as it often is for several weeks, the de-

904 DISEASES OF THE SA:NGUrN"OUS FUKCTIOK.

stroyed parts of the membrane become softened, and the sloughs sepa-
rate. "It seems scarcely possible," says Baly, "that life should be
long maintained with a portion of the alimentary canal in such a state
as this ; but where the gangrenous process has not affected the coats so
deeply, the patients survive for some time the loss by sloughing of the
mucous membrane, and of the sub-mucous tissue, through more than half
the length of the large intestines."

Teeatment. — The first object is to counteract all the unfavorable
circumstances in which the disease originated. Pure air, cleanliness,
perfect rest, and prompt removal of putrid effuvia from the evacuations
are indispensible. While the air of the room should be moderately
cool the skin should be kept comfortably warm, and every care taken
to avoid all expenditure of strength; all rising from the, bed should, if
possible, be avoided.

The diet should be restricted to the most mild and unirritating ar-
ticles. Well-cooked milk and flour-gruel have been generally allowed;
but it is better to give at first no animal food whatever^ Barley-water,
gum-water, slippery elm-water, mucilaginous articles, such as sago, or
the finest grueV of farina, pure starch, arrow-root, oat-meal or rice-flour
will furnish a sufficient variety till the disease is arrested. Of fruits
the finest grapes or black-berries, fully ripe, ar^ freed from the seeds
and hulls are almost the only ones that may be considered safe. These
and also whortle-berries are known to often cure dysentery. In Europe^
the use of fruits was proved a century ago to prevent as well as cure
dysentery. (Tissot) In SGorbutio epidemics they are sometimes found
specific remedies. Mutton broth, from its mild, oily qualities, has been
often prescribed, but we have very often seen the disease excited by
broths and soups of different kinds, and regard all fresh meats and all
preparations of them, as dangerous in every stage of the disease. Milk
and farinaceous articles are allowed by nearly all writers.

Deinks. — Pure water made mucilaginous with slippery elm, gum-
arabic, or by beating up the albumen" of an egg in ^ pint of water, toast
water or black tea, weak, are as good as any thing for drink. But all
drinks should be moderately warm, oiever cold. The treatment of
dysentery by cold drinks, and ice-water injections is founded upon a false
view of its pathology; and, although it is still persisted in by many who
have charge of public hospitals, as well as in private practice, it causes
uniformly increased suffering and cures none, though some of the mildej
cases may survive its pernicious influence.

On ship-board in hot climates the .subject of hygiene becomes in the
highest degree important. Dampness exists everywhere through all
the apartments; and frequent washings are required to keep the ship
in a state of sufficient purity. It it now considered most judicious to
flood the decks with water and wash them thoroughly when the weather

DrSENTERY. 905

is bright, ancl evaporation will be rapid; but when cold damp raw
weather prevails, the health and comfort of the crew is best promoted
by dry cleaning. Lord Collingwood, the model naval commander, re-
lied chiefly upon "attention to keeping the ship dry, (rarely permitting
washing, even between decks), frequent ventilation of hammocks and
clothes, and circulation below of fresh air." {Memoirs^ p. 266.) As
the result of this system he reports in October, 1803, "H. B. M. Ship
Venerable, eighteen weeks at sea, very rotten. On sick list none.'^
"H. M. Ship Ocean, off Toulon, May 15, 1808. Long time at sea, never
getting fresh beef nor a vegetable; not one man sick." {Mem., p. 265.)
"This flag-ship had usually 800 men; on one occasion was more than
a year and a half without going into port ; during that time never had
more than six, and generally but four on the sick-list." {Ibid, p. 266.)
If similar results can not be reached in tropical climates they might
be approximated in all climates. {Dr, Mo Sherry, Amer, Med, Joicr.y
Oct. 1849, p. 406.)

Medical Teeatment. — Selection of the Projper Eeraedy. The
question has been asked "In dysentery, what is the 'like,' which cures,
and how are we to find it?" * We must learn to distinguish it by se-
parating between the two classes of symptoms, the generio and the
sjpecifiG, The generic symptoms belong to all cases of this disease.
They are : ^^Freguent, for the most part sr)%all discharges from the
rectum of Uood, or mucus, or loth, with colic pains, tenesmus, and
feverP If we seek for a remedy that covers ^A^<9^ symptoms only, we
may well be confused with the vast number of remedies under which
they are found. We may try one after another before we stumble on
the right one, feeling all the way that there is no precision attainable
in the application of the boasted law of cure. Though these symp-
toms have only misled us, they certainly are "striking" symptoms*
" They stand on the very surface, and are the first to arrest the atten-
tion. And yet we have failed to cure." Why have we failed? Be-
cause the symptoms we have attended to were such as might have
been produced by a large number of irritating agents and we could not
distinguish which one v^diS specifically o^dli^Qdi to do it.

The generic symptoms of disease are analogous to those symptoms
in the pathogenesis of a large class of drugs, "which rather indicate that
the organism revolts against drug assault, than point out the particular
active agent in the assault;" as "the vomiting produced by one irritant
poison is so like that of every other, that from this alone it can* not be
told what that irritant is." The generic symptoms, then, in which so
many drugs agree must be excluded from the circle of curative rela-
tionship.", "Where then are we to look for this? Evidently in the

* Diarrhosa and Dysentery, by Dr. P. P. "Wells, pp. 26 — 31,

906 DISEASES OF THE SANGUINOUS FUJSTCTIOK.

list of those symptoms which individualize both the disease and the
drug. That which distinguishes the individual case of the disease
to be treated from other cases of the same disease, is to find its re-
semblaiice among those effects of the drug which distinguish it from
other drugs. This is what we mean when we talk of charaGteTistics.
When we say Wke cures li'ke^ this is the ^li'ke'' we mean."

The principal remedies are: Mercurius, ArseniGum, Ohamomillaj
Pulsatilla, Goloeynth, Aconite, Ipecacuanha, Nux-vomica, Carho-
veg., Sulphur, Dulcamara, Aloes, Acid-nitr., Acid-mur.

Aconite one drop, or twenty pilules of the sixth potency may be dis-
solved in six or eight spoonsful of water, and a tea-spoonful given every
hour in urgent cases till the fever moderates ; then at longer intervals,
or till followed by the next remedy.

Symptoms of Aconite: Skin hot and dry; high inflammatory fever;
colic pains and tormina ; frequent small soft stools with tenesmus *
rheumatic pains in the head, neck, shoulders : heat, chills, thirst,
[See Sympto7ns of Aeon., p. 651.) In every form of dysentery it is
the remedy first to be thought of Dr. L. Pratt, of 111. says [State Hoin.
Med, Asso., 1859) that the patients who took Aconite in small doses
every half hour during the first twenty-four or forty-eight hours re-
covered much sooner than the others ( U, St. Journ, HomcBop,, Vol I,,
p. 146.)

Aconite is the best remedy when dysentery occurs during very hot
weather, followed by cold nights, and when the case is characterized by
a violent chill, great heat and thirst, with rheumatic pains in the limbs,
head, neck, and shoulders. {Hering)

In epidemic dysentery with inflammatory symptoms, it is necessary
to administer at first a few doses of Aconite, before we can count on
the efiicacy of Mercurius. Here Aconite proves its efficacy as an anti-
phlogistic, in curing the inflammation in 24 hours. But it is necessary
to repeat the doses at intervals of from four to six hours. {Engelhardt,
Coramunications, Pratiques, Gap, III., p. 84.)

A little girl, ten years old, had dysentery, took Yeratrum twelfth,
on the twentieth of September. On the twenty-second, a dose of
Aeon, and many doses of Mercicr-sol, twelfth. On the twenty-fourth
of September there were : griping pains of such violence as to cause
her to scream with pain ; frequent alvine evacuations, bloody mucus,
greenish, and mixed with whitish fibres ; nausea, retchings, and occasion-
ally mucous vomitings; bowels much bloated, and excessively sensitive
to the touch ; violent thirst, painful micturition, skin dry and very hot,
headache and delirium.

After the administration of Aconite, twenty-fourth, a dose every four
hours, the external heat ceased on the next day, thirst still remained,
the gripes were less severe, the stools less frequent, less painful and

DYSENTERY. 907

less bloodyj micturition not painful, still some delirium during the night,
no perspiration. {Engelhardty Commen. Prat, p. 25.)

, Symptoms j>artiGularly GharaoteristiG, — Inflam^matory fever. Skii
hot and dry, great thirst, rheumatiG pains in the liwhs^ headache
greenish and bloody stools^ acute pains in the intestines. {Jahr,)

Aloes. — This remedy has often caused dysentery when given as a
purgative in different forms of fever. The abdomen is distended and
sensitive to the touch; the colon is inflamed, particularly at its termi-
nation in the rectum ; pressing, burning and rending pains along the
course of the colon ; fluid slimy, evacuations mixed with blood ; tenes-
mus, heat, faintness, burning in the rectum; colic, haemorrhoids; exco>
nations ; heat, thirst, tongue dry and red, congestion of the abdomen.

Rau says, he used Aloes with distinguished success in purely in-
flammatory dysentery. The indications are : abdomen distended and
tender to the touch; stools slimy and mixed with blood, or thin and
watery; urine scanty and high-colored; tongue red and dry; pulse full
and rapid; skin hot and dry, &c.

Severe pressing, cutting and burning pains in the lower part of the
abdomen; violent tenesmus and smarting in the rectum, during the eva-
cuations, with sharp pains extending to the sacrum and abdomen; high
fever ; pain in urinating, &c.

Anxiety and general indications of nervous excitement.

Administratio:^. — Same as Chamomilla.

Belladonna. Alternates well with Aconite in sanguine tempera-
ments, of full habit, lively ardent disposition, with tendency of blood to
the head, distention of superficial vessels, face red and hot ; delirium ;
whitish tongue, the tip dry; spasmodic pain of the bowels, distended,
sensitive abdomen; tenesmus and fruitless urging to stool; violent press-
ing; intense thirst and sleeplessness.

Coloeynth, — Cramp-like, colicky pains in the bowels, with inflamma-
tion of the whole abdomen; slimy or bilious evacuations, with pains and
contractions at the rectum ; bitter taste, with urgent desire for cold
drinks ; nausea and vomiting of bilious fluids ; shooting and cramp-like
pains on one side of the body;*pains in the head, and throbbing of the
temporal arteries.

This is one of the best remedies, and applicable to almost every form
of dysentery, especially for: "Violent colic pains, griping in the hypo-
gastric region, causing the patient to bend together, restlessness, fre-
quent evacuations of greenish yellow or watery mucus," afterwards
streaked with blood or bloody mucus ; pain relieved by the evacuation
but soon returning on taking food or drink, tenesmus only slight ; full-
ness and pressure in the abdomen, white-coated tongue, chills, thirst
and febrile heat, irritable dejected state of mind. {Humphreys^ ^, 59.)
Broackes says, two globules of Colocynth, given immediately on the be-

908 DISEASES OF THE SANGUTN-OUS FTm-CTION.

ginning of tlie disease, cured one case in twenty-four hours. In other
cases, after beginning with Ohamomilla, a single dose of Colocynth gave
relief in six hours, and nothing further was given. Meyer gives it for
dysentery with severe colic pains and pressure on the rectum: Trink's
regards tenesmus as a characteristic of Coloc.

ArseniGUTn-aTbitim — Where dysentery has arisen from the abuse of
drastic and other debilitating medicines, after excessive loss of blood,
or after the organism has been enfeebled from previous disease, Arse-
nicum will be found an efficient remedy. It is also peculiarly useful
in dysenteric affections, occurring in individuals of a nervous, dropsi-
cal, or lymphatic constitution, and when the disease is attended with
typhoid complications.

General appearance of debility and prostration; trembling or stiffness
of the limbs ; face pale or yellowish, hollow or cadaverous ; position on
the back, with tendency to sink to the foot of the bed ; eyes dull and
sunken ; lips dry and dark-colored ; tongue dry and brownish ; abdomen
swollen and hard, or tympanitic; faeces offensive, putrid, and variable
in color, but generally slimy and streaked with blood, or greenish or
darkish; skin cold and bluish, or dry and shrivelled; breathing short
and oppressed; pulse frequent, small, thready, sometimes irregular.

Violent, sharp and cramp-like pains in the abdomen, accompanied
with nausea and vomiting ; sensation of fullness and burning in the
bowels; frequent eructations; flatulency; frequent evacuations with
some tenesmus, burning pain at the anus, with nausea ; retention of
urine, or burning pain in making water ; pain increased by the slightest
motion; faintness upon the least exertion; great tenderness of the ab-
domen ; colliquative sweats ; entire inability to sit up, or make any ef-
fort; puffiness of the eyes or. cheeks; disturbed sleep, with constant
jerking of the limbs, and tossing.

Sad; desponding; anxious; discouraged; irritability; impatience;
delirium; loss of consciousness.

Administeatio]^-. — One grain of the first trituration to two ounces
of distilled water. — A tea spoonful once in two or three hours until the
required effect is produced.

