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ELEMENTS 


HOMOEOPATHIC  PRACTICE  OF  PHYSIC. 


C    AND  3.  ADLAK.D,    PRINTERS,  nARTHQLOMKW   CLOSE. 


ELEMENTS 


HOMOEOPATHIC    PRACTICE 


PHYSIC. 


J.  LAURIE,  M.D. 


LICENTIATE  OF  THE  ROYAL  COLLEGE  OF  SURGEONS,  EDINBURGH  ; 

FORMERLY  ONE  OF  THE  PHYSICIANS  TO  THE  WESTMINSTER  AND  LAMBETH  HOMOEOPATHIC 

MEDICAL  INSTITUTION  AND  DISPENSARY. 


LONDON: 

J.  LEATH,  5,  ST.  PAUL'S  CHURCHYARD. 

THOMPSON  AND  SON,  CHURCH  STREET,  LIVERPOOL. 

TURNER,  PICCADILLY,  MANCHESTER. 

HEADLAND,  HANOVER  STREET,  EDINBURGH. 

1847. 


CONTENTS. 


INTRODUCTION. 

PAGE 

Regimen     .        .  ' xvii 

Choice  of  the  Remedy.    Potencies  of  the  Medicaments          .....  xix 

The  Choice  of  the  Proper  Remedy xx 

The  Potency,  Attenuation,  or  Dilution  of  the  Medicament xxi 

The  Dose  and  its  Repetition         .        .        .        . xxvi 

Remarks     .        .        .        . xxxi 


NATURE  AND  FORM  OF  HOMOSOPATHIC  MEDICINES           .            .  XXXU1 

Of  Vehicles  which  serve  for  the  Preparation  of  Homoeopathic  Medicines         .        .  xxxvi 

1.  Of  Alcohol ib. 

2.  Sugar  of  Milk xxxix 

3.  Sugar  Globules ,  xli 

4.  Water ib. 

5.  Ether xliii 

Of  the  Preparation  of  Medicines  in  their  Primitive  State xliv 

1.  Observations  and  General  Rules             .......  ib. 

2.  Particular  Rules  for  the  Preparation  of  Fresh  Plants — Tinctures     .        .  xlvii 

3.  Preparation  of  Exotic  Vegetable  Products xlviii 

4.  Preparation  of  Mineral  and  Animal  Substances — Triturations    •     .  1 
Of  Homoeopathic  Attenuations lii 

1.  Of  Attenuations  in  general ib. 

2.  the  Preparation  of  Attenuations        .......  lix 

Of  the  Dispensation  and  of  the  Preservation  of  Homoeopathic  Medicines        .        .  lxiii 

1.  Of  the  Dispensation  of  Medicines ib. 

2.  the  Preservation  of  Medicines lxiv 

List  of  Medicines  adapted  to  particular  temperaments,  &c.    ...        .        .  lxvii 

Table  of  Medicines,  with  abbreviations         . lxix 


VI  CONTENTS. 

PAGE 

List  of  Medicines 1 

Synopsis  of  the  Rules  for  Diet  under  Homoeopathic  Treatment       ....  3 

Aliments  allowed ib. 

Aliments  prohibited -      »  ■         4 


PART  I. 

ON  THE  SYMPTOMS,  CHARACTER,  DISTINCTION  AND  TREATMENT 
OF  DISEASES. 

FEVERS. 

General  consideration  of  Fever 5 

Causes        .        .        .        ....        .         .        .        .         t        .        .  ib. 

General  Treatment  in  Fever  and  Diet            7 

Simple  or  Ephemeral  Fever.     Febris  simplex 8 

Inflammatory  Fever,  Synochal  Fever.     Febris  inflammatoria  simplex.     Synocha. 

Febris  synochalis.          ............  9 

Nervous  Fever.     Slow  Fever.     Febris  nervosa.     Typhus        .....  12 

Putrid  Fever,  Pestilential  Fever,  or  Malignant  Typhus.     Typhus putridus.     Typhus 

abdominalis          .         .         .         ,         .         .         .    ■..    .         .         .  27 

Contagious  Typhus,  Camp  Fever,  Jail  Fever,  Petechial  Fever.    Typhus  contagiosus    .  29 

Accessory  Treatment.    Prophylaxes,  &c.       .         .         ....         ,         .  ib. 

— .           Febris  lent  a  nervosa   .      .   ..     .         .         .         .         .         .         .         ...  30 

Intermittent  Fevers.     Ague.     Febres  intermittentes          ..     .         .   .      .         .         .  31 

Raphania.     Morbus  cerealis,  Convulsio  cerealis.     Eclampsia  typhoides             .        ..  41 

The  Plague.     Pestis.     Pestis  bubonica.     Typhus  pestilentialis       .   ..      ..         .         .  44 

Remittent  Fever.     Yellow  Fever.     Febris  flava.     Typhus  icterodes        .         .         .  47 

Hectic  Fever.     Febris  hectica .         .  48 

Mucous  Fever.     Febris  pituitosa.     Febris  mucosa           ......  52 

Gastric  Fever.     Bilious  Fever.     Febris  gastrica  biliosa 56 

Eruptive  Fevers ,  58 

Scarlet  Fever      .         . .         .  ib. 

Scarlet  Rash.     Purpura  rubra,  s.  Miliaris  Hahnemanni.  .  Scarlatina  miliaris,  mili- 

'  formis,  papulosa.     Miliaria  purpurea              ........  64 

Measles.     Rubeola ,  81 

Smallpox.     Variola 84 

Chickenrpock.     Variola  spuria,  Varicella      .         .         .         .         .         .         .         .  90 

Miliary  Fever.     Miliaria.     Miliaria  alba.     Miliaris  sudatoria.     Sudor  miliaris       .  91 

Nettle-rash.     Urticaria 94 


CONTENTS.  VII 


DISEASES    OF    ORGANS    CONNECTED    WITH    THE    DIGESTIVE    SYSTEM. 

PAGE 

Toothache.     Odontalgia       .         .         ....         .         .         .         .         .  96 

Sore  Throat,  or  Quinsy.      Aphthous  Sore  Throat.      Angina  faucium,   Tonsillitis 

phlegmonoides,   Cynanehe   tonsillaris.     Angina   aphthosa,  8fc.         .         .         .  100 

Ulcerated  Sore  Throat.     Malignant  Quinsy,  Malignant,  Putrid  or  Gangrenous  Sore 

Throat.     Angina  maligna,  Tonsillitis,  maligna,  Cynanehe  maligna            .         .  107 

Inflammation  of  the  (Esophagus.     Oesophagitis    .         .         .         .         .         .         .  Ill 

Mumps.     Parotitis.     Angina  par otidea       .         .         .         .         .         .         .         .  112 

Indigestion,  or  Dyspepsia     ..........         .  114 

Want  of  Appetite.     Apepsia.     Anorexia       .         .         .         .         .         .         .         •  125 

Derangement  of  the  Stomach,  Eructations,  &c.     .        .        .        .         .        .        .  129 

Flatulency.     Flatulentia.     Flatus.     Tympanitis  intestinalis           .         .         .         .  132 

Spasm  of  the  Stomach.     Gastrodynia,  Cardialgia,  Gastralgia        .         .         .         .  134 

Heartburn.     Black-water.     Water-brash.     Pyrosis      ...         .         .         .  140 

Vomiting  of  Blood.     Hcematemesis ib« 

Costiveness,  Constipation,  Obstipation.     Cpnstipatio,  Obstipatio,  Obstructio  alvi    .  143 

Piles.     Hemorrhoids        ,.,... 148 

Stricture  of  the  Rectum 151 

Abscesses,  in  Ano.    Fistula  in  Ano        .        .        .        . 154 

Proctalgia 157 

Protrusion  of  the  Intestine.     Prolapsus  ani 158 

Colic.     Enteralgia       .....         .         .         .         .         ,         .         .  159 

Determination  of  Blood  to  the  Abdomen.     Congestio  viscerum  abdominis.     Con- 
gest™ ad  abdomen         ...........  163 

Looseness  of  the  Bowels.     Diarrhoea 164 

Dysentery.     Dysenteria.    Febris  dysenterica        .         .         .         .         .         .         .  170 

Cholera 177 

Cholerine 200 

Liver  Complaint          ...        .                 .        .        .         .        .                 .  ib. 

Acute  Inflammation  of  the  Liver.     Hepatitis ib. 

Liver  Complaint,  or  Chronic  Inflammation  of  the  Liver,     Hepatitis  chronica        .  204 

Jaundice.     Icterus      .         .         .         . 205 

Inflammation  of  the  Spleen.     Splenitis        .......        .  207 

Stomach.     Gastritis     ...         ...         .         .  209 

Bowels.    Enteritis        .         .     «    .         .         .         .     •■    .        .  212 

Peritoneum.     Peritonitis       ...        .         .         .         .218 

Invermination.     Worms.     Helminthiasis.     Febris  helminthiaca     .         .         .         .  219 

Blenorrhoea 226 


Vlll  CONTENTS. 


DISEASES    OF   THE   ORGANS    CONNECTED   WITH  THE   RESPIRATORY   SYSTEM. 

PAGE 

Catarrh,  or  Common  Cold.    Catarrhal  Fever 231 

Inflammation  of  the  Larynx.     Laryngitis      ...         .     *   .         .         .         .  236 

Hoarseness.     Raucitas         .        .         .        .         .        .         .         .         .         .         .  238 

Cold  in  the  Head.     Coryza 240 

Cough.     Tussis 242 

Hooping-cough.     Tussis  convulsiva.    Pertussis .         .  254 

Croup.     Angina  membranaced.  Angina  perniciosa.  Cynanche  laryngea.     Cynanche 

tracheitis,  s.  trachealis,  8fc.  8fc. .        ,  258 

Influenza ° 262 

Determination  of  Blood  to  the  Chest.  Congestio  ad  pectus  .  .  •  .  265 
Inflammation  of  the  Mucous  Membrane  of  the  Bronchial  Tubes.   Cold  on  the  Chest. 

Pulmonary  Catarrh.     Bronchitis           .        . 268 

Inflammation  of  the  Lungs.    'Pneumonia  vera,  Peripneumonia.,  Pneumonitis,  PuU 

monitis     ?    .         .         .         .         .         .         .         .         .         ,         .         .  276 

Peripneumonia  Notha,  s.  Occulta.   Catarrhus  Bronchiorum.  Spurious  Peripneumony  299 

Typhoid,  or  Congestive  Pneumonia 301 

Inflammation  of  the  Pleura.     Pleurisy.     Pleuritis         .         .         .        .         .         .  302 

Spurious,  or  Bastard  Pleurisy.     Pleurodynia,  Pseudo- Pleuritis,  Pleuritis  muscularis  311 

Diaphragmitis 312 

Spitting  of  Blood.    Hemorrhage  from  the  Lungs.   Sputum  cruentum.    Hamorrhagia 

pulmonum.    Haemoptysis .        .         .  314 

Pulmonary  Consumption.    Phthisis  Pulmonalis    .                ...        .        .  319 

Asthma 324 


DISEASES  OF  OR  CONNECTED  WITH  THE  BRAIN,  AND  OTHER  PARTS  OF  THE 
NERVOUS  SYSTEM. 

Determination  of  Blood  to  the  Head.     Congestio  ad  caput    .....  331 

Inflammation  of  the  Brain  and  its  Tissues.    Brain  Fever.    Phrenitis,    Encephalitis  335 

Apoplexy.     Apoplexia 339 

Acute  Inflammation  of  the  Spinal  Cord  and  its  Membranes.    Myelitis.    Meningitis 

spinalis 345 

Palsy.    Paralysis 347 

Tetanus      * 348 

Delirium  Tremens  Potatorum 351 

Epilepsy.    Epilepsia.    Morbus  sacer.    Morbus  caducus.    Morbus  divinus.    Morbus 

herculeus.     Morbus  comitialis 353 

Neuralgia.     Cephalalgia.     Cephalcea.    Cephalalgia  arthritica.    Cephalalgia  nervosa. 

Hemicrarlia  (megrim).     Clavus  hystericus .  358 

DISEASES  OF  THE  CIRCULATING  SYSTEM. 

Angina  Pectoris 367 

Pericarditis 370 

Endocarditis *  381 

Carditis 409 


CONTENTS.  IX 


CUTANEOUS    DISEASES. 

PAGE 

St.  Anthony's  Fire.    Rose.    Erysipelas .  413 

Boil.     Furunculus.     Abscessus  nucleatus     .         .         .         .         .         .         .         .  416 

Carbuncle.    Anthrax.    Furunculus  malignans.    Pustula  nigra    .        .        .        .  417 

Chilblains.     Perniones ib. 

Corns.     Clam  pedis .         .  419 

Abscess.    Lymphatic  Tumours.    Disease  of  the  Conglobate  Glands       ...  ib. 

Itch.     Scabies.    Psora        ...         . 422 

Whitlow.     Paronychia.     Panaris        .         . 425 

Irritation,  or  Itching  of  the  Skin.     Prurigo 426 

Ringworm     (Herpetic  or  Vesicular).     Herpes  circinnatus.     Herpes  serpigo         .  427 
Ringworm  of  the  Scalp.     Pustular  Ringworm.     Porrigo  scutulata.     Tinea  capitis. 

Tinea  annularis.     Favus  confertus        .         .         .      ■  *         .         .         .         .  428 

Intertrigo .        .        .        .  432 

Psoriasis ib. 

Pemphigus.     Febris  bullosa,  Pompholyx       .                 .         .         .         .         .         •  433 

Shingles.     Zona.     Herpes  zoster.     Cingulum.     Ignis  sacer,  8fc 435 

Ulcers.     Ulcera           .        .        . 437 


DISEASES  OF  THE  URINARY  AND  GENITAL  ORGANS. 

Inflammation  of  the  Kidneys.     Nephritis .        .  444 

Inflammation  of  the  Bladder.     Cystitis        .    *   ' 447 

Retention  of  Urine.     Ischuria 449 

Difficulty  in  Discharging  the  Urine.     Dysuria.     Stranguria           .         .         .         .  451 

Suppression  of  Urine            .         .         .         .         .         .         .         .         .         •         .  454 

Stricture  of  the  Urethra       .        .        .        .        .        .        .         .        .         .        .  456 

Urinary  Abscess  and  Fistula.     Fistula  in  perinceo 458 

Incontinence  of  Urine          .        .        . 459 

Diabetes 461 

Hematuria.     Nictus  cruentus 463 

Discharge  of  Blood  from  the  Urethra.     Urethrorrhagia.     Hemorrhagia  urethra. 

Stymatosis           .         .         .         ... 466 

Inflammation  of  the  Urethra.     Clap.     Urethretis.     Gonorrhoea.    Blenorrhoea        .  ib. 

Inflammation  of  the  Glans  Penis.     Balanitis.    Balano-blenorrhoea          .         .         .  472 

Inflammation  of  the  Testis.     Swelled  Testicle.     Orchitis.     Hernia  humeralis         .  473 

Sarcocele    .        .        .        .        .        .        .        .        .  ■      .        .    ■     .        .        .  474 

Varicocele 475 

Hydrocele   .        .        . 476 

Venereal  Disease.     Syphilis.     Lues  Venerea 479 

Phimosis 494 

Paraphimosis 495 

Herpes  Preputials 496 

Sycosis                                 < 497 


CONTENTS. 


DISEASES  OP  PARTICULAR  ORGANS  AND  REGIONS,  OR  OF  THE  SYSTEM 
IN  GENERAL. 

PA^GE 

Gout.     Arthritis         .    ,    .. .         .  515 

Rheumatism.   Rheumatic  Fever.     Febris  rheumatica.    Rheumatismus    .         .         .  517 

Lumbago    .         .         ............         .         .         .  525 

Inflammation  of  the  Psoas  Muscle.     Psoitis          .         .         .        .         .         .         .  .  526 

Sciatica ...         .         .         .  527 

Pain  in  the  Hip.     Hip-gout.     Rheumatism  in  the  Hip.    Coocalgia,  Coxagra.    Ischias  528 

Hip-disease.     Morbus  coxarius     ...         .         .         .         .                 .         .  530 

Determination  of  Blood  to  the  Abdomen,     Congestio  viscerum  abdominis.     Con- 

gestio  ad  abdomen     .         .                  .                      .         .         .         ,         .         •  533 

Acute  Inflammation  of  the  Eye*§.     Ophthalmia      .         .         .         .        . .                  .  534 

Hordeolum.     Stye      .         .         . .         •  540 

Ectropium .         .         .         .         •         .     .     •  541 

Entropium.     Irichiasis 542 

Inflammation  of  the  Ears  and  Earache.     Otitis.     Otalgia      .         .         .         .         .  543 

Bleeding  of  the  Nose.     Epistaxis          .         . 547 

Swelling  of  the  Nose 550 

Canker  of  the  Mouth.     Scurvy  in  the  Mouth.     Cancrum  oris.     Gangrena  oris. 

Stomacace   .............  552 

Scurvy.     Scorbutus     . 554 

Inflammation  of  the  Tongue.     Glossitis        .         .         .         .         .         .         .         .  556 

Offensive  Breath 557 

Cramp  in  the  Legs      .         .         .         .         . 558 

Bronchocele.     Goitre.     Derbyshire  neck 559 

Sweating  Feet. .         .         .         .         .         .  560 

Sleeplessness.     Agrypnia     .         .         .         ....         .         .         .         .         .  561 

Nightmare.     Incubus.     Ephialtes 577 

Rupture.     Hernia •  578 

Incarcerated  Ruptures     {Hernice  incarcerated)       .         .         .         .         .         .         .  582 

Fainting.     Swooning.     Syncope            .         . 589 

Pains  in  the  Loins.     Notalgia 591 

Dropsy.     Hydrops       .         .....         .         .         .         .         .         .  592 

Ascites 593 

Dropsy  of  the  Cellular  Tissue.     Anasarca    .         .         ...         .         .         .  596 

Dropsy  of  the  Chest.     Hydrothorax.     Hydrops  pectoris.     Hydrops  thoracis          .  600 

Scrofula .                  •         .    .     •         •  602 

Ostitis.     Caries.     Necrosis.     Exostosis.        .         • 604 

Rickets.     Rachitis       .         .         .         . •         •  612 


CONTENTS. 


XI 


CASUALTIES. 

PAGE 

Concussion,  Bruises,  Sprains  or  Strains,  Wounds,  Dislocations,  and  Fractures          .  613 

Burns  and  Scalds.     Ambustiones          .         ...         .         ....  628 

Fatigue        .         .        .         .  ■      .        .        .        ...        ...        .  630 

Overheating.    Exposure  to  Heat           .        .        .        ...        .         .        .  631 

Stings  of  Insects          .         .         .         . .  632 

Sea-sickness ib. 

Apparent  Death.     Asphyxia -.■■.-.         .  633 

Hydrophobia ....         .         .  637 

Mental  Emotions         .        .                 ....        .         .         .         .         :  644 


PART  II, 

TREATMENT  OF  FEMALES,  AND  OF  THEIR  PECULIAR 
AFFECTIONS. 


Chlorosis.     Emansio  mensium 

Amenorrhoea.     Suppressio  mensium 

Menstruatio  Nimia.     Menorrhagia 

Dysmenorrhea 

Hysterics.     Hysteria.     Passio  hysterica 

Inflammation  of  the  Ovaries.     Ovaritis 

Inflammation  of  the  Labia  Majora  and  Vagina 


649 
652 
653 
655 
ib. 
657 
659 


OBSERVATIONS  ON  PREGNANCY* 


Air  and  Exercise          .  '       .         .         . .  662 

Clothing     .         .         .         ...         ......         .         .  663 

Diet            .        ...        .        ...        .        .         ,        .         .        .  665 

Employment  of  the  Mind  and  Habits  during  Pregnancy ib. 

Influence  of  External  Objects  upon  the  unborn  Infant  , 666 

Mental  Emotions .        .        .  ib. 


Xll  CONTENTS. 


DERANGEMENTS  DURING  PREGNANCY. 


PAGE 

Menstruation 668 

Morning  Sickness '  ib. 

Constipation .         ,        .        ,        ,         .        .  669 

Diarrhoea  during  Pregnancy         .  , 670 

Fainting  and  Hysteric  Fits            . ibT 

Toothache 671 

Swelled  Face 676 

Varices,  or  Swelled  Veins 677 

Pains  in  the  Back  during  Pregnancy.    Lumbosacral  Pains           .        .        .         .  678 

Miscarriage.    Abortus ib. 


TREATMENT    BEFORE   PARTURITION. 

Preparation  of  the  Breasts 684 

Remedies  before  Labour      .        .        ..        . 685 

False  Pains ib. 

Parturition .  687 

Tedious  or  Complicated  Labours ib. 

Spasmodic  Pains,  Cramps,  and  Convulsions 690 


TREATMENT   AFTER   DELIVERY. 

After-pains 693 

Duration  of  Confinement 694 


DISEASES    FOLLOWING   PARTURITION. 

Suppressed  Secretion  of  Milk 696 

Excessive  Secretion  of  Milk 697 

Perspiration  after  Delivery,  Suppression  or  Excess  of ib. 

Milk  Fever 698 

Irregularities  of  the  Lochial  Discharge .        .  699 

Diarrhoea  in  Lying-in  Women 701 

Abdominal  Deformity ib. 

Falling  off  of  the  Hair .        .  702 

Leucorrhcea  after  Parturition 703 

Internal  or  Uterine  Swelling  and  Prolapsus ib. 

Inflammation  of  the  Womb.     Inflammatio  uteri.     Metritis 704 

Weakness  after  Delivery 706 


CONTENTS.  Xlll 


OBSTACLES  TO  SUCKLING. 

PAGE 

Disinclination  of  the  Infant 707 

Excoriation  of  the  Nipples .                 .        ,        .  ib. 

Inflammation  of  the  Breasts 708 

Mental  Emotions  affecting  the  Milk             .        ..        ..        .         .        .  710 

Deficiency  in  the  Secretion  of  Milk.     Suppressed  Secretion  of  Milk         ...  ib. 

Deterioration  and  Discoloration  of  Milk .         .  711 

Mothers  not  Suckling  their  Children             ib. 


PART  III. 

TREATMENT  OF  INFANTS  AND  CHILDREN. 

Introductory  Remarks .        •        •  715 

Treatment  after  Birth _        ...  716 

Asphyxia             717 

Swelling  of  the  Head 718 

Navel  Rupture  in  Infants ib. 

Meconium,  Expulsion  of ■ .        «        <         •  719 

Suckling  of  the  Infant          .     * 720 

The  Choice  of  a  Nurse 722 

Diet  during  Nursing ib. 

Supplementary  Diet  of  Infants 723 

Duration  of  Suckling.    Weaning 725 

Sleep.    Sleeplessness 727 

Exercise 729 

DISEASES   OF    INFANCY. 

Inflammation  of  the  Eyes  in  New-born  Infants     . 732 

Cold  in  the  Head         .... 733 

Crying  and  Wakefulness  of  New-born  Children 734 

Regurgitation  of  Milk.    Acidity,  Flatulence,  &c.            736 

Spasmodic  Asthma.     Spasms  in  the  Chest    .        .        .        ;        .        .        .        .  737 
Milk-Crust.  Milk-Scab.  Milk*Blotches.    Crusta  lactea.   Porrigo  larvalis.    Eczema 

faciei.     Tinea  faciei 738 

Thrush,  or  Aphthae 739 ' 

Constipation.     Obstructio  aim  neonatorum            741 

Bowel  Complaints  of  Infants.     Diarrhoea  neonatorum ib. 


XIV  CONTENTS* 

PAGE 

Excoriations.     Eoocoriationes  neonatorum.     Intertrigo 750 

Jaundice.     Icterus  neonatorum             ib. 

Induration  of  the  Cellular  Tissue.     Infantile  Erysipelas.     Erysipelas  infantum        .  751 

Lockjaw  of  Infants.     Trismus  nascentium     .         .         .         .         .         .         .         .  752 

HeatSpots 753 

Derangements  during  Teething     .         . ib. 

Convulsions  in  Children        ... 756 

Water  in  the  Head.     Dropsy  of  the  Brain.     Dropsy  of  the  Head.     Hydrocephalus 

membranarum  et  ventricularum     .         . 760 

Asthma  of  Millar.     Laryngismus  stridulus    .         .         .         ,         .        '.         .         .  762 

Infantile  Remittent  Fever 763 

Atrophy.     Atrophia 768 

Vaccination ,    .  769 

Index         .                                           771 


PREFACE  AND  INTRODUCTION. 


A  considerable  portion  of  the  contents  of  this  work 
has  already  appeared  under  the  title  of  '  Homoeopathic 
Domestic  Medicine,  arranged  to  serve,  in  some  measure,  as 
a  Practical  Work  for  Students.5  But,  in  consequence  of  the 
growing  attention  which  medical  men  are  beginning  to  bestow 
upon  our  science,  the  Author  has  been  advised  to  give  the 
result  of  his  labours  in  a  separate  form  to  the  professional 
public.  He  has  accordingly  made  considerable  alterations 
in  those  parts  of  the  aforesaid  work  which  must  necessarily 
be  retained  in  the  present  one,  and  has  added  many  articles 
which  were  purposely  omitted  in  what  was  chiefly  designed 
to  be  a  treatise  on  domestic  medicine.  The  Author  therefore 
trusts  that,  notwithstanding  its  manifold  imperfections,  this 
humble  effort  to  furnish  the  professional  inquirer  with  '  an 
elementary  practice  of  physic  according  to  the  homoeopathic 
principle/  may  be  viewed  with  that  kind  indulgence  which 
the  occasion  calls  for,  and  ardently  hopes  that  it  may  be 
instrumental  in  creating  a  desire  for  more  extensive  infor- 
mation to  be  gleaned  from  works  of  greater  pretensions. 

In  compiling  the  work,  the  Author  has  derived  much  assistance 
from  Hahnemann's  Kronischen  KranMeiten,  Jahr's  Nouveau 
Manuel  de  Medecine  Homceopathique,  Hartmann's  Therapie  akuter 
Krankheitsformen,  Boeninghausen's  Manuel  de  Therapeutique 
Homceopathique,  Hering's  (of  Philadelphia)  Hausarzt,  andKnoack 


XVI  INTRODUCTION. 

and  Trinks's  forthcoming  Handbuch  der  Homceopatischen  Arz- 
neimittellehre  ;#  which,  together  with  the  Materia  Medica 
Purax  the  Organon  of  Hahnemann,  that  of  Rau,  Hamilton's 
Guide  to  Homoeopathy,  Black's  Principles  and  Practice  of 
Homoeopathy,  and  the  following  periodicals — the  British  Journal 
of  Homoeopathy,  the  American  Homoeopathic  Examiner,  the 
American  Journal  of  Homoeopathy,  the  Archiv  fur  Homceopatische 
Heilkunst,  the  Allgemeine  Homceopatische  Zeitung,  the  Hygea, 
the  Oesterreichische  Zeitschrift fur  Homoeopathic,  the  Journal  de 
la  Medecine  Homceopathique,  and  the  Journal  Hahnemannien, 
the  Author  would  particularly  recommend  to  the  professional 
student  who  may  be  desirous  of  cultivating  an  intimate  ac- 
quaintance with  the  science  of  Homoeopathy. 