Ohamomillaf—A. useful remedy in dysenteric affections arising from
a sudden chill, from difficult and protracted dentition, from violent grief
or passion. It applies especially to affections of this nature which oc-
cur in women and children ; and, when judiciously prescribed, will often
act promptly and efficiently. Laurie prescribes it in cases attended
with inflammatory symptoms, after these symptoms have been partially
subdued by Aconite, It may be given at the third potency as circum-
stances may require.

Pulsatilla, — This remedy has been highly recommended in fall
dysenteries^ and in some cases of chronio dysentery. The indications

DYSENTERY. 909

for its use are nausea, vomiting, bad feeling in the head ; bruised sen-
sation in the integuments of the abdomen ; cutting pains in the bowels,
with discharges of sanguineous mucus ; pain in the small of the back ;
chilliness, especially towards night; bad taste in the mouth; eructations,
acid or bitter ; prickling or numbness of the skin ; constant inclination
to sleep during the day ; yellow tinge of the skin.

ADMii>riSTRATiON. — Four drops of the third dilution to a,n ounce of
distilled water ; a dessert spoonful every two, four or six hours in acute
cases. One dose every afternoon in chronic dysentery.

Teeatment. — Ipecao, Dysenteries occurring in autumn, in which
there is great nausea ; repugnance to food ; vomiting; pain in the region
of the stomach ; coated tongue ; pressing headache ; slimy stools, after-
wards mixed with blood, ^'ith violent urging ; tenesmus following foetid
discharges ; more chilliness than heat ; evening exacerbations^ Dysen-
tery in its early stage, where cramps prevail ; also in the latter stages
after inflammatory symptoms are removed, great weakness of the intes-
tines and tendency to tenesmus remaining.

MevGurius-soL — This form of Mercury is more particularly adapted
to the treatment of those cases, which are principally located in the
upper portion of the intestinal canal.

Yellowish color of the skin; offensive breath; tongue covered with
a white, thick, tenacious mucus; distention in the upper part of the
abdomen ; evacuations of foetid mucus and bilious matter of a darkish or
green color, or of bloody mucus; prolapsus of the rectum, which is red
and inflamed ; urine of a deep red or brown color and offensive ; posi-
tion, respiration, pulse, temperature, thirst, &c., the same as under
Merc.-Gor,

Violent cutting pains in the abdomen, accompanied by shivering
during and after the" evacuations ; great tenderness on pressure in the
region of the small intestines; frequent desire to evacuate the bowels,
accompanied by violent tenesmus ; discharges small in quantity ; ag-
gravation of pains at night ; frequent and urgent desire ; nausea and
vomiting, with pain in the stomach ; thirst for cold drinks ; cramps and
contractions in the umbilical region; weakness and rapid sinking of
strength ; painful sense of distention in the abdomen ; sense of fatigue
and great weakness in the limbs.

Morose peevish; irritable; great anguish and discouragement; pee-
vish ; quarrelsome.

Administration the same as Mere^-corrosivus,

Remarks. — In malignant dysenteYjyMercurmS'Sol Si:nd JVitric-aoid
are remedies of the highest importance. In all cases where the symp-
toms are not covered by one of them alone^ we may use them in alter-
nation or alternate either with another appropriate remedy.

Mereurius-corrosivus,' — Autumnal dysenteries of the most violent

910 DISEASES OE THE SANGUmOTJS EUNCTION.

form. The disease seems to be caused by cold nights succeeding hot
days, in persons saturated with marsh-miasm. Symptoms are ; Very
frequent small stools of bloody mucus, or of chopped-up greenish masses
mixed with blood, continuing day and night with almost constant
cuttings in the bowels, and an unsupportable and painful urging and
tenesmus. Sometimes the dysenteric discharges are Mlious^ very
foetid green or brownish ; frequently after long-continued violent strain-
ing and pressing, a little bloody mucus only is discharged ; the tenes-
mus scarcely abating for a moment, and then returning again. The
colic pains, griping and cutting in the bowels are very severe, often ex-
tend to the back with chills, heat, thirst and anxiety.

This remedy is more efficacious in the higher than the lower attenua-
tions. Prepare by dissolving the pure crystals in distilled water for
the first attenuation, dilute Alcohol for the second, pure Alcohol for the
third. Give of the twelfth or higher potence, every hour, till some im-
provement is manifested, then at longer intervals. Becker says, a few
doses of the sixth dilution were sufficient to stop the most violent at-
tacks. In one case, antiphlogistic s did not diminish the anxiety, the
tenesmus, or thirst, and sanguineous mucus mixed with blood was
vomited every ten minutes. On the third day he took Mercur.-corros.,
sixteenth, which cured him in a few days. (p. 102.)

Administration. — One grain of the third trituration may be given
every hour until the violence of the disease is subdued, when the inter-
vals may be lengthened, or the medicine suspended, according to the
exigencies of the case. Sometimes when the symptoms of this remedy
as well as those of Golooynth are present, these two articles may be
given in alternations and their beneficial influence will be speedily
manifested. In inflammatory cases alternate with Aconite.

Jfercurms-vivus.—GeneYdl range of symptoms the same as Mer-
GuriuS'SoL<f and mode of administration the same. It has been used
quite frequently and always with success.

Nicx-vo'iniGa, — As dysentery scarcely ever occurs except in con-
nexion with constipation, Nux- vomica often prevents it, by removing the
constipation that leads to it. It is useful also when the disease is about
to assume an adynamic or an intermittent type. Indications : " frequent
small stools, consisting of bloody mucus, or when from time to time
scybalse are seen in the discharges." But for this purpose it should
be used at the beginning of the disease. " Frequent small slimy stools
with urging and tenesmus ; violent cutting pains about the umbilical
region; intense heat; great thirst, or pitch-like ragged or villous dis-
charges ; pressure on the rectum." Urine suppressed, or voided by
drops, after repeated fruitless efforts ; retching or vomiting ; bitter putrid
taste in the mouth ; confusion of intellect ; aggravation in morning
hours ; tendency to hsemorrhoids.

DTSENTEEY. 911

NuX'Vomica sometimes effects a speedy cure in protracted dysenteric
discharges, which appear to be kept up from relaxation and loss of
tone in the abdominal mucous membrane rather than from actual in-
flammation. By imparting tone and vigor to the enfeebled nerves of
the stomach and intestines, it cures the disease, and enables these or-
gans to resume their healthy functions. The indications for its employ-
ment are : fullness and distention of the abdomen ; contractive or
cramp-like pains in the umbilical, epigastric, or hypochondriac region;
frequent, small evacuations of mucus and bloody matters ; contractive
pain in the rectum during the discharges ; bowels and cheeks hot ;
thirst; faeces offensive.

Administration.— A drop of the third dilution may be given every
two to six hours, as the urgency of the symptoms demand, until an im-
pression upon the disease is apparent.

Iodide of MerGury. — {IIL State Horn, Med. Association^ 1859.) In
first or second triturations it was successful in cases where Merc-sol.,
Merc.-viv., Coloc, Nux-vom., Podophyl. had failed. The evacuations con-
taining less blood but more of green mucus, violent tenesmus and grip-
ing pains. Evacuations twenty-four to forty in twenty-four hours,
lod.-mor. produced most satisfactory and surprising results. Only two
doses being in many cases sufficient to change the dark, grass -green
discharges to a whitish fermenting character, with from six to twenty
ascarides. {Dr. C. A. Jaeger. JElgin.)

Dr. Christison says, a man tried to cure himself of rheumatism by
having half a drachm of Corros.-sublim. rubbed into the a,ffected part
before going to bed. It produced at the time only a sensation of heat
m the part, but during the night there' were pains in the stomach,
retching and vomiting. Purging and tenesmus followed and became in-
cessant, producing extreme debility; the arm to the shoulder was
largely swollen, red and blistered. Kext day there was a brassy taste
in the mouth, tenderness of the gums, regular salivation supervened,
[O71 Poisons^ p. 892.)

Ajpis-mel. — Dr. Wolf recommends Apis for almost every form of
dysentery. Dr. Lorbacher, of Germany, says, he has found it effective,
where Mercury had entirely failed.

SuVphicriG-acid has been highly commended in putrid dysentery.
Indications : thin, bloody, and very foetid stools ; red or darkish urine,
turbid, or depositing a dirty sediment ; burning, hot skin; aphthss;
petechias ; blood-blisters ; vomiting of water and food.

Frequent inclination to go to stool, with severe tenesmus ; nausea
and vomiting ; desire for acids, fresh fruits, &c.

Indifferent or irritable ; irascible and peevish. It may be given in
the same manner as Nitric-acid.

912 DISEASES OF THE SAl^GUINOUS FUNCTION".

InMUous, catarrhal, erethistio d^iR^ rheumatiG ionms oi dijsexiiQvy
examine ColoGynth, Puis*, Nux-vom,, Cujpr., Cham,, China, Bhu^.,
SulpKy Tpeoao,, DuIg,, Euphor,, Ganth., Antim.'Grud., Rheum,

We have often observed the most decided benefit follow the employ-
ment of enemata of moderately cold water in dysenteric inflammations
Administered after each evacuation they afford evident relief.

DulGamara may be used in dysentery arising from cold, and at-
tended with cutting pains in the intestines, bloody discharges, burning
and itching of the rectum, heat of skin and thirst. It may be pre-
scribed at the third potency,— a dose, once iii two to six hours, ac-
cording to circumstances.

C%m^—— Cases which seem to have a malarious origin, and assume
the intermitting form. The stools in other instances assume a black,
putrid character, and the disease fails to yield to Arsenicum or Carbo-
veg. We have seen cases of malarious dysentery, in which the patients
w^ere rapidly sinking into a hopeless typhoid state, rapidly change their
character under the use of China, given in a fine trituration or tincture.
In a few hours the black foetid sores on the skin assume a red inflam-
matory appearance. In the last stage of this form of the disease Bark,
Wine and Brandy are often indispensible. But we should make every
effort to subdue the inflammation before this stage is reached.

Nitrio-aGid, — -Constant pressing in the rectum without any or only
very slight discharge; bloody dysenteric stools with tenesmus, fever,
and headache over the whole head. Frequent stools consisting only
of mucus, sometimes with cuttings in the abdomen and violent tenes-
mus, constant urging to stool with only slight discharge of slimy mucus.
Long urging and pressing ; small fluid evacuations, passing ofi' with
great difficulty ; great heat ; thirst, with unequal intermitting pulse.

Dr. Freitag has related the results of a poisoning case by Nitric-
acid, and Clotar Miiller considered the case a highly interesting one,
inasmuch as the mouth and pharynx showed very little erosions ; the
ileum perfectly healthy, and only in the colon was found a state per-
fectly corresponding with the pathology of dysentery.

MhuS'toxiGodendron,' — In dysenteries where typhoid symptoms ap-
pear, the patient is weak, becoming emaciated ; the plasticity of the
blood is diminished ; the stools are of sanguineous mucus, often passing
off voluntarily without pain or tenesmus ; incontinence of urine ; great
weakness and prostration ; bleeding from the nose ; confusion of head;
evening-chills, followed by heat with excessive thirst, dejection and
anxiety also form further indications for its employment. Broackes
says : In a case of a child of eight years there was pain over the right
eyelid ; violent colic in the epigastrium ; evacuations painful ; mucous,
blood-stained, containing ascarides and pure blood ; thirst ; general
coldness; paleness; emaciation; fever in the afternoon, ceasing to-

DYSENTERY. 918

wards evening. After Sulphur, Mercurius-corros. and Colocynth failed,
Rhus three times repeated cured.

Veratrmn,^ — Watery sanguineous flocculent discharges, in which
portions of faeces are manifestly present, or dysentery with vomiting.;
coldness of the surface ; extraordinary weakness ; cramps in the mus-
cles of the legs ; cold sweat ; retention of urine ; evacuations more
frequent at night than by day, with colic, chills, and rarely tenesmus.

Tartav-emetiG, — Becker says, Broackes cured a case of dysentery
with this remedy. The skin was dry ; sharp, shooting pains in the ab-
domen ; thirst ; bitter taste in the mouth ; bilious and bloody evacua-
tions. «A few doses cured in three or four days.

It is more appropriate after dysentery, cholera-infantum, cholera or
abdominal typhus, when there remains great prostration, frequent cold
sweats, colic pains, distention of the abdomen, tenderness on pressure,
nausea., diarrhoea, borborygmus, putrid eructations, rapid, weak pulse,
&c. (Marcy^ New Mater, Med,^ pa-ge 426. Also proper in dysentery,
after the tenesmus, mucous and bloody discharges have nearly subsided,
the patient remaining weak from brownish, sanguineous discharges ac-
companied by nausea and occasional vomiting. The third trituration
preferred.

OarbO'Vegetdbilis. — Adynamic or malignant dysentery: putrid stools
great prostration, pressure, on the rectum and burning, burning pains
cold breath, cold surface.

Garbo-veg, may succeed or alternate with ArseniGum in certain low
forms of dysentery, when the former does not act with efficiency. It
may be given for the same train of symptoms and at the same potency
as Arsenicum.

Sulj>hiir, — In many of the worst cases where the disease yields
slowly after other remedies have been tried, or where there is a psoric
poison or dyscrasia, perhaps inherited, which prevents the proper re*
medy from taking effect. Characteristic symptoms : mucous stools
streaked with blood; violent tenesmus; frequent urging to stool, espe*
cially at night; discharges of mucus, with or without blood, preceded
by cuttings in the abdomen with tenesmus, fever, vomiting and griping
pain, irritable disposition, haemorrhoids, &c. The thirtieth attenuation
is more effectual than any lower.

Sulphur deserves consideration in instances where the more ordinary
remedies fail in affording prompt relief, and especially if any latent
miasm is suspected to have conduced to the disease, or prevented the
usual action of medicines administered. It is often serviceable in the
dysenteries of hsemorrhoidal patients.

In no disease have allopathic physicians come nearer reaching the
true ground without finding it, than "in the treatment of this disease by
mild purgatives. It is useless to pass in review the long catalogue of

Vol. I.— 58.

914 DISEASES OF THE SANGUmOTJS FUNCTION.

the articles they have tried, and show in each the reason of their
failure. In severe autumnal dysenteries purgatives always aggravate
the disease instead of curing it. Often have we seen a common case
of bilious remittent fever take the form of a most dangerous dysentery
from the operation of a common purgative. The people accustomed to
relieve the common constipation in the marshy districts with pills,
composed in part of Aloes, Gamboge, Calomel, &c., try the same re-
medy in fever. Small doses fail to operate and they are followed by
large ones. At length a large evacuation is procured though with great
irritation. It is followed by several others in succession. Each suc-
ceeding discharge is more fluid than the last. In a day or two the
evacuations take place at regular intervals of three or four hours, and
consist of reddish water only. The pulse was one hundred per minute
on the first day ; it gradually increases to one hundred and twenty in
an adult, and continues to increase in frequency. Is it possible that
further purging is needed, now ? In some cases a purgative syrup, of
which Rhubarb is the strongest ingredient, may pass through the bowels,
carry a small quantity of solid fsscal matter. If this occurs, a change
is affected for the better. But if it will not pass, a few large injections
of warm water with some oleaginous substance in it may be thrown far
up the colon and, aiding the purgative, may wash out the inflamed
colon. In a bad case it will either not pass into the colon, or will bo
instantly expelled, bringing nothing with it. Just here many a case
has been abandoned as hopeless, and death has always followed.

There is one resource more in the flexible gum-elastic tube first used
in dysentery by Dr. O'Bierne, of Dublin, though often used by others
for other purposes. In one case, after all common efforts had been
made for twelve hours and the patient was rapidly sinking, we directed
the gradual and careful introduction of the tube through the rectum
into the colon. When the upper end of the tube had entered the sig-
moid flexure, it encountered an obstruction, which for several minutes
resisted its passage. The tube was made to press its way gently
through a solid mass of some inches in length, when it passed the ob-
struction it moved freely several inches further. About three pints of
tepid water, or weak beef-tea, was now thrown up through the tube with
a common syringe. The quantity of water, though not large, was suf-
ficient to dissolve away by degrees the solid mass through which the
tube had passed. A sudden and permanent change was at once visible.
The pulse was immediately reduced in frequency below one hundred
per minute ; perspiration was established ; the skin recovered a natural
warmth; and the spasmodic action of the large intestines and abdomi-
nal muscles gradually subsided.

In none of the common cases of dysentery is this treatment neces-
sary. Indeed under judicious homoeopathic treatment few cases, if

MUCOUS DYSENTERY.

915

any, would ever run into the condition above described. But such cases
will be met with among patients who have passed through the perils of
other systems of treatment, and the characteristic of the true phy-
sician is, that he is never without a resource.

The single objection of the tenderness of the rectum and the diffi-
culty of passing any substance through the curvatures of this canal and
the colon is only met by the consideration, that although these difficul-
ties are real^ there are cases where it is better to meet them than to
do worse. In no case have we directed this treatment, except where
death would have resulted from any common allopathic efforts. In
every instance life was manifestly saved by the course pursued, and
the result was at least satisfactory to those interested.

16. MUCOUS DYSENTERY.— MUCO-ENTERITIS.

Dr. Chambers^^ says : The excreted matters vary greatly in a,ppear-
ance, presenting almost every aspect but a healthy one. Sometimes
they are light-colored and abundant, of a faint, putrid smell, and con-
taining principally unaltered food; sometimes they are dark, like pitch,
scanty and slimy. There is often separated from them, when fluid, a
good deal of oily matter, probably derived from undigested adipose
tissue of the victuals. The mucus itself may look like lumps of fat,
being in Avhite, opaque masses, which however are easily distinguished
in the microscope by the presence of the usual globules of mucus. At
other times it has more the lappearance of macaroni, drawn out into
adhesive strings. The appetite is always very bad. The urine is high-
colored and thick ; but, except when the disorder is at the worst^ it is
most frequently natural. The pain in the abdomen is very difficult to
assign to any particular spot. If any one place is fixed upon, it is
usually either the right hypochondrium, or the neighborhood of the
navel, and sometimes the sensation seems to follow the food from the
former to the latter situation. Sometimes acute attacks of spasmodic
pain around the waist come on, and sometimes the skin around the
navel is so sensitive, that the case might be almost mistaken for one
of perforation or peritonitis. There is almost always distressing flatu-
lence, causing palpitation. Intestinal mucous flux has very generally
a periodic character. The patient is pretty well for a week, or a fort-
night, or a month, and then the symptoms above described, or an ag-
gravation of them occur.

Pkognosis. — "It can hardly be immediately fatal of itself, yet it re-
duces the body not unfrequently to such a state of anaemia., that other
diseases supervene and conduct the patient to the grave. I have known

* Digestion and its Derangements.

916 DISEASES OF THE SAKGTJINOUS FUNCTIOlsr.

degeneration of the kidneys so induced, which finally destroyed by
dropsy and diarrhoea."

Tb,batm:e^t.— 'Hygienic Measures. — Long and hurried journeys may
be injurious, but some variation of air and scenery is often very benefi-
cial and often produces an immediate change in the appearance and
smell of the fseces, which is often speedily followed by return to health
and strength. Riding is specially beneficial as it induces more active
secretion of the liver and promotes absorption from the bowels. Dr.
Chambers says, " the foetor of putridity, which it is the business of the
bile to prevent, and the undissolved muscular fibre, which it is the
business of the bowels to take up, disappear simultaneously from tha
stools."

Of the value of sleep in chronic diseases he says; "It is sadly under,
estimated by medical men;" and "there is probably no disorder in
which this is so important as in the mucous flux of the intestines, and
I have known the expedient of lying in bed till 9 o'clock in the morning,
make treatment effective, which previously had been perfectly useless."

Diagnosis.

Acute Enteritis.

Violent abdominal pains, aggravated
by pressure and accompanied by vomit-
ing, and marked symptoms of inflam-
matory fever. The more numerous the
coats of the intestine implicated in the
inflammatory process, the more acute
and violent the symptoms.

Uncomplicated peritonitis is almost
invariably attended with constipation.

Muco-Enteeitis.
The mucous coat being less sensitive
than the serous or peritoneal coat, the
suffering and danger are less extreme
and threatening.

Inflammation of the enteric mucous
membrane is not generally attended by
constipation ; but almost invariably by
diarrhoea or dysentery.

Teeatment. — MerGurius,---Cfises> resembling genuine dysentery with
symptoms of acute sthenic inflammation, the evacuations being com-
posed of a mixture of blood and mucus ; urging, tenesmus, with febrile
and inflammatory and bilious symptoms, marked by rheumatic lesion
of the muscular coat of the lower bowels ; acute cases of recent origin,
aggravated by night, while the patient is lying down.

J!f^uX'Vomica, — The discharges from the bowels consist of simple
mucus in small quantity, voided with considerable pain in the rectum,
and urging, which is sometimes ineffectual; mucus of green color and
excoriating in character; dyspeptic symptoms, including persistent
anorexia, with a sallow complexion and some colic marked and de-
cided.

Arsenicum-alium, — It has some especial relation to the gastric and
enteric mucous membrane : sensitiveness of the prsecordial region, ir-
ritability of the stomach ; more or less thirst, with vomiting of the fluif]

COLITIS.

917

taken ; alternate constipation and diarrhoea, with yellow, slimy stools ;
tenesmus; sense of excoriation at the anus, debility and emaciation.

ChroniG Ulceration of the Intestines, — Dr. Chambers {Digestive
Organs and their Diseases^ says : There is no disorder, of which
emaciation is so marked a feature throughout its whole course, as
chronic ulceration of the Avhole intestines. Ulcerations of the coecum,
tubercular or not, produce as much, nay often more diarrhoea, but they
are not by any means so distinguished in their power of reducing the
patient. In this lesion of the ilia even the parts, which are not the ac-
tual seat of disease, seem incapacitated from absorbing nutriment, and
the victuals pass through the alimentary canalin the same state, as
when they left the stomach, except being made putrid by chemical de-
position; all the stages of digestion are equally suspended.

Remedies.- — Arsenicum^ Calcarea, He^ar-sulph., Nitric-acid^ Si^
licea, Phosphorus.

17. COLITIS.— CAMP-DIARRH(EA.

In that form of intestinal disease that prevails extensively in the
Mississippi valley, and was extremely common among the soldiers and
volunteers of the American army in the war with Mexico, (more recently
known as the camp-diarrhoea in all the American armies) medical treat-
ment was peculiarly unsuccessful ; and it has been asserted, that more
men died of this disease than did from the bullets of the Mexicans.
(See Prof. Adams. U. /S, Jour. Homoeop. Vol. L, p. Qb^ &c.)

Predisposing Caiises. — Previous derangement of the bowels and
debility. It most commonly attacked persons not acclimated to a mala-
rious climate, and varied much in its intensity in different cases.

1. Mucous diarrhoea. — Discharges composed entire^ of gelatinous
mucus, pale gray, mixed with white slime or mucus.

2. Serous diarrhoea. — Discharge merely a clear or muddy water,
. 8. Bilious diarrhoea. — Evacuations more or less tinged with bile.

4. Lientery. — Evacuations consisting mostly of undigested food,
paste-like, and sometimes in a state of fermentation, frothy, like chalk
and beer.

5. Purulent diarrhoea. — Evacuations consisting partially or entirely
of pus.

In none of these forms is blood generally passed, though the tormina,
and tenesmus are extremely distressing and exhaustive. In moderate
cases the pain in the abdomen is only felt before each evacuation.
This takes place every three or four hours, is attended with much
rumbling uneasiness and feeling of prostration ; the appetite being at
the same time morbidly craving. In severer cases the stools occur fif-
teen or twenty times in twenty-four hours ; and sometimes become

918 DISEASES OF THE SAITGUINOUS FUIfCTIOliJ".

quite liquid and often involuntary. The pain in some of these cases
becomes excruciating, in some even causing fainting ; emaciation and
debility progress. When the disease involves the mesenteric glands
there is hectic fever well marked. The abdomen is flat, inelastic, and
retracted, though sometimes it becomes tympanitic. The skin is dry
shrivelled and desquamating, and of a sallow hue. The inflammation
in many cases involves the c^cum, and there is dull aching pain in its
region. Sometimes this becomes acute for a time, during which the
countenance expresses anguish, sadness, and extreme dejection ; It is
worse a few hours after eating, may be excited by riding, or other jolting ^
exercise, by anger, or wrong diet. In severe cases the inflammation
of the caecum proceeds to disorganization in the course of ten or fifteen
days. This severe inflammation of this organ is detected by the "round,
doughy, inelastic tumefaction of this organ, felt on pressure with the
hand. After death in fatal cases may be found " a mass of disease
and inflammation with induration in the right iliac region." [Adcmis)

TREATMENT.— -^(?6'mz5^ in the earlier stages of colitis will of itself
prove eflicacious in removing every vestige of the disease. To make
. a deep impression on the disorder and diminish the congestion and
inflammation of the engorged mucous membrane give the pure tinc-
ture in repeated doses during ten or twelve hours. Aconite is tJw
great remedy of colitis, controlling all its symptoms.

Colocynth, — After Aconite, when tenesmus and tormina continue.

For Lientery g\yQ Arsenicwn and China in alternation; also for
chronic colitis, with debility and emaciation.

Mucous Diarrhoea, — Arnica, Pulsatilla, Chamomilla, Merc-sol. — -
When stools are muddy and watery: Arsenicum, Cham., Dulc, China^
Ferrum,. Phosphoric-acid, Pulsatilla, Rhus.

Bilious Diarrhma, — Mer.-corrosivus, Dulc, Puis., Podophyllum.

Purulent Diarrhoea,-— hxmo^^.^ Silicea, Phos.

Pursue a rigorous dietetic system, keep the colon as empty as pos-
sible till the disease is cured, guard against atmospheric influences..
Bathing and frictions to the surface. {Prof, P, E.W. Adams,
St Louis.)