It  will  he  found  that  the  Author  has  introduced  into  the 
work  a  number  of  diseases  which  are  not  ordinarily  included 
in  writings  on  the  practice  of  physic.  In  deviating  thus  from 
the  beaten  track,  he  has  been  led  by  the  conviction  that  the 
line  of  demarcation  which  has  been  attempted  to  be  drawn 
between  diseases  that  are  considered  to  belong  to  the  province 
of  the  surgeon,  and  those  which  have  been  allotted  to  the 
sphere  of  the  physician,  is  by  far  too  artificial  to  admit  of  its 
being  rigidly  adhered  to  in  a  practical  point  of  view.  Palpably 
apparent  as  this  must  be  to  the  allopathic  practitioner^  it  is 
still  more  strikingly  so  to  the  experienced  homoeopathist  who 
has  had  repeated  opportunities  of  witnessing  the  cure  of  a 
variety  of  affections  by  the  instrumentality  of  medicine,  which 
he  had  formerly  been  taught  to  believe  to  be  removable  by 
the  knife  alone. 

The  principal  points  it  is  now  purposed  to  allude  to  are 
the  Regimen— the  Choice  of  the  Remedy — the  Potencies  in 
general  use-— and  the  Dose. 

*  English  translations  of  all  the  above  works  have  already  been,  or  are  in  the  course 
of  being  published  either  in  this  country  or  in  America. 


INTRODUCTION.  XV11 


REGIMEN. 


The  homoeopathic  regimen  consists  merely  of  the  avoidance 
of  medicinal  and  indigestible  substances  during  treatment, 
both  as  calculated  to  interfere  with  the  actions  of  the  medi- 
cines and  the  proper  functions  of  the  alimentary  system. 
Consequently,  among  liquids,  the  articles  generally  proscribed, 
particularly  in  the  different  forms  of  dyspepsia,  as  also  in 
affections  of  the  liver,  in  gout,  hemorrhoids,  and  in  dis- 
orders of  the  bladder,  are,  green  tea,  or  strong  black  tea, 
coffee,  malt  liquors,  wine,*  spirits,  and  stimulants  of  every 
description,  lemonade,  or  other  acid  or  alkaline  drinks,  and 
natural  or  artificial  mineral  waters.  Cocoa,  unspiced  choco- 
late, toast-,  rice-,  or  barley-water,  oatmeal  gruel  sweetened 
with  a  little  sugar,  or  raspberry  or  strawberry  syrup,  if 
desired ;  whey,  milk  and  water,  or  pure  milk,  not  too  recent 
from  the  cow,  boiled  milk,  and  in  some  instances  buttermilk, 
or  in  fact  any  non-medicinal  beverage  is  allowable.! 

In  animal  food,  pork,  young  meats — such  as  veal,  lamb, 
&c.j -and  among  poultry,  ducks  and  geese,  had  better  be 
avoided,  especially  when  derangement  of  the  digestive  func- 
tion exists.  Beef,  mutton,  venison,  and  most  descriptions  of 
game,  if  not  too  long  kept  (high),  pigeons,  larks,  rabbits,  are 
allowable  at  discretion.!  (Vide  Synopsis,  p.  3.)  Ham,  and 
neats'  tongues  under  certain  restrictions. 

*  Wine  should  invariably  be  forbidden  in  cases  where  Nux  v.  is  the  remedy  prescribed ; 
and  coffee  when  Puis.,  Ignatia,  &c,  are  being  taken. 

f  The  idiosyncrasies  in  some  individuals,  in  respect  of  diet,  are  remarkable;  as  for 
example,  some  cannot  take  the  smallest  quantity  of  milk  without  serious  inconvenience ; 
others  throw  out  a  rash  after  partaking  of  fish  ;  and  again,  others  loathe  the  very  sight  of 
animal  food.  These  peculiarities  should  not  only  be  attended  to  in  prescribing  a  suitable 
course  of  regimen,  but  should  also  be  taken  into  account  in  the  selection  of  the  remedies. 

J  In  some  forms  of  dyspepsia  meat  requires  to  be  prohibited  for  a  short  time,  or  taken 
only  every  second  or  third  day.  (See  Dyspepsia.)  The  same  rule,  it  may  be  added,  may 
sometimes  be  advantageously  followed  when  the  patient  is  under  the  action  of  particular 
remedies,  such  as  Calcarea,  Silicea. 

a 


XV111  INTRODUCTION. 

Fish  is  a  wholesome  article  of  diet,  and  may,  in  most  cases, 
be  partaken  of  without  scruple,  with  the  exception  of  the 
oleaginous  species,  such  as  eels,  salmon,  &c,  or  shellfish,  as 
oysters,  lobsters,  &c. 

Eggs,  raw  or  soft  boiled;  butter,  if  free  from  rancid  or 
unusual  taste ;  cream,  plain  unseasoned  custards,  and  curds. 

Stimulating  soups  and  made  dishes  are  so  evidently  op- 
posed to  homoeopathic  regimen,  as  scarcely  to  require  further 
notice.  Beef-tea,  veal,  or  chicken  broth,  &c,  thickened  with 
rice,  macaroni,  or  sago,  and  seasoned  merely  with  a  little 
salt,  are  of  course  allowable. 

Among  vegetables,  all  of  a  pungent,  aromatic,  medicinal, 
or  indigestible  description,  or  greened  with  copper,  are  pro- 
hibited ;  such  as  onions,  garlic,  eschalots,  asparagus,  radishes, 
horseradish,  celery,  parsley,  mint,  sage,  mushrooms,  tomatoes, 
beets,  artichokes,  parsnips,  &c. ;  but  others  free  from  such 
qualities,  such  as  potatoes,  French  beans,  green  peas  or  beans, 
cauliflower,  spinach,  seakale,  &c,  may  be  used  with  the 
needful  precaution  of  avoiding  any  particular  article  of  diet, 
whether  of  the  animal  or  vegetable  kingdom,  that  may  seem 
to  disagree  with  the  individual.  Lemon  or  orange-peel, 
laurel-leaves,  bitter  almonds,  peach-leaves  or  kernels,  fennel, 
aniseed,  marjoram,  are  objectionable ;  acids,  and  the  ordinary 
condiments,  such  as  pepper,  mustard,  pickles,  &c,  and  salads, 
ought  either  to  be  sparingly  partaken  of,  or  entirely  abstained 
from,  particularly  by  the  dyspeptic.  Salt  and  sugar  in 
moderation  are  admissible. 

Acid  or  unripe  fruits  are  clearly  objectionable,  and  even 
ripe  fruits  possessing  little  or  no  acidity,  if  fresh  or  prepared 
by  cooking,  such  as  peaches,  raspberries,  sweet  cherries, 
grapes,  and  dried  or  preserved  fruits,  as  figs,  prunes,  apples, 
pears,  should  be  used  in  moderation,  particularly  by  dys- 
peptic individuals,  and  by  those  subject  to  colic  or  diarrhoea 
not  at  all.     Cold  fruits,  such  as  melons,  and  raw  vegetables* 


INTRODUCTION.  XIX 

such  as  cucumbers,  &c.,  are  inhibited;  nuts  of  every  de- 
scription are  forbidden. 

All  kinds  of  light  bread*  and  biscuit,  free  from  soda  or 
potash  and  such  like,  not  new-baked  ;  also  simple  cakes  com- 
posed of  flour  or  meal,  eggs,  sugar,  and  a  little  good  butter ; 
or  light  puddings,  such  as  bread-,  rice-,  sago-,  semolina-, 
without  wines,  spices,  or  rich  sauces,  are  admissible;  but 
coloured  confectionary,  pastry,  and  also  honey,  are  not  so. 
Regularity  in  the  hours  of  meals  should  be  observed,  and 
too  long  fasting,  as  well  as  too  great  a  quantity  of  food  at 
one  time,  should  be  avoided.-^ 

During  fevers  and  inflammatory  affections,  the  patient  must 
of  course  be  kept  upon  a  low  regimen ;  gruel,  barley-water, 
&c. ;  and  at  the  commencement  of  convalescence  a  light 
pudding,  with  a  little  weak  beef-tea  or  mutton  or  chicken 
broth,  should  form  the  whole  of  the  nourishment  given. 
Nature,  however,  is  our  best  guide,  and  when  she  takes 
away  appetite,  thereby  intimates  the  necessity  of  not  taxing 
the  digestive  functions.  (See  also  Synopsis  of  the  diet 
rules.) 

The  use  of  any  medicinal  or  aromatic  substances  in  the 
arrangement  of  the  toilet,  such  as  camphorated  or  otherwise 
medicated  dentifrices,  lip-salve,  smelling  salts,  or  cosmetics,  is 
detrimental  to  the  action  of  the  medicines,  and  had  therefore 
better  be  avoided. 

*■  Unfermented  bread  is  perhaps  to  be  recommended  in  preference  to  any  other.  There 
are  instances,  however,  in  which  bread  so  made  does  not  agree,  and  produces  symptoms 
of  indigestion.  In  such  cases  the  use  of  bread,  in  the  making  of  which  German  yeast  has 
been  employed,  will  often  prove  of  easier  digestion. 

f  In  almost  every  instance  where  it  is  necessary  to  make  a  great  alteration  in  the  diet 
of  the  patient,  it  is  advisable  to  do  so  gradually  and  cautiously,  particularly  in  the  case  of 
those  persons  who  have  been  long  accustomed  to  the  daily  use  of  stimulants  of  various 
kinds. 


XX  INTRODUCTION. 


CHOICE  OF  THE  REMEDY.     POTENCIES  OF  THE  MEDICAMENTS. 
DOSE  AND  ITS  REPETITION. 

In  homoeopathic  practice  there  are  three  points  which  merit 
most  particular  attention :  the  first  and  principal  is  the 
Choice  of  the  Proper  Pemedy ;  the  second  the  Potency  at 
which  it  should  be  exhibited ;  and  the  third  the  Dose  and  its 
Bepetition. 

THE    CHOICE    OF    THE    PROPER   REMEDY. 

To  accomplish  this,  in  accordance  with  the  law  similia 
similibus,  Hahnemann  has  directed  us  to  form  "a  correct 
image  of  the  disease/'  by  committing  to  writing  every  detail 
of  the  case ;  commencing,  in  the  first  place,  to  note  down  all 
those  particulars  which  bear  generally  on  the  case,  as  its 
history,  the  previous  health  of  the  patient,  hereditary  predis- 
position, presumed  cause  of  the  disease  ;  the  former  treat- 
ment; the  patient's  age,  temperament,  and  appearance;  his 
mode  of  living,  occupation,  and  disposition,  and  whether  his 
malady  has  in  any  degree  altered  his  normal  disposition. 

In  the  next  place,  the  questions  put  must  bear  minutely 
upon  the  disease  itself,  not  only  for  the  purpose  of  ascer- 
taining those  of  an  important  and  primary  description,  but 
also  those  which  are  purely  sympathetic  or  secondary,  from 
the  circumstance  that  the  latter,  in  addition  to  their  being 
frequently  very  characteristic  of  the  disorder,  are  moreover 
the  indices  to  the  selection  of  the  individual  specific  remedy 
from  amongst  a  class. 

This  part  of  the  examination*  as  a  general  rule,  is  to  be 
commenced  at  the  head,  external  and  internal,  proceeding  to 
the  senses — sight,  hearing,  smell,  and  touch — thence  to  the 


INTRODUCTION.  XXI 

mouth,  tongue,  throat,  and  the  digestive  organs ;  from  thence 
to  the  genital,  the  urinary,  and  the  thoracic  organs ;'  and 
then  the  back  and  the  superior  and  inferior  extremities. 
Afterwards  the  skin,  with  particulars  as  to  its  temperature, 
secretion,  appearance  (the  anterior  or  present  existence  of 
eruptions),  the  sleep,  dreams,  moral  symptoms,  pulse,  &c. 

The  character,  as  well  as  the  seat  of  the  symptoms  is  of 
great  importance.  Thus  it  is  of  little  use  to  our  purpose  when 
the  patient  intimates  that  he  has  a  severe  pain,  but  he  must 
describe  its  nature  as  accurately  as  possible,  as  whether  it  is 
gnawing,  throbbing,  aching,  burning,  shooting  (darting), 
pricking,  cutting,  dragging,  piercing,  &c.  Whether  the 
symptoms  are  increased  by  movement  or  by  rest  (walking, 
lying,  standing,  or  sitting),  at  night  or  during  the  day,  in  the 
house  or  in  the  open  air,  by  heat  or  cold,  dampness  or  dry- 
ness ;  after  eating,  drinking,  or  during  abstinence.  If  worse 
after  particular  kinds  of  food ;  if  continuous  or  periodical ;  and 
if  increased  by  mental  exertion,  emotion,  &c. 

With  females,  it  is  essential  to  pay  attention  to  the  fol- 
lowing additional  particulars :  pregnancy,  labour,  lactation, 
miscarriage,  sterility,  and  the  state  of  the  menses.  In  refer- 
ence to  the  latter,  it  is  requisite  to  learn  whether  an  irregu- 
larity exists,  such  as  too  short  or  too  long  an  interval  between 
the  returns  ;  if  the  discharge  exudes  uninterruptedly  or  only 
at  intervals ;  if  it  is  copious  or  scanty ;  its  colour ;  and  if 
attended  with  pain ;  the  state  of  the  body  and  mind  previous 
to,  during,  and  subsequent  to  the  catamenia  should  also  be 
inquired  after ;  and  if  the  patient  is  affected  with  leucorrhcea, 
its  nature,  quantity,  the  periods  at  which  it  occurs,  or  the 
circumstances  under  which  it  manifests  itself  should  be  ascer- 
tained. The  selection  of  the  proper  remedy  is,  farther, 
materially  facilitated  by  the  nature  of  the  cause  of  the  disease  ; 
we  should  never  omit,  therefore,  to  elicit  that  information 
when  practicable. 


XX11  INTRODUCTION. 


THE     POTENCY,    ATTENUATION,     OR     DILUTION     OF     THE 

MEDICAMENT. 

In  proceeding  to  the  consideration  of  this  second  point,  I 
may  make  the  preliminary  remark  that  it  is  a  subject  which 
is  as  yet  by  no  means  finally  determined  under  what  circum- 
stances and  conditions  the  lowest  (viz.  the  1st,  2d,  3d,  and  6th, 
&c.)  the  highest  (the  18th,  24th,  30th),  or  the  recently  pro- 
mulgated so-called  highest  potencies  (the  100th  to  the  2000th, 
and  even  upwards),  are  to  be  preferred.  The  majority,  how- 
ever, especially  amongst  the  more  modern  homceopathists, 
may  be  said  to  have  decided  hitherto  in  favour  of  the  lower, 
and  particularly  the  3d  and  6th,  in  acute,  and  the  higher, 
especially  the  18th,  24th,  30th,  &c,  in  chronic  diseases.  The 
main  point  to  be  attended  to  is  the  correct  selection  of  the 
remedy ;  nevertheless,  as  the  Author  is  of  opinion  that  some 
importance  is  to  be  attached  to  the  dilution,  attenuation,  or 
potency  in  the  treatment  of  the  multifarious  forms  of  disease 
which  come  under  the  observation  of  the  medical  man  in 
extensive  practice,  he  ventures  to  throw  out  the  following 
suggestions,  premising  at  the  same  time  that  much  depends 
upon  the  discrimination  of  the  practitioner,  and  that  it  is 
almost  impossible  to  give  any  rule  to  which  there  are  not 
exceptions. 

The  principal  points  to  be  attended  to  are,  the  susceptibility 
of  the  patient  to  medicinal  influence,  how  far  modified  by  cir- 
cumstances, the  age,  sex,  temperament,  and  habits — the 
disease  itself,  and  further,  the  nature  of  the  medicament 
employed. 

As  regards  the  first,  the  susceptibility  of  the  patient,  we  find 
four  classes  : 

First  class.  Those  who  are  comparatively  insensible  to 
medicinal  influence,  particularly  at  high  potencies,  upon  whom 


INTRODUCTION.  XX111 

the  medicines  show  neither  marked  action  nor  reaction.  Such 
individuals  are  generally  of  what  is  denominated  the  leuco- 
phlegmatic  temperament ;  they  require  generally  low  potencies 
and  frequent  repetition — such  cases  are  not  without  their 
parallel  in  allopathic  practice.  Also,  in  disease,  we  find  some 
persons  who  appear  to  enjoy  a  peculiar  exemption  from  infec- 
tious and  even  contagious  influence.  To  this  rule,  however,  of 
giving  the  low  potencies  in  such  cases,  there  are  exceptions  ; 
I  have  found  in  practice,  after  a  careful  study  of  the  individual, 
and  a  selection  of  a  remedy  suitable  to  temperament,  a  marked 
action  and  reaction  produced  by  a  very  high  potency,  where  a 
lower  of  the  same  medicament  had  failed  to  elicit  any  apparent 
effect,  &Ti&*vice  versa. 

Second  class.  A  marked  susceptibility  to  medicinal  action 
without  a  corresponding  reflex  action :  such  patients  are  gene* 
rally  of  a  highly  nervous  temperament,  exceedingly  difficult  to 
treat,  and  require  particular  study ;  here  the  higher  potencies 
are  generally  called  for,  although  we  frequently  find  benefit  in 
resorting  to  the  lower. 

Third  class.  Those  in  whom  no  marked  or  a  scarcely  per- 
ceptible medicinal  action  declares  itself,  but  a  well-marked 
reaction ;  in  such  cases  we  must  be  guided  by  other  indica- 
tions in  the  selection  of  the  potency ;  watch  the  effect  care- 
fully, and  avoid  too  frequent  a  repetition. 

Fourth  class.  Those  in  whom  the  medicines  show;  a  well- 
marked  action  and  reaction ;  here,  also,  we  must  be  guided  by 
other  circumstances  in  the  selection  of  the  potency,  so  as  to 
obtain  the  greatest  possible  benefit  without  materially  increas- 
ing the  sufferings  of  the  patient. 

We  generally  find  a  particular  susceptibility  to  medicinal 
influence,  at  any  potency,  in  persons  dwelling  in  the  country, 
of  robust  frame,  simple  habits,  and  regular  lives,  who  are  not 


XXIV  INTRODUCTION. 

subject  to  any  peculiar  dyscrasia.  In  towns,  particularly  in 
large  densely-populated  cities,  this  susceptibility  is  greatly 
developed^,  but  the  reaction  less  evident ;  however,  much 
depending  upon  the  individual's  employment,  habits,  and 
pursuits,  it  is  difficult  to  give  any  fixed  rule. 

Age.  In  infancy  and  early  childhood,  we  find  a  marked 
receptivity  to  medicinal  influence,  a  decided  action  and  speedy 
reaction,  consequently  the  higher  potencies  are  the  most  appli- 
cable in  their  diseases,  and  they  rarely  require  so  frequent  a 
repetition  ;  however,  in  acute  diseases  of  any  of  the  more 
noble  oy gans,  we  may  exhibit  lower  potencies,  particularly 
of  some  of  the  less  energetic  medicines,  fo*  example, 
Sambucus,  Ferrum,  Ipecacuanha,  Chamomilla,  etc.,  a  globule 
constituting  the  maximum  dose.  Some  further  remarks  upon 
this  subject  have  been  made  in  Diseases  of  Infancy. 

Sex.  Females,  for  the  most  part,  possess  a  higher  degree 
of  susceptibility  than  males,  in  which  they  approach  nearer  to 
children  ;  for  them  the  higher  and  medium  potencies  are 
generally  most  suitable;  to  this  rule,  however,  there  are 
many  exceptions,  particularly  in  those  who  are  engaged  in 
laborious  employments. 

Temperaments.  In  the  Sanguine  temperament,  there  is 
considerable  susceptibility  to  all  the  potencies  and  a  speedy 
reaction.  In  the  Nervous,  we  find  great  susceptibility,  some- 
times without  an  equivalent  reaction :  here  we  should  be 
cautious  in  administering,  and  generally  use  the  higher 
potencies.  In  the  Bilious,  there  is  generally  but  little  suscep- 
tibility, but  the  reaction,  when  roused,  is  powerful,  and  pro- 
longed ;  hence  a  necessity  for  low  potencies,  generally  given  at 
long  intervals.  The  Lymphatic  being  the  least  susceptible  of 
all  temperaments,  the  medicines  may  be  given  at  low  potencies, 
and  frequently  repeated  till  some  effect  is  produced. 


INTRODUCTION.  XXV 

Since  these  temperaments  often  occur  in  a  mixed  form,  the 
rules  above  given  must  be  modified  accordingly. 

We  may  observe  that  the  remarks  above  made  refer  princi- 
pally to  chronic  and  subacute  diseases. 

The  Disease.  In  severe  acute  diseases,  we  are  usually  in 
the  habit  of  resorting  to  the  low  potencies^  and  in  tinctures, 
from  the  circumstance  that  we  have  commonly  found  them 
more  certain  in  their  effect  than  the  12th,  18th,  or  30th  in  such 
affections.  In  the  cases  of  children,  an  exception  may  be  made, 
as  already  observed.  In  ordinary  cases  the  best  range  is  from 
the  third  to  the  twelth  potency ;  this  rule  should  of  course,  be 
modified  according  to  the  remedy  itself,  the  disease,  and  the 
individuality  of  the  patient.  The  seat,  character,  and  the 
exciting  cause  of  the  disease  are  generally  considered  of  im- 
portance in  regulating  the  dose  and  potency:  thus,  in  inflam- 
mation of  the  brain,  or  in  erysipelas  of  the  head,  with 
implication  of  the  meninges  and  delirium,  Belladonna  is  not 
required  at  so  low  a  potency  (2,  3,  or  6)  as  it  is  called  for  in 
erysipelas  of  the  extremities.  Dulcamara  is  more  efficacious  at 
a  low  potency  (3)  in  catarrhal  affections,  or  diseases  of  any 
kind  proceeding  from  exposure  to  cold,  than  at  a  high 
one.  Aconitwn  is  more  suitable  at  a  low  attenuation,  when 
given  to  allay  the  violence  of  the  accompanying  fever  in 
inflammations,  than  when  it  is  prescribed  as  the  specific 
remedy  to  the  inflammation  itself.  And,  finally,  the  low 
dilutions  are  held  to  be  the  best  adapted  to  inflammations  of 
a  torpid  character ;  the  high  to  inflammatory  affections  with 
increased  arterial  action.  It  is  undeniable,  however,  that 
deviations  from  the  above  rules  may  often  be  made  without 
disadvantage. 

The  Nature  of  the  Remedy.  Medicaments  which,  in 
their  crude  state,  possess  little  or  no  appreciable  medicinal 
property,  but  whose  virtues  have  been  developed  by  tritura- 


XXVI  INTRODUCTION. 

tion  and  segregation  of  particles,  such  as  Lycopodium,  Ndtrum 
muriaticum,  Calcarea  carbonica,  Sepia,  Carlo  vegetabilis,  Silicea, 
&c,  should  generally  be  used  at  the  higher  potencies.  Others 
also,  which  have  been  found  from  experience  to  display  con- 
siderable efficacy,  even  when  greatly  attenuated,  such  as 
Sulphur,  Lachesis,  Acidum  nitricum,  Arsenicum,  &c.  On  the 
contrary,  some  which  have  a  short-lived,  but  well-marked 
action,  may  be  used  in  some  cases  in  the  original  substance  ; 
for  example,  Moschus,  Valerian,  and  Camphor,  but  in  exceed- 
ingly small  doses.  Others  again  have  been  found  most  useful 
at  the  first,  second,  or  third  potency,  such  as  Tartarus  emeti- 
cus,  Ferrum,  Ipecacuanha,  Hepar  sulphuris,  Stannum,  Rhus  toxi- 
codendron, Opium,  and  in  many  cases  Cinchona.  Still,  all  these 
remedies,  in  peculiar  cases,  act  well  at  the  higher. 


THE    DOSE  AND    ITS    REPETITION. 

Although  it  is  almost  impossible  to  give  any  general 
rule  that  will  serve  in  all  cases,  much  more  depending 
upon  the  discrimination  of  the  administrator,  and  a  careful 
observance  of  the  symptoms  than  routine,  the  following 
remarks  may  prove  of  some  service  to  beginners,  for  whom 
indeed,  as  has  already  been  intimated,  the  contents  of  the 
entire  work  are  almost  exclusively  intended. 

From  the  diversity  of  opinion  which  as  yet  exists  as  to 
the  "  potency  of  the  medicament,"  it  may  readily  be  sur- 
mised that  various  differences  prevail  as  to  the  mode  of 
prescribing  or  administering  the  homoeopathic  remedies. 
Some  there  are  who  invariably  give  one  or  more  drops,  or 
grains ;  others,  again,  adhere  as  rigidly  to  globules ;  whilst 
a  third  party  give  drops  in  acute,  and  globules  in  subacute, 
and  in  chronic  cases. 

To  the  beginner,  whose  former  habits  may  very  naturally 


INTRODUCTION.  XXV11 

incline  him  to  err  on  the  side  of  excess,  by  invariably  flying 
to  mother  tinctures,  low  dilutions,  first  triturations,  &c.,  in 
large  and  rapidly-repeated  doses,  we  should  say,  "  strive 
ever  to  cure  by  means  of  the  smallest  possible  dose,  and 
do  not  imagine  that  because  with  a  minute  dose  you  have 
done  much,  that  by  increasing  it  you  will  do  more — more 
indeed  you  may  do,  but  that  may  as  likely  prove  to  be  to 
the  detriment  as  to  the  welfare  of  your  patient."  For  our- 
selves, we  may  state  that  on  most,  although  by  no  means 
on  all  occasions,  we  are  in  the  habit  of  prescribing  drops, 
in  the  diluted  form  we  have  mentioned  in  certain  parts  of 
the  work  (see  Pneumonia,  Pleuritis,  &c),  in  the  treat- 
ment of  acute  diseases ;  whereas  in  subacute  and  in  chronic 
affections,  we  very  generally,  if  not  exclusively,  confine 
ourselves  to  the  employment  of  globules,  varying  the  form 
of  prescription  according  to  the  age,  sex,  and  temperament 
of  the  patient.  On  ordinary  occasions,  in  the  treatment  of 
chronic  maladies,  we  order  a  couple  of  globules  to  be  taken 
every  night  in  a  dessert-spoonful  of  pure  cold  water  at  bed- 
time for  a  week,  and  then  allow  the  remedy  to  act  for  from 
four  to  eight  days,  and  even  upwards  in  particular  cases  and 
under  particular  circumstances,  before  repeating  the  remedy, 
or  selecting  another.  But  where  the  patient  is  extremely 
susceptible  to  the  action  of  the  medicines,  and,  usually,  in 
young  subjects,  we  give  only  one,  or  at  the  most  two  doses, 
(one  night  and  morning)  consisting  of  one  or  of  two 
globules,  either  undissolved  or  in  a  teaspoonful  of  water, 
and  allow  the  remedy  to  act  for  the  same  period  as  above 
specified.  In  many  cases  of  a  chronic  description,  and 
particularly  when  the  patients  are  found  to  be  moderately 
sensitive,  we  give  a  dose  for  four  successive  days,  and  then 
wait  for  two  to  six  days  for  a  development  of  improvement. 