The National PEotel Epidemic at Washington^ D. (7., in the
summer of 1857, is believed to have originated in a poisonous miasm
generated in stagnant water and the accumulations of animal and vege-
table materials left to putrefy in the sewers and communicating with
the privies of the house. At the time of the outbreak of the disease
the water from the Potomac was unusually high, and flowed through
the Tiber, having for a time overflowed the low and filthy foundations
of the Hotel. When thus established in a house crowded with occu-
pants the cause of the disease followed the usual laws of infectious
dysenteries. The germs by which the disease communicated itself to

STKUCTURxiL DISEASE OF THE COLOI^. 919

new subjects consisted of orga/ni^edj though excessively minute spo^
rules, capable of reproducing themselves, and so extremely minute as to
be able to diffuse themselves to some extent in the air.

18. STRUCTURAL DISEASE OF THE COLON.

l>iAai![os>i8, -—Sympathetic effects of Structural Disease. — The kid-
neys and bladder, being immediately in the vicinity, are often much ir-
ritated during attacks of colic, but these affections are but secondary,
and subside when the colic is relieved. Numerous other symptoms are
sometimes traced to disease of the colon which in other cases are con-
sidered as primary diseases or symptoms of other secondary disorders.
Some of these are : Epilepsy, loss of power approaching to paraplegia^
pains simulating rheumatism, cramps, spasms in the limbs, &c. Any
of these alarming symptoms may be excited by nervous irritation originat-
ing in the colon and communicated to the brain and spinal marrow.
A single attack of epilepsy is sometimes induced by this irritation in
younger persons, who may not afterwards be subject to it. In habitual
epileptics, irritation of the canal, more particularly of the colon, multi-
plies the number of the attacks and increases their severity.

Sympto'ins of f meal accumulations in the Colon, — The structure
and position of the colon show that nature has not designed that col-
lections should take place here as they do in the coecum. The colon
is not supported in its position in the same way, and, therefore, its
weight, when fully loaded conveys an uneasy sensation, described as if
something was dragging the bowels away from the stomach; the arch
thus gives notice by pain that matters are retained within it for which
it was not constructed. There is also a pain under the left shoulder-
blade which is relieved by pressure, referred to the external respira-
tory nerve through the medium of the stomach. The collections in the
arch of the colon interfere mechanically with the stomach, and cause
the dyspeptic symptoms that come on when the stomach is empty and
in a disordered state ; as eructations of wind, pyrosis, and other severe
symptoms often mistaken for structural disease, great and long con-
tinued pain, fullness of the abdomen, pains in the lower extremities, las-
situde, despondency of mind, &c., which cause the patient to regard his
disease as structural and beyond the reach of the simpler remedial
measures, and he flies from one active purgative to another to find only
temporary relief, followed by increased debility and local accumula-
tions. (Condensed from Alderson^ Diseases of Stomachy (&c,)

To review all the diseases of the colon, says Alderson, would be to
recapitulate the whole train of dyspeptic symptoms. When the colon
is obviously the point of derarngement and the seat of pain, and the
more prominent symptoms are not those of a more dyspeptic characteri

920 DISEASES OF THE SANGUINOUS FUNCTION.

accumulations to a large amount, accompanied by a large evolution of
gas generally exist. This often leads to severe colic. Collections in
the emoum do not produce such distressing dyspeptic symptoms as
^Yhen they take place in the arch ; the coecum is so bound down by
membrane, and so preserved in its natural position, and it is so sup-
ported from the effects of gravity by. lying on the side of the pelvis,
that it is only from distention that pain is felt in this spot.

The coecum being out of the current appears to be the natural depot
•where collections to some extent are always intended to exist. There
are probably especial reasons for this delay, and though the function
of the appendix vermiformis is not well understood, it is presumed that
some change takes place at this point for which delay is necessary.
The coecum is also situated out of the reach of other organs and is less
likely by its state of distention to interfere with them. The mere col-
lection, therefore, of matters within the coecum is not necessarily a
cause of colic, as it is designed as a depot for a specific purpose, un-
less, by too long continuance here, decomposition or fermentation
should take place. In this case gas may be evolved, which being ob-
structed by accumulations in the colon above, may excite severe pain
from distention of the intestine. {Alderson,)

19. MALIGNANT ULCERATION OF THE COLON.

This disease would hardly be considered as carcinomatous except for
the accompanying secondary deposit of encephaloid matter in the liver,
as there occurs no such deposit at the seat of ulceration.

Diagnosis. — The general symptoms are those that accompany can-
cerous deposits in other parts of the system ; loss of flesh, change of
color and complexion anxious countenance ; pulse and tongue natural
to a very late period. When ulceration occurs in the colon its com-
mencement is marked by dysenteric symptoms which appear many
months before the disease approaches a crisis. When the symptoms
become chronic, the ulceration progresses through the coats, and, as
an instinctive effort of nature to prevent rupture into the cavity of the
abdomen, lymph is poured out, and neighboring organs as the bladder,
or vagina, agglutinated together. The lymph thus thrown out is of a
smoky hue, of a melanotic tinge, and is easily torn through. A shiver-
mg fit, accompanied by delirium, marks the time when perforation is
effected through the coats.

This instinctive or preservative process of throwing out lymph is
properly but a prolonged process of destruction. It occurs only in
chronic disease, and where the constitution is in a failing state, and
never in early life or in acute disease, where we would naturally look
for such a restorative effort of nature. In one case of malignant ul-

CANCER OF THE BECTUM. 921

ceratioH in the sigmoid flexure of the colon, lymph was poured out, and
adhesion took place between the intestine and the bladder ; the contents
of the colon passed through the bladder; and the urine in turn pro-
duced irritation of the rectum. The patient had through life suffered
from indigestion, from gall-stones, and spasms of the gall-ducts. After
death, a large gall-stone was found in the gall-bladder, and the liver
was extensively studded with encephaloid deposit.

Ulceration of the coecum of a character not malignant, is a common
result of obstinate constipation. (Alderson, on Diseases of the
StomaGh and Alimentary Canal^ Lond, 1847.)

Treatment. — In malignant structural disease of the colon we can
trust only to those specifics mentioned under cancer of the stomach,
and those mild palliative measures which may soothe if they can not
cure.

In many cases positive relief may be given by regardmg the case as
one of functional derangement already terminating in local hypertrophy
or other structural disease of the aifected organ ; and making judicious
efforts to wash out the offending accumulations from the entire colon.
Here all the measures we have presented under Dysentery are avail-
able. Active purgatives, which in most cases may be suspected to
have caused the disease, are highly dangerous, as they destroy the tone
of the digestive organs, and however persistently used, may never dis-
lodge the contents of the cells of the colon. "The peculiar construction
of the colon," says Alderson, "admits of a passage along the course of a
channel, the sides of which consist of so many loaded cells ; thus, though
there is action of the bowels, the disturbing cause may still remain,
and can only be fully dislodged by a change of aperient and other re-
medies." It is certain that large collections in the colon may exist,
and be for a long time retained, while at the same time a daily evacua-
tion of some kind may take place. This fact is made the basis of a
purgative treatment which only perpetuates and increases the difficulty,
{See Ware on Purgatives^ c&g) The only treatment admissible in
cases of structural disease of the colon are those already pointed out
under Dysentery and Colitis. See pp. 904 to 917.

20. CARCINOMA OF THE RECTUM.— Cancer of the Rectum.

Symptoms. — Local pain, sometimes dull and aching, at others acute
and lancinating; sense of weight and confinement in the part, with un-
easiness around the loins and pubes ; numbness in the hips and thighs,
aggravated by standing, walking, or sitting, relieved by lying down.
Operation of the bowels increases distress. The faeces passed in a
liquid state or in small fragments, and, after repeated efforts, blood and
mucus expelled with them. Females suffer in addition from irritation

922 DISEASES OF THE SANGUINOUS FUNCTION.

of the bladder, pain in urinating, incontinence of urine, &c., bearing
down of the uterus, also from faecal accumulations ; fits of abdominal
distention and pain, with t,enderness, hiccough and vomiting.

Treatment. — In these melancholy cases palliation may be the only
thing possible ; and, in our efforts to reach this, we must resort to such
expedients as have been tried. When we have given a trial to the con-
stitutional remedies, which are found successful in cancer in other lo-
calities, we may be driven back to mere palliatives. It is proposed to
allay the pain with Opium in a solid form, or with Morphine, extract
of Stramonium, or other narcotics. Solid Opium taken into the stomach
acts better than it does applied locally to the diseased surface, though
many use a watery infusion of Opium, adding to it Acetate of Lead. As
constipation increases the pain of the diseased part and hastens its
progress, it is desirable to prevent it by only such means as are en-
tirely unobjectionable. The free drinking of water, if it can be borne
to a sufficient extent, is the best reliance ; injections of blood-warm
water may be used when they give no pain. Purgatives of almost every
form are injurious and must be avoided,

In the use of Opium we are not expecting to cure, but only to palliate
in incurable cases. In these, if we begin with it, it should only be in
the latter stages, when the pain is extreme and when there is no pro-
bability of continuing it long. The constipation it causes ceases to be
an objection after the patient has become habituated to its operation.
For further remedies see Canoer in its different forms. — Index-—
Volume II.

INFLAMMATORY DISEASES OF THE LIVEE.

1. Congestion;

2. Inflammation, and its consequences ;

8. Diseases which result from an abnormal nutrition of the liver, or
from " faulty secretion;"

4. Diseases which result from some growth foreign to the natural
structure.

5. Jaundice. — See page 401, 405.

Congestion of the Livee. — General Hemarlcs. See Article Oon-
gestion. This disease is generally compicated with congestion of
other abdominal organs. It may take place suddenly from a sudden
suspension of the cutaneous perspiration, which very frequently hap-
pens from a slight change of temperature after exposure to great heat.
The complexion is usually purplish with a mixture of dingy yellow.

Diagnosis.— When the circulation of the liver is unusually impeded
and the organ is materially engorged with blood the liver increases in

ESTFLAMMATION OF THE LIVEK. 923

Size. Its edge can be felt two or three inches below the false ribs. If
the congestion be relieved by treatment, by diuretics or by rest, the
organ returns to its former volume. Enlargement and subsidence thus
alternately follow each other in quick succession. In judging of its
relative size and position it must be noted that it naturally sinks an
inch or two lower after a full inspiration, or when the patient is in the
erect position and that it can be pushed down by fluid in the cavity ox
the pleura, or by a bloated emphysematous lung. {Budd^ Diseases
of the Liver^ p. 41.) It may be sufficiently distinguished from in-
flammation by the shortness of the time that has elapsed from its com-
mencement ; the evidence plainly visible of imperfect decarbonization
of the blood, and the presence of the materials from which the bile
should- have been secreted.

Causes.— Sudden exposure to cold after great heat. It is a com-
mon disease in malarious districts, where. all the functions are deranged
by the poisonous influence of marsh miasm. (See Malaria) In autumn,
when hot days are succeeded by cold nights, the action of the liver is
checked by a sudden chill, or by long-continued exposure to air not
extremely cold. All the causes of congestive fevers may excite con-
gestion of the liver in persons in whom the organ has been debilitated
or injured by marsh fevers imperfectly cured, and by the reckless use
of mercurials. In ague the liver is almost always temporarily engorged
with blood ; in purpura congestion of a different character occurs ; but
it requires a very different treatment.

Pathology.— The condition of the internal secretory . apparatus of
the liver in a state of congestion is easily comprehended when the
minute anatomy of the hepatic parenchyma is recalled to the mind.
"The lobules of the liver," says Dr. Budd, " are spaces mapped out by
the ultimate twigs of the portal vein, which are hairy, as it were, with
capillaries springing immediately from them on every side, and forming
a close and continuous network; and the interstices of these capillaries
are filled with nucleated cells. It is in these cells that the vital
chemistry of secretion goes on. It is seen by the microscope that in
different livers, the cells vary in size; that in some they are almost
transparent, in others opaque, and apparently more solid ; that in some
they contain but a few very small oil globules, while in others,, they
are distended almost to bursting with globules of oil ; that in some they
are colorless or nearly so, and in others yellow with bile; that in some
specimens, again, they are broken down and destroyed." In some cases
the cells are only slowly reproduced ; a,nd, without complete destruction
they become less productive of new cells, so that at length the number
of active cells is much diminished. These differences in the condition
of the cells cause corresponding differences in the size, color and tex-
ture of the liver. {Diseases of the Ziver^ p. 197.)

924 DISEASES OF THE SANGUIKOUS FUNCTION.

The first efiect of congestion of the liver is to suspend the secretion
of the bile, permitting the large quantity of carbon usually carried off
in this secretion to remain in the blood. In addition to the retained
carbon there are left in the blood those numerous impurities which the
veins from the stomach and intestines carry to the liver to be there
thrown out, and also, all the waste materials collected by the absorbents
from the wear and decay of the same organs. All of these matters
are unfit to form new blood or serve any other purpose in the body.
And yet, a sudden suspension of the biliary secretion throws all these
elements of disease again upon the general circulation. When the con-
gestion continues for a considerable time, the proper secretory appara-
tus (the nucleated cells) of the liver seems to be more and more in-
jured until it may become irretrievably damaged ; and then the secre-
tion of bile almost entirely ceases. Dr. Budd gives some cases in
which the common bile duct of the liver had been entirely closed ; and
" the liver had entirely lost its lobular appearance and contained no
nucleated cells ; so that, when a portion of it was examined under the
microscope nothing was seen but free oil globules and irregular par-
ticles of greenish or yellow biliary matter." The same effect may arise
from other serious lesion of the extreme vessels or biliary tubules, as
we see in that granular state of the liver so frequent in drunkards,
called Cirrhosis,

ACUTE INFLAMMATION OF THE LIVER.

1. Adhesive Inflammation.

2. Suppurative do.
8. Gangrenous do.

4. Inflammation of the Veins.

5. Inflammation of the Gall Bladder and Ducts.

ADHESIVE INFLAMMATION.-HEPATITIS.

1. Inflammation attended with the effusion of coagulahle Lymph
may exist on the surface of the liver, or may penetrate the parenchy-
matous substance of the organ. The latter is most important and is
most common. It is characterized by well-marked symptoms of in-
flammation of the liver, pain in the right side, vomiting, fever and
yellowness of the skin. When these symptoms have continued for a
time they subside ; but the patient does not regain his former health.
The liver has been permanently injured ; part of its secreting substance
has become atrophied from closure of the small portal veins. The
patient still has difficult digestion, has a sallow complexion, and does
not recover his former strength.

Diagnosis.— When the disease occupies the convex surface of the

INFLAMMATION OF THE LIVEK. 925

liver, we shall have fullness and severe pain in the region of this organ,
increased on pressure, either of a sharp, aching or burning character ;
pains extending into the chest, under the clavicle, between the shoul-
der-blades, infto the top of the right shoulder, and sometimes down the
arm; short, dry cough; dyspnoea; difficulty in lying upon the left side;
hot and dry skin ; thirst ; scanty and high-colored urine ; constipation ;
clay-colored evacuations ; full, hard, and frequent pulse; headache, and
more or less mental disorder. If the inflammation is in the Gonoave
portion of the liver, we shall have, in addition to the symptoms already
enumerated, distressing nausea and vomiting ; tongue covered with a
white or yellow fiir; bitter taste ; urgent thirst; an aggravation of the
pain in the hypochondrium on pressure ; urine scanty, and of a dark
yellow or saffron color ; eyes and skin tinged with yellow ; bowels con-
stipated or relaxed ; pains in the back and limbs ; ideas confutsed ; mind
clouded or delirious.

In most instances of acute hepatitis, it is highly probable that the
peritoneal covering of the liver is implicated to a greater or less ex-
tent, and this may serve to render the pains more severcj and the ac-
companying symptoms more violent.

The characteristic symptoms of adhesive hepatitis vary according
to the acuteness of the attack and the stage in which it comes under
our notice. Pain and tenderness over the region of the liver in a spirit
drinker may be regarded as suspicious. When the orga,n has become
seriously diseased the complexion is always jaundiced and the skin
dry and rough. There is in most cases a tendency to ascites. " If
the subject of diseased liver," says James Johnson, "will not forsake at
once the use of intoxicating drinks, his fate is sealed; and bloated
dropsy with all its horrors will soon be upon him." {Morbid Sensibility
of Stomachy <&c) Hsemorrhagic phenomena are common : bleeding
from the nose or rectum, haemorrhoids, purpuric spots on the face ; en-
larged or varicose veins of the abdomen, arising from impediment to
the free return of blood along the deep-seated vessels. The portal
circulation is at first chiefly involved, hence the ascites often exists
alone, and without oedema of the legs or any other part. In a later
Stage the oedema of other parts is established, showing a more per-
manent and serious form of the disease.

Causes.-— Habitual drinking of alcoholic liquors ; exposure to vicis-
situdes of weather ; residence in hot climates ; all the causes of deranged
functions of the chylopoetic viscera; organic afiections of the
stomach, &c.

PATHOLoaY.- — On dissection lymph is found effused into the areolar
tissue in the portal canals ; and, if life be long continued after the ef-
fusion took place, all the considerable branches of the portal vein are
found surrounded in some places to a distance of half an inch by new

926 DISEASES OF THE SANGUINOUS FUNOTIOK.

fibrous tissue, which sometimes contracts and puckers the adjacent
portions of the liver* The main branches of the vein are pervious, but
many of the small twigs that spring from them are obliterated; and
the parts supplied by these branches are atrophied, reducing that much
of the liver in bulk. There are also thick false membranes on the cap-
sula of the liver, or extensive adhesions between this and the neighbor-
ing organs. The deposition of lymph having rendered the parenchyma
of the liver tougher and more indurated than in' health, its tissue is
paler than natural, contains but a small quantity of blood; and it is
sometimes yellowish from accumulation of biliary matter in the cells.
This gives in section the yellowish gray color of impure beesrwax, for
which reason the French have called* the disease Girrhosis^ (Greek
Kirros^ yellowish), the "gin-drinkers' liver." In its early stage the vis-
cus is enlarged; but, later, the more watery parts are absorbed; the
lobular part receives less blood and wastes till it becomes smaller than
in health. When hepatitis is caused by ardent spirits, the alcohol,
being carried directly to the pa^renchyma of the liver, makes its first
impression on, it; and here we find the first traces of structural disease,
the capsule and investing membrane being secondarily affected. In
dogs poisoned by alcohol, says Percy of Birmingham, the spirit could
be extracted from the liver in greater quantities than from the blood,
brain, or other organs. [Pri^e Essay) M. Becquerel has shown.tha,t
in about half the cases of cirrhosis there is also disease of the heart.
(ArcMv. Generale^ 1840.)

PEoaNOSis,— This is only unfavorable when extensive structural dis-
ease already exists and the dropsical symptoms show important com-
plications in other organs. Plepatitis, however induced, is a curable
disease so long as permanent organic alterations have not* been de-
veloped in the intimate structure of the liver. The extent to which
these may be believed to be present; and the degree in which the
general system' is already involved in the consequences of obstructions
and cessation of function already in existence, must govern our estimate
of the degree and proximity of danger.

2. Suppurative Inflammation of the Ziver.— Not only is the liver
subject to the formation of abscesses, as the legitimate result of a com-
mon inflammation of that organ, it is peculiarly liable to the formation
of abscesses of a peculiar character, which have been supposed to be
in some way related to suppuration going on in some other organ.

Causes. — It may occur from a blow or other mechanical injury on
the side, {AQidral) but it more frequently arises from inflammation of
some vein and consequent contamination of the blood with pus. An
abscess of the liver, and more frequently the lungs, often follows in-
juries or surgical operations. It is believed that the mimediate cause
of the abscess consists in the presence of some poisonous substance,

INFLAMMATION OF THE LIVER. 927

commonly pus, conveyed from the inner surface of a vein to the minute
capillaries of the lungs where they excite suppurative inflammation.
If any of the purulent globules pass through the capillaries of the lungs,
and proceed to other organs, they become arrested in some of them, ex-
cite inflammation pro.gressing rapidly into abscess. [Budd^ on Dis-
eases of the Liver) When abscess of the liver, lungs, heart or spleen
follows injury of the head, we may believe that suppurative suppuration-
of a vein somewhere exists, either in the soft parts or between the tables
of the skull. {See jResearches iy Dance^ CruTieilliieT and Larrey in
France^ and Arnott in England) The purulent matter must, in such
cases, pass through the capillaries of the lungs, hence these "metastatic
abscesses are more common in the lungs than elsewhere. But, if the
seat of the suppurative phlebitis be in one of the veins that go to form
the vense portse, " the pus will be carried first to the liver ; and then
the abscess will be found in it alone. Gruveilhier injected Mercury
into one of the the mesenteric veins, and found that it was stopped in its
course through the liver, and caused circumscribed abscesses through-
out its substance. When the Mercury was injected into the cruval vein,
it was stopped in the lungs, and the abscesses were formed there.
When the mesenteric veins become inflamed from any cause, as they
may do after operations on the rectum or for strangulated hernia, the
abscess formed as a consequence of transla.ted pus is always in the liver
alone, as there the peccant matter is stopped. {Dance and Cruveil-
hier)

Abscess of the liver is most frequently caused by ulceration of some
part of the alimentary canal, or of the gall-bladder or ducts, the veins
of which parts empty into the portal system. They convey the purulent
matter, the poisonous fluids generated by the softening of tissues, and
also the foetid gases and liquid contents of the large intestine; all
these contaminating fluids, when absorbed, must pass directly to the
liver. There the fluids that readily dissolve in the blood cause diffuse
inflammation of the liver. Morbid matters that do not readily mix with
the blood, as pus, or globules of Mercury, produce small circumscribed
abscesses. {Budd, p. 64.)

Broussais first showed, that ulceration of the stomach often led to
hepatic abscesses. {Stokes, Cydojp, Praet Med) Ulceration of the
gall-bladder and ducts, which are nourished by the hepatic artery, and
not by the portal vein, cause ulcers of the liver in the same manner as
that of the parts already mentioned. Another cause of purulent ab-
scesses in the liver is the deadly miasm developed in marshy regions
in hot climates.

Diagnosis.— The characteristic features are not well marked, and the
disease is often overlooked during life. The pain in the side or shoul-
der, the vomiting and the jaundiced color looked for are often absent.

928 DISEASES OF THE SANaUINOIJS FUNCTION.

{Andral^ AheTcomhie^ Annesley.) When the pain in the right shout'
der exists, it indicates, that the disease is in the right lobe of the liver^
Tension, or rigidity of the right rectus rriusGle may be found in other
forms of liver-disease. When the pain yields to tonics, we may presume
it was neuralgic, if to Colchicum or Alkalis, we may presume it was
of gouty origin, if to depletion and purgatives it must have been inflam-
matory or congestive. Of the action of Mercury it has been said by
Mr. Annesley, that its specific powers can not be induced after sup-
puration has taken place. {Med, Chir, Hev. Vol. 47, p. 503.)

Abscess of the liver may generally be distinguished by the presence
of a soft tumor, which may be felt under the ribs of the right side, fluc-
tuating on pressure. If by rupture of the abscess, pus is discharged,
the matter is distinguished by its resemblance to wine dregs, with some
mixture of bile. There is jaundiced color of the skin, rapidly increasing
emaciation of the whole body, and the, fever peculiar to hepatic phthisis
with periodical exacerbations.

The termination of acute hepatitis in suppuration is announced by
rigorSj a sense of sinking in the praecordia, night-sweats, prickly sense
of creeping in the skin; fullness and sense of weight about the margin
of the ribs ; dull, throbbing pain in the liver. (See Abscess^ p. 652.)
If fluctuation be distinctly felt under the ribs, and we may believe, that
the suppuration is complete, and the abscess not at too great a depth,
it should be opened. When the pain and general fullness are diminished,
and replaced by a distinct tumor without acute pain; if it is soft and
fluctuating at the apex, elastic, yet livid or red on the surface, while
the base is somewhat hardened and elevated, we may puncture the ab-
scess with confidence in a successful result. The inflammation which
leads to abscess is often confined to the substance of the liver, and does
not involve its capsule. As the a.bscess approaches the surface, ad-
hesive inflammation of the peritoneum immediately above it usually
takes place, and a small quantity of lymph is poured out, which causes
adhesion between the wall of the abscess and the parts with which it is
brought into contact. These adhesions are often of very small extent,
sometimes they do not form at all and the abscess bursts into the cavity
of the peritoneum, causing speedy collapse and death. By opening an
abscess of the liver before adhesions have formed, we may be directly
instrumental in bringing on this fatal issue, — the pus may escape into
the cavity of the peritoneum, and the patient die in a few hours, ob
viously in consequence of the operation. Another danger is also en-
countered in allowing air to enter the cavity of the abscess and decom-
position of both results, air and pus, and fresh inflammatory action is
developed.

Abscesses of the liver often attain an immense size. Dr. Budd saw
one that contained two quarts of pus. Annesley examined one that

mFLAMMATION OF THE GALL-BLABBEE. 929

contained ninety ounces, and Dr. Inman of Liverpool saw one tliat con-
tained thirteen pints.

Prognosis. — The abscess may burst externally through the walls of
the abdomen, inwardly into the lung or pleura, into an intestine, or into
the cavity of the abdomen. The opinion formerly entertained that the
pus could be absorbed and eliminated from the pleura is erroneous.
Pus-globules are too large to enter the minute blood-vessels, or to es-
cape from them. The matter found in the bladder during the progress
of purulent phlebitis is not pus, though it has the appearance of it.
The microscope shows it to be composed of " beautiful phosphatic
crystals." {Budd. Diseases of the Liver ^ p. 78.)

Cragie says, that besides the abcess discharging into the abdominal
cavity, the pus may pass through the air-cells into the bronchi, by the
adhesive process into some part of the intestinal canal, the stomach,
transverse arch of the colon or even the duodenum, and Rokitansky
mentions several other outlets, as into the gall-bladder, or one of the
, larger branches of the hepatic duct ; through the diaphragm into the
pericardium, and even into the large vessels, as the vena cava. He
mentions a case, in which a communication was established between
a hepatic abscess and the venae portae and the duodenum. A case is
given in the London Medical Repos, (July, 1827), in which an abscess
of the liver spontaneously made its way into the chest, and the purulent
matter was evacuated by paracentesis thoracis.