We,  as  already  stated,  occasionally  vary  our  mode  of 
prescribing,  being  guided  in  doing  so  by  the  sex  and 
constitution  of  the  patient,  the  character  of  the  disease,  and 


XXV111  INTRODUCTION. 

the  nature  of  the  remedy  (see  art.  Potencies  of  the 
Medicaments),  but  ever  prefer  the  smallest  possible  dose  to 
a  large  one,  and  globules  in  place  of  drops  of  the  tincture, 
even  when  from  no  other  motive  than  that  of  prescribing  a  medi- 
cine free  from  taste— an  advantage  of  no  small  importance 
in  the  treatment  of  children — whenever  we  feel  convinced 
that  we  can  do  so  without  fear  of  allowing  the  disease  to 
gain  head,  or  of  retarding  recovery  by  the  insufficiency  of 
the  dose. 

Slight  diseases  are  often  removed  by  a  single  dose  of  a 
well-chosen  medicine,  but  more  severe  and  deeply-seated 
disorders  require  a  frequent  repetition. 

In  acute  diseases,  we  must  carefully  watch  the  symptoms, 
and  when  we  feel  assured  we  have  chosen  the  proper  remedy, 
if  no  perceptible  medicinal  aggravation  or  amelioration  declare 
itself,  after  an  interval  of  from  two  to  four  hours  at  the 
utmost,  but  the  disease  seems  to  gain  ground,  repeat  the 
medicine.  In  cases  of  high  inflammatory  action,  or  the 
severest  forms  of  acute  diseases,  ajs  cynanche  lar  ngea, 
cholera,  pneumonia,  pleuritis,  dysenteria,  febres  nervosa, 
phrenitis,  cystitis,  &c,  attended  with  signs  of  imminent  dan- 
ger, the  dose  must  be  repeated  every  quarter,  every  half, 
every  hour,  or  every  three  or  four  hours. 

If  a  medicinal  aggravation*  take  place,  followed  by  amelio- 
ration, we  must  let  the  medicine  continue  its  action,  until  the 
amelioration  appears  to  cease,  and  the  disease  again  make 
head ;  if  new  symptoms  set  in,  we  must  then  have  recourse 
to  the  medicine  thereby  indicated.  Should,  however,  no 
perceptible  medicinal  aggravation  take  place,  but  an  ameliora- 


*  It  is  necessary  to  remark  that  very  striking  medicinal  aggravations  are,  comparatively 
speaking,  very  rarely  met  with.  In  chronic  maladies,  occurring  in  highly  sensitive  persons, 
and  proceeding  from  or  attended  with  cerebro-spinal  irritation,  we  encounter  them  more 
frequently  than  in  acute  diseases.  They  are,  in  general,  more  prone  to  take  place  in  the 
instances  alluded  to,  with  considerable  intensity,  after  the  employment  of  the  higher  than 
the  lower  attenuations.     So  at  least  the  author's  experience  teaches  him  to  conclude. 


INTRODUCTION.  XXIX 

tion  follow,  we  may  safely  await  its  approach  to  its  termina- 
tion, ere  we  again  administer.  If  any  symptoms  remain, 
from  the  remedy  first  selected  having  afforded  only  partial 
relief,  we  must  have  recourse  to  some  other  medicine  which 
seems  best  fitted  to  meet  them  ;  but  refrain  from  changing  the 
remedy  as  long  as  benefit  results  from  its  employment. 

In  chronic,  subacute,  and  indeed  almost  all  cases,  when  a 
very  striking  improvement  takes  place,  it  will  generally  be 
found  advantageous  to  cease  to  administer  the  medicine  as 
long  as  the  improvement  continues,  and  only  to  repeat  as 
soon  as  the  slightest  symptoms  of  activity  in  the  morbid 
phenomena  reappear.  But  when  a  sudden  or  marked 
improvement  of  comparatively  short  duration  follows  the 
first  dose  of  a  remedy,  and,  on  repeating  the  dose,  the 
symptoms  of  the  complaint  increase  instead  of  subsiding, 
as  they  did  in  the  first  instance,  it  may  be  concluded  that  the 
medicine  does  not  answer,  and  that  another  must  accordingly 
be  had  recourse  to,  in  the  selection  of  which  it  will  be 
necessary  to  choose  one  related  to  the  remedy  first  pre- 
scribed. 

When  the  action  of  a  well-chosen  remedy  has  been 
disturbed  or  arrested  by  some  incidental  cause,  such  as  an 
error  in  diet,  exposure  to  cold,  &c,  some  intermediate  medi- 
cine should  be  prescribed  against  the  new  symptoms  thus 
developed,  and  on  their  removal  the  remedy  first  employed 
should  again  be  resorted  to. 

The  distinguishing  of  the  medicinal  aggravation  from 
that  of  the  disease  being  a  point  of  material  consequence, 
we  shall  here  endeavour  to  give  the  usual  characteristics  of 
each.  The  medicinal  aggravation  comes  on  suddenly  and  with- 
out previous  amelioration :  the  aggravation  of  the  disease 
more  gradually,  and  frequently  following  an  amelioration. 
Moreover,  in  the  former,  several  of  the  medicinal  symptoms, 
some  of  which  we  may  meet  under  the  indications  for  the 
remedy,  and  not  before  remarked,  declare  themselves. 


XXX  INTRODUCTION. 

Too  much  stress  cannot  be  laid  upon  the  necessity  of 
carefully  watching  the  effects  of  each  dose,  as,  in  addition 
to  the  temporary  aggravation  of  the  symptoms  which  some- 
times sets  in,  a  development  of  collateral  or  pathogenetic 
signs  occasionally  takes  place,  particularly  after  frequent 
repetition  of  different  remedies  in  susceptible  patients ;  by 
a  wrant  of  attention  to  this  important  point,  we  may  incur 
confusion,  and  may  be  unconsciously  treating  a  medicinal 
disease  of  our  own  creation.  Such,  unhappily,  but  too 
frequently  occurs  in  allopathic  practice  from  ignorance  of  the 
real  properties  of  the  drugs  employed.  We  must  also  guard 
against  falling  into  the  opposite  extreme,  and  allowing  the 
disease  to  gain  head  unchecked. 

In  severe  acute  affections  we  may  often  repeat  the  same 
medicine  at  the  same  dose,  at  regular  intervals,  as  long  as  it  does 
good;  but  this  rule  has  many  exceptions,  and  the  directions 
already  given  at  the  commencement  of  this  article  should  be 
borne  in  mind. 

In  chronic  cases,  by  a  long-continued  administration  of 
the  same  medicine,  the  patient  often  becomes  less  susceptible; 
in  such  instances,  if  the  improvement  remain  stationary,  or 
progress  slowly,  we  may  alter  the  attenuation,  or,  still  better, 
give  at  suitable  intervals  some  other  remedy  or  remedies  of  as 
nearly  analogous  medicinal  properties  to  that  first  adminis- 
tered as  possible,  and  then  return  to  the  original  remedy,  if 
needful ;  if,  on  the  other  hand,  decided  amelioration  follows 
each  administration,  we  should  allow  a  longer  interval  to 
elapse  before  repeating,  by  which  means  the  system  gradually 
recovers  itself,  and  the  susceptibility  to  the  medicinal  influence 
remains  unimpaired  until  the  cure  is  completed. 

In  rare  cases,  this  susceptibility  increases;  in  such  instances 
a  higher  potency  should  be  selected,  or  vice  versa  if  that 
employed  has  been  one  of  the  most  minutely  subdivided — 
provided  the  remedy  still  appears  to  be  appropriate, — and 
the  intervals  between  the  exhibitions  lengthened.      This  occa- 


INTRODUCTION.  XXXI 

sionally  occurs  when  the  medicine  has  been  frequently 
repeated,  and  given  in  solution.  When  the  beneficial  effect  of 
a  medicine  is  interrupted  by  an  attack  of  cold,  diarrhoea,  &c, 
some  other  medicine  must  be  given  for  the  new  affection,  on 
the  removal  of  which,  the  medicine  which  was  previously 
acting  favorably  must  be  recurred  to. 


REMARKS. 

In  the  Selection  of  the  Hemedy,  it  is  not  necessary  that  all 
the  symptoms  noted  should  be  present;  at  the  same  time 
taking  care  that  there  are  no  symptoms  not  covered  by  the 
medicine,  or  more  strongly  indicating  another.  When  the 
symptoms  are  few  in  number,  not  characteristic  or  well- 
marked,  attention  to  the  following  points  is  of  material 
assistance :  the  period  of  the  day  at  which  they  occur,  or 
become  most  prominent;  the  side  of  the  body  which  is 
affected ;  the  disposition  of  the  patient ;  his  propensities  or- 
peculiar  habits  and  likings  ;  the  agreeing  or  disagreeing  of 
different  kinds  of  food  ;  the  longing  and  craving  for,  or  the 
unconquerable  aversion  to  certain  aliments,  &c. 

When  it  is  requisite  to  keep  a  medicine  in  solution  for 
some  days,  a  few  drops  of  proof  spirit  may  be  added  to  the 
water,  which  should  be  as  pure  as  possible,  in  order  to  pre- 
serve it  from  decomposition. 

Homoeopathists  prescribe  only  one  medicine  at  a  time  ; 
but  in  some  complicated  cases  considerable  advantage  is  to 
be  derived  from  the  alternate  employment  of  two  remedies, 
which  are  equally  indicated  in  the  case  under  treatment. 

It  may  be  scarcely  necessary  to  explain  the  Pharmaceutical 
Signs  used  in  this  work,  to  signify  the  potency  and  quantum 
of  the  dose ;  but  as  the  book  is  intended  for  beginners,  and 

t 


XXXii  INTRODUCTION. 

may  fall  into  hands  otherwise  wholly  unacquainted  with  the 
science,  we  do  so  as  a  measure  of  precaution ;  it  will  therefore 
be  sufficient  to  remark,  that  Tinct.  Aeon.  3  gtt.  ij,  means  two 
drops  of  the  third  attenuation  or  potency  of  Aconite  ;  Tinct. 
Bry.  6  gtt.  iij,  three  drops  of  the  sixth  of  Bryonia,  and  the 
same  with  any  other  medicine.  The  Germans  commonly 
make  use  of  the  Roman  numerals  to  denote  the  attenuation, 
and  as  only  every  third  attenuation  is  very  generally  used 
(particularly  in  northern  Germany)  the  above  signs  would  be 
written  thus :  Tinct.  Aeon.  I,  gtt.  00  or  2.  Tinct.  Bry.  II, 
gtt.  000  or  3.  The  Roman  numeral  multiplied  by  3,  indi- 
cating the  attenuation  meant.  When  we  wish  to  prescribe 
globules,  the  contraction  gl.  is  usually  employed. 

The  medicines  should  be  taken  fasting,  and  food  or  drink, 
as  also  excessive  bodily  or  mental  exertion,  abstained  from 
for  half  an  hour  to  an  hour  afterwards.  The  homoeopathic 
remedies  should  be  kept  in  a  clean,  dry,  dark  place,  free 
from  odours.  Every  description  of  allopathic  medicine, 
patent  or  domestic,  is  prohibited ;  likewise  bleedings,  blisters, 
medicated  fomentations,  perfumery,  and  everything  con- 
taining camphor.  In  cases  of  obstinate  constipation,  recourse 
may  be  had  to  an  enema,  or  lavement  of  cold  or  of  tepid 
water  when  the  former  disagrees,  to  which  may  be  added,  if 
necessary,  a  tablespoonful  of  olive  oil. 

We  shall  conclude  these  introductory  observations  with 
some  extracts  from  Jahr's  New  Homoeopathic  Pharmacopoeia 
andPosology*  for  the  information  of  those  of  our  readers  who 
are  ignorant  of  the  method  in  which  the  homoeopathic  medi- 
cines are  prepared,  &c. 

*  Translated,  with  additions,  by  James  Kitchen,  M.D.,  Philadelphia. 


INTRODUCTION.  XXX111 


f  NATURE  AND  FORM  OF  HOMOEOPATHIC  MEDICINES. 


u  1.  We  make  use  of  the  same  simple  substances  in  homoeopathy  as  in  the 
old  school ;  but,  instead  of  making  of  them,  as  in  it,  compound  remedies,  we 
seek,  on  the  contrary,  to  procure  each  medicine  in  all  its  purity,  and  to 
administer  it  without  any  admixture  which  might  alter  its  proper  virtues. 
Without  going  into  detail  here  on  the  preference  to  be  given  to  this 
mode  of  administration,  we  should,  nevertheless,  observe  that  it  is  bound  to 
the  principle  of  homoeopathy  in  so  firm  a  manner,  that  it  cannot  be  sundered 
without  injury  to  the  practice.  In  consequence  of  the  principle,  that  no 
medicine  can  be  employed  with  success,  except  so  far  as  it  is  known  in  its 
pure  effects,  homoeopathy  has  subjected  to  examination  a  number  of  simple 
medicines,  which  it  is  important  now  to  reproduce,  such  as  they  have  been 
experimented  on,  if  we  wish  to  rely  on  these  observations.  Even  for  the 
medicines  which  have  not  yet  been  experimented  on,  it  is  not  the  less  impor- 
tant to  submit  them  to  these  experiments  in  all  their  purity  and  simplicity ; 
for  though  each  compound  remedy  forms,  after  all,  also  a  kind  of  remedial 
unity,  which  maybe  studied  in  its  effects,  still  we  can  never  reproduce  a 
second  time  precisely  the  same  effects  as  the  first,  whilst  the  productions  of 
nature  exhibit  at  all  times  and  in  every  place  the  same  properties. 

"2.  In  thus  rejecting  all  the  compound  remedies  of  the  old  school,  as 
improper  to  be  submitted  to  study  and  to  be  employed  in  practice,  homoeo- 
pathy claims  not,  however,  the  pretension  to  use  only  perfectly  simple  bodies, 
such  as  sulphur,  for  example,  metals  and  other  elementary  substances ;  she 
derives,  on  the  contrary,  her  medicines  from  three  kingdoms  of  nature,  the 
same  as  the  old  school,  and  all  the  various  chemical  combinations,  which,  after 
invariable  laws,  are  constantly  produced  in  the  same  manner,  can  be  of  use 
to  it  as  remedial  means. 

"  In  one  word,  the  simplicity  of  homoeopathic  preparations,  of  which  we 
speak,  has  no  reference  to  the  primitive  substance,  •which  serves  for  the 
medicine,  but  to  the  medicine  itself,  which,  as  such,  ought  to  be  composed 
of  only  one  remedial  substance,  and  prepared  in  such  a  manner  that  the 
virtues  of  that  substance  be  as  pure  and  as  developed  as  possible. 

"  3.  If  all  substances  endowed  with  remedial  virtues,  presented  themselves 
under  a  form  as  convenient  as  some  mineral  waters,  for  example,  nothing 
would  be  more  natural  nor  more  rational  than  to  employ  them  as  nature  pre- 
sented them.  But  with  a  great  many  of  these  substances,  the  real  virtue  is 
found  in  a  state  more  or  less  latent,  and  could  not  be  put  into  activity  except 

b 


XXXIV  INTRODUCTION. 

by  the  destruction  of  the  primitive  matter,  and  the  addition  of  another  sub- 
stance, which,  in  quality  of  simple  vehicle,  receives  the  developed  virtue,  and 
transmits  it  to  the  organism.  In  other  substances,  on  the  contrary,  the 
remedial  virtue  is  found  developed,  but  it  is  so  energetic  that,  without  the 
addition  of  a  substance  which  can  moderate  the  effects,  we  cannot  employ 
them  without  danger  to  the  health,  or  even  the  lives  of  the  sick.  In  fine, 
there  are  yet  other  substances  which,  though  their  virtues  need  not  to  be  either 
developed  or  moderated,  present  themselves  under  a  power  which  opposes  as 
well  to  their  dispensation  as  preservation,  and  which,  in  consequence,  equally 
exacts  the  addition  of  foreign  substances  in  order  to  be  conveniently  prepared 
for  use. 

"  4.  The  preparation  and  administration  of  medicines  being  then  impos- 
sible under  any  mixture,  it  is  important  to  discover  substances  which,  at  the 
same  time  operating  under  the  form  of  medicines,  are  innocent  enough  in 
themselves  not  sto  alter  the  virtues  of  them.  This  condition,  simple  as  it 
may  appear  in  theory,  is  not,  however,  so  easy  to  fulfil  as  it  appears — for, 
perhaps,  there  exists  not  a  substance  in  the  world,  which,  under  such  and 
such  circumstances,  may  not  exercise  a  pathogenetic  influence,  and,  conse- 
quently, alter  the  specific  effects  of  a  medicine  with  which  it  may  be  mixed. 
Even  pure  water,  the  substance  the  most  innocent  that  we  know,  is  not 
completely  exempt  from  this  inconvenience,  and  even  were  it  so,  it  would 
not  suffice  alone,  neither  for  the  preparation  nor  the  preservation  of  medi- 
cines. In  consequence  homoeopathy  has  substituted  two  other  vehicles,  viz.  : 
1,  Alcohol  or  spirits  of  wine,  for  the  preparation  of  liquid  or  soluble  sub- 
stances ;  2,  Sugar  of  milk,  for  the  preparation  of  dry  substances  :  and 
though  these  two  substances  are  not  entirely  void  of  medicinal  effects,  the 
practical  facts  are  still  the  same  as  if  these  substances  were  entirely  pure, 
since  all  the  preparations  which  are  made  in  this  manner,  are  constantly  the 
same  among  themselves. 

"5.  By  means  of  these  two  substances,  pure  alcohol  and  sugar  of  milk, 
homoeopathy  makes  all  its  medicinal  preparations,  without  exception,  whether 
under  the  form  of  tinctures  or  powders.  The  first  are"  obtained,  that  is,  the 
tinctures,  in  mingling  with  alcohol  the  juice  recently  expressed  from  fresh 
plants,  or  in  infusing  in  this  liquid  the  dry  substances,  the  active  principles 
of  which  can  be  extracted  in  this  way.  The  powders,  on  the  other  hand,  are 
obtained  by  the  trituration  of  the  insoluble  substances  with  a  suitable  quan- 
tity of  sugar  of  milk.  The  alcoholic  tinctures  and  the  powders  are  then  the 
only  preparations  known  in  homoeopathy.  All  kinds  of  essences,  syrups, 
pastes,  ptisans  and  other  inventions  of  the  old  school,  are  entirely  foreign 
to  it. 

"  6.  From  this,  however,  it  does  not  follow  that  homoeopathy  always 
employs  the  primitive  preparations  of  medicines ;  on  the  contrary,  in  the 
majority  of  cases  she  considers  them  too  energetic  to  be  administered  such 


INTRODUCTION.  XXXV 

as  they  are  obtained.  But,  instead  of  seeking  to  diminish  their  energy  by 
the  means  which  the  old  school  call  correctives,  homoeopathy  endeavours 
to  obtain  this  end  by  the  simple  attenuation  of  the  primitive  substance.  It 
is  thus  that,  seeing  that  a  grain  or  a  drop  of  the  primitive  preparation  of  a 
poisonous  substance,  for  example,  would  be  too  active,  she  attenuates  this 
drop  or  this  grain  in  mingling  it  with  a  new  quantity  of  vehicle,  until  a 
preparation  is  obtained,  which  is  neither  too  strong  nor  too  weak  to  operate 
the  cure,  nor  too  energetic  to  fear  any  unfortunate  consequences.  Homoeo- 
pathy thus  prepares  out  of  each  substance  a  series  of  attenuations,  of  which 
the  following  one  contains  ordinarily  the  100th  or  sometimes  the  10th  part 
of  the  active  principle  of  the  preceding  one,  and  it  is  generally  from  one  of 
these  attenuations,  and  rarely  from  the  primitive  preparation  of  a  medicine, 
that  the  homoeopathic  physician  administers  to  his  patients. 

"  7.  Finally,  as  to  the  form  under  which  the  homoeopathic  physician 
dispenses  his  medicines,  it  is  not  less  simple  than  the  preparation,  and  is 
equally  made  without  any  other  mixture  than  that  of  the  least  medicinal 
substances,  such  as  alcohol,  pure  water,  sugar  of  milk  and  globules  com- 
posed of  sugar  and  starch.  The  attenuations  of  each  medicine  being 
previously  prepared,  the  patient  receives  of  them  the  dose  prescribed,  either 
in  form  of  solution,  with  a  convenient  quantity  of  pure  water,  or  water 
mixed  with  alcohol,  or  in  form  of  powder,  mixed  with  a  small  quantity  of 
sugar  of  milk,  or  yet  again  in  form  of  globules  impregnated  with  the  alco- 
holic attenuation  of  the  medicine. 

"8.  How  simple  soever  may  be  the  preparation  of  homoeopathic  remedies, 
as  to  its  principle,  it  nevertheless  exacts  much  precaution  and  very  particular 
care,  if  we  would  be^ sure  to  have  medicines  as  active  and  as  sure  as  possible 
in  their  effects.  To  this  end  also  homoeopathy  has  prescriptions  and  positive 
rules,  which  it  is  important  to  know  before  all,  in  order  to  follow  them  with 
exactitude,  and  to  prevent  thus  the  faults,  which,  diminutive  as  they  may 
appear  in  themselves,  are,  nevertheless,  very  serious  in  practice.  In  the 
following  chapters  we  shall  pass  in  review  all  these  rules  and  prescriptions 
in  treating  in  succession — 1.  Of  vehicles  which  serve  for  the  preparation  of 
medicines.  2.  Of  the  preparations  of  medicines  in  their  primitive  state, 
3.  Of  attenuations.  4.  Of  the  dispensation  and  preservation  of  homoeopathic 
medicines.  These  four  chapters  containing  all  that  has  reference  to  the 
general  pharmacopoeia,  we  shall  occupy  ourselves  in  the  second  part  of  this 
work  with  the  special  pharmacopoeia,  that  is  to  say,  with  the  rules  to  be 
observed  in  the  preparation  of  each  medicine  in  particular,  and  with  the 
description  of  primitive  substances  which  homoeopathy  has  introduced  into 
its  pharmacy. 


XXXVI  INTRODUCTION. 


"    OF   VEHICLES,    WHICH    SERVE    FOR    THE    PREPARATION    OF    HOMCEOPATIIIC 

MEDICINES. 

"  9.  The  vehicles  which  homoeopathy  uses  for  the  preparation  of  its  medi- 
cines are,  in  all,  of  the  number  of  four,  viz. :  1 .  Alcohol,  or  spirit  of  wine. 
2.  Sugar  of  milk.  3.  Globules  composed  of  sugar  and  starch.  4.  Pure 
water.  Some  physicians  have  wished  to  add  a  fifth  to  the  above,  viz,  ether, 
and  we  shall  see  below  (28)  to  what  destination  this  liquid  is  suitable.  As  to 
the  four  vehicles  which  we  have  just  cited,  homoeopathy  has  thus  far  used 
them  for  all  its  preparations ;  and  it  is  important  to  obtain  them  as  pure  as 
possible,  in  order  to  be  sure  to  obtain  preparations,  in  every  respect,  identical 
with  those  with  which  Hahnemann  and  his  disciples  have  made  their  pure  and 
clinical  observations.  This  purity  is  not,  however,  always  the  distinctive 
quality  of  the  objects  which  we  find  in  commerce  or  that  nature  furnishes, 
and  that  is  the  reason  why  it  is  almost  indispensable  that  homoeopathy  should 
know  how  to  prepare  herself  vehicles,  or  at  least  to  render  them  proper  for 
the  use  she  makes  of  them.  We  shall  endeavour  to  give  in#this  chapter  the 
instructions  necessary  to  this  end. 

"10.  Alcohol  {spiritus  vini,  spiritus  vini  alcoholisatus,  spirits  of  wine, 
alcoholized  spirits  of  wine)  is  never  found  in  nature — it  is  always  the  product 
of  art — but  it  is  formed  every  time  that  sugar  is  found  in  contact  with  a 
fermentable  matter  in  water,  and  at  a  suitable  temperature ;  that  is  to  say, 
that  it  is  developed  in  the  course  of  fermentation,  to  which  has  been  given, 
after  this  phenomenon,  the  name  of  spirituous  or  alcoholic.  As  all  liquors 
which  have  undergone  the  spirituous  fermentation  contain  alcohol,  and  as 
those  which  abound  in  the  saccharine  material,  are  by  that  susceptible  of 
affording  it,  it  results  that  we  may  obtain  it  from  a  great  number  of  vegetable 
substances,  such  as  wine,  beer,  cider,  malt,  grape  dregs,  sugar-cane  juice, 
germinating  cerealia,  pounded  cherries,  molasses,  juice  of  carrots  or  beets, 
potatoes,  honey,  &c.  The  Tartars  extract  it  even  from  the  milk  of  their 
mares. 

"11.  From  whatever  substance  we  obtain  it,  alcohol  is  identical ;  but  we 
must  always  have  recourse  to  means  more  or  less  complicated  to  obtain  it 
pure.  In  every  case  it  contains  a  more  or  less  ]arge  quantity  of  water,  and 
very  often  it  is  mixed  either  with  acetic  acid,  or  a  small  proportion  of  prussic 
acid  or  empyreumatic  oil,  &c,  according  to  the  substances  from  which  it  has 
been  extracted.  The  alcohol  which  seems  to  be  the  best  for  homoeopathic 
preparations  is  that  obtained  from  the  dregs  of  grapes  (marc  de  raisin)* 

*  This  is  the  refuse  of  the  grape,  after  the  juice  has  been  pressed  out,  in  the  process  of 
making  wine. 


INTRODUCTION.  XXXV11 

without  the  addition  of  other  substances/  or  else  the  alcohol  of  rye  or  wheat. 
The  least  suitable  kinds  are  such  as  come  from  the  laboratories  of  chemists 
or  pharmaceutists,  and  which,  for  the  most  part,  are  drawn  from  the  residue 
of  some  chemical  preparation,  such  as  the  resin  of  jalap,  &c.  Alcohol 
extracted  from  potatoes  is  not  more  suitable  for  homoeopathic  preparations, 
since  it  contains  a  large  quantity  of  empyreumatic  oil,  of  which  even  the 
chemical  proceedings,  which  consist  in  clearing  it  by  the  chloride  of  lime  and 
powder  of  charcoal,  do  not  entirely  purify  it.  This  oil  is  often  found  even  in 
the  alcohol  from  rye  or  wheat ;  but  in  this  case  it  is  sufficient  to  mingle  this 
spirit  with  a  suitable  quantity  of  pure  olive  oil,  and  to  shake  it  from  time  to 
time  for  several  days ;  in  this  way  the  empyreumatic  oil  combines  with  the 
olive  oil,  and  swims  on  the  alcohol,  whence  it  may  he  easily  taken. 

"■12.  Alcohol  pure  and  perfectly  anhydrous  is  a  colourless  liquid,  of  a 
remarkable  fluidity,  of  a  sweet  and  penetrating  odour,  of  a  hot  and  burning 
flavour,  and  whilst  it  is  ruhbed  hetween  the  hands,  it  should  not  lather  nor 
emit  any  foreign  odour.  Its  specific  weight  is  much  less  than  that  of  water, 
in  which  it  dissolves  perfectly,  and  in  all  proportions,  with  disengagement  of 
heat.  Exposed  to  the  air,  it  evaporates  in  part,  and  the  part  which  remains 
loses  its  power  in  becoming  saturated  with  the  humidity  of  the  atmosphere, 
of  which  it  is  exceedingly  greedy.  At  the  approach  of  a  candle,  or  by  the 
effect  of  the  electric  spark,  alcohol  burns  rapidly,  with  a  flame  white  at  the 
centre  and  blue  at  the  edges,  and  leaves  no  residue.  Put  in  contact  with 
other  substances,  it  dissolves  a  great  many,  such,  among  others,  as  phosphorus 
and  sulphur'  (both  in  small  quantities),  the  fixed  alkalies,  halsams,  resins, 
camphor,  sugar,  volatile  oils,  extractive  matter,  &c.  Acids  have  a  marked 
action  on  it ;  some  dissolve  in  it  simply,  whilst  others  are  transformed  into 
ether. 

"13.  Alcohol,  in  the  state  of  complete  purity,  has  a  specific  gravity  of 
0*791.  It  then  contains  not  a  trace  of  water,  and  marks  hy  the  alcoholmeter 
100  degrees  of  force.  But  it  is  never  employed  at  this  stage  of  concen- 
tration ;  that  which  commerce  presents,  as  well  as  that  which  we  find  in 
medicine,  is  always  more  or  less  weakened.  According  to  the  proportions 
with  which  water  is  mixed  with  it,  we  may  generally  distinguish  four  kinds, 
viz. :  1st.  Spirits  of  wine  of  commerce,  the  weakest  quality,  having  a  specific 
gravity  of  but  0*910  to  0*920.  2d.  Rectified  spirits  of  wine,  the  quality 
which  is  obtained  by  mingling  7  parts  of  water  with  17  parts  of  the  best 
rectified  spirits  of  wine  (see  3d)  ;  the  specific  gravity  of  this  spirit  is  from 
0*890  to  0*900,  and  its  degree  of  concentration  60°.  3d.  The  best  rectified 
spirits  of  wine,  superior  quality,  the  specific  gravity  of  which  is  from  0*830 
to  0*840,  and  its  degree  of  concentration  85°.  4th.  Alcoholized  spirits  of 
wine,  or  absolute  alcohol,  the  most  concentrated  quality,  having  a  specific 
gravity  of  0*810  to  0*820,  and  containing  from  96°  to  100°  of  alcohol.  For 
the  preparation  of  the  mother  tinctures  of  homoeopathy,   the  most  suitable 


XXXV111  INTRODUCTION. 

quality  is  the  absolute  alcohol  of  95° ;  for  the   attenuations,  we  may,  in  the 
majority  of  cases,  be  content  with  a  spirit  of  wine  of  60°  to  70°. 

"14.  In  order  to  obtain  an  alcohol  as  anhydrous  as  possible,  recourse  has 
been  had  to  various  chemical  measures,  which  succeed  well  enough,  as 
regards  the  concentration,  but  the  majority  of  these  measures  (lime,  acetate 
of  lime,  sulphate  of  soda,  alum,  &c.)  constantly  produce  a  more  or  less 
powerful  alteration  in  this  liquid.  Even  chloride  of  lime  is  not  exempt  from 
this  fault,  which  may  easily  be  recognised,  in  burning  rectified  alcohol  by 
this  means,  after  having  added  to  it  nitrate  of  silver,  and  afterwards  examin- 
ing the  residue.  This  is  the  reason  why  the  homceopathist  should  never 
make  use  of  alcohol  rectified  in  these  chemical  ways,  but  endeavour  to  obtain 
the  desired  quality  by  more  innocent  proceedings.  That  which  appears  to 
be  the  most  suitable,  consists  in  obtaining  the  concentration  by  simple 
evaporation.  For  a  long  time  it  has  been  remarked,  that  alcohol  preserved 
in  vessels'  closed  with  prepared  bladder  acquires  strength,  whilst  it  loses 
strength  if.  closed  by  caoutchouc,  insomuch  that  to  concentrate  it,  it  is 
only  necessary  to  put  it  in  beef-  or  pig-bladders,  and  suspend  them  in  a  warm 
and  dry  place.  To  this  effect,  after  having  carefully  cleansed  the  bladder, 
we  paint  it  with  a  thin  coat  of  fish-glue ;  then  we  fill  it  with  the  alcohol  we 
wish  to  concentrate  and  suspend  it,  well  closed,  in  a  perfectly  dry  place,  and 
at  a  temperature  of  20°  to  25°  E».  The  drier  the  air  that  surrounds  the 
bladder,  the  more  prompt  is  the  evaporation  of  the  water ;  and  in  leaving 
the  bladder  in  proper  conditions  until  we  perceive  the  odour  of  alcohol,  we 
may  be  sure  of  obtaining  a  quality  as  anhydrous  as  possible. 

"15.  The  most  simple  and  the  most  sure  method  of  obtaining  an  alcohol  as 
concentrated  and  as  pure  as  homoeopathy  wants,  would  then  be,  to  take  the 
first-quality  brandies  and  to  concentrate  them  after  the  method  indicated 
above.  Alcohol  obtained  in  this  way  is  generally  in  a  state  of  concentration 
of  95°  to  96°,  and  thus  is  perfectly  suitable  for  the  preparation  of  alcoholic 
extracts  ;  only,  before  employing  it,  it  should  be  once  again  rectified  by  a  new 
distillation.  For  this,  we  should  be  careful  to  use  only  glass  apparatus, 
since  copper  or  tin  vessels  often  give  out  to  the  product  of  distillation  some 
of  their  material,  an  adulteration,  which  is  the  more  to  be  guarded  against, 
as,  often,  chemical  means  are  not  capable  of  revealing  it,  though  it  should 
be  strong  enough  to  alter  the  effects  of  medicines  which  might  be  prepared 
with  a  product  of  that  kind. 

"16.  Respecting  the  brandies  from  which  we  might  wish  to  obtain  alcohol, 
we  have  said  above  that  the  best  were  those  obtained  from  the  dregs  of 
grapes  or  else  from  rye.  But  in  taking  these  liquors  such  as  they  are  found 
in  commerce,  we  should  always  be  well  assured  that  they  are  pure.  Often 
we  find  in  them  lead,  which  we  may  detect  By  treating  them  with  the  liver 
of  sulphur,  which  causes  a  brownish  or  blackish  precipitate.  Should  they 
contain  copper,  liquid  ammonia  produces  a  blue  colour.     The  adulteration  of 


INTRODUCTION.  XXXIX 

brandies  by  alum  may  be  discovered  by  the  addition  of  a  solution  of  potash, 
and  the  mineral  sulphates  by  acetate  of  barytes.  In  fine,  to  be  sure  that  the 
alcohol  we  use  is  really  made  of  the  wished-for  substance,  we  mingle  30 
parts  of  it  with  0*15  parts  of  liquid  caustic  potash,  and  heating  this  mixture 
with  spirit  of  wine,  we  permit  it  to  evaporate  until  there  remain  but  four 
parts.  We  take  this  residue,  to  which  we  add  four  parts  of  weak  sulphuric 
acid,  in  a  well-stoppered  small  flagon,  taking  care  to  shake  the  mixture  ;  in 
unstoppering  the  flagon  afterwards,  we  shall  perceive  a  perfect  odour  of  the 
substance  of  which  the  brandy  has  been  made. 

"  Sugar  of  Milk. 

"  17.  Sugar  of  milk  (saccharum  lactis),  is  a  salt  of  a  sweet  taste,  slightly 
sugary ;  it  forms  masses  moderately  thick,  hard,  crystalline,  semi-transparent, 
colourless,  and  inodorous.  By  its  properties,  both  physical  and  chemical, 
this  substance,  which  is  exclusively  proper  to  the  milk  of  different  animals, 
seems  to  be  intermediate  between  sugar  and  gum.  Sufficiently  purified, 
sugar  of  milk  contains  no  azote ;  it  dissolves  in  12  times  its  weight  of  cold 
water,  and  four  times  its  weight  of  boiling  water.  Alcohol  dissolves  it  but  in 
a. very  small  proportion,  and  ether  not  at  all;  it  does  not  alter  by  the  air,  is 
not  susceptible  of  undergoing  the  vinous  fermentation,  melts,  puffs  up,  and  is 
transformed  into  a  kind  of  gummy  matter  by  the  action  of  fire,  decomposes  the 
acetate  of  copper  the  same  as  common  sugar ;  in  fine,  treated  with  nitric 
acid,  it  forms  mucic  acid,  and  by  sulphuric  acid  or  muriatic  acid  diluted,  the 
sugar  of  grapes.  Its  proportion,  as  that  of  the  other  constituent  principles 
of  milk,  varies  in  the  different  kinds  of  mammiferse.  In  general  it 
abounds  more  in  the  milk  of  the  ass  than  in  that  of  the  cow,  or  mare,  or 
goat,  &c.  According  to  Berzelius,  one  thousand  parts  of  skimmed  milk  give 
35,  and  the  same  quantity  of  cream  gives  44  parts  of  sugar  of  milk,  mingled 
with  saline  matters. 

"  18.  It  is  in  the  mountains  of  Switzerland  that  the  sugar  of  milk  is  pre- 
pared which  we  find  in  commerce.  It  is  prepared  from  the  evaporation  of 
the  whey,  which  they  obtain  in  such  large  quantities  in  the  preparation  of 
cheese.  It  presents  many  varieties,  according  to  its  degree  of  purity.  The 
crystalline  sugar  in  grape  form  is  considered  the  most  pure  ;  the  other  kinds 
always  contain  more  or  less  animal  matter.  We  often  also  find  in  commerce, 
under  the  name  of  sac.  lac.  inspissatum,  the  whey  of  milk  solidified  and  dried  ; 
but  this  is  a  kind  that  in  nowise  is  proper  for  homoeopathic  preparations. 
The  sugar  of  milk  which  we  find  at  the  druggists  is,  in  the  majority  of  cases, 
more  or  less  altered  by  mortars  of  copper  or  iron  in  which  it  has  been  pul- 
verized, and  still  more  often  impregnated  with  exhalations  of  a  quantity  of 
aromatic  substances,  in  the  midst  of  which  it  is  preserved.  Hence  the  neces- 
sity of  the  homoeopathic  physician  to  prepare  it  himself,  every  time  that  he 
has  it  in  his  power,  or  at  least  to  purify  it  by  a  new  crystallization,  if  he  is 


Xl  INTRODUCTION. 

obliged  to  provide  himself  with  it  from  the  druggist.  This,  however,  is  not 
without  difficulty,  since  the  sugar  of  milk  does  not  crystallize,  in  watery 
solution,  but  very  slowly,  and  always  in  an  incomplete  manner.  It  is  only  by 
treating  it  with  equal  parts  of  alcohol  and  water  that  we  can  succeed  well ; 
the  operation,  it  is  true,  becomes  more  costly,  but  considering  the  advantages 
which  this  procedure  offers,  we  think  that  the  cost  is  no  reason  for  its  rejec- 
tion. 

"19.  To  purify  the  sugar  of  milk  in  this  way,  we  dissolve  about  two  and 
a  half  pounds  of  the  best  quality  in  ten  pounds  of  rain-water  or  distilled 
water  in  a  boiling  state,  then  filter  the  solution  through  filtering  paper,  in  a 
vessel  of  porcelain  or  glass,  and  mix  it  with  four  kilogrammes  of  absolute 
alcohol;  after  which  place  the  vessel  containing  this  mixture  in  a  dry  place, 
and  leave  it  perfectly  still.  The  sugar  of  milk  being  insoluble  in  absolute 
alcohol,  and  this  being  very  attractive  of  water,  drawing  away  a  large  quantity, 
the  crystallization  advances  pretty  rapidly,  and  often  at  the  end  of  three  or 
four  days  a  crust  of  white  and  brilliant  crystals  may  be  obtained,  of  the 
weight  nearly  of  the  sugar  of  milk  that  was  dissolved  in  the  water.  When 
this  crust  is  formed,  it  is  taken  away,  washed  with  distilled  water,  to  which 
has  been  added  a  little  alcohol,  and  then  dried  on  blotting  paper.  That 
done,  we  may  consider  the  sugar  as  altogether  suitable  for  all  the  homoeo- 
pathic preparations,  even  the  most  delicate ;  it  is  completely  colourless  and 
inodorous — tested  by  the  most  active  reagents  it  shows  not  a  trace  of  foreign 
salts. 

"  20.  Notwithstanding  the  process  we  have  described  above,  it  would  be  of 
little  avail,  were  the  sugar  of  milk  not  of  a  good  quality  in  the  first  instance. 
In  order  to  be  sure  of  that,  it  should  be  separated  from  all  fatty  substances 
and  other  foreign  matters  which  milk  contains,  which  is  recognisable  by  its 
perfectly  white  colour,  by  its  due  degree  of  resistance  to  the  atmospheric  air, 
and  its  odour  and  pure  and  natural  taste.  The  adulteration  of  sugar  of  milk 
with  common  sugar  may  be  known  by  its  sugary  taste— -with  alum,  by  the 
aid  of  acetate  of  lead  or  oxydulated  nitrate  of  mercury.  To  examine  sugar  of 
milk  that  has  been  boiled  in  copper  vessels,  we  dissolve  a  certain  quantity  in 
water  and  pour  on  it  some  caustic  ammonia,  which  colours  it  blue,  should  it 
contain  any  of  that  metal.  Nitrate  of  silver  detects  the  presence  of  kitchen 
salt,  and  acetate  of  lead  that  of  sulphuric  acid.  When  prepared  from  sour 
whey,  it  reddens  the  tincture  of  tournesol. 

"21.  To  reduce  the  crystallised  sugar  of  milk  to  powder,  we  first  break 
the  crust  in  the  direction  of  the  crystals,  upon  a  sufficiently  thick  piece  of 
wood,  with  a  wooden  hammer  and  a  strong  knife ;  then  we  put  the  pieces  in 
a  mortar  of  porcelain,  when  we  break  and  triturate  them  until  the  powder 
becomes  sufficiently  fine  for  use.  That  done,  we  pass  the  powder  through  a 
sieve  of  crape  which  we  have  fitted  above  and  below  with  parchment.  The 
finest  part,  after  being  sifted,  is  found  below  the  sieve,  whilst  the  grosser 


INTRODUCTION.  xll 

part  above  should  be  triturated  again.  To  preserve  sugar  of  milk,  it  should 
be  placed  in  a  dry  place,  in  order  to  keep  it  from  the  moisture  of  the  air 
and  prevent  it  from  spoiling. 

"3.  The  Sugar  Globules. 

' '  22 .  The  sngar-globules  (globuli  saccharini)  are  small  nonpar eilles  destined 
to  be  saturated  with  homoeopathic  medicines,  in  order  to  be  able  to  dispense 
these  last  with  more  facility.  They  are  generally  found  at  the  confectioners, 
who  prepare  them  from  sugar  and  starch ;  but  as  the  sugar  of  the  cane  or  the 
beet,  which  enters  into  this  preparation,  is  not  pure  enough  for  the  purpose 
indicated,  it  is  better  to  have  globules  made  expressly  from  sugar  of  milk, 
or  else  with  the  ordinary  purified  sugar.  As  to  the  size  of  these  globules 
they  should  not  be  too  large,  so  that  we  may  be  able  to  dispense  the  smallest 
doses.  Hahnemann  proposed  to  give  them  the  size  of  a  poppy  seed,  so  that 
about  40  of  them  would  weigh  about  one  and  a  half  grains,  (one  centi- 
gramme.) This  form  has  been  adopted  by  the  majority  of  homoeopaths  ; 
some,  however,  use  them  of  the  size  of  a  millet  seed. 

"23.  To  charge  these  globules  with  the  active  principles  of  the  medicine, 
and  to  prepare  them  so  that  in  a  large  quantity  they  may  not  deteriorate,  we 
imbibe  them  first  with  those  alcoholic  attenuations  which  we  desire ;  then, 
after  being  well  assured  that  all  have  been  well  impregnated,  we  dry  them 
and  put  them  in  a  well-stoppered  bottle.  The  complete  desiccation  of  the 
globules  before  bottling  them  is  absolutely  indispensable,  since  without  that 
precaution  they  fall  into  powder  in  a  short  time,  and  afterwards  lose,  in 
becoming  decomposed,  their  medicinal  virtue.  This  is  the  reason  why,  after 
imbibition  in  a  suitable  bottle,  it  is  well  to  turn  them  out  on  paper  with  raised 
edges,  where  they  may  be  agitated  until  they  do  not  adhere  one  to  the  other. 
Should  we  wish  afterwards  to  put  them  into  the  same  bottle  in  which  we 
have  imbibed  them,  we  should  take  care  to  dry  it  also,  before  making  use  of 
it,  or  to  empty  it  afresh  and  dry  the  globules  until  they  do  not  adhere  to 
the  bottle.  All  the  globules  so  imbibed  have  a  dry  and  smooth  hue,  whilst 
in  their  natural  state  they  are  white  and  brilliant. 

"4.   Water. 

"  24.  Among  all  the  vehicles  there  is  not  one  that  is  more  free  from 
medicinal  virtue,  properly  so  called,  than  pure  water;  but,  on  the  other 
hand,  nothing  is  more  rare  than  to  find  in  nature  this  fluid  in  a  perfectly 
pure  condition.  Under  whatever  form  water  presents  itself,  it  is  more  or 
less  charged  with  foreign  matters,  such  as  gas,  salts,  earths,  &c.  The  purest 
quality  of  water  is  rain-water,  which,  as  well  as  distilled  water,  has  neither 
odour,  nor  taste,  nor  colour;  besides  atmospheric  air,  which  this  water 
contains,  there  is  but  a  small  portion  of  fixed  matters, —only  after  a  storm, 
we  find,  occasionally,  a  trace  of  nitric  acid  combined  with  ammonia.     The 


Xlii  INTRODUCTION. 

water  of  springs  and  wells  constantly  contain  many  kinds  of  neutral  salts, 
earths,  and  muriatic  compounds.  As  to  the  waters  of  rivers,  lakes,  and 
ponds,  in  inhabited  countries,  it  is  far  from  the  conditions  of  pure  water  to 
merit  attention  here. 

"25.  Homoeopathy  uses  water  for  three  different  purposes,  viz. — l,for  the 
chemical  operations,  which  require  the  purification  of  many  primitive  sub- 
stances ;  2,  for  the  preparation  of  some  of  the  attenuations  ;  and  3,  for  the 
administration  of  medicines  in  the  form  of  watery  solution.  For  the  last  of 
these  uses  we  may  well  enough  make  use  6f  river  or  spring-water  well 
filtered ;  for  the  chemical  operations,  rain-water  procured  during  a  calm 
answers  in  all  cases ;  but  for  the  preparation  of  the  attenuations,  we  must 
have  the  purest  water  we  can  possibly  obtain.  For  this,  distilled  water, 
which  is  found  in  the  pharmacies,  is  not  suitable ;  for  even  if  it  has  not 
been  distilled  in  copper  or  other  metallic  vessels,  it  is  always  to  be  feared 
that  it  is  impregnated  with  foreign  matters,  derived  from  substances  which, 
perhaps,  but  a  short  time  previously  had  been  distilled  in  the  same  apparatus, 
and  of  which  the  ordinary  care  employed  in  cleansing  them  is  far  from 
discharging  the  whole. 

"  26.  To  obtain  a  perfectly  pure  water,  the  homoeopath  must  himself 
undertake  the  distillation  in  vessels  of  porcelain  or  glass,  as  indicated  under 
the  head  of  alcohol.  The  most  suitable  water  to  distil  is  rain-water,  above 
all,  if  we  take  care,  as  we  have  above  remarked,  not  to  procure  that  which 
falls  during  a  storm,  or  when  the  sun  shines.  We  must  not,  even  in  an  ordi- 
nary rain,  gather  the  first  rain  that  falls,  since  this  commonly  contains  the 
impurities  suspended  in  the  air ;  it  is  only  after  rain  has  fallen  four  or  six 
hours  that  we  are  able  to  gather  it  in  its  purest  possible  condition.  Still  this 
water  contains  a  certain  quantity  of  carbonic  acid,  and  hence,  Uefore  submit- 
ting it  to  distillation,  we  shall  do  well  to  boil  it  in  a  porcelain  vase  and  let  it 
cool.  Respecting  the  distillation  itself,  we  must  be  cautious  gradually  to 
augment  the  fire  under  the  apparatus,  and  to  preserve,  by  wet  cloths,  the 
neck  of  the  retort  at  a  moderate  temperature,  so  that  the  vapour,  in  passing, 
may  not  dissolve  from  the  sides  of  the  vessel  even  a  trace  of  silex  or  alkali. 
The  first  distillation  should  be  rejected,  and  when  the  liquid  in  the  retort  is 
diminished  two  thirds  we  must  cease.  A  good  distilled  water  should  leave 
no  residue  on  evaporation ;  it  should  be  perfectly  limpid,  insipid  and  inodo- 
rous, and  neither  precipitate  by  muriate  of  barytes,  nor  nitrate  of  silver,  nor 
hydrosulphuric  acid,  nor  the  hydrosulphates.  To  preserve  it,  it  should  be 
put  into  bottles  or  new  jars  of  yellow  glass,  that  we  have  been  careful  to 
cleanse  at  first  with  a  part  of  the  same  water,  and  which  we  put  afterwards  in 
a  place  as  cool  as  possible. 


INTRODUCTION.  xliii 


"5.  Ether. 


"  27.  Sulphuric  ether,  or  ether  par  excellence  (ather  sulphuricus,  spiritus 
sulphurico-ethereus),  is  a  light,  volatile,  odorous  and  inflammable  liquid. 
Like  the  other  hydratic  ethers,  as  the  phosphoric,  arsenic  ethers,  &c,  it  is 
composed  of  two  volumes  of  bicarbonated  hydrogen  gas  and  one  volume  of 
vapour  of  water,  so  that  it  may  be  considered  either  as  alcohol  deprived  of  a 
certain  proportion  of  the  elements  of  water,  or  as  a  hydrate  of  bicarbonated 
hydrogen.  Recently  prepared,  it  is  neither  alkaline  nor  acid,  and  when 
burnt,  it  shows  no  trace  of  sulphuric  acid,  an  evident  proof  that  the  sulphur 
enters  for  nothing  into  its  composition.  It  unites  with  difficulty  with  water, 
which  requires  ten  times  its  weight  to  dissolve  it,  but  with  alcohol  and  all  the 
essential  oils  it  unites  in  all  proportions.  The  fixed  oils,  also,  the  strong 
acids,  balsams,  several  kinds  of  resins,  phosphorus,  sulphur,  bromine,  and 
many  hydrochloric  salts,  are  perfectly  soluble  in  ether. 

"28.  In  homoeopathy,  we  as  yet  are  not  acquainted  with  any  etherial 
preparation,  except  phosphorus,  which  some  have  proposed  to  substitute  for 
the  alcoholic  preparation  of  this  substance.  This  substitution  of  etherial 
tinctures  for  alcoholic  tinctures,  not  only  for  phosphorus,  but  also  for  many 
other  substances,  appears  to  us  to  be  suitable  in  a  great  many  cases,  and  we 
should  not  hesitate  in  the  least  to  advise  it  to  all  the  homoeopathic  physicians 
and  pharmaceutists,  were  we  well  assured  that  the  medicines  would  not 
undergo  any  modification  in  being  indifferently  treated  by  the  one  or  the 
other  of  these  vehicles.  The  knowledge  of  the  chemical  constituents  of 
which  ether  is  composed  is  not  sufficient  for  us  to  conclude  on  its  patho- 
genetic effects,  and  so  long  as  this  doubt  is  not  settled  by  pure  experiments, 
we  think  that  all  those  who  wish  to  be  guided  by  the  observations  contained 
in  the  homoeopathic  materia  medica  will  do  well  to  procure  such  prepa- 
rations as  have  been  employed  by  the  authors  of  these  observations.  From 
this,  however,  it  does  not  follow  that  we  should  not  prepare  any  etherial 
tincture,  and  we  are  ourselves  far  from  wishing  to  interdict  it  here,  but  we 
only  insist  on  the  necessity  not  to  confound  them  with  those  of  alcohol, 
and  to  note  at  least  on  the  label  the  vehicle  with  the  aid  of  which  they  have 
been  prepared. 

"29.  Ether,  such  as  it  is  found  in  our  shops,  under  the  name  of  rectified 
ether,  is  qrdinarily  pure  enough ;  it  only  sometimes  contains  a  little  alcohol, 
of  which,  however,  it  ought  to  be  freed.  To  do  this,  we  shake  it  a  short 
time  with  double  its  volume  of  water,  and  when  it  is  separated  from  it  we 
pour  it  on  quicklime,  with  which  it  should  be  shaken  at  intervals  for  some 
days.  In  afterwards  distilling  this  mixture,  until  there  remains  in  the  retort 
about  two  thirds,  the  third  which  has  passed  into  the  recipient  is  perfectly 
pure   ether.       Often,  however,  we  find  it  adulterated  with  a  quantity  of 


Xliv  INTRODUCTION. 

sulphuric  acid  or  other  acids.  The  adulteration  with  water  is  known  by  the 
watery  residuum  evident,  whilst  at  a  mean  temperature  we  expose  a  small 
portion  of  ether  to  evaporation.  The  presence  of  sulphuric  acid  betrays 
itself  by  its  disagreeable  odour,  and  that  of  other  acids  by  its  reddening 
tournesol.  Finally,  to  preserve  ether  free  from  all  deterioration,  it  should 
be  put  into  little  bottles,  the  mouths  of  which  terminate  in  points,  so  that 
they  may  be  hermetically  sealed  by  the  flame  of  a  lamp.  When  ether  has 
been  deteriorated  by  the  action  of  the  air  or  the  light,  it  is  less  volatile,  of 
an  acrid  and  burning  taste,  and  miscible  with  water  in  all  proportions. 


"  OF  THE  PREPARATION  OF  HOMOEOPATHIC  MEDICINES  IN  THEIR  PRIMITIVE 

STATE. 