21. INFLAMMATION OF THE GALL-BLADDER AND DUCTS.

Symptoms. — Pain in the situation of the duct, followed, in two or
three days, by jaundice and distinction of the gall-bladder ; fever,
constipation, nausea, vomiting ; pain, limited to a small spot in the
situation of the common duct.

Causes. — Mechanical irritation of gall-stones, which in turn are
pl'omoted in their growth by the thickening of the lining membrane of
the ducts.

Diagnosis. — Distinguished from inflammatory jaundice by the early
appearance of a large, moveable, pear-shaped tumor, produced by pro-
jection of the gall-bladder, this is painful and tender.

Pathology. — In a case, given by Graves {Glinioal Medioine)^ the
pain during life had been confined to a point between the right hy-
pochondrium and epigastrium, was greatly increased by pressure. On
dissection, the gall-bladder was distended, being completely filled with
a dark-green mass of a tenacious viscid nature, apparently lymph. It
was of the shape of the gall-bladder. On removing it, the lining mem-
brane of the gall-bladder was found of a bright scarlet color and villous
appearance, not softened or ulcerated, the walls of the gall-bladder

Vol. I.— 59

980 DISEASES OF THE SANGUINOUS FUNCTION.

much thickened ; no obstruction or vascularity in the common duct,
the cystic or hepatic ducts ; duodenum and stomach stained with bile,
but otherwise healthy.

Ulceration of the Gall-Bladder, — This lesion often occurs in re-
mittent fever of the more severe forms, as the Walcheren fever, as de
scribed by Sir Gilbert Blane, and the Sierra Leone fever. {Dr. Boyle)
In the more temperate climates this affection is connected with the
presence of gall-stones, which also often close the cystic, or even the
common biliary -duct. This last condition always terminates in incur-
able jaundice, and ultimately certain death. The gall-bladder in some
cases acquires a large size.

Pathology. — When the gall-bladder and ducts become thus largely
distended, the proper nucleated cells of the liver, which secrete the
bile are damaged or totally destroyed, the capillaries waste, and the
whole organ shrinks and no longer presents any appearance of distinct
lobules. ( Williams^ in Guifs Sosp, Reports) Nothing is now visi-
ble in these structures but minute free fatty particles and floating
granular matter. In cases of closure of the common duct, there is often
present a voracious appetite, arising as in diabetes from an imperfect
digestion of food, Hsematemesis is a frequent symptom of this as well
as other forms of hepatic disease ; the cause is seen in the obstruction
of the circulation through \kx^ portal vein. This produces a back-pres-
sure upon the current of blood in the gastric and mesenteric veins.

In some cases of obstructed secretion of bile, the brain is affected
with delirium, coma or convulsions before death, which is often at a
long period after the disease begins. In some cases the common gall-
duct has been closed, and the parenchyma of the liver was in a great
degree atrophied at the same time ; and thus for several years there
was suspension of the secretion of the bile and of its excretion also.
The duration of life under such circumstances depends on the condition
of the other chylopoetic viscera,, the nature of the food taken and the
state of the other excretory functions. Death, however, always ulti-
mately follows this state from gradual but progressive wasting from
impaired nutrition. The use of ox-gall in pill, after eating, is not a
substitute for the natural secretion.

Treatment of Inflammatory Diseases of the Livek. — The prin-
cipal remedies are : Aeon., BelL, Bry., Cham., Chin., Lachesis, Merc,
Nux-vom., Puis., Sulph.

Aconite, — Inflammation of the liver with fever, stitches in the region
of the liver; intolerable pain ; moaning; tossing about; anguish, and
dread of death. (For further symptoms see p. 410.)

Bryonia, — Aching pains, with tension in the hypochondria; yellow-
coated tongue ; violent oppression of the chest, with hurried, anxious
breathing; constipation; aggravation of the pains by motion.

INFLAMMATION OF THE LIVEE. 981

Chamomilla, — Dull aching pains, not aggravated either by pressure,
motion, or breathing ; pressure in the stomach ; tension in the hy-
pochondria ; oppression of the chest; yellow color of the skin ; yellow-
coated tongue ; bitter taste in the mouth, and paroxysms of anguish.

China, — Disease of the liver, originating in malaria ; aggravation
every other day, with stitching, aching pains ; swelling and hardness
of the region of the liver and stomach; headache; bitter taste in the
mouth, and yellow-coated tongue.

Lacliesis, — Disease of the liver, caused by intemperance ; after
Aeon., Merc, and Bell, have been used without sufficient effect.

Belladonna, — Aching pains extending to the chest and shoulder;
distention in the pit of the stomach ; tension in the region of the
stomach ; labored and anxious breathing ; congestion of blood to the
head ; obscuration of sight ; vertigo with fainting ; burning thirst ; anx-
ious tossing about and sleeplessness. It may be given after Aconite,
in alternation with Mercury or Lachesis.

MeTGitrius, — After Aconite, Bell, and Lachesis have been used with
partially good results ; and there remain aching pains, which do not
permit one to lie on the right side ; bitter taste in the mouth ; loss of
appetite ; thirst ; constant chills ; very yellow color of the skin and
eyes. For effects of Mercury more at length see page 403 to 405.

Nux-vomica, — Stitching or beating pains, with excessive sensitive-
ness of the region of the liver to the touch ; bitter and sour taste ;
vomiting or nausea ; pressure in the hypochondria and region of the
stomach, with short breath ; thirst ; red urine ; headache ; vertigo, and
paroxysms of anguish.

Pulsatilla, — Paroxysms of anguish, especially at night; diarrhoea;
greenish and slimy stools ; desire to vomit ; bitter taste in the mouth ;
yellow-coated tongue ; oppressed chest ; tension in the hypochondria
and pressure in the stomach.

Sulphur, — Chronic cases in psoric constitutions, persisting after
Nux-vomica and the above remedies have been partially successful.

Podophyllum, — Appetite voracious ; eating followed by nausea and
vomiting. Diarrhoea immqdiately after eating or drinking. Stomach
sour; eructations ; nausea ; fullness of the head; vomiting an hour
after eating, and then craving for food immediately afterwards ; extreme
nausea continued for several hours ; heartburn ; waterbrash and heat of
the stomach ; exudations of hot flatus very sour. Sensation of hollow-
ness in the epigastrium; throbbing in the epigastrium and stitches from
coughing. Gastric affection attended by depression of spirits.

Fullness of the right side of the abdomen with flatulence and stitches ;
weight and dragging in the region of the descending colon ; colic with
retraction of the abdominal muscles ; pain in the transverse colon, fol-
lowed by diarrhoea; p^in in the bowels relieved by warmth and by

932 DISEASES OF THE SANGUTNOUS FIJK'CTT.OlNr.

bending the body forward ; the pain attended by coldness, paiD, heat
and perspiration. It diminishes the frequency of the pulse from seventy-
six to sixty-one.

Chronic hepatitis with constipation ; fullness and soreness of the right
hypochondrium ; constipation with flatulence and headache ; constipa-
tion with remittent fever ; faeces dry and hard ; extreme weakness with
cutting pain in the intestines after stool; chalk-like stools, very offen-
sive, with gagging and incessant thirst in children; large countenance ;
sunken and blue under the eyes.

Chronic diarrhoea with prolapsus ani at every stool ; prolapsus ani
with diarrhoea for six years in an adult; descent of the rectum from
small exertion, followed by stool or discharge of thick, transparent mu-
cus mixed with blood; involuntary discharge of urine during sleep;
diminished secretion; suppression; leucorrhoea with bearing down,
producing prolapsus uteri; pain in the region of the ovaria.

In 1819 Dr. Snow gave a decoction made from one ounce of the
root, simmered down from a pint to four ounces, to a full grown dog.
In ten minutes after the last dose, the pulsations of the heart were very
weak and from fifty to fifty-five per minute. In an hour he vomited.
There was copious salivation, no narcosis ; he vomited almost in-
cessantly till he died.

Leptandra-virginiGa, Culverts physic Blaokroot, Tall Veronica,
Corresponds in a slight degree to mercurials in its action on the liver.
It is said to promote the biliary secretion in a gradual manner, cor-
recting the secretion and leading to restoration to the healthy action
of the bowels, when they have been affected with diarrhoea, cholera in-
fantum, dysentery, or constipation ; and when there is habitual torpor
of the liver, jaundice, haemorrhoids, dyspepsia.

When suppuration has occurred and the abscess has been favorably
evacuated, one of the best remedies is Nitro-muriatic-acid,

If itro-muriatiG' acid Foot-hath, — Add one-half ounce of the acid to a
gallon of water, increasing the strength, if the skin will bear it without
irritation ; and use it thirty or forty minutes every evening.

Nitro-muriatic-acid, — Has been used with success in chronic he-
patitis with obstinate constipation, torpor of the liver, dyspepsia, some
forms of scrofula, and many cases of pseudo-syphilis. It has a prompt
and decided effect on the biliary secretion, and determines the action
to the skin.

It is best suited to cases of chronic hepatitis with indolent engorge-
ments of the capillary and parenchymatous structures. In its deob-
struent properties it corresponds partially with Mercury.

In attenuated doses it is applicable in inflammatory cases where un
diluted it could only increase inflammation and fever. Whether applied
externally or internally its effects are the same. When the doses are

CHRONIC HEPATITIS. 938

too large, it produces excessive secretion of acrid bile, which irritates
the bowels, producing tenesmus and bloody discharges. Diluted and in
small doses it cures these conditions and exerts a curative infiu^ce
on diseases of the parenchymatous structures, the glandular system,
secerning, secreting and absorbing surfaces.

22. CHRONIC HEPATITIS.

Diagnosis. — The symptoms of chronic liver complaint are somewhat
similar to those of the acute form, but more mild in their character.
For example, the pain in the right hypochondrium is dull, heavy, and
dragging, that in the shoulder and arm of a vague and heavy kind ; the
skin is somewhat hot and dry; the tongue furred; the countenance and
albuginea yellow ; the urine and perspiration of a dark or yellowish
color; the bowels costive, sometimes alternating, with diarrhoea;
evacuations light ; occasional cramp-like pains in the stomach ; great
weakness and loss of energy throughout the entire system ; inclination
to sleep a good part of the time ; trembling of the knees on the slightest
exercise ; dejection and indifference to life ; enlargement and induration
of the liver.

Causes. — This is a disease of hot, rather than of temperate latitudes,
and may arise from a too free use of animal food, stimulating drinks,
and other articles abounding in carbon. As the blood passes through
the liver, its office is {in part) to separate the carbon, &c., which is not
wanted in the system. We can therefore readily perceive how prone
this important organ must be to be overtasked in so rarefied a tempera-
ture, unless the utmost care is taken to retain the organs in a healthy
state, as well as to avoid highly seasoned animal food, stimulants, &c.

The chronic form of hepatitis often follows, and is a consequence of
dyspepsia. Indeed, there are but few, if any, cases of the latter dis-
order, which are entirely unattended with derangement of the liver.

Want of exercise, depression of spirits, misfortune, sudden suppres-
sion of perspiration, accustomed discharges, &c., may often exercise a
powerful influence in inducing this disease.

Treatment. — The best remedies are : Acon,^ Mercicr,^ Bry.^ Nux-
^6>m., Sulphur^ Aurum, Zachesis, LyGopodium, JVatrum-magnes,-
mur.^ Alum^-amb,^ Galc,^ Ghin.^ Sil., Ghelidonium^ Ignatia^ Iodine^
Conhcm^ Pulsatilla^ PodojyJiyL^ Leptandra^ Sangtdnaria.

For Swelling or Induration of the Liver. — Arsen,^ Galo.^ Ghin.^
Wux^vom,^ Sulph,^ GrapJh,^ Mercurius^ Natrurrh-mur,^ Taraxacum,

Abscesses of the Liver, — Lachesis^ Silicea^ Bell,^ Hepar.

Administration. — The medicines may be used from the first to the
sixth attenuations, and repeated, in acute cases, every two, four, or six
hours, according to circumstances. In chronic hepatitis, a dose of the

934 DISEASES OF THE SANGUINOUS EUKCTIOK.

appropriate specific should be given olice or twice in the twentyrfour
hours, at the same time inculcating the importance of rigid dietetic re-
gulations.

In chronic hepatitis there is a peculiarly dry and harsh state of the
skin, and on this account we strongly advise the daily use of cold
sponging^ or tathing, to be followed by vigorous exercise in order that
the pores may be opened, and the cutaneous functions thus restored.

HypeHrophy of the Lwer» — Auricm, — A gentleman, a.ged forty-
five, dark complexion, had undergone long courses of treatment within
the last ten years ; and now presents the following symptoms : Weight
in the right side of the abdomen ; occasional sharp pain felt there ;
quick darting, and alternating with a similar pain in the upper arm ;
obstinate constipation ; urine scanty, colorless during the first hours,
then turbid, with brick-dust sediment ; little appetite ; deep sadness;
discouragement ; desire for death, and inclination to suicide, notwith-
standing the open profession of religious ideas. The right hypochon-
drium gives resistance on palpation. In pressing the palm of the hand
under the false ribs, from in front backwards are felt three hard lumps
belonging to the thin edge of the liver ; this pressure causes sharp
pains, and much difiiculty of breathing. The left side sound from the
umbilicus. No disturbance of the circulation.