"  1.   General  Observations  and  Rules, 

"  30.  Tn  order  to  obtain  good  homoeopathic  preparations,  it  is  necessary, 
first  of  all,  to  procure  the  primitive  substances  of  the  best  possible  quality, 
and  in  the  state  most  suitable  for  their  destination.  All  the  substances  which 
are  furnished  us  by  the  animal  and  vegetable  kingdoms  always  lose  more  or 
less  of  their  power  in  drying,  and  this  is  the  reason  why  every  homoeopathic 
physician  and  pharmaceutist  should  endeavour  to  procure  them  himself,  as 
much  as  possible,  in  the  fresh  state,  and  immediately  to  submit  them  for 
preparation.  As  to  the  substances  which  are  only  found  in  far  distant  lands, 
and  which,  in  consequence,  we  can  only  obtain  in  the  tincture,  prepared  on 
the  spot  where  they  grow,  or  else  the  substance  itself  in  a  dry  state,  it  is 
better  to  accept  this  last,  in  this  state,  than  to  trust  to  a  preparation,  of  the 
purity  of  which  it  is  impossible  to  be  sure.  The  cunning  of  our  age  has 
carried  to  such  an  extent  the  falsification  of  drugs,  that  it  is  impossible,  with 
confidence,  to  make  use,  for  homoeopathic  preparations,  of  the  products  of 
commerce,  and  among  them,  the  tinctures  are  those  which  are  the  worst,  and 
consequently,  the  least  proper.  As  to  the  substances,  which  are  generally 
sold  in  powder,  we  need  equal  precaution  ;  above  all  should  they  be  clear,  as 
amber,  castor,  &c.  Should  it  be  impossible  to  procure  them  in  their  natural 
state,  we  should  never  accept  them,  unless  we  are  perfectly  assured  of  their 
purity.  The  same  may  be  said  of  all  the  chemical  products  which  are  found 
in  commerce  ;  there  is  not  a  single  one  which  homoeopathy  can  make  use  of 
without  a  previous  careful  examination  of  its  quality. 

"  3L  A  point,  not  less  important  than  the  good  quality  of  substances,  is 
the  exact  choice  of  the  particular  kind  which  homoeopathy  makes  use  of, 
and  this  is  a  point  upon  which  we  believe  ourselves  bound  to  insist  so  much 
the  more,  since  not  only  some  pharmaceutists,  but  also  homoeopathic  physi- 
cians, have  often  thought  to  introduce  a  real  advantage,  in  substituting,  for 
substances  used  in  homoeopathy,  others  which  appeared  to  them  either  more 


INTRODUCTION.  xlv 

energetic  or  more  pure  in  their  chemical  qualities.  However  great  these 
advantages  may  be  in  a  scientific  view,  it  is  not  the  less  certain,  that  the 
least  essential  change  introduced  into  the  preparation  of  a  medicine  may 
cause  the  most  disastrous  consequences  to  the  safety  of  practice.  What  is 
most  important  to  the  practitioner  is,  not  that  the  preparation  should  be 
more  or  less  scientific,  but  that  it  should  be  similar  with  that  which  has  been 
employed  in  the  experiments,  and  the  more  the  conformity  in  this  point  of 
view,  so  much  the  more  the  preparation  will  be  perfect  to  the  end  it  ought 
to  fulfil.  Thus,  to  obtain  the  calcarea  or  subcarbonate  of  lime,  for  example, 
such  as  is  employed  in  homoeopathy,  it  is  absolutely  necessary  to  prepare  the 
oyster-shell  just  as  Hahnemann  prescribed,  though  such  preparation  is  far 
from  containing  the  pure  subcarbonate  of  lime.  It  is  thus  also  that 
cinchona,  opium,  nux  vomicaj  &c,  such  as  are  used  to  prepare  the  tinctures 
of  the  same  names,  can  never  be  replaced  by  the  quinine,  the  morphine,  the 
strychnine,  &c,  without  inconvenience,  notwithstanding  these  last  substances 
are  reputed  to  contain  the  active  principles  of  the  first  in  a  perfectly  pure 
state. 

"  32.  It  is  absolutely  the  same  as-  to  the  measures  adopted  by  homoeopathy 
in  the  pharmaceutical  preparations  of  its  medicines.  Here,  as  in  the 
gathering  and  chemical  preparation  of  substances,  the  strictest  observation 
of  prescribed  rules  is  binding.  All  the  substances  which  homoeopathy 
transforms  into  tinctures,  should  be  prepared  alone  with  alcohol,  and  those 
which  are  neither  soluble  in  this  fluid  nor  in  water,  by  the  simple  trituration 
with  sugar  of  milk.  The  vehicles,  such  as  alcohol,  sugar  of  milk,  water,  &c, 
ought  to  be  perfectly  pure  and  good.  At  the  same  time,  the  proportions 
indicated  for  the  mixtures,  as  well  as  the  manipulations  prescribed  for  the 
solution  and  division  of  substances,  ought  to  be  observed  with  the  utmost 
possible  exactitude.  Often,  it  is  true,  these  indications  and  prescriptions 
are  of  a  nature  to  leave  a  certain  latitude  in  their  execution,  according  to  the 
use  we  wish  to  make  of  the  medicines,  or  the  degree  of  energy  which  we 
propose  to  give  to  them ;  but  even  in  this  last  case,  the  principles  which 
have  dictated  the  rules  ought  always  to  serve  as  guides  in  their  application  ; 
and  in  every  case,  where  the  indications  are  positive,  homoeopathic  phy- 
sicians and  pharmaceutists  have  no  business,  under  any  pretext  whatsoever, 
arbitrarily  to  depart  from  them. 

"33.  In  addition  to  the  precision  to  be  observed  in  the  process  of  the 
preparation,  it  is  also  necessary  to  prevent,  with  the  greatest  care,  any  foreign 
influence,  so  that  the  virtues  of  the  medicines  be  not  changed,  and  the 
action  thus  rendered  uncertain.  For  this  it  is  requisite,  in  the  first  place, 
to  make  them  in  a  place  where  the  temperature  is  not  above  that  of  houses 
in  general,  and  where  the  substances  are  not  exposed  to  the  direct  rays  of 
the  sun.  At  the  same  time,  the  atmosphere  in  which  we  work  should  be 
pure  and  exempt  from  every  odour  or  vapour,  but,  above  all,  of  every  medi- 


Xlvi  INTRODUCTION. 

cinal  emanation,  such  as  are  generally  found  in  the  pharmacies  in  ordinary ; 
for  all  these  exhalations,  placed  in  contact  with  homoeopathic  preparations, 
are  liable  to  change  their  virtues.  The  same  may  be  said  respecting  vessels 
or  other  instruments  which  have  been  used  for  the  preparation  of  substances 
very  odorous  or  susceptible  of  adhering  tenaciously,  as  musk,  essences, 
arsenic,  corrosive  sublimate,  &c.  We  should  never  make  use  of  such  vessels, 
without  having  previously  cleansed  them  with  the  most  perfect  care.  As  to 
small  bottles  and  corks  which  have  already  been  in  use,  they  should  never 
be  employed  but  for  the  same  substance,  no  more  than  the  cloth  which  has 
been  used  for  filtering  or  expressing  the  juice  of  a  plant ;  for,  notwithstanding 
all  the  endeavours  we  may  use  to  clean  them,  we  can  never  be  sure  that  we 
have  entirely  purged  them  of  all  particles  which  may  adhere  to  them. 

"  34.  Homoeopathy  exacts  a  much  greater  cleanliness  than  is  ordinarily 
given  to  vessels  of  pharmacy,  notwithstanding  the  care  bestowed  on  it. 
Even  the  washing  in  large  quantities  of  water,  as  in  rivers,  which  has  been 
recommended,  are  far  from  fulfilling  the  conditions.  No  matter  how  we 
look  on  it,  a  vessel,  for  example,  which  has  served  for  the  trituration  of 
substances  such  as  sulphur,  musk,  assafcetida,  &c,  constantly  preserves  its 
odour,  even  after  having  been  washed  and  dried  several  times.  As  to  the 
cleansing  with  certain  chemical  articles,  such  as  acids,  chlorine,  lime,  potash, 
&c,  it  cannot  be  tolerated  in  any  case,  since  these  substances  themselves, 
whilst  they  have  been  in  a  vessel,  need  to  be  carefully  cleaned  out.  Some 
have  still  imagined  to  clean  the  vessels  with  spirits  of  wine,  but  even  this  is 
a  great  error,  for  either  the  spirits  of  wine  dissolves  the  substance  we  wish 
to  get  rid  of,  or  it  does  not  dissolve  it ;  in  this  last  case,  it  will  clean  out 
nothing,  and,  in  the  first,  it  will  form,  with  the  rest  of  the  substance,  a 
medicinal  preparation,  which,  though  weak,  will  always  be  stronger  than  one 
of  the  last  dilutions,  and  no  homoeopath  in  effect  will  look  upon  these 
preparations  as  suitable  for  the  end  proposed.  The  best  way  to  obtain  the 
perfect  purity  of  vessels  is,  at  first  to  clean  them  with  boiling  water  several 
times,  and  then  to  expose  them  to  the  continual  action  of  a  strong  heat,  as 
for  example  of  an  oven,  or  else  to  burn,  several  times,  in  them  absolute 
alcohol  of  the  greatest  purity.  As  to  the  stones  which  have  served  for  the 
pulverization  of  a  metal,  we  should  cleanse  them  before  employing  them 
again  for  the  preparation  of  another  substance,  by  scraping  their  surface 
with  a  piece  of  glass. 

"35.  Finally,  as  to  the  vessels  themselves,  it  is  necessary  that  all  which 
are  used  in  homoeopathic  preparations  should  be  of  a  substance  not  calcu- 
lated to  alter  the  effects  of  substances.  Hence,  all  the  mortars,  pestles,  and 
spatules,  as  well  as  the  spoons  and  other  instruments  needful,  should  be  of 
quartz,  porphyry,  glass,  porcelain,  or  horn  ;  those  of  metal,  marble,  serpen- 
tine, or  wood  are  absolutely  inadmissible.  To  close  the  bottles,  stoppers  of 
glass  are  always  to  be  preferred  to  those  of  cork,  above  all  for  the  substances 


INTRODUCTION.  xlvii 

prepared  with  sugar  of  milk,  to  which  the  cork  stoppers  often  give  a 
disagreeable  odour.  For  the  corrosive  substances,  such  as  the  acids,  iodine, 
kreosote,  &c,  glass  stoppers  are  indispensable.  If,  for  the  alcoholic  prepa- 
rations, we  would,  nevertheless,  use  stoppers  of  cork,  we  should  procure 
them  of  the  best  quality,  never  used  before.  Before  making  use  of  them, 
we  should  temper  them  in  pure  water,  after  which  we  should  wash  them  in 
spirits  of  wine,  and  let  them  dry  at  a  moderate  temperature.  It  has  also 
been  advised  to  boil  them,  in  order  to  make  them  larger  and  softer ;  but 
prepared  in  this  way,  they  become  very  susceptible  of  imbibing  the  humidity 
of  the  air  and  of  constantly  changing  their  size. 

"2.  Particular  Rules  for  the  Preparation  of  Plants  in  the  fresh  State. 

Tinctures. 

"36.  That  the  plants  may  be  entirely  suitable  to  medical  use,  we  should 
gather  them  a  little  before  or,  better  still,  during  their  flowering,  and  we 
should  never  take  those  which  grow  on  a  very  humid  spot  and  deprived  of 
the  sun  and  of  the  free  air,  unless  the  nature  of  the  plant  require  those 
conditions.  In  the  majority  of  cases,  it  is  important  not  to  gather  the 
flowers  and  the  leaves  during  a  continued  cold  or  damp  time,  since  then  the 
etherial  oils,  the  corrosive  resins,  and  the  alkaline  matters  do  not  become 
developed  as  they  should,  and  it  permits  the  separation  of  albumen  but 
in  a  very  incomplete  manner.  The  most  favorable  moment  is  when,  after 
several  warm  days,  there  has  been  a  shower  of  rain ;  for  it  is  then  that  the 
formation  of  the  active  principles  and  the  free  development  of  hydrogen  are 
the  most  favored.  In  every  case,  where  homoeopathy  indicates  nothing 
particular,  we  constantly  use  the  entire  plant,  flowers,  body  and  root. 
Before  submitting  it  to  preparation,  we  wash  it  carefully  with  fresh  water, 
in  order  to  wash  away  the  dust  and  other  impurities  adhering  to  it. 

"  37.  After  this,  to  prepare  the  plant,  in  order  to  bring  together  all  the 
properties  of  its  different  parts,  we  cut  it  up  as  small  as  possible,  we  put  it 
into  a  mortar  of  stone  and  reduce  it  to  a  fine  paste,  which  is  put  into  a  piece 
of  suitable  cloth,  in  order  to  submit  it  to  the  action  of  a  press  of  wood 
expressly  constructed,  thus  to  obtain  the  juice  of  the  plant.  This  juice  is 
at  once  mixed  intimately  with  an  equal  quantity  of  alcohol,  and  put  into 
well-stoppered  bottles.  At  the  end  of  24  hours  we  decant  the  clear  liquor, 
which  swims  on  the  precipitate  of  fibrine  and  albumen,  and  we  put  it  apart 
for  medical  use.  Alcohol  prevents  fermentation  from  taking  place  in  the 
vegetable  juice,  and  the  virtue  of  this  is  thus  preserved  completely,  without 
alteration,  and  for  ever,  provided  we  only  take  care  to  keep  it  from  the  rays 
of  the  sun  and  in  well-stoppered  bottles.  The  medicine  thus  obtained  by 
expression,  and  by  the  mixture  of  the  juice  with  an  equal  quantity  of 
alcohol,  is  the  mother  tincture  of  the  plant,  obtained  by  expression  {per 
expressionem). 


Xlviii  INTRODUCTION. 

"  38.  The  preparation  of  the  mother  tincture,  by  expression,  is,  however, 
only  applicable  to  plants  abounding  in  juice;  for  those  plants  containing 
much  thick  mucilage  and  albumen,  it  is  better  to  make  their  preparations  by 
macerating  them  in  a  double  proportion  of  alcohol.  To  do  this  we  should 
at  first  half  dry  them  in  exposing  them  in  the  shade,  in  an  airy  place,  and 
at  a  slightly  elevated  temperature,  after  which  we  cut  them  as  fine  as 
possible,  and  then  add  the  necessary  quantity  of  alcohol.  As  to  those  plants 
which  have  but  an  excessively  small  quantity  of  juice,  such  as  the  laurel, 
rose,  thuya,  &c,  we  should  begin  by  pounding  them  alone  ;  then,  after 
reducing  them  to  a  fine  and  moist  paste,  we  imbibe  this  paste  with  the  double 
of  alcohol,  so  that  the  juice,  thus  mixed  with  this  liquid,  may  be  expressed 
more  easily.  The  medicine  obtained  after  this  method  is  the  mother  tinc- 
ture by  maceration  {per  macerationem) . 

"  39.  In  addition  to  these  two  measures  for  obtaining  the  mother  tinctures, 
there  is  yet  a  third,  which,  though  inferior  to  the  two  preceding,  deserves, 
nevertheless,  to  be  mentioned,  as  convenient  in  some  particular  cases.  It  is, 
above  all,  whilst  the  circumstances  do  not  permit  us  to  express  the  juice  of 
the  fresh  plants,  immediately  after  having  gathered  them ;  and  that,  fearing 
that  their  withering,  no  matter  how  little,  may  injure  their  virtues.  Under 
these  conditions  we  may  remedy  this  inconvenience  in  digesting  separately  in 
alcohol  each  part  of  the  plant.  To  do  this  we  begin  by  sundering  the  root 
into  four,  and  cutting  it  into  little  pieces — we  do  the  same  with  the  leaves  ; 
then,  after  putting  each  of  these  two  parts  into  a  separate  bottle  of  sufficient 
size,  we  pour  upon  them  an  equal  quantity  of  alcohol.  In  thus  digesting  the 
separate  parts  during  some  time,  and  reuniting  afterwards  in  one  bottle  the 
obtained  products,  we  have  a  mother  tincture  by  digestion  {per  digestionem), 
which  will  not  only  be  perfectly  pure,  but  also  sufficiently  impregnated  with 
the  active  principles  to  merit  confidence.  For  the  rest,  in  every  case,  unless 
absolutely  obliged  to  have  recourse  to  this  proceeding,  the  preparation  of  the 
mother  tinctures  by  expression  and  maceration  is  far  preferable ;  but  every 
time  that  we  are  obliged  to  hunt  the  plants  which  we  want,  in  distant  coun- 
tries, where  we  cannot  carry  the  apparatus  necessary  for  expression,  we 
should  prefer  preparing  them  at  once,  by  digestion,  to  carrying  them  home 
withered  and  bereft  of  their  active  principles. 

"3.  Of  the  Preparation  of  Exotic  Vegetable  Substances. 

"  40.  All  exotic  vegetable  substances  used  in  homoeopathy,  such  as  plants, 
bark,  grains,  resins,  wood,  &c,  should  be  selected  in  the  crude  state,  and 
never  when  in  powder.  For,  even  should  we  fear  no  adulteration  with  other 
matters,  the  ordinary  means  employed  in  pulverising  them  are  not  of  a  kind 
to  prevent  all  adulteration  possible.  All  vegetable  substances,  even  when 
perfectly  dried,  still  contain,  when  entire  and  in  the  crude  state,  a  certain 


INTRODUCTION.  xlix 

amount  of  humidity,   which  becomes  useless  in  the  state  of  powder,  and 
which,  if  not  dissipated,  deteriorates  the  powder  in  a  short  time. 

"  If,  then,  the  homoeopath  would  be  perfectly  sure  of  having  a  powder  not 
only  pure,  but  also  susceptible  of  preservation  without  any  alteration,  he 
must  himself  undertake  the  necessary  preparation. 

"  41 .  Hahnemann  first  taught  the  best  method  to  reduce  foreign  substances 
to  an  unalterable  powder,  and  free  from  all  humidity.  This  consists  in 
spreading  the  powder  on  a  flat  surface  of  tin  with  raised  borders*  and  to 
shake  it  till  it  no  longer  forms  lumps,  until  all  the  particles  equally  and 
easily  slip  on  each  other,  like  fine  sand.  To  succeed  well,  we  must  take  care 
to  keep  the  heater  constantly  full  of  water  of  an  equable  temperature,  so  as 
not  to  expose  the  powder  to  a  too  elevated  heat,  as  it  would  destroy  organic 
substances.  By  inclosing  the  powders  thus  obtained  in  bottles  well  stoppered 
and  sealed,  and  protecting  them  from  the  sun's  rays  and  the  light  of  day,  we 
may  preserve  them  a  long  time  without  deterioration.  It  is  still  doubtful 
whether,  by  this  procedure,  those  substances  of  volatile  principles  do  not  lose 
their  virtues  during  the  operation,  and  whether,  in  consequence,  it  would 
not  be  preferable  to  make  an  alcoholic  tincture  of  them  immediately  after 
pulverization. 

"42.  To  prepare  the  tincture  of  dry  substances,  we  begin  by  breaking 
them  in  a  mortar  of  marble;  then,  after  having  reduced  them  to  a  fine 
powder,  we  add  twenty  parts  of  alcohol,  in  which  we  digest  them  six  or  eight 
days,  after  which  we  decant  the  clear  liquor,  to  preserve  it  for  use.  Those 
substances  which  are  very  susceptible  of  attracting  the  humidity  of  the  air? 
should  either  be  deprived  of  it  before  pulverization,  or  powdered  in  a  warm 
mortar,  and,  if  particularly  hard  and  tenacious,  they  should  be  grated  or 
filed.  As  to  the  proportion  in  which  alcohol  ought  to  be  added,  many 
physicians  have  proposed  to  make  it  1  to  10,  instead  of  1  to  20,  that  is  to 
say,  to  pour  but  10  parts  of  alcohol  on  the  pulverized  substance ;  but,  inde- 
pendent of  the  certainty  there  is  in  the  proportion  of  1  to  20,  the  vehicle 
will  necessarily  take  up  all  the  medicinal  virtues,  and  the  tinctures  of  many, 
as  cinchona,  opium,  ratanhia,  &c,  seem  to  be  so  fully  saturated  in  this  pro- 
portion, that  it  is  very  doubtful  whether,  in  the  proportion  of  1  to  10,  they 
would  really  acquire  more  energy. 

"  43.  Lately,  Hahnemann  has  advised  that  dry  vegetable  substances  should 
not  be  prepared  in  the  form  of  tincture,  but  made  after  the  manner  of  solid 
mineral  substances ;  that  is  to  say,  by  triturating  them  with  the  necessary 
quantity  of  sugar  of  milk.  It  is  evident  that,  for  all  the  substances  which  we 
wish  to  employ  at  a  certain  degree  of  concentration,  and  to  mix  with  the 
vehicle  in  the  proportion  of  10  to  100,  this  procedure  would,  as  far  as  regards 
the  preservation  of  the  preparations,  be  subject  to  all  the  inconvenience  that 
we  have  spoken  of  in  the  beginning  of  this  article.  Even  in  weighing  the 
substance  with  the  vehicle,  in  the  proportion  of  1   to   1 00,  the  humidity  it 

c 


1  INTRODUCTION. 

would  communicate  to  the  trituration  would  still  be  too  sensible  to  obviate 
all  fear  of  the  alteration  of  the  preparation,  should  it  be  put  into  stoppered 
bottles.  But  the  question  differs  when  we  wish  to  use  only  a  preparation  of 
a  low  attenuation  (6,  15,  30)  ;  in  this  case,  the  proposed  plan  would  do,  in 
effect,  not  only  for  dry  vegetable  substances,  but  also  for  all  the  fresh  plants 
which  contain  too  small  a  quantity  of  juice  to  afford  tinctures  by  expression  ; 
when  we  do  not  wish  to  preserve  any  of  the  low  attenuations  above  the  third 
trituration,  this  would  always  be  sufficiently  exempt,  for  example,  from  vege- 
table humidity,  to  leave  nothing  to  desire,  and  the  triturations  being,  in 
general,  less  subject  to  alteration  than  the  tinctures,  this  proceeding  would 
unite  the  double  advantage  of  preserving  all  the  active  principles  of  the 
medicines,  and  of  rendering  their  preparations  as  unalterable  as  possible. 

"4.  Of  the  Preparation  of  Mineral  and  Animal  Substances — Trituration^ 

"  44.  All  the  non-vegetable  substances  made  use  of  in  homoeopathy,  such 
as  animal  substances,  mineral  bodies,  and  chemical  products,  are  generally 
prepared  by  trituration  with  sugar  of  milk,  whether,  in  their  natural  state, 
they  are  liquid  or  solid,  soluble  or  non-soluble  in  alcohol.  Certain  substances 
only,  such  as  the  acetate  of  copper,  several  acids,  and  all  those  of  which  the 
chemical  qualities  do  not  permit  a  mixture  with  sugar  of  milk,  should  be 
prepared  in  a  particular  way,  which  will  be  specially  indicated  under  the  head 
of  each  substance.  As  to  the  substances  which  are  soluble  in  alcohol,  we  can 
equally  well  prepare  the  tinctures  of  them  by  solution  in  20  parts  of  this 
liquid ;  but  for  the  safe  preservation  of  the  preparations,  and  the  develop- 
ment of  the  medicinal  virtues,  the  trituration  with  sugar  of  milk  merits 
by  far  the  preference.  Even  for  those  recent  animal  substances  which  are 
commonly  prepared  by  digestion  in  20  parts  of  alcohol,  after  a  reduction  to 
a  fine  paste,  trituration  is  infinitely  better. 

"  45.  To  submit  all  these  substances  to  trituration,  we  may,  in  the  majority 
of  cases,  take  them  as  they  are  found  in  their  pure  state ;  only  as  to  the 
metals,  if  we  cannot  procure  them  in  very  thin  leaves,  like  gold,  silver, 
tin,  &c,  it  is  necessary  to  reduce  them  to  powder.  To  effect  this,  we  may 
treat  them  in  two  ways  :  the  first  of  which  consists  in  rubbing  under  water  a 
small  fragment  of  the  regulus  against  a  good  hone,  until  we  have  obtained  a 
sufficient  quantity  of  metallic  powder.  The  majority  of  homoeopaths  employ 
this  measure,  but  should  the  stone  we  use  be  too  soft,  the  powder  obtained 
in  this  manner  is  rarely  pure,  and,  in  such  a  case,  it  is  better  to  obtain  it  by 
the  decomposition  of  the  solutions  of  these  metals  in  acids.  In  plunging  in 
such  solution  a  small  polished  rod  of  a  metal  whose  affinity  with  oxygen  is 
stronger  than  that  of  the  metal  in  solution,  it  is  immediately  precipi- 
tated on  the  rod,  and  adheres  to  it  in  the  form  of  powder.  To  obtain,  then, 
this  powder  perfectly  pure,  we  wash  it  frequently  with  distilled  water,  until 
it  does  not  show  a  trace  of  acid.     The  reduction  to  powder  of  metals  by  the 


INTRODUCTION.  li 

file  is  a  proceeding  which  is  suitable  to  iron  alone,  since,  by  the  observation 
of  Wells,  it  is  proved  that  the  metal  thus  obtained  easily  acquires  the  virtues 
of  that  against  which  it  has  been  rubbed. 

"46.  As  the  trituration  of  substances  with  sugar  of  milk  has  chiefly  in 
view  the  development  of  all  the  active  principles,  by  the  division  of  mole- 
cules, it  is  essential  that  the  proportion  in  which  the  medicine  is  mixed  with 
the  vehicle  be  not  too  great,  and  that  the  quantity  that  is  submitted  to  tritu- 
ration at  one  time  be  small  enough  to  be  well  manipulated.  -  To  effect  this, 
Hahnemann  has  proposed  never  to  make  a  trituration  which  contains 
more  than  5  grammes  (100  grains)  of  sugar  of  milk,  and  to  mingle  the 
medicine  in  the  proportion  only  of  1  to  100,  that  is  to  say,  of  the  weight  of 
5  centigrammes  (1  grain)  nearly,  so  that  the  trituration  being  made,  each 
gramme  of  this  contains  but  one  centigramme  of  the  primitive  medicine. 
This  proportion  of  1  to  100  is,  in  general,  that  upon  which  all  the  hpmceo- 
pathic  physicians  rely;  but  as  for  many  substances,  the  volume  of  ^.ye 
centigrammes  of  their  weight  is  too  small  in  proportion  to  that  which 
the  sugar  of  milk  makes,  and  as  it  is  essential  that  the  whole  should  be 
impregnated  with  the  medicine,  many  physicians  have  lately  preferred 
making  all  the  fast  triturations  in  the  proportion  of  10  to  100.  In  conse- 
quence, instead  of  taking  but  five  centigrammes  (1  grain)  of  the  medicine, 
they  take  50  (10  grains)  to  mix  with  five  grammes  (100  grains)  of  sugar 
of  milk,  so  that  each  gramme  of  the  trituration,  wrhen  finished,  contains  10 
centigrammes  of  the  medicine.  It  is  easy  to  see  that  this  proceeding 
has  the  preference  in  every  case,  since  it  not  only  affords  a  greater  surety 
for  the  exactitude  of  the  mixture,  but  also  because  afterwards,  to  establish 
the  proportion  indicated  by  Hahnemann,  we  have  *only  to  take  50  centi- 
grammes (10  grains)  of  the  obtained  trituration,  and  triturate  them  anew 
with  five  other  grammes  (100  grains)  of  sugar  of  milk. 

"47.  As  to  the  operation  of  trituration,  Hahnemann  recommends  the 
following.  After  having  weighed  the  necessary  quantity  of  the  medicine 
and  .of  the  sugar  of  milk,  take  about  a  third  of  this  last  and  place  it, 
with  the  entire  quantity  of  the  medicine,  in  a  mortar  of  porcelain  ;  mix 
these  two  portions  with  a  spatula  of  bone  or  horn,  and  triturate  with 
sufficient  force  six  minutes  ;  detach  with  the  spatula  the  mass  from  the 
sides  and  bottom  of  the  mortar  and  pestle,  and  mingle  them  anew,  after 
which  continue  the  trituration  for  another  six  minutes;  that  done,  again 
detach  the  matter  from  the  mortar  and  pestle,  and  add  the  second  third 
of  the  sugar  of  milk,  which  mingle  with  the  rest  with  the  spatula  and 
triturate  afresh  during  six  minutes ;  detach,  triturate  and  detach  afresh 
as  for  the  first  third ;  finally  add  the  last  third  of  the  sugar  of  milk, 
which  is  mingled,  triturated  and  detached  in  the  same  way  and  during  the 
same  space  of  time  as  with  the  first  two.  In  thus  triturating  each  third 
during  twice  six  minutes,  and  counting  about  four  minutes  for  the  time 


Hi  INTRODUCTION. 

taken  up  in  detaching  and  remingling  the  powder,  we  shall  occupy  one  hour 
in  the  preparation  of  each  trituration. 

"48.  In  the  first  article  of  this  chapter  we  have  already  observed  that,  for 
the  triturations,  mortars  of  serpentine  can  in  no  way  be  admissible,  and  that 
the  best  are  of  porcelain.  Wood  and  glass  are  not  more  suitable  either : 
the  first,  on  account  of  its  porosity;  the  second,  because  the  rubbing 
detaches  from  it  particles,  which  contain  sodium.  As  to  those  of  porcelain, 
the  unpolished  ones  are  to  be  preferred,  since  the  smootKer  the  surface  the  less 
true  is  the  rubbing,  and  this  is  the  reason  why,  if  we  can  only  obtain  mortars 
of  polished  porcelain,  we  must  unpolish  them  by  working  them  previously 
with  sand.  The  pestle  should  be  of  the  same  material  as  the  mortar,  and 
treated  in  the  same  way.  To  prevent,  with  the  greatest  certainty,  all  possible 
alteration  of  the  preparations,  either  by  particles  of  silex  which  the  porcelain 
might  afford,  or  by  the  remains  which  previous  triturations  might  leave  in 
the  mortar,  it  has  been  proposed  to  coat  this,  as  well  as  the  pestle,  with  a 
thin  covering  of  pure  ichthyocolla,  mingled  with  a  little  sugar  of  milk,  and  to 
renew  this  covering  for  each  new  preparation.  We  cannot  decide  on  the 
absolute  necessity  of  this  method,  but  we  think,  nevertheless,  that  it  merits, 
at  all  times,  the  serious  attention  of  practitioners. 

"  49.  As  to  the  form  of  mortars,  it  is  easy  to  see  that  those  with  flat 
bottoms  are  no  ways  suitable,  since,  in  such,  the  substance  would  tend  to 
enter  the  corners,  which  would  impede  the  trituration  being  made  equally. 
The  best  form  to  give  the  interior  of  mortars  is  that  of  the  butt-end  of  an 
egg.  At  the  same  time,  it  should  have  a  large  enough  capacity  to  allow  the 
rubbing  with  the  necessary  force,  and  hindering  the  powder  from  dispersing; 
its  sides  should  be  level  and  without  the  least  inequality,  and  its  weight  such 
as,  during  the  process,  it  can  easily  be  held  in  the  left  hand  without 
fatigue.  The  pestle  should  be  large  enough  at  its  base  to  fit  exactly  to  the 
concave  bottom  of  the  mortar.  In  order  to  detach  the  triturated  mass  which 
adheres  to  the  pestle  and  mortar,  Hahnemann  advises  us  to  use  a  spatula,  but 
this  operation  is  much  better  accomplished  with  a  hard  brush  of  a  suitable 
form,  made  for  the  purpose.  As  to  the  other  necessary  instruments,  such  as 
the  spatula,  spoon,  &c,  we  have  already  said  that  they  should  be  of  bone,  or 
horn,  or  porcelain,  and  that  those  in  metal  are  absolutely  inadmissible, 
except  the  mortars  of  iron  to  break  down  certain  substances  of  considerable 
hardness  before  preparing  them  for  trituration. 


"OF  HOMCEOPATHIC  ATTENUATIONS. 

"  On  the  Attenuations  in  general. 

"50.  In  speaking  of  the  nature  and  form  of  homoeopathic  medicines,  we 
have  already  observed  that,  instead  of  correcting  the  too  energetic  effects  of 


INTRODUCTION.  liii 

some  substances  by  the  addition  of  another  medicinal  substance,  homoeopathy 
seeks  to  mollify  them  by  the  preparation  of  a  series  of  attenuations,  in  which 
the  medicine  is  found  mingled  in  the  vehicle  but  in  a  very  small  proportion. 
In  the  commencement  of  his  medical  career,  Hahnemann  limited  himself  in 
these  attenuations  to  1  to  100;  that  is  to  say,  in  mingling  a  very  small 
quantity  of  the  concentrated  substance  with  a  quantity  100  times  larger  of  a 
substance  non-medicinal;  but  seeing  that  these  preparations  often  acted  too 
powerfully  still,  he  soon  went  further  and  prepared  a  second,  and  then  a  third 
attenuation,  in  mingling  for  the  second  the  100th  part  of  the  first,  and  for 
the  third  the  100th  part  of  the  second  with  100  parts  of  the  vehicle.  This 
third  attenuation,  though  only  containing  the  medicine  in  the  proportion  of 
1  to  100-3,  or  of  l.to  1,000,000,  Hahnemann  still  found  at  times  too  active, 
which  induced  him  to  carry  the  attenuations  yet  further,  and  to  go  from 
attenuation  to  attenuation,  in  order  to  find  the  one  the  most  appropriate.  It 
is  thus  that,  latterly,  he  has  carried  the  number  of  attenuations,  for  all  the 
medicinal  substances  without  distinction,  up  to  30,  so  that,  in  this  last 
attenuation,  the  medicine  is  found  mingled  with  the  vehicle  but  in  the  pro- 
portion of  1  to  100-30,  or  of  1  to  1,000,000-10. 

"51.  However  absurd  the  first  view  of  these  infinitesimal  attenuations 
may  appear,  it  is  not  the  less  true  that,  even  the  30th,  far  from  having  lost 
all  efficacy,  often  shows  itself  too  energetic;  and  Dr.  Korsakow,  of  St. 
Petersburg,  who  has  carried  the  attenuations  as  high  as  1500,  has  declared 
the  same  fact  as  to  the  last  preparation  of  his  series.  In  effect,  on  examin- 
ing attentively  the  degree  of  intensity  with  which  the  various  homoeopathic 
attenuations  act,  we  may  easily  perceive  that  the  diminution  of  their  energy 
is  in  no  way  proportioned  to  the  diminution  of  their  matter.  On  the  con- 
trary, many  substances  which,  in  their  state  of  concentration,  have  little 
or  no  action  on  the  body,  as  lycopodium,  vegetable  charcoal,  &c,  often 
become  very  active  at  the  second  or  third  attenuation,  so  that  we  are  almost 
inclined  to  *  believe  that  the  mode  of  preparation  adopted  by  Hahnemann 
rather  contributes^to  develop  than  to  weaken  the  virtues  of  medicines,  or, 
at  any  rate,  to  render  them  more  apt  to  exercise,  in  the  smallest  doses,  their 
influence  on  the  organism.  Hence  Hahnemann  has,  for  a  long  time,  ceased 
to  look  upon  these  preparations  as  dilutions,  in  the  true  acceptation  of  this 
word  ;  and  if,  at  the  present  time,  he  wishes  all  the  medicines  to  be  carried 
to  the  30th  attenuation,  it  is  only  in  the  supposition  that  by  this  procedure 
they  can  best  develop  all  their  active  principles,*  and  become  more  suitable 
for  practice. 

<"52.   To  explain  the  extraordinary  fact  of  the  efficacy  of  his  attenua- 
tions, Hahnemann  has  endeavoured  to  set  down  as  a  principle,  that  the 

*  Or  be  more  readily  received  into  the  system  in  consequence  of  the  minute  subdivision 
or  segregation  of  the  particles. — J.  L. 


liv  INTRODUCTION. 

more  we  destroy  the  material  parts  of  a  substance,  so  much  the  more  we 
develop  or  loosen  the  dynamic  force,  or,  in  other  words,  the  spirit  of  the 
medicine ;  and  that,  to  augment  the  energy  of  preparations  to  an  incredible 
extent,  we  have  only  to  carry  them  from  attenuation  to  attenuation,  in 
submitting  them  at  the  same  time  to  a  great  number  of  triturations  and 
shakes.  If  this  principle  were  conformable  to  experience,  it  would  result 
that,  from  a  substance,  for  example,  of  which  one  grain  would  be  sufficient 
to  cause  death*  the  same  dose  of  the  30th  attenuation  would  produce  the 
same  effect  in  a  much  more  certain  manner*  which,  however,  is  not  the  fact. 
If  we  would  even  limit  this  principle  to  those  substances  which  only  exhibit 
their  virtues  by  attenuation,  it  is  still  equally  adverse  to  observation  that 
the  30th  attenuation,  for  example,  of  these  substances  have  an  action 
absolutely  more  energetic  than  the  6th,  12th,  15th,  &c.  On  the  contrary, 
to  judge  from  the  experience  of  many  homoeopaths,  the  degrees  of  energy 
among  the  attenuations  of  a  medicine  are  so  small,  that  thus  far  a  decision 
has  not  been  formed  with  certainty  whether  it  is  the  first  or  the  last  attenua- 
tions which  exhibit  the  strongest  action.  This  is  the  reason  why,  in 
admitting  the  efficacy  of  the  attenuations,  many  homoeopaths  have  rejected 
the  explanation  given  by  Hahnemann,  and  have  considered  the  procedure  by 
which  they  acquire  their  efficacy  as  analogous  to  the  infection  by  miasm. 
According  to  them,  the  active  principle  of  the  drug  being  set  free  by  the 
destruction  of  the  matter,  it  communicates  itself  to  the  vehicle,  which  thereby 
becomes  infected  and  as  active  as  the  drug  itself. 

"53.  As  to  the  comparison  with  miasms,  this  last  opinion  is,  without 
contradiction,  that  which  merits  the  most  attention ;  but  the  explanation 
it  gives  is  far  from  satisfying  all  demands,  since,  instead  of  explaining  the 
difficulty,  it  refers  it  to  another  order  of  facts,  which,  though  generally 
admitted,  are  not,  however,  themselves  yet  explained.  Miasm,  though  being 
an  imponderable  body,  is  not  the  less  for  that,  a  body ;  that  is  to  say,  matter, 
and  amenable  to  the  laws  of  matter.  Now,  every  action  of  matter,  whether 
mechanical  or  dynamical,  is  proportioned  to  the  quantity  of  active  atoms 
which  a  given  volume  presents  ;  and  every  one  knows,  that  not  only  a  large 
stone  weighs  more  than  a  small  one,  but  also  that  a  magnet  of  considerable 
volume  is  capable  of  developing  and  of  manifesting  a  much  stronger  action  than 
another  which  is  less  voluminous.  If,  then,  we  would  pretend  that  there  is 
manifested  somewhere  the  action  of  a  body  either  ponderable  or  imponder- 
able, we  are  absolutely  obliged  to  admit  also  the  presence  of  a  certain  quan- 
tity of  atoms ;  and,  what  is  still  more  certain  is,  that  as  this  quantity 
diminishes  in  a  given  volume,  the  action  of  it  will  also  diminish  in  energy. 
Thus  we  see  that,  even  should  we  prove  that  our  attenuations,  to  be  able  to 
act,  only  require  to  be  impregnated  with  imponderable  particles,  like  miasms, 
we  shall  still  have  accomplished  nothing  in  demonstrating  that  their  energy 
does  not  diminish  in  proportion  to  the  loss  of  matter  which  they  suffer ;  or 


INTRODUCTION.  lv 

in  explaining  how  an  attenuation,  for  example,  which  contains  but  the 
billionth  part  of  the  medicinal  atoms  of  another,  manifests  an  intensity  not 
only  equal,  but  often  also  superior  to  that  of  this  last. 

"  54.  These  facts  are,  however,  such  as  we  cite  them ;  and,  perhaps,  we 
should  not  have  found  anything  astonishing  if,  at  the  beginning,  we  had 
reflected  better  on  the  manner  in  which  our  medicines  act  in  general,  and  on 
the  changes  which  substances  undergo  by  our  mode  of  preparation.  We 
ought  to  have  noticed  that  each  medicinal  dose  contains  a  great  number 
of  atoms  which  are  perfectly  inactive,  in  consequence  of  their  being  shut  up 
in  the  interior  of  the  molecules,  and  not  brought  into  contact  with  our  organs  ; 
it  therefore  follows  that  every  time  we,  by  any  means  whatever,  come  to 
divide  these  molecules  into  smaller  corpuscules,  and  thus  augment  their 
whole  surface,  the  energy  of  the  dose  will  so  increase  that  the  smallest  part 
will  become  capable  of  exercising  an  influence,  if  not  superior,  at  any  rate 
equal  to  that  of  the  entire  dose  in  its  primitive  condition.  It  is  thus  that 
Dr.  Doppler,  of  Prague,  has  explained  the  efficacy  of  our  attenuations  ;  and 
such  is,  according  to  him,  the  effect  which  the  infinite  division  produces  on 
the  molecules,  that  if  the  molecules  of  a  fine  powder  are,  at  the  dose  of  5 
centigrammes  (1  grain),  in  a  condition  to  constitute,  by  the  sum  of  their 
surface,  a  total  superficies  of  100  metres  square,  and  if  each  trituration  of 
20  minutes  only  divided  each  molecule  into  100  lesser  corpuscules,  the 
molecules  of  the  30th  attenuation  would  be  so  divided  that,  at  the  dose  of 
one  drop  only,  they  would  occupy,  by  the  sum  of  their  surfaces,  a  total 
superficies  of  many  millions  of  decametres  square. 

"  55.  If  this  calculation,  which  any  one  can  easily  verify,  is  just,  there  is 
nothing,  in  truth,  more  easy  than  to  conceive,  not  only  how  the  30th  attenua- 
tion may  yet  be  able  to  exhibit  efficacy,  but  also  how  a  single  globule  of  this 
attenuation  may  still  have  virtue  enough  to  render  a  tumbler  of  water  almost 
as  energetic  as  the  pure  drug.  For  let  us  suppose  that  the  total  superficies 
of  a  drop  of  the  30th  attenuation  can  cover,  by  the  surfaces  of  its  infinitely 
small  molecules,  even  only  four  thousand  decametres  square,  on  imbibing 
with  this  drop  200  sugar-globules,  each  globule  will  contain  enough  to  cover 
a  superficies  of  at  least  200  metres  square,  and  will  act,  in  consequence,  with 
a  force  not  less  than  that  which  10  centigrammes  (2  grains)  of  a  non- 
attenuated  substance  would  exhibit,  but  which  will  be  reduced  to  a  powder 
fine  enough  for  the  molecules  of  each  centigramme  to  cover  a  total  superficies 
of  20  metres  square.  Now,  if  one  globule  of  the  30th  attenuation  has  such 
power,  it  is  clear  that,  in  dissolving  it  in  a  volume  of  8  spoonfuls  (4  ounces, 
or  120  grammes)  of  water,  the  preparation  we  shall  obtain  will  in  no 
instance  be  less  efficacious  than  a  mother  tincture,  which,  in  30  grammes 
(one  ounce)  of  liquid,  will  contain  5  centigrammes  (one  grain)  of  the  pre- 
ceding, and  dissolved  so  that  the  molecules  of  this  grain  may  cover  a  total 
superficies  of  500  metres  square.     All  these  calculations  are,  it  is  true,  not 


lvi  INTRODUCTION. 

rigorously  exact ;  but  if  there  is  error,  it  is  rather  on  account  of  having 
placed  the  ciphers  too  low  than  too  high ;  and  if  we  suppose,  which  is  more 
than  probable,  that  each  trituration  of  20  minutes  changes  each  molecule  of 
the  primitive  substance  into  more  than  two  or  three  smaller  corpuscules,  the 
result  will  be  still  more  astonishing. 

"56.  Arguments  have  been  raised  against  homoeopathic  preparations,  that 
if  the  influence  exercised  by  trituration  and  succussion  were  really  such  as 
the  homoeopaths  pretend,  the  energy  of  the  attenuations  ought  not  only  to 
increase  with  the  number,  but  also  increase  in  a  prodigious  manner,  since 
more  powerful  means  are  employed  in  each  attenuation  to  effect  the  division 
of  the  molecules.  This  is  undoubtedly  true  in  principle,  and  we  should 
daily  obtain  practical  evidence  of  the  fact,  were  it  always  possible  to  make  use 
of  the  increase  in  surface  which  a  given  volume  has  gained  in  the  said  manner. 
But  the  total  surface  which,  after  the  usual  triturations  and  succussions,  a 
single  globule  of  the  20th  attenuation  would  afford  is  really  so  vast,  that  if 
time  be  not  allowed,  it  will  never  find  sufficient  space  in  the  organs  to 
develop  itself  so  that  all  its  infinity  of  molecules  can  enter  into  action  ; 
and  it  is  thus  that  all  that  we  could  add  to  this  quantity  of  molecules  would 
only  increase  the  number  of  those  which  remain  inactive.  This  is  the 
explanation,  also,  why  two,  three,  or  four  globules,  and  even  a  whole  drop 
of  an  attenuation,  often  appear  to  produce  no  more  effect  than  a  single 
spoonful  of  a  solution  of  a  globule  in  eight  spoonfuls  of  water ;  and  if  we 
seek  the  reason  why  these  last  attenuations  are  not  distinguishable  from  the 
first  by  any  other  quality  than  that  of  a  more  prolonged  action,  it  is  still  in 
the  same  way  that  we  shall  find  the  means  to  account  for  it. 

"57 '.  There  are,  however,  certain  substances,  whose  energy  really  augments 
in  a  sensible  manner  as  the  attenuations  advance,  and  which,  often  alto- 
gether inert  in  their  natural  condition,  become  by  this  method  of  preparation 
not  less  active  than  the  most  energetic  medicines.  Such  are  those  sub- 
stances which,  even  in  the  state  of  the  finest  powder,  have  probably  their 
truly  active  molecules  still  shut  up  in  a  species  of  envelope,  which  prevents 
them  from  coming  into  immediate  contact  with  the  organs,  and  which  the 
ordinary  means  of  pulverization  and  of  solution  are  incapable  of  destroying. 
For  in  rubbing,  as  is  ordinarily  done,  the  substances  by  themselves,  the 
molecules  of  a  powder,  already  very  fine,  escape  the  force  which  tends  to 
render  them  still  finer,  and  it  is  only  in  triturating  them  with  another  sub- 
stance, against  the  corpuscules  of  which  they  can  be  rubbed,  that  we  can 
succeed  in  accomplishing  an  infinite  division.  But  we  shall  only  accomplish 
this  in  a  very  incomplete  way,  if,  at  the  same  time,  we  do  not  take  care  to 
separate  the  newly  obtained  particles  as  much  as  possible,  in  proportion 
as  the  trituration  increases  the  number ;  since  the  more  the  molecules  remain 
agglomerated  one  with  the  other,  so  much  the  less  easily  will  the  whole  be 
divided.     This  is  the  reason  why  many  substances  frequently  do  not  seem 


INTRODUCTION.  Ivii 

to  develop  all  their  virtue  till  after  three  successive  triturations,  prepared  so 
that  each  new  trituration  shall  contain  the  100th  part  of  the  preceding. 

"  58.  What  we  have  just  said  of  the  trituration  of  substances  in  powders, 
equally  applies,  in  the  same  way,  to  the  attenuation  of  liquid  substances, 
and  to  the  succussion  of  soluble  substances  with  a  liquid  vehicle.  For 
though  the  molecules  of  liquids,  on  account  of  their  globular  nature,  are 
absolutely  incapable  of  being  divided  by  any  kind  of  ordinary  rubbing, 
being  triturated  with  a  vehicle  in  form  of  powder,  or  being  treated  by 
succussion  with  a  liquid  vehicle,  they  undergo,  as  well  as  solid  substances, 
infinite  division.  The  same  holds  good  for  all  substances  ordinarily  insoluble 
in  water  or  alcohol,  whilst,  by  sufficient  triturations,  their  molecules  are 
sufficiently  divided  to  be  held  in  suspension  between  the  molecules  of  these 
liquids ;  they  then  become  abstracted  not  only  from  the  law  which  held 
them  in  a  state  of  aggregation,  but  being  shaken  with  the  vehicle,  which  has 
dissolved  them,  they  also  receive  all  the  other  ulterior  divisions  of  which 
liquid  substances  are  susceptible.  It  is  thus  that,  after  the  third  trituration, 
the  attenuation  even  of  metals  may  be  continued,  without  the  least  incon- 
venience, by  the  succussion  of  these  substances  with  the  liquid  vehicles  ;  and 
it  is  thus  also  that  all  the  attenuations  made  in  this  way  tend,  as  well  as  the 
triturations,  to  increase  the  resources  of  our  doses,  so  that  if  we  submit  to 
new  succussions  the  solution  made  with  a  single  globule  of  the  30th  in 
8  ounces  of  water,  we  may  render  this  solution  such  that  each  drop  of  it  shall 
form  a  dose  much  stronger  than  that  of  the  globule  which  was  dissolved 
in  it. 

"  59.  If  then  there  is  a  method  more  than  any  other  capable  of  furnishing 
energetic  medicines,  it  is,  without  contradiction,  the  mode  of  preparation 
adopted  by  homoeopathy.  As  to  the  substances  which,  in  their  natural  state, 
have  their  virtues  already  suitably  developed,  this  proceeding  will  not,  it  is 
true,  augment  the  energy  of  the  usual  doses  of  the  school,  since,  as  we  have 
above  said,  there  is  scarcely  a  means  of  making  use  of  all  the  resources  which 
these  doses  may  create ;  but  the  advantage  we  shall  derive  from  them  will 
always  be  that  of  finding  the  attenuations  of  these  substances,  at  the  dose  of 
a  single  globule,  not  only  equally  as  efficacious  as  the  entire  dose  of  which 
they  have  been  made,  but  also  more  appropriate  in  exercising  a  longer  and 
more  continued  action.  The  same  may  be  said  of  those  substances  whose 
virtues  are  latent,  when  their  virtues  have  been  fully  developed ;  the  attenua- 
tions made  beyond  this  point  cannot  act  with  any  more  striking  effect  over 
the  energy  of  usual  doses,  but  the  farther  we  carry  them,  the  more  we 
shall  see  that  the  smallest  possible  dose  is  still  more  than  sufficient  to  produce 
all  the  effects  that  can  be  produced  by  medicines,  given  in  the  strongest 
usual  doses  ;  that  may  even  be  carried  to  the  point  that  if,  by  simple  mixture 
and  without  any  succussion,  we  dissolve  a  single  globule  of  a  sufficiently  high 
attenuation  in  a  volume  of  three  or  four  glasses  of  water,  and  even  more, 


lviii  INTRODUCTION. 

each  teaspoonful  of  this  mixture  would  still  be  equal  to  produce  all  that 
could  be  obtained  from  an  entire  drop  of  the  ordinary  medicinal  prepara- 
tions. 

"60.  From  this  we  see  that  if  we  wish  to  obtain  much  from  little  (multum 
per  pauca),  it  is  indispensable  to  prepare  the  medicines  after  the  prescribed 
method  of  homoeopathy ;  whilst,  if  we  wish  to  render  the  effects  of  the  usual 
doses,  at  times  already  too  violent,  more  prompt  and  more  violent  still,  this 
proceeding  will  be  not  only  useless,  but  altogether  contrary  to  the  end  we 
propose.  For  though  the  resources  of  doses  augment  by  this  method  of 
preparation,  it  is,  however,  not  the  less  ascertained,  that  many  sub- 
stances also  lose  their  primitive  energy  by  attenuation,  as  for  example,  all 
poisons,  which,  as  all  homoeopaths  well  know,  are  much  less  to  be  feared  in 
their  attenuations  than  in  their  primitive  state.  This  will  even  be  the  case 
with  all  substances  whose  molecules,  besides  the  property  of  being  easily  ab- 
sorbed and  spread  in  the  organism,  have  likewise  that  of  undergoing  a  certain 
solution  or  division.  In  the  attenuations  they  will  still  possess  the  first  of 
these  properties,  but  as  soon  as  art  has  divided  them  more  than  the  organism 
can  do,  none  of  the  subsequent  attenuations  can,  at  a  given  dose,  be  in  a 
state  to  furnish  to  the  absorbing  faculty  as  many  active  elements  as  the 
substance  in  its  primitive  condition.  Up  to  this  point  the  energy  of  doses 
will  even  gradually  diminish ;  whilst,  this  limit  passed,  their  resources  will 
augment  in  proportion  as  art  shall  operate,  in  the  subsequent  attenuations, 
the  ulterior  division  of  molecules  the  same  as  that  which  takes  place  in 
other  substances. 