Teeatment. — Aurum 6^, a drop in 120 grammes of water, a tea-
spoonful in the evening. Diet exclusively of white meats, fish, and
fresh vegetables. Avoid all milk and fermented drinks. At the end
of one week no change, Saccharum-lactis for ten days. By that time
the stools were regular; urine normal. The patient feels less heavy,
less sad, more confident. Aurum 80°, 4 globules. A week later the
whole condition was improved; stools free, appetite better; he is
calmer; no further ideas of suicide ; some pain in the right hypochon-
drium on pressure, Magnes.-mur. 6°, one drop in 120 grammes of water.
A month later, cheerful, appetite and stools normal ; no pains, no longer
pain in region of the liver on pressure. Magnes.-mur. 6° one drop.

The efficacy of Aurum is most marked when the local symptoms are
added to the mental troubles, deep sadness and desire for death which
so often accompany liver diseases ; these moral symptoms are indispen-
sable to its success.

A priest, of whose liver the left lobe was enormously hypertrophied,
presenting the corporeal but not the moral symptoms. Aurum 6° and
30° were continued three months without effect. Nux and Magnes.-
mur. failed, and he had already been drinking the Vichy waters several
years ; within the last two months the engorgement considerably dimi-
nished under Sulphur 80°, alternated every fortnight with Lycopodium
80°. (Jotirnal de Societe Gallicane^ Jwly, 1859.)

Fatty Degeneration of the Liver, - Mr. Bowman has shown that the

INFLAMMATION OF THE LTVEE. 935

greater portion of the superabundant fatty matter in the liver exists in
the form of oil-globules within the proper nucleated cells of the affected
organ. In this disease the number and size of these oil-globules is
enormously increased ; in some cases one-half the entire bulk of the
liver is composed of them, and it is often much larger than natural.
"When the quantity of oil is less the liver presents what is called the
" Nutmeg" appearance. The functions of the organ may not be much
deranged, though the distention of the abdomen causes inconvenience.
But, as the disease advances, the increase of the fatty matter, which
was first destined to constitute a portion of the bile becomes a poison,
by its presence obstructing the process of secretion. As fat contains
50 per cent, of carbon, its secretion at first is a protective measure.

Diagnosis. — The great enlargement of the abdomen in the region of
the liver in a corpulent inactive person, particularly of a lymphatic
temperament, may be suspected to be of this nature. Though no posi-
tive characteristics have been pointed out. As the disease progresses,
the effects on the general system and on the tuberculous degeneration
of the lungs make its character intelligible. ( Williams^ on the Patho-
logy of Cells)

Causes.- — Corpulent tendency generally ; inactive life ; gross and full
living ; free use of heavy malt liquors ; oily food in excess, or vegetable
products which are chemically nearly the same, as potatoes, sugar, &c.
" Sugar furnishes a material for respiration which is soluble in the
blood, and is acted upon more readily than the insoluble fat, which is
thus protected and laid up in the system. Alcohol has a still stronger
protecting power, and for similar reasons." [Budd) Magendie found
that dogs fed too exclusively on oleaginous matters, as butter and lard,
died of inanition although they became remarkably fat; in all the liver
was fatty. Wasting disease : of consumptive patients about one-third
have accumulations of fat in the liver, and in many cases about the
heart, though its muscular tissue is wasting at the same time. {Loids,)
^* The mode by which the fat is accumulated is displayed in all those
diseases in which emaciation is a striking feature;" in the process of
wasting, the fat stored up in the body is largely taken up by the veins,,
so that it comes to be in excess in the blood, and is then laid hold of
by the hepatic cells which have a natural affinity for it." In fatty de-
generation of the liver then the essential disease consists in the ac-
cumulation of fat in the veins from the food beyond what the organs
of nutrition can properly appropriate; it is lodged in the liver on the
effort being made by that organ to eliminate it from the system. Faulty
assimilation is then the essential disease.

Mr. Bowman says in one-third of the cases in which the lungs are
disorganized the epithelium cells of the liver become more or less
gorged with adipose particles. It is noticed that no fat globule has

936 DISEASES OF THE SANGUINOTJS EUNOTIOI^.

yet been found A^dthin the nuclear cell. It always occnpies the inter-
val between the nuclear and outer capsule. ( Williams,}

During the progress of fatty degeneration of the liver the parenchy-
mal cells distended by accumulated fat, fail to perform their part in
the process of secretion and they eventually hurst A universal sus-
pension of the secreting agency takes place ; and thus the last avenue
for the elimination of the carbon from the blood suffers fatal obstruction,
and the whole body is soon oppressed by its accumulation in the bloodo
(See Cell Formation, p. 641, 646, 647.)

Tkeatment. — The remedies most likely to correct these structural
degenerations of the liver must be sought for among those already
enumerated under the forms of hepatic disease. Taraxacic'in^ Muriate
of Ammonia^ Nitro-muriatic-acid, Mercur.-proto-oxide, PodophyL^
Leptand.j Sanguinaria and Aurum are the most important

23. CANCER OF THE LIVER.

This is one of the most severe as well as the most common of struc-
tural diseases of the liver. It appears in the form of disseminated
cancer^ as we have already seen disseminated ahscesses in the section
on suppurative inflammation of the liver.

DiAGi^osis.— The most significant symptom is enlargement of the
liver till it reaches below the false ribs, even to the brim of the pelvis ;
its surface is then often tuberculated with cancerous growths, and is
felt to be irregular and knobby to the feel on applying the hand. The
size is diminished in but few cases. In some there is ascitic effusion,
but seldom so much as in cirrhosis ^ jaundice is common. The enlarge-
ment comes on in the middle of life, is progressive ; there is no probable
cause for it. There is no obstructed circulation in the chest, the patient
is not consumptive, has not been intemperate to cause cirrhosis ; when
many of these circumstances a.re present, cancer of the liver may be
expected, especially if it be of great size and is nodulous or uneven,
there is no longer room for doubt. Constant pain and tenderness also
are almost decisive symptoms of cancer. {.Biodd^ p. 326.)

CATJBES.—Cancer of the liver is generally consequent on cancer in
some other part, especially the stomach or mammae. In few cases it
originates in the liver. When cancer exists in some other organ, the
liver, next to the lungs, is most likely to be the seat to which if wnll be
likely to be transferred. The reason is, that the entire venous blood
of the stomach and intestines has to pass through its substance, and all
abnormal substances contained by the blood are liable to be detained
in the capillary vessels. The cells of pus, of cancer, and other morbid
degenerations are apt to be arrested in their course. The matters thus
arrested become foci of purulent cancerous or other disease of the

INFLAMMATION OF THE SPLEEN. 937

parenchyma of the liver. When therefore the stomach or any portion
of the intestines become affected with cancer, we may expect the liver
to become the depository of some of the morbific germs. These are
likely to be located in a great many different points, often hundreds.
Some of these are found of the size of a bean, or even as large as an
orange ; others are so minute tha.t they are distinguished with difficulty.

Pathology.— -Cancerous tumors in the liver are sometimes white
and fibrous, usually termed scirrhous / but more frequently they are
soft or medullary; in a few subjects they are found of both kinds. We
find the same variety in cancer of the liver as in other organs. In
some soft cancers we find some with but few vessels, in a substance
pulpy and whitish, resembling softened brain, called by Laennec en-
cepkccloid. In others the tumors are extremely vascular, resembling
fungus hsematodes ; others again are melanotic. The color of the mela-
notic tumors of the liver varies according to the pigment they contain,
and they are found of every shade from light-brown to black. [Budd^
p. 302.) (See Cell Formation^ Diseased^ p. %^^)

The prognosis is always unfavorable, such cases being in general
ultimately fatal.

Treatment. — The only reliance will be upon the general treatment
of cancer, to which we refer. The worst treatment is that which is
quite likely in most cases to be adopted. The use of large or often
repeated doses of Mercury can only prove speedily injurious by ex-
hausting the patient's strength, and always aggravating the local
malady. But much benefit will be derived from minute homoeopathic
doses of Mercurius-hyd. ; also from Kali-hyd., Iodine, Silicea, Arseni-
cum, Arsenic um-hyd., Cannabis, Aconite, Hepar-sulph., Calcarea-caTb.

24. SPLENITIS.— INFLAMMATION OF THE SPLEEN.

The function of the spleen has been regarded as more abscure than
that of any other of the abdominal viscera. From its immediate con-
nection with the stomach and the several organs pertaining to the
portal system, it is believed to be at least a " chylopoetic agent ;" and
it may be classed with the lymphatic glands, which in its anatomical
character it closely resembles. This organ is only found in those
classes of animals in which a distinct lymphatic system exists ; and
its size is always proportioned to the development of that system.
When the spleen becomes hypertrophied, the lymphatic glands are
often inflamed, as a sympathetic phenomenon ; hypertrophy of the spleen
is also often a consequence of disease of the lymphatic glands of the
abdomen. The mesenteric glands have also been observed to become
enlarged after extirpation of the spleen (Mayer and Czermak), and

938 DISEASES OF THE SANGUINOUS FUNCTIOI^.

the thyroid gland also became enlarged after the same mutilation*
(Tiedemann.) Thus there is a vicarious activity of other lymphatic
glands to supply the action of the removed spleen.

There was a time when physiologists thought to ascertain the func-
tion of this organ by removing it from animals. At first they seemed
to get along well ; and soon, says Mr. Abernathy, " every man who
could procure a dog was cutting out the spleen, and publishing the
history of the case." But disappointment followed. The dogs, which
had improved in appetite on the loss of the spleen, all died after trying
for a short time to live without it ; and the experimenters confessed
that nature must have had some object in creating it.

FoEMS OF Diseases of the Spleen. — 1. HypercBTnia with con-
sequent Syperirophy. — This consists in a morbid increase of the
vital activity of the spleen. It results in intumescence, and then in
alterations of structure, such as fibrinous, fatty, albuminous, serous, or
other degeneration of structure. In malarious countries, enlargement
of the spleen or " ague cake" is as common as the ague which origi-
nates it.

2. Atnrojphy of the Sjpleen, — Phlebolitia. — Morbid diminution of the
vital activity of the spleen.

8. Sehnen-Fleisch, — Exudation of firm, white, tendon-like, in-
separable exudations which appear on the upper surface of the spleen,
as well as on some organs.

4. Cartilaginous^ lony^ and earthy degeneration of the spleen.

5. Episplenitis. — Inflammation of the capsule of the spleen.

6. Splenitis. — Inflammation of the spleen. It may be acute or
chronic ; and may terminate in hepatization, suppuration, softening, or
gangrene.

7. Spleno-Phlehitis, — Inflammation of the splenic veins.

8. Other structural diseases of the spleen have been described under
the names of emphysema of the sjpleen^ ^5<3'W6?6>-morphosis, including
melanosis^ lipoma, and steatoma, hydatids^ acephalooysts^ soirrhus,
and tubercles. The accidental injuries described consist of rupture
of the spleen.^ rupture of the splenic artery, with or without the for-
mation of aneurism^ rupture of the splenic vein, and wounds of the
spleen.

The distinction between these obscure forms of disease, in an organ
to which no very influential position has been assigned by medical
philosophers, and the specific treatment proper to each cannot be
given in detail without devoting to the subject a space disproportionate
to its importance. We shall be content with a general view of essential
points only.

Diagnosis. — The symptoms which indicate the existence of splenic
inflammation are liable to be confounded with those of disease of the

INFLAMMATION OF THE SPLEEN, 939

left lung, the heart, the diaphra,gm, peritoneum, the stomach, the left
lobe of the liver, the cauda of the pancreas, the omentum, the descend-
ing colon, or the left kidney. The symptoms which more particularly
point to disease of the spleen are : location of the seat of complaint in
the left hypochondrium ; functional disturbance of the stomach ; thirst,
variable appetite, as desire for unusual articles of food, sour or bitter
taste in the mouth ; acid eructations ; redness, dryness, with whitish
or yellow coating on the tongue, with indentations of its edges ; spongi-
ness of the gums, with offensive breath ; ptyalism, nausea and vomiting ;
diarrhoea only occasionally ; perceptible hardness or intumescence felt
by the hand in the region of the spleen; obstinate constipation and
occasional colic pains.

The disturbance of the respiration is only secondary. The fever
corresponds with that seen in the more common forms of disease of
the liver. The morbid condition of the blood is manifested by ecchy-
mosis, pemphigus or pompholyx, erysipelas, erythema, herpes, and
other eruptions on the skin; also by haemorrhages from the stomach
and bowels, meloena., &c.

Causes of Splenitis. — The spleen being deeply concealed beneath
the short ribs, is not often injured by mechanical causes or severe
blows or falls on the left side, except when diseased. In cases in which
tumefaction and softening of the liver are already present, violent con-
cussions may produce a rupture of its enveloping membrane, and give
rise to a fatal hsemorrhage into the abdominal cavity. The spleen
is liable to be w^ounded when morbidly enlarged, or when during di-
gestion it is distended with blood. In oiae case given by Mayer, a lum-
bricoid worm, which had penetrated the coats of the colon, entered
deeply into the substance of the spleen, and caused active splenitis.
Other causes of this disease are : drinking of ice-cold water when the
body is overheated ; sudden chilling of the surface after exposure in
the sun ; sudden arrest of menstruation, or of haemorrhoidal bleeding ;
over-distention of the organ with blood after the amputation of a limb ;
long-continued running or swimming, or excessive dancing ; tumefac-
tion and inflammation of the spleen occur in drunkards, in gluttons,
and in persons under the influence of malaria, from distention and irri-
tation of the texture of the organ, as well as through the morbid changes
produced in the composition of the blood. Splenitis has been caused
by terror, fear, grief, despondency, and other depressing emotions.
Bree describes a case in a female who had been, in a frolic, six times
immersed in the sea. The immoderate use of alcoholic drinks by
overloading the blood with carbon, produces a dyscrasia which is con-
nected either with simple tumefaction of the spleen, with tumefaction
and softening, or with dropsy or scirrhous hardening. Disease of the

940 DITEASES OF THE SANaTJINOTJS FUNCTION.

spleen is produced, also by drinking the water of marshy groimJlSj
and has been often observed in persons subject to epilepsy.

Articles of food supposed to predispose to disease of the spleen are :
grains rich in amylaceous matter, peas and beans, potatoes, the fat
vegetable oils, sugar, in short, all nutritive substances which introduce
into the blood a large amount of carbon and hydrogen.

Narcotics, especially hydrocyanic-acid, when taken in a certain
quantity, produce a decomposition of the entire mass of the circulating
fluid, reducing the blood to a black, thin fluid, and are enumerated
among the causes of softening and distention of the spleen ; though
H. Meyer, in his experiments with hydrocyanic-acid on difi*erent animals,
never found the blood-cells altered, and says nothing of morbid ap-
pearances in the spleen. Sulphuret of Ammonia and sulphuretted
hydrogen, also the miasm of typhus and different kinds of malaria are
known to produce similar effects upon the blood.

Certain employments and habits predispose to abdominal plethora.
Among these are shoe-making, weaving, and many others in which we
see sedentary position of the body, continued with much pressure or
bruising of the abdomen.

Meteorological causes have been enumerated under malaria (pages
477, 469, 399).

Treatment. — Congestion and inflammation of this organ are so com-
monly met with in connection Avith intermittent fever, that we have al-
ready noticed them under that head. (See pages 512, 516.) The phy-
siology of the spleen being not in all respects satisfactory, the treatment
of its diseases is generally embraced in that of the general affections
in which they are involved. In addition to remedies already men-
tioned some others have been thought to act specifically on the spleen.
The most important of these is the Iodide of Potassium.

It is generally conceded, that a great destruction of blood-cells oc-
curs in the spleen. In cases of ague we often observe congestive en-
largement of this organ followed rapidly by anasmia. A short course
of Iodide of Potassium, especially taken early, is general followed by
subsidence of the congestion, diminution of the size of the organ, and a
stop of the anaemia. The onodus operandi is not the point in question;
it is certain that there is primarily congestion ; that this is accompanied
by destruction of the blood-cells ; and this results in ansemia because
the iron is discharged^ and fresh, red corpuscles are n'ot formed in
sufficient quantity to replenish the loss ; but when the congestion is
rem^oved^ the destruction of blood-cells ceases^ and the anaemia is soon
replaced by the ruddiness of health.

Other Remedies are ; China, (see page 489, this volume.) Natrum-
muriaticum, {Synnptoms^ p. 504.). Common Salt is a popular remedy

C^LAMMATIOK OF THE PAKCEEAS. 941

25. PANCREATITIS.—INFLAMMATION OF THE PANCREAS.

The office of the pancreas is supposed to relate to the complete con-
version of chyme into chyle. (See page 220.) It is also probable
that it has something to do with the conversion of chyle into blood,
or in the formation of hsematozine, since great emaciation and anaemia
have been observed in cases in which chronic disease and obstruction
of this viscus terminated in death. The diseases of the pancreas are
divided into :

1. Ftmctional Disorder.-— Alt^rdJdon^ in the quality or quantity
of the pancreatic fluid. The only known symptoms of this condition
are : indigestion, emaciation, anaemia, imperfect sanguification and as-
similation. Brunner made the experiment of extirpating the pancreas ;
but he only learned by his cruelty that the alvine evacuations became
scanty and indurated.

Copland has endeavored to show 'that the fluid discharged from the
stomach in pyrosis, consists chiefly of augmented pancreatic fluid re-
gurgitated Into the stomach, there occasioning pain and irritation,
followed by its rejection. Dupuytren, with less plausibility, attributed
the enormous fluid discharge in epidemic cholera to an excessive se-
cretion from this viscus.

2. Inflammation of the Pancreas. — Diagnosis. — There is deep-
seated pain somewhat below the pit of the stomach, or between this
part and the umbilicus, extending to the back and under the left shoulder-
blade ; there are also occasional vomiting of an albuminous and ropy
fluid ; great thirst, and symptomatic fever. This inflammation may
be either acute^ sitb-aoute or chronic. Its existence may be inferred
when the pain beneath the pit of the stomach is increased b^ bending
the body forwards, and is but little afiected by pressure. There is a
sense of constriction or of anxiety at the praecordia ; unusual dryness
of the fauces, thirst and symptomatic fever; feeling of heat and tension
at the epigastrium ; and, the organ being much tumefied when inflamed,
there is pressure upon the bile-ducts, producing jaundice. In some
cases, a hard, painful, deep-seated tumor is felt between the scrobiculis
cordis and the umbilicus, entirely distinct from the liver and the sto-
mach. Occasionally there is a flow of ropy fluid into the stomach which
is discharged without retching, nausea or anorexia ; in other cases
there is nausea, with vomiting of a ropy mucous fluid of a whitish-gray
color, or tinged with bile ; and the flow of saliva is increased ; the
bowels at the same time are confined. At other ^times there is a
mucous, loose diarrhoea with ropy fluid evacuations.

Chronic pancreatitis presents the above symptoms in a less per-
ceptible form ; the pain at the epigastrium, the tension and heat are

942 DISEASES OF THE SANGUINOUS FUNCTION".

felt only after a meal, or are aggravated by it. There are flatulence,
tTuctations, pyrosis, and uneasiness in the back ; some enlargement or
tumor; the pyrosis appears every morning; salivation occurs in some
instances.

Pancreatitis terminates in : 1. resolution ; 2. The effusion of co-
agulable lymph on the surface of the organ; 8. suppuration; 4. gan-
grene ; 5. chronic enlargement and induration.

Causes. — The first and most pernicious cause of this disease is
abuse of Mercury. The following also operate in a deleterious manner
on this organ as well as on the system generally. Tobacco in all the
modes in which it is used; abuse of alcoholic drinks; frequent resort
to purgatives; falls, blows, or other injuries ; extension of inflammation
from other organs. Pancreatitis also occurs sympathetically of inflam-
mation of the salivary glands. In one case the parotids were greatly
.enlarged, but they diminished rapidly in size, and this was followed by
symptoms of disease of the pancreas ; on its subsidence, there was
inflammation of the testicle ; which was again superceded by inflam-
mation of the parotid, ending in suppuration.

TREATMENT. — In Seeking for remedies capa-ble of affecting the pan-
creas specifically, we must endeavor to meet the symptoms of the in-
dividual case with some of the medicines known to be applicable to
analogous diseases in other organs of the digestive system. When
there is evident inflammation, we can only rely upon Aeon., Mercur.,
Bry., Arsenicum, Tartar-emetic, Iodine, Kali-hydriodicum.

When the case is protracted, we can find remedies among those
described under dyspepsia and chronic diseases of the liver, jaundice,
&c. When chronic pancreatitis is evidently connected with a cancer-
ous or scrofulous dyscrasia, it will be cured by the treatment given
under those diseases. See pages 284 to 296.

26 . LEUCOTHYiEMIA SPLENICA.

In this disease, first described by Dr. Hughes Bennett, of Edinburgh,
the blood displays an excess of the white corpuscles ; but there is not
the extreme anaemia seen in anaemia lymphatica. Dr. Wilks regards
the last-named as a destructive process in the lymphatic glands a.ffected.
The present disease is characterized also by epistaxis, purpura, and
other haemorrhagic tendencies, with wasting of the body; and the
patient needs to keep the bed. The invasion has been gradual in the
cases observed.

Causes, — Ague^has in all cases preceded the full formation of this
disease. In one case, examined after death, the spleen was very much
enlarged ; but there was no distinct circumscribed deposit as in anaemia
lymphatica.

LEUCOSIS. 943

27. LEUCOSIS.

This is a condition of tlie system which, is essentially ancBmic^
though associated with nervous exhaustion. It is closely related to
chlorosis. It may appear in men, women, and children as well as in
old age. Symptoms :

The toDgue is pale, like a piece of raw veal; often coated, moist ;
deeply-marked with impressions from the teeth, flaccid, often tremulous,
almost bloodless ; muscular system powerless ; countenance pale, as
from effects of lead; lips blanched, often red; when red, it is. only
for a short period; in the highest form of this affection the tongue is
slightly swollen ; when the lips are red, there is nervous irritability
with less apparent exhaustion.

In this disease, as well as in phthisis, and some other dyscrasias
connected with deficiency of some of the normal elements of the blood,
it is now believed that the secretions and excretions abound in an ex-
cessive amount of phosphates ; and, in proportion to this excessive loss
of materials essential to healthy blood, the consequent debility and
symptomatic fever continually progress. Hence, in surgical cases of
wounds, abscesses, or sloughing, occurring in such patients, it is per-
petually necessary to assist the digestive organs in the assimilation of
food duly supplied with all t*he elements essential to healthy nutrition ;
and a positive necessity exists for producing a normal phosphatized
blood to furnish healthy exudations for uniting wounds and fractures.
^' The idea," "says Lehmann, " that the plasticity of an exudation is de-
pendent on the quantity of fibrin it contains is erroneous." Some
plastic exudations are without fibrin, and some non-plastic contain it.
But the plasticity of the exudations is constantly associated with the
presence of soluble phosphates. The integrity of the textures, there-
fore, depends upon their supply just as much as in their first organi-
zation, wherein special providential design is exercised. In the , ex-
ample of incubation^ the egg phosphates are placed in the yolh of the
egg for the early nutrition of the embryo chick, and glycero-phosphate
is provided in the shell for the double purpose of affording protection
during gestation, and nutritious support during the latter period of
embryo development, by endesmosis through the albumen, and the
consequent thinning of the shell preparatory to the young animal's
escape at maturity from its imprisonment. Chossat produced rickets
artificially in animals by restricting them to food which contained no
phosphate of lime.

During the period of human gestation, if there be a deficiency of
phosphatic salts taken in the food and assimilated, supplementary de-
mands are made upon the mother's own tissues to furnish the necessary
supply of these ingredients for the growth and development of the

944 DISEASES OF THE SANGUmOUS FUNCTION.

child. The parent soon manifests the loss by complaining of defective
secretions ; dyspepsia, stitches, neuralgic pains ; absorption of fat and
muscle ; pinched features ; and the long train of symptoms usually
ascribed to the irritation of uterine expansion and reflex excitement.

This disease has been cured by S7nall doses of Hypophosphite of
Potash three or four times a day, taken in diluted form. This salt is
readily dissolyed by animal fluids, and is speedily converted into a
phosphate. The ground of preference of the hypophosphites over the
phosphates as remedies, consists in the fact that the latter require for
their solution weak acids which are not invariably present in the
alimentary canal ; then bread and animal food cease to nourish through
the ffiilure of the mucous secretions ; and we see how the Hypophos-
phites of Potash or Soda may reach the lacteals and be taken into the
blood when the phosphites might not be absorbed. {Bischoff) Phos-
phorus, says Corewinder, " is the element which accompanies nitrogen-
ous matter in all its phases." We are therefore justifiable in imi-
tating nature in "accompanying nitrogenous food with the most soluble
and absorbable salt of phosphorus" in all the forms of disease in which a
deficiency of the phosphates is known to exist. The following are a
few of these troublesome and often serious aifections : 1. Oonseqioences
of lactation too long continued y' dentition in feeble, pale, and scro-
fulous children; leucothycemia ; . (See page 924.) general ancemia
(see p. 712). Mercurial cachexia (p. 404); profuse catarrhal and
leucorrhceal discharges; all inordinate sujppiirations * myalgia^ oa^
neuralgic muscular pains often mistaken for inflammation ; some forms
of dyspepsia.

Other remedies for leucosis and kindred affections ; Calcarea-carl).
(see pages 851, 448, 507, 614, 228). China; Ferriirn ; (page 507);
Ignatia (p. 507).

28. MESENTERITIS.—See Marasmus.— Index.

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