."61.  All  the  theoretic  explanations  which  we  have  just  given  would  be 
entirely  without  value,  if  practice  did  not  confirm  all  the  facts  which  we 
have  above  mentioned.  Many  homoeopaths,  it  is  true,  have  supposed  that 
they  have  observed  that  the  last  attenuations  which  they  make  use  of  do 
not  always  produce  effects  conformable  to  those  which  they  had  the  right  to 
look  for,  if  the  theory,  upon  which  this  doctrine  is  based,  were  correct. 
But,  according  to  our  view,  these  exceptions  are  rather  made  to  confirm  the 
theory  than  to  destroy  it ;  above  all,  if  we  remember  that  these  contradictory 
observations  have  been  made  for  the  most  part  by  individuals  who  did  not 
prepare  the  attenuations  they  employed,  or  who  did  not  conform  more  or 
less  exactly  to  the  indispensable  rules  to  be  attended  to  in  their  peparation. 
For  it  is  certain  that  if  we  neglect  to  produce  in  each  new  attenuation  a  new 
division  of  molecules,  the  first  attenuations  thus  obtained  may  still  have 
sufficient  resources ;  but  as  we  advance  in  this  way,  the  more  will  they 
become  exhausted.  If  the  division  of  molecules  in  the  first  triturations  has 
been  carried  to  a  sufficiently  high  degree,  it  is  even  possible  that,  without 
any  new  division,  we  may  continue  the  simple  partition  of  doses  up  to  the 
30th,  without  this  last  failing  in  its  resources ;  but  the  preparations  thus 
obtained  will  not  the  less  be  pure  dilutions  and  not  dynamizations,  as  they 


INTRODUCTION.  lix 

would  be  if,  in  each  one,  we  had  anew  augmented  the  resources  of  the  doses. 
In  the  following  article  we  shall  give  the  rules  and  precautions  to  be  observed, 
in  order  to  prepare  the  attenuations  so  that  they  shall  all  be  true  dynamiza- 
tions. 

te  2.  Of  the  Preparation  of  the  Attenuations, 

"  62.  We  have  already  said  that  the  homoeopathic  attenuations  are  ob- 
tained, in  general,  in  such  a  way  that  the  first  contains  one  grain  (5  centi- 
grammes), or  one  drop  of  the  medicine  mingled  with  100  grains  (5  grammes) 
of  sugar  of  milk,  or  100  drops  of  alcohol;  and  that,  after  sufficient  tritura- 
tions and  succussions,  the  second  is  obtained  in  manipulating,  in  the  same 
manner,  the  100th  part  of  the  1st  with  100  new  parts  of  vehicle;  the  3d, 
in  submitting  to  the  same  process  the  100th  part  of  the  second,  and  so  on 
to  the  30th.  This  way  of  making  the  attenuations,  in  the  proportion  of 
1  to  100,  is  that  of  Hahnemann,  and  which  is  always  understood  when 
we  indicate  an  attenuation  by  its  number.  Latterly,  however,  it  has  been 
found  more  suitable  to  make  the  mixtures  only  in  the  proportion  of  10 
to  100,  so  that  instead  of  mingling  only  one  grain  or  one  drop  with  100 
parts  of  vehicle,  we  mingle  10  each  time.  This  process  has  the  advantage 
of  giving  more  certitude  that  in  each  preparation  the  molecules  of  the  medi- 
cine are  well  mingled  with  those  of  the  vehicle,  though,  on  the  other  hand, 
it  permits  less  extension.  But  as  we  can  easily  repair  this  inconvenience 
in  preparing  two  attenuations  each  time,  in  the  proportion  of  10  to  100, 
instead  of  1  to  100,  we  recommend  this  process  to  all  the  homoeopathic 
physicians  and  pharmaceutists;  cautioning,  however,  these  last  that  every 
time  that  they  make  use  of  another  proportion  than  that  of  1  to  100,  they 
shall  take  care  to  indicate  it  on  the  label  of  the  preparations,  in  order 
that  we  may  know  in  what  proportion  the  number  which  each  attenuation 
bears,  is  made. 

"  63.  In  general,  we  can  lay  it  down  as  a  principle,  that  the  smaller  the 
proportion  in  which  the  medicine  is  mingled  with  the  vehicle,  the  more 
difficult  will  it  be  to  obtain  a  perfectly  intimate  mixture,  and  to  spread  the 
molecules  of  the  drug  over  all  the  points  of  the  preparation ;  likewise,  the 
larger  the  volume  of  each  preparation,  the  less  easy  will  it  be  to  make  the 
necessary  division  of  the  medicinal  molecules.  One  drop  of  a  medicine 
poured  into  a  lake  will  never  make  a  homoeopathic  attenuation,  though  the 
proportion  which  this  drop  bears  to  the  lake  in  question  is  far  from  being  a 
fraction  so  small  as  that  which  is  found  in  the  30th  attenuations.  But  that 
which  causes  this  attenuation,  notwithstanding  the  infinitely  small  proportion 
in  which  it  contains  the  drug,  to  possess,  nevertheless,  all  its  virtues  is,  that 
it  has  been  obtained  by  degrees,  in  preparing  at  first,  at  the  farthest,  but  100 
grains,  or  100  drops,  of  a  vehicle  with  1  or  10  of  the  drug,  and  in  not  employing 
this  preparation  to  make  a  second,  until  it  has  been  thoroughly  impregnated 


lx  INTRODUCTION. 

with  the  molecules  of  the  drug.  It  is  thus  that  we  are  successively  enabled 
to  spread  out  and  increase  the  number  of  infinitely  small  particles,  so  that 
at  last,  at  the  30th,  they  are  as  much  disseminated  through  the  whole  pre- 
paration as  in  the  first.  This  is  the  reason,  also,  why  the  attenuations 
obtained  in  the  proportion  of  10  to  100  are  much  more  sure  than  those 
of  1  to  1 00 ;  and  it  is  also  the  reason  why  we  should  never  'prepare  any 
attenuation  which  contains  more  than  100  grains  {five  grammes),  or  more 
than  100  drops  of  the  vehicle, 

"64.  The  attenuations  of  substances  which,  from  the  commencement, 
have  been  prepared  under  the  form  of  tinctures,  are  made  of  alcohol  from 
first  to  last.  For  this  purpose,  if  we  wish  to  preserve  all  the  attenuations, 
we  prepare,  for  each  substance,  30  small  bottles,  quite  new,  each  of  the  capacity 
of  150  drops;  we  fill  all  these  bottles  with  alcohol  to  two  thirds  of  their 
capacity,  and  mark,  on  the  label  as  well  as  on  the  cork,  the  name  of  the  sub- 
stance we  are  to  attenuate.  This  done,  we  take  one  of  these  bottles  and  pour 
into  it,  after  the  process  of  Hahnemann,  one  drop  of  the  mother  tincture,  and 
give  to  it  100  or  200  sufficiently  strong  shakes,  after  which  we  mark  on  the 
bottle  the  cipher  1,  to  indicate  that  the  preparation  it  contains  is  the  first 
attenuation.  Of  this  attenuation  we  in  like  manner  pour  one  drop  into  another 
of  these  bottles,  containing  about  100  drops  of  alcohol,  and  after  having  sub- 
mitted it  also  to  100  or  200  shakes,  we  mark  it  with  the  cipher  2,  to  indicate 
that  this  one  contains  the  second  attenuation.  In  this  manner  we  continue  to 
prepare  and  to  label  to  the  30th,  in  pouring  each  time  one  drop  of  the 
attenuation  just  obtained  into  the  bottle  which  will  contain  the  following 
attenuation.  The  rule  is  the  same  when  we  wish  to  prepare  each  attenuation 
in  the  proportion  of  10  to  100  ;  but  instead  of  pouring  but  one  drop  each 
time,  we  must  pour  ten;  but  as,  after  this  method,  we  want  two  attenuations 
each  time  to  equal  one  in  the  proportion  of  1  to  100,  the  same  ciphers  will 
not  be  suitable  to  indicate  these  two  sorts  of  attenuations,  but  we  may  make 
them  agree,  in  using,  for  the  preparation  of  10  to  100,  halves,  in  such  a  way 
as  to  designate  the  first  of  this  series  by  j,  the  second  by  1,  the  third  by  1^, 
the  fourth  by  2,  and  so  on  to  the  30th. 

"65.  For  the  substances  which,  from  the  first,  have  been  prepared  by 
trituration,  we  prefer  to  obtain  the  first  three  by  the  same  process.  To 
effect  this,  we  take  one  grain  (five  centigrammes)  of  the  first  preparation, 
obtained  by  the  trituration  of  one  grain  of  the  primitive  substance  with 
100  grains  (five  grammes)  of  sugar  of  milk,  and  which  carries  the  name  of 
the  first  attenuation  ;  we  mix  this  grain  (five  centigrammes)  with  100  other 
grains  (500  centigrammes)  of  sugar  of  milk,  and  triturate  this  mixture 
as  described  in  the  article  on  the  .Preparation  of  Dry  Substances.  This 
trituration  made,  we  give  to  it  the  name  of  the  2d  attenuation,  and  we  take 
of  it  one  grain  to  mingle  with  100  other  grains  of  sugar  of  milk  to  obtain 
the  3d  attenuation.     Of  this  trituration  we  then  take  one  grain,  which  we 


INTRODUCTION.  lxi 

dissolve  in  a  bottle  filled  with  100  drops  of  water  to  two  thirds  of  its  capa- 
city, and  shake  this  mixture,  as  in  the  attenuations  made  with  alcohol,  to 
which  we  give  the  name  of  4th  attenuation.  This  4th  attenuation  should 
be  made  with  water,  or  at  least  with  equal  quantities  of  water  and  alcohol, 
because  the  sugar  of  milk  does  not  dissolve  in  the  least  in  pure  alcohol,  but 
all  the  following  attenuations  are  then  made  with  pure  alcohol,  the  same  as 
the  tinctures.  Should  we  wish  to  make  the  triturations,  for  the  first  as  well 
as  the  subsequent  ones,  not  in  the  proportion  indicated  by  Hahnemann,  but 
in  that  of  10  to  100,  we  shall  be  obliged  to  make  six  of  them  instead  of 
three,  and  designate  the  first  of  this  series  by  the  cipher  §,  the  second  1, 
the  third  by  \\,  and  so  on.  The  attenuation  made  with  diluted  alcohol  should 
then  bear  the  cipher  3±. 

"66.  As  we  rarely  preserve  all  the  attenuations,  and  we  seldom  use  in 
practice  any  but  the  1st,  3d,  6th,  9th,  12th,  15th,  18th,  24th,  30th,  it  would 
be  useless  to  sacrifice,  each  time,  more  bottles  than  necessary,  since,  for 
example,  if  we  do  not  wish  to  preserve  the  2d  attenuation,  it  will  suffice,  in 
order  to  obtain  the  3d,  to  decant  nearly  to  the  last  drop  the  bottle  which 
contains  the  2d,  to  fill  it  afresh  with  100  drops  of  alcohol,  and  to  submit 
this  mixture  to  the  necessary  number  of  shakes.  It  is  thus  that,  should  we 
wish  to  have  but  the  30th  attenuation  of  a  substance,  we  can  make  all  the 
intermediate  attenuations,  by  pouring  off  to  nearly  the  last  drop  of  the  attenua- 
tion last  obtained,  and  filling  up  this  with  100  fresh  drops  of  alcohol.  In  a 
series  of  attenuations  of  such  a  length  we  can  even,  as  regards  those  we  throw 
away,  make  use  of  distilled  water ;  but  for  the  last  two,  that  which  we  wish 
to  preserve  and  that  which  precedes  it,  it  is  most  proper  to  use  alcohol.  The 
alcohol,  which  is  proper  for  the  preparation  of  the  attenuations,  should  not 
be  so  concentrated  as  that  used  for  the  preparation  of  the  mother  tinctures, 
but  it  ought  not  to  be  less  than  60°  or  70°  Centigrade. 

"67*  There  was  a  time  when  Hahnemann,  for  fear  of  imparting  too  great  a 
force  to  his  preparations,  advised  only  one  or  two  shakes  to  be  given  to  each 
attenuation,  whilst,  at  present,  he  counsels  the  contrary;  that  is  to  say,  to 
give  each  attenuation  a  considerable  number  of  shakes  (200  to  300),  so  as  to 
be  sure  of  obtaining  preparations  sufficiently  efficacious.  It  is  in  starting  from 
this  last  point  of  view  that  many  homoeopaths  have  even  tried  to  construct 
machines  of  succussion,  by  means  of  which  they  might  submit  their 
attenuations  to  2000  or  3000  shakes  of  the  greatest  force;  whilst  others  have 
dreaded  even  to  displace  a  bottle,  lest  the  movement  beyond  the  prescribed 
cipher  might  impart  too  great  energy  to  the  dose.  The  fact  is,  that  as  we 
have  shown  the  succussion  increases  the  effect  of  the  doses,  and  if  each 
attenuation  ought  to  be  a  new  dynamization,  the  succussion  consisting  of  two 
shakes  only  is  insufficient.  If,  as  we  have  also  shown,  the  first  attenuations 
have  produced  a  considerable  division  of  the  molecules,  we  may  obtain,  per- 
haps, 10  or  even  12  subsequent  attenuations,  each  of  which  shall  possess 
sufficient  power  without  having  been  subjected  to  any  new  succussion ;  but, 


lxii  INTRODUCTION. 

in  continuing  in  this  way,  we  shall  inevitably  arrive  at  nothing  but  mere  dilu- 
tions, which,  deprived  more  and  more  of  their  active  elements,  shall  be  by 
degrees  weakened,  even  to  the  utter  extinction  of  their  virtue. 

"  68.  Hence,  however,  it  does  not  yet  result  that,  to  obtain  as  many  new 
dynamizations  as  attenuations,  it  is  indispensable  to  make  use  of  machines, 
such,  among  others,  as  the  famous  catapult,  invented  and  recommended  by 
M.  Mure,  as  the  only  means  to  obtain  efficacious  preparations.  For,  after  the 
explanations  which  we  have  just  given  in  the  preceding  paragraph,  it  is  easy  to 
see  that,  so  soon  as  the  succussions  have  given  sufficient  medicinal  power 
to  an  attenuation,  all  the  surplus  added  to  it  can  be  of  no  advantage,  not  even 
in  the  small  homoeopathic  doses,  from  the  circumstance  that  there  would  be 
no  means  of  making  use  of  them.  This  is  why  we  believe  that  if  we  bestow 
1 00  or  200  shakes  on  each  attenuation,  this  number  will  be  more  than  suffi- 
cient in  every  case ;  and  those  who  have  no  machines,  will  find  that,  apart  from 
the  inconvenience  of  being  fatigued,  their  arms  are  as  appropriate  as  the  best 
mechanism  to  communicate  to  the  attenuations  the  indispensable  resources. 
Do  we  not  constantly  find  that  the  homoeopathic  preparations  which  have  been 
carried  great  distances,  during  which  they  have  been  shaken  for  weeks  at  a 
time,  do  not  show  more  intensity  in  their  effects  than  those  which  have  not 
undergone,  at  the  farthest,  but  200  shakes  at  each  attenuation  ;  an  evident 
proof  that  the  resources  which,  by  this  process,  they  should  have  gained, 
had  no  effect  on  their  indispensable  elements,  but  on  what  was  superfluous. 

"69.  Another  question  of  no  less  importance  would  be  to  know  if,  to 
obtain  all  the  advantages  that  attenuations  can  give,  it  is  indispensable  to  go 
as  far  as  the  30th.  What  is  certain  is,  that  the  mass  of  new  particles  which 
is  furnished  by  the  division  of  molecules  must  be  diminished  from  time  to 
time,  in-  order  to  permit  a  greater  extension*  of  the  surface  of  those  which 
remain,  and  thus  to  facilitate  their  ulterior  division.  But  what  is  equally 
certain  is,  that  this  division  of  molecules  can  no  longer  have  any  object,  as 
soon  as  it  has  succeeded  in  developing  all  the  virtues  of  substances  of  latent 
virtue,  or  even  in  rendering  too  energetic  substances  incapable  of  experiencing 
any  further  solution  in  the  organism.  This  is  the  case,  in  all  probability, 
after  having  arrived  at  the  6th  or  even  at  the  3d  attenuation;  and  if  we, 
examine  the  manner  in  which  all  our  attenuations  act,  from  the  15th, 
or  even  the  10th,  up  to  the  30thj  it  is  easy  to  discover  that  this  process  ceases 
to  exert  any  influence,  in  a  sensible  manner,  even  in  the  smallest  possible  doses ; 
so  that  we  are  almost  inclined  to  think  that  all  that  we  do,  beyond  the 
12th,  must  be  superfluous.  Nevertheless,  as  the  attenuations  carried  out 
farther  do  not  become  less  suitable  for  use  than  the  preceding,  provided  they 
have  been  well  prepared*  we  have  not  hesitated  to  carry,  according  to  received 
usage,  the  officinal  number  to  30,  leaving  to  those  who  may  find  it  too  high, 
as  well  as  to  those  who  would  go  still  higher,  the  choice  of  the  cipher  which 
may  ^appear  to  them  the  most  suitable. 

"  70.  In  the  commencement  of  his  homoeopathic  carveer,  Hahnemann  had 


INTRODUCTION.  lxiii 

fixed,  for  each  particular  substance,  the  attenuation  at  which  it  appeared 
to  him  to  be  employed  with  the  greatest  success ;  but  latterly,  to  simplify 
the  preparation  of  medicines,  and  render  it  more  uniform,  he  has  advised 
to  carry  them  all,  without  distinction,  to  the  30th.  So  in  the  old  homoeopathic 
pharmacopoeias  we  find,  carefully  noted,  the  number  of  attenuations  suitable 
to  each  substance — numbers,  which  many  persons  respect  as  a  sort  of  gospel, 
imagining  that  all  would  be  lost  if  they  had  not  the  medicine  at  the  attenua- 
tion which  the  authors  of  pharmacopoeias  have  been  pleased  to  mark  out. 
All  homoeopaths,  even  Hahnemann  himself,  make  use  of  different  attenua- 
tions, from  the  1st  to  the  30th,  and  not  one  of  those  who  have  entered  the 
least  into  the  spirit  of  homoeopathy  any  longer  regard  those  ancient  ciphers 
than  as  purely  arbitrary  marks. 


"  OF  THE   DISPENSATION  AND   PRESERVATION  OE  HOMOEOPATHIC 
MEDICINES. 

"  1 .  Of  the  Dispensation  of  Homoeopathic  Medicines. 

"75.  Homoeopathic  medicines  are  generally  administered  in  the  form  of 
powder.  To  effect  this,  we  mix  the  drop  or  the  prescribed  number  of 
globules  with  a  few  grains  of  sugar  of  milk,  and  inclose  it  in  a  paper,  to  be 
administered  to  the  patient  either  dissolved  in  a  spoonful  of  water  or  in  the 
dry  state.  The  sugar  of  milk  being  only  intended  in  this  case  to  act  as  the 
vehicle  and  not  to  produce  a  new  dynamization,  we  have  no  need  of  rubbing 
it  up  with  the  medicinal  dose  ;  we  should  even  guard  against  doing  it,  if  we 
wish  that  this  last  should  not  act  with  too  much  force,  since  by  doing  so 
we  should  still  increase  the  power.  Again,  should  we  wish  this  dose  to  act 
more  promptly  and  with  more  energy,  we  dissolve  it  in  a  spoonful  of  water, 
which  immediately  develops  more  powers,  and  presents  them  to  the  organs 
in  a  greater  extension  than  when  the  dose  is  taken  dry.  In  some  cases 
also,  in  order  to  avoid  the  continued  administration  of  a  white  powder,  which 
might  in  time  become  disgusting  to  the  patient,  we  may  add  to  the  sugar  of 
milk  a  small  portion  of  the  powder  of  cocoa,  liquorice,  or  salep ;  these  powders 
will  give  to  the  doses  another  colour,  without  interfering  in  the  least  with 
their  virtues.  The  quantity  of  sugar  of  milk  we  ought  to  add  to  the  dose 
is  usually  two,  three,  or  four  grains  ;  but  for  those  patients  who  would  not 
be  satisfied  with  such  small  powders,  we  may  add  as  much  as  they  seem  to 
wish. 

"76.  Another  method,  not  less  frequently  made  use  of  in  homoeopathy, 
is  to  dissolve  the  dose  we  wish  to  administer  in  four  or  six  ounces  of  water^ 
and  to  give  to  the  patient  a  single  spoonful,  or  several,  at  intervals,  more 
or  less  extended.  As,  in  this  case,  the  water  is  no  more  designed  than  the 
sugar  of  milk  to  augment  the  powers  of  the  doses,  but  only  to  develop 


lxiv  INTRODUCTION. 

them,  and  render  the  reception  easier,  it  would  be  equally  adverse  to  the  end 
proposed  to  submit  this  solution  to  new  succussions.  In  general,  the  best 
way  to  obtain  these  solutions  is,  to  put  the  dose  in  a  bottle  of  a  sufficiently 
large  size  to  permit  the  wished-for  quantity  of  filtered  water  to  be  poured  on 
it,  and  to  leave  the  medicine  to  dissolve  of  itself ;  after  which  we  give  a  few 
shakes  to  this  solution,  sufficient  only  to  mingle  the  parts  well,  without, 
however,  operating  a  new  division  of  molecules.  We  will  only  add,  that  if 
for  each  solution  we  employ  a  new  bottle,  we  shall  do  better  than  if  we 
make  the  solution  in  a  tumbler  belonging  to  the  patient  himself,  for,  not- 
withstanding the  most  careful  recommendations  on  the  part  of  the  physician, 
these  tumblers  are  scarcely  ever  cleansed  with  sufficient  care,  to  prevent  an 
alteration  of  the  medicine  by  the  particles  which  might  remain  of  the  pre- 
ceding one. 

"  79.  In  cases  where  the  imagination  of  the  patient  must  be  gratified,  we 
add  to  the  medicinal  doses  a  few  powders  of  sugar  of  milk  alone.*  Thus,  for 
example,  if  we  wish  to  give  the  patient  six  powders,  of  which  three  only 
contain  the  medicine  {durum  for  instance),  we  should  write,  if  these  powders 
are  to  be  taken  alternately, 

Aur.3/15.  No.  1.  3.  5. 

Pulv.  sacch.  lact.  q.  s.  No.  2.  4.  6. 
Or  else,  if  the  first  three  are  to  contain  the  medicine : 
Aur.  3/15.   No.  1.  2.  3. 

Pulv.  sacch.  lact.  q.  s.  No.  4.  5.  6. 
A  still  more  simple  plan  consists  in  not  indicating  the  sugar  of  milk  in  the 
prescription,  but  placing  the  numbers  which  are  to  contain  this  vehicle  behind 
those  which  are  to  contain  the  medicine,  and  separating  them  by  the  follow- 
ing sign  ($),  as  for  example : 

Aur.  3/15.   No.  1.  3.  5.  #  2.  4.  6. 
Or  else : 

Aur.3/15.   No.  1.  2.  3.  #4.  5.  6. 

ff  2.  On  the  Preservation  of  Homoeopathic  Medicines. 

^f8L  All  the  medicines,  not  excepting  the  powders,  ought  to  be  preserved 
in  bottles ;  boxes  afford  too  great  access  to  air,  and  allow  too  much  evapora- 
tion. For  the  alcoholic  tinctures,  cork  stoppers  are  the  best,  since  they  adapt 
themselves  to  the  bottle  in  a  more  exact  manner  than  those  of  glass,  and 
more  effectually  guard  against  evaporation.  As  to  very  strong  and  very 
volatile  substances,  it  is  better  to  tie  a  piece  of  prepared  bladder  over  the 
stopper.     Moreover,  these  stoppers  ought  to  be  changed  from  time  to  time, 

*■  A  procedure  which  is  often  necessary  where  patients  have  long  been  accustomed  to  the 
daily  use  of  medicine  under  allopathic  treatment. — J.  L. 


INTRODUCTION.  lxv 

above  all,  those  of  bottles  which  contain  metallic  solutions  ;  and  in  general,  we 
should  not  neglect  to  do  so  as  soon  as  we  discover  that  their  extremity  begins 
to  change  colour ;  for  in  the  latter  case,  alcohol  may,  without  this  precaution, 
dissolve  a  little  of  their  medicinal  virtue,  and  impair  the  efficacy  of  the  prepara- 
tion. Acids  do  not  admit  of  the  use  of  cork  stoppers,  they  attack  them  imme- 
diately, and  the  portion  dissolved  alters  the  purity  of  the  medicine  ;  we  must, 
therefore,  use  stoppers  of  ground  glass ;  but  in  order  to  prevent  evaporation 
they,  as  well  as  the  neck  of  the  bottle,  should  be  coated  with  wax. 

•■"82.  As  nothing  has  more  influence  on  the  preservation  of  homoeopathic 
medicines  than  heat,  the  rays  of  the  sun,  and  light  of  the  day,  we  must  be 
very  careful  to  exclude  these  as  much  as  possible.  The  action  of  the  solar 
light  and  of  the  light  of  day  easily  acidifies  alcohol,  and,  besides,  destroys 
the  virtues  of  the  medicines.  This  is  the  reason  why  we  should  preserve 
homoeopathic  preparations  in  a  cool  and  dark  place,  and  assure  ourselves, 
from  time  to  time,  that  they  are  in  a  good  state  of  preservation.  We 
discover  when  they  have  become  acidified  by  letting  a  drop  fall  on  the  sur- 
face of  a  piece  of  pure  carbonate  of  lime,  flattened  by  pressure  ;  if  the  drop 
insinuate  itself  tranquilly,  the  tincture  is  still  good,  but  if  it  form  bubbles,  it 
it  has  become  acid,  and  cannot,  in  consequence,  be  made  use  of  anymore.  As 
to  substances  and  their  dilutions,  which  are  more  especiajlysensible  to  the  action 
of  the  light,  astheprussic  acid,  phosphoric  acid,  &c,  it  is  prudent  to  preserve 
them  in  bottles  of  black  glass,  or,  at  any  rate,  covered  with  black  paper.  Finally, 
it  is  also  advisable  to  put  the  homoeopathic  medicines,  particularly  the  acetate 
of  lime,  hepar  sulphuris,  barytes,  and  all  the  preparations  which  are  preserved 
in  the  form  of  powder,  beyond  the  reach  of  humidity, — as  they  become  dete- 
riorated when  exposed  thereto. 


LIST     OF     MEDICINES 


WHICH  ARE  WELL  ADAPTED  TO  PARTICULAR 


TEMPERAMENTS,  CONSTITUTIONS,  AND  DISPOSITIONS. 


Lymphatic  Temperaments  (characterized  by  superabundance  of  the  humours  with 
repletion  of  the  cellular  tissue,  giving  a  considerable  bulk  to  the  whole  body, 
which  is,  moreover,  distinguished  by  roundness  of  form,  softness  of  the  muscular 
system,  fair  hair,  pale  clear  skin,  and  a  lustreless,  or  hazy,  inanimate  eye.  The 
circulation  is  slow,  the  brain  inactive,  and  the  passions  languid.)  Merc,  Sulph., 
Calc,  Puis.,  Caps.,  China,  Ars.,  Acid,  nit.,  Bella.,  Hyos.,  Phosph.,  Hell.,  Dulc,  Sep., 
Ant.,  Lye,  Card,  v.,  Am.,  Dig.,  Con.,  Clem.,  Sil,  etc. 

Sanguine  Temperament  (indicated  by  predominant  activity  in  the  circulating  system, 
with  a  moderately  full  habit,  soft  skin,  florid  complexion,  blue  eyes,  red,  auburn,  or 
yellow  hair ;  corporal  and  mental  activity.)  Aeon.,  Am.,  Bella.,  Calc,  Hep.,  Merc, 
Cham.,  Nwc  v.,  Bry.,  Lach.,  Phosph.,  Ac  nitr.,  Ars.,  Cocc,  etc. 

Bilious  Temperament.  (By  this  term  is  meant  that  habit  of  body  which  is  distin- 
guished by  black  hair,  dark  eyes  and  skin,  the  latter  generally  inclining  to  yellow, 
moderate  fulness,  but  much  firmness  of  flesh  ;  the  countenance  strongly  marked, 
and  expressive  of  the  great  energy  of  character  which  this  temperament  obtains ; 
the  passions  violent,  the  pulse  strong,  hard,  and  frequent.)  Aeon.,  Bry.,  Nux  v., 
Cham.,  Cocc,  Ars.,  Am.,  China,  Sulph.,  Plat.,  etc. 

Melancholic  Temperament.  (A  modification  of  the  bilious,  with  less  activity  of  the 
nervous  and  muscular  systems ;  black  hair,  dark  complexion ;  the  disposition  grave, 
meditative,  suspicious,  and  gloomy.  Derangement  of  the  functions  of  the  nervous 
system,  with  sluggish  bowels,  dry  habit  of  body,  hard,  slow,  and  habitually  contracted 
pulse,  usually  attend  this,  so  to  speak,  abnormal  modification  of  the  bilious  tem- 
perament.) Nuos  v.,  Lach.,  Sulph.,  Aurum,  Staph.,  Veratr.,  China,  Con.,  Grat., 
Mosch.  natr.,  Phosph.,  Stann.,  Viol,  odor.,  Acid,  nitr.,  Plat.,  Amir  a,  Ars.,  Bry.,  Sil, 
Puis.,  Sep.,  Magn.  m.,  etc. 

Nervous  Temperament.  (Defined  by  fine  thin  hair,  thin  skin,  small,  attenuated 
muscles,  paleness  of  countenance  and  often  indifferent  or  delicate  health.  Pre- 
dominant activity  of  the  brain  and  entire  nervous  system;  suddenness  and  muta- 
bility of  decision  and  judgment ;  quickness  in  muscular  motion.)  Aeon.,  Coffea, 
Bry.,  Cham.,  Nuoc  v.,  Sep.,  Plat.,  Lach.,  Ac  nitr.,  Cocc,  Ambr.,  Ars.,  China,  Zinc, 
Cup.,  Jgn.,  Phosph.,  etc. 


lxvili  LIST    OF    MEDICINES. 

Constitution  or  Habit  of  Body,  Cachectic.     Ars.,  [Sulph.,  Calc,  China,  Merc,  Ac 
nitr.,  Phosph.,  SiL,  Natr.  m.,  Carl,  v.,  Am,,  etc. 

Debilitated    or    Exhausted  :    Ars.,    Sulph.,    Calc,    Phosph.,  Phosph.  ac, 


Ars.,  Carl,  v.,    Nux  v.,    China,    Lach.,    Merc,    Natr,  m.,  Staph.,   Ac  nit.,   Sep., 
Veratr.,   SiL,   Ant.  c,   Kali,  Am.,    Can.,  etc. 

-  ■■■    Dry  :  Bry.,  Nux  v.,  Ac  nitr.,  Amlra,  China,  etc. 


— Plethoric,  Corpulent,  Leuco-phlegmatic :  Aeon.,  Bella.,  Calc,  Am.,  Baryt.  c, 

Ant,,  Sulph.,  Pals.,  Hell.,  Merc,  Sep.,  etc* 

Lean  Habit  of  Body  :    Nux  v.,   SiL,   Lach.,  Ac  nitr.,  China,  Amlra,  Bry.,  etc, 

Disposition,   Choleric  :    Bry.,   Nux  v.,    Cham.,    Cocc,   Aeon.,   Sulph.,  China,  etc. 

- Hypochondriacal  :     Nux  v.,   Sulph.,  Staph.,   Veratr.,    Aurum,  China,  Con., 


Stann.)  Phosph.,  Grat.,  Mosch.,  Puis.,   Asa.,  Bella.,  Cham.,  Magn.  m.,   HelL,  Plumb., 
Mez.,  VaL,  Zinc,  etc. 

— Melancholy  ;  Aeon.,  Ign.,  Natr.  m.,  Lach.,  Ars.,  Nux  v.,  Bry.,  China, 


Merc,   Graph.,   Calc,  Staph.,  Aur.,  Lye.,  Plat.,  Puis.,  Veratr.,  SiL,  Sep.,  Ac  nitr., 
Stram.,  Calc,  Con.,  Chel.,  etc. 

— —  Mild  (quiet,  easy)  :   Puis.,  Ign.,  Amlra,  Cic,  Mag.  arct.,  Stann.,  Sulph.,  Calad., 


Lye,  SiL,  etc 

Phlegmatic,   (inactive,  inanimate,  indolent) :  Caps.,  Cocc,   Puis.,  Ac  phos., 

Sep.,  Anac,  Ars.,  Hell.,  Bella.,  ScilL,  SiL,  Sulph.,  Zinc,  Ac  mur,,  Natr.  m.,  Cyc, 
u,  etc. 

Sensitive  :  Ign.,  Cap.,  Phosph.,  etc. 


As  we  very  frequently  meet  with  mixed  forms  of  temperament,  such  as  a  combination  of 
the  sanguine  and  lymphatic,  the  nervous  and  lymphatic,  and  the  nervous  and 
bilious,  forming  the  sanguine-lymphatic,  the  nervo-sanguine  and  the  nervo*bilious 
temperaments,  the  remedies  which  correspond  to  the  two  pure  varieties  which  form 
the  compound  one  ought  to  be  selected  where  possible,  or  those  which  correspond 
best  to  the  more  prominent  development  of  temperament,  when  a  medicament  cannot 
be  found  which  is  equally  well  adapted  to  the  two  different  temperaments  form- 
ing the  mixed  variety.  We  must*  of  course,  be  guided  by  the  entire  morbid 
picture  in  making  a  selection  from  amongst  the  medicaments  which  are  most  appli- 
cable to  particular    temperaments. 


TABLE  OF  MEDICINES 

CONTAINED     IN    THIS    WORK, 

TOGETHER  WITH  THE  ABBREVIATIONS  EMPLOYED, 


1.  Aeon. — Aconitum  napellus. 

2.  Act.— Acteea  spicata. 

3.  iEth. — iEthusa  Cynaphmi* 

4.  Agar.— Agaricus  muscarius* 

5.  Agn.— Agnus  castus. 

6.  Al. — Aloes. 

7.  Alum. — Alumina. 

8.  Ambr* — Ambra  grisea* 

9.  Am.  c— Ammonium  carbonicuim 
LO.  Am.  in. — Ammonium  muriaticum. 
LI.  Anac.< — Anacardium* 

L2.  Anis.— Anisum  stellatum. 
L3.  Ang. — Angustura  vera. 

14.  Ant. — Antimonium  crudum, 

15.  Arg. — Argentum. 

16.  Arn. — Arnica  montana. 

17.  Art.— Artemesia  vulgaris. 

18.  Ars.— Arsenicum  album. 

19.  Arum.— -Arum  maculatum. 

20.  Asa. — Asafcetida. 

21.  Asar.— Asarum  europeeum. 

22.  Aur. — Aurum  foliatum. 

23.  Aur.  m.r- Aurum  muriat. 

24.  Bar.  c. — Baryta*  carbonica. 

25.  Bar.  m. — Baryta  muriatica* 

26.  Bell.— Belladonna. 

27.  Berb.— Berberis  vulgaris. 

28.  Bis. — Bismuthum. 

29.  Bor.— Borax  veneta. 

30.  Bov.— Bovista. 

31.  Bry.— Bryonia  alba* 

32.  Bruc.< — Brucea  anti-dysenterica. 

33.  Cal. — Caladium  seguinum. 

34.  Calc. — Calcarea  carbonica. 

35.  Calc.  ph.— Calcar.  phosphorata. 

36.  Camph. — Camphora. 

37.  Cann. — Cannabis. 

38.  Canths. — Cantharis. 

39.  Caps* — Capsicum. 

40.  Carb.  an. — Carbo  animalis. 

41.  Carb.  v. — Carbo  vegetabilis. 

42.  Case— Cascarilla. 

43.  Cast. — Castoreum. 

44.  Caus. — Causticum, 


45.  Cham.— Chamomilla. 

46.  Chel.— Chelidonium. 

47.  Cin.— Cina. 

48.  Cic— Cicuta  virosa. 

49.  Cinch.,  Chin.  —  China,    Cinchona  offi- 

cinalis. 

50.  Cinn.— Cinnabaris. 

51.  Cinnam. — Cinnamomum. 

52.  Cist. — Cistus  canadensis. 

53.  Citr. — Citri  acidum. 

54.  Clem. — Clematis  erecta. 

55.  Coccion.— Coccionella. 

56.  Cocc. — Cocculus. 

57.  Cof.— CofFea  cruda. 

58.  Colch.— Colchicum. 
59*  Coloe— Colocynthis. 

60.  Con. — Conium  maculatum. 

61.  Conv.— Convolvulus  arvensis. 

62.  Cop. — Copaivse  balsamum. 

63.  Coral. — Corallia  rubra. 

64.  Croc— Crocus  sativus. 

65.  Crot.— Crotum  Tiglium. 

66.  Cub.— Cubebffi. 

67.  Cupr. — Cuprum. 

68.  Cyc. — Cyclamen. 

69.  Daph. — Daphnee  indica. 

70.  Diad. — Diadema. 

71.  Diet.— Dictamus  albus. 

72.  Dig. — Digitalis  purpurea, 

73.  Dros.— Drosera  rotundifolia. 

74.  Dulc. — Dulcamara. 

75.  Eug. — Eugenia  Iambos. 

76.  Euph. — Euphorbium  officinale. 
,77.  Euph.— Euphrasia. 

78.  Evon. — Eyonymus  europseus. 

79.  Fer. — Ferrum. 

80.  Fer.  ch. — Ferrum  chloratum. 

81.  Ferr.  mg.— FeiTum  magneticum. 

82.  Fil.— Filix  mas. 

83.  Frag. — Fragaria  vesca. 

84.  Gran. — Granatum. 

85.  Graph. — Graphites. 

86.  Grat. — Gratiola  officinalis. 

87.  Guai. — Guaicum  officinale. 


lxx 


TABLE    OF    MEDICINES. 


88.  Haem. — Hsematoxyl.  camp. 

89.  Hell. — Helleborus  niger. 

90.  Hep. — Hepar  sulphuris  calcareum. 

91.  Hyos.-— Hyoscyamus  niger. 

92.  Jalap.— Jalappa. 

93.  Iatr.— -Iatropha. 

94.  Ign. — Ignatia  amara. 

95.  Ind. — Indigo. 

96.  Iod. — Iodium. 

97.  Ipec. — Ipecacuanha. 

98.  Kal.— Kali  carbonicum. 

99.  Kal.  ch. — Kali  chloroticum, 

100.  Kal.  h. — Kali  hydriodicum. 

101.  Kreos. — Kreosotmn. 

102.  Lach. — Lachesis. 

103.  Lac. — Lactuca  virosa. 

104.  Lam.— Lamium  album. 

105.  Laur.— Laurocerasus. 

106.  Led.— Ledum  palustre. 

107.  Lye. — Lycopodium. 

108.  Magn. — Magnesia  carbonica. 

109.  Magn.  m. — Magnesia  muriat. 

110.  Magn.s. — Magnesia  sulphur. 

111.  Mang. — Manganum  oxydat. 

112.  Men. — Menyanthes. 

113.  Meph. — Mephitis  putorius. 

114.  Merc. — Mercurius. 

115.  Merc,  c—  Mercur.  subl.  corr. 

116.  Mez. — Mezereum. 

117.  Mil.— Millefolium. 

118.  Mosc. — Moschus. 

119.  Mur.  ac. — Muriatis  acidum. 

120.  Natr. — Natrum  carbonicum. 

121.  Natr.  m. — Natrum  muriaticum. 

122.  Natr.  n. — Natrum  nitricum. 

123.  Natr.  s.— Natrum  sulphuricum. 

124.  Nic — Niccolum. 

125.  Nitr.— Nitrum. 

126.  Nitr.  ac. — Nitri  acidum. 

127.  Nitr.  sp. — Nitri  spirit,  dul. 

128.  N.  mos. — Nux  moschata. 

129.  N.  vom. — Nux  vomica. 

130.  Oleand.— Oleander. 

131.  01.  an.— Oleum  anim.  aether. 

132.  01.  jec. — Oleum  jecoris  morhuae. 

133.  Onis. — Oniscus  asellus. 

134.  Op.— Opium. 

135.  Pceon. — Pceonia. 

136.  Par. — Paris  quadrifolia. 

137.  Petr. — Petroleum. 

138.  Petros. — Petroselinum. 

139.  Phell. — Phellandrium  aquat. 

140.  Phos. — Phosphorus. 

141.  Phos.  ac— Phosphori  acidum. 

142.  Pin. — Pinus. 

143.  Plat.— Platina. 

144.  Plumb. — Plumbum. 

145.  Prun.— Prunus  spinosa. 

146.  Puis.— Pulsatilla. 


147. 

148. 
149. 
150. 

151. 
152. 
153. 
154. 
155. 
156. 
157. 
158. 
159. 
160. 
161. 
162. 
163. 
164. 
165. 
166. 
167. 
168. 
169. 
170. 
171. 
172. 
173. 
174. 
175. 
176. 
177. 
178. 
179. 
180. 
181. 
182. 
183. 
184. 
185. 
186. 
187. 
188. 
189. 
190. 
191. 
192. 
193. 
194. 
195. 
196. 
197. 
198. 
199. 
200. 


Ran. — Ranunculus  bulbosus. 

Ran.  sc. — Ranunculus  sceleratus. 

Rat. — Ratanhia. 

Rhab. — Rhabarbarum  (Rheum  palma- 

turn). 
Rhod. — Rhododendron. 
Rhus. — Rhus  toxicodendron. 
Rhus  v. — Rhus  vernix. 
Rut.  g. — Ruta  graveolens. 
Sabad. — Sabadilla. 
Sabin. — Sabina. 
Samb. — Sambucus  nigra. 
Sang. — Sanguinarius  canadensis, 
Sap. — Sapo  domesticus. 
Sass. — Sassaparilla. 
Sec. — Secale  cornutum. 
Selen. — Selenium. 
Seneg.  —  Senega. 
Senn. — Senna. 
Sep. — Sepiae  succus. 
Sil. — Silicea. 

Sol.  m. — Solanum  mammosum. 
Sol.  n. — Solanum  nigrum. 
Spig. — Spigelia. 
Spong. — Spongia. 
Squill. — Squilla  (scilla)  maritima. 
Stann. — Stannum. 
Staph. — Staphysagria. 
Stram. — Stramonium. 
Stront. — Strontiana. 
Sulph. — Sulphur. 
Sulph.  ac— Sulphuris  acidum. 
Tab. — Tabacum. 
Tan. — Tanacetum  vulgare. 
Tarax. — Taraxacum. 
Tart. — Tartarus  emeticus. 
Tart,  ac — Tartari  acidum. 
Tax. — Taxus  baccata. 
Tereb. — Terebinthina. 
Teucr. — Teucrium  marum  verum. 
The. — Thea  csesarea. 
Ther. — Theridion  curassavicum. 
Thuj. — Thuya  occidentalis. 
Tong. — Tongo. 
Urt. — Urtica  urens. 
Uva. — Uva  Ursi. 
Valer. — Valeriana. 
Verat. — Veratrum  album. 
Verb. — Verbascum  thapsus. 
Vine — Vinca  minor. 
Viol.  od. — Viola  odorata. 
Viol.  tr. — Viola  tricolor. 
Zinc — Zincum. 
Zinc.  s. — Zincum  smphuricum. 
Zing. — Zingiber. 


201.  Mgs. — Magnus  artificialis. 

202.  M.  arc. — Magnetis  polus  arcticus. 

203.  M.  aus.— Magnetis  polus  australis. 


lxxi 


ERRATA. 

41,  line  21,  for  Connulsio  cerealis  read  Convuisio  eerealis. 
114,  —  14  from  the  foot,  transfer  the  clause  or  section  commencing  with 

"  an  abuse  of  coffee  and  tea,"  and  terminating  with  "  and  will  be 

found  useful,"  to  the  chapter  on  Headache. 
155,  —  10,  for  exterior  read  interior. 
221,  —  18  from  the  foot,  after  beyond,  insert  the  words  "  the  fact  of  their 

occasional  evacuation  at  stool." 
233,  —  11  from  the  foot,  transfer  the  clause  commencing  with  "  Conium 

maculatum,"  to  after  that  terminating  with  "  remain  unmiti- 
gated." 
306,  —  4  from  the  foot,   after  Dose,   erase  the  words  which  precede 

"  a  dessert-spoonful  every  two  to  six  hours." 
351,  —  2,  for  "and  is  so  called  from  being  nearly  peculiar  to  drunkards," 

read  and  is  nearly  peculiar  to  drunkards,  hence  its  name. 

373,  —  6  from  the  foot,  after  heart,  insert  "  friction  sounds." 

374,  —  3,  for  lung  read  sac. 

—    last  line,  after  the,  insert  general. 

376,  line  8,  erase  the  words  "  burning  pain  in  the  seat  of  the  surface." 
466,  —  20,  for  urethretis  read  urethritis. 
473,  —  13,  for  humeralis  read  humoralis. 
481,  —  2,  for  (siphilida)  read  (siphilides). 
484,  —  11  from  the  foot,/or  "Arsenicum or  Carbo  was,"  read  "Arsenicum 

and  Carbo  were." 
526,  —  20,  for  "  we  find  swelling  of  the  psoas  muscle  and  in  the  region  of 

the  groin,"  read  "  we  find  some  degree  of  external  swelling." 
542,  —  3,  for  Irichiasis  read  Trichiasis. 
760,  —  2,  for  ventricularum  read  ventriculorum. 


Ixxii 


The  Medicines  which  the  Author  has  been  in  the  habit  of  using,  in 
common  with  the  principal  homoeopathic  practitioners  in  this  country, 
are  those  prepared  by  Mr.  Wm.  Headland,  Chemist,  15,  Princes  street, 
Hanover  square,  London,  and  Hanover  street,  Edinburgh,  who  has  for 
years  devoted  himself  exclusively  to  homoeopathic  pharmacy.  From, 
having  tested  their  efficacy  both  in  private  and  dispensary  practice,  the 
Author  feels  that  he  can  with  safety  recommend  them  to  the  continued 
confidence  of  the  public. 

N.B.  Mr.  Headland's  Homoeopathic  Preparations  may  be  had  of  the 
Publisher  of  this  work. 


HOM(EOPATHIC 

PRACTICE    OF    PHYSIC. 


It  has  been  repeatedly  found  that  some  remedies  act  very  bene- 
ficially when  administered  after  the  previous  employment  of  certain 
others.  The  subjoined  list  affords  a  few  such  examples,  and  may  prove 
useful  in  the  treatment  of  particular  cases :  the  remedy  to  be  selected 
must  be  in  accordance  with  the  symptoms. 

Acidum  nitri.  Cole.,  Petr.,  Puis.,  Sulph.,  are  often  used  with 
success  after  Acidum  nitri. 

Acidum  phos.  China,  Lack.,  Rhus,  Verat.,  are  sometimes  suitable 
after  Acidum  phos. 

Acidum  sulph.     Puis,  is  sometimes  useful  after  Acid.  sulph. 

Aconite.  Am.,  Ars.,  Bella.,  Bryon.,  Cann.,  Ipec,  Spong.,  Sulph.,  &c, 
will  frequently  be  found  of  use  after  Aconite. 

Alumina.  Bryon.  is  often  of  great  use  after  Alumina,  when  it  is 
indicated. 

Ant.   crudum.     Puis,   and  Merc,   sometimes  answer  well  after 


Arnica.   Aeon.,  Ipec,  Rhus,  Sulph.  ac,  are  sometimes  suitable  after 


Arsenicum.  China,  Ipec.,  Nux  vom.,  Sulph.,  Veratr.,  will  sometimes 
be  found  beneficial  after  Arsenic. 

Belladonna.  China,  Ipec,  Bulc,  Hepar,  Bach.,  Rhus,  Seneg., 
Stram.,  Valer.,  are  sometimes  the  most  appropriate  medicines  after 
Belladonna. 

Bryonia.     Alum,  and  Rhus  will  sometimes  be  found  suitable  after 

Bryonia. 

1 


2  LIST    OF    MEDICINES. 

Calcarea  carbonica.  Lycopodium,  Nitr.  ac,  Phos.,  and  Silicea, 
will  be  found  most  useful  after  Calcarea. 

Carbo  vegetabilis.  Arsen.,  Kali.,  Merc,  will  often  be  found 
suitable  after  Carbo  vegetabilis. 

Cinchona.  Arsen.,  Bella.,  Puis.,  Veratr.,  are  sometimes  suitable 
after  Cinchona. 

Cuprum.  Calc.  and  Veratr.  are  sometimes  of  service  after 
Cuprum. 

Hepar  sulph.  Bella.,  Merc,  Nitr.  ac,  Spong.,  Silicea,  are  some- 
times suitable  after  Hepar  sulph. 

Ipecacuanha.  Am.,  Ars.,  Chin.,  Cocc,  Ign.,  Nux,  are  sometimes 
suitable  after  Ipecacuanha. 

Lachesis.  Ahim.,  Ars.,  Bell.,  Carb.  v.,  Con.,  Bulc,  Merc,  Nux  vom., 
Pkos.  acid.,  are  sometimes  useful  after  Lachesis. 

Lycopodium.  Graph.,  Ledum,  Phos.,  Puls.9  SiUc,  are  sometimes 
serviceable  after  Lycopodium. 

Mercurius.  After  Mercurius,  Bell.,  Bulc,  Hepar,  Lach.,  Nitr.  acid., 
Lep.,  Sulph.,  are  sometimes  suitable. 

Nux  vomica.  Bryon.,  Puis.,  and  Sulph.,  will  frequently  be  found 
efficacious  after  Nux  vomica. 

Opium.  After  Opium,  Calc,  Petr.,  Puis.,  will  sometimes  be  found 
of  use. 

Phosphorus.  Petr.  and  Rhus  will  be  found  suitable  after  Phos- 
phorus. 

Pulsatilla.  Asa,,  Bryon.,  Nitr.  ac,  and  Sepia,  are  sometimes 
suitable  after  Pulsatilla. 

Rhus  toxicodendron.  Am.  c,  Ars.,  Bryon.,  Calc,  Con.,  Phos., 
Phos.  ac,  Puis.,  and  Sulph.,  are  sometimes  useful  after  Rhus  tow. 

Sepia.      After  Sepia, —  Carbo  v.,  Puis,  are  sometimes  suitable. 

Silicea.  After  Silicea, — Hepar,  Lach.,  Lyco.,  Sepia,  are  sometimes 
of  service. 

Spongia.  Hepar  sulph.  is  sometimes  suitable  after  Spongia — for 
instance  in  croup. 

Sulphur.  Aeon.,  Bell.,  Calc,  Cupr.,  Merc,  Nitr.  ac,  Puis.,  Rhus, 
Sepia,  Sil.,  are  sometimes  suitable  after  Sulphur. 

Tartarus  emeticus.  After  Tatar,  emet.,  Bar.  c,Ipec,Puls.,  Sep., 
are  sometimes  useful. 

Veratrum.  After  Veratrum,  Ars.,  Am.,  Chin.,  Cupr.,  Ipec,  are 
sometimes  suitable. 


RULES    FOR    DIET. 

SYNOPSIS  OF  THE  RULES  FOR  DIET. 

UNDER  HOMOEOPATHIC  TREATMENT. 


ALIMENTS    ALLOWED. 


Soup  or  broth  made  from  the  lean  of  beef,  veal,  mutton,  or  chicken : 
to  which  may  be  added,  well  boiled  sago,  tapioca,  vermicelli,  rice, 
semolina,  or  maccaroni,  young  peas,  carrots,  pearl  barley,  or  other 
farinaceous  materials,  seasoned  merely  with  a  little  salt. 

Meats.  Beef,  mutton,  (poultry  rarely,)  pigeons,  larks,  rabbits, 
(venison,  and  game  in  general,  may  in  most  cases  be  partaken  of  in 
moderation,  but  never  when  high,)  plainly  cooked,  and  roasted,  broiled, 
or  stewed  in  its  own  juice,  in  preference  to  boiled.  (Ham  or  neat's 
tongue  rarely.) 

Msh.  Soles,  whiting,  smelts,  trout,  and  flounders,  perch,  and 
such  like,  boiled  in  preference  to  fried ;  when  cooked  in  the  latter 
manner,  the  white  must  alone  be  partaken  q|,  and  the  outer  or  fried 
portions  rejected. 

Vegetables.  Potatoes,  brocoli,  green  peas,  cauliflower,  spinach, 
artichokes,  parsnips,  carrots,  turnips,  French-beans,  sea-cale,vegetable 
marrow,  stewed  lettuce,  well  cooked,  and  prepared  with  the  gravy  of 
meat,  or  with  milk,  where  required,  instead  of  butter. 

Eggs  lightly  dressed;  all  kinds  of  light  bread,  not  new-baked;  and 
biscuit,  free  from  soda,  potash,  and  the  like  ingredients. 

Light  puddings,  such  as  those  made  from  vermicelli,  semolina,  fecula 
of  potato,  sago,  arrow-root,  bread,  rice ;  simple  cakes,  composed  of 
flour  or  meal,  eggs,  sugar,  and  a  little  good  butter. 

Fruit.  Baked,  stewed,  or  preserved  apples  and  pears :  also  goose- 
berries, raspberries,  grapes,  or  any  other  wholesome  fruit  not  of  an 
acid  quality,  fully  ripe,  preserved,  or  in  the  form  of  jelly,  may  occa- 
sionally be  partaken  of. 

Beverage.  Water,  milk,  cocoa,  chocolate  (unspiced),  arrow-root  or 
gruel  (made  thin),  toast- water,  barley-water,  milk  and  water,  sugar 
and  water,  rice-water. 

Salt  should  be  used  in  moderation. 


UTILES    FOR   DIET. 


ALIMENTS    PROHIBITED. 


Soups.  Turtle,  mock-turtle,  ox-tail,  giblet,  mulligatawny,  and  all 
rich  and  seasoned  soups. 

Meats.  Pork,  bacon,  calf's  head,  veal,  turkey,  duck,  goose,  sau- 
sages, kidney,  liver,  tripe,  and  every  kind  of  fat  and  salted  meat. 

Fish.  Crab,  lobster,  oysters,  and  shell-fish  in  general ;  and  almost 
all  other  fish  not  specified  in  Aliments  allowed. 

Vegetables.  Cucumber,  celery,  onions,  greens,  cabbage,  radishes, 
parsley,  horseradish,  leeks,  thyme,  garlic,  asparagus ;  and  every 
description  of  pickles,  salads,  and  raw  vegetables,  or  vegetables 
greened  with  copper. 

Pastry  of  all  kinds,  whether  boiled,  baked,  or  fried. 

Spices,  Aromatics,  and  Artificial  Sauces  of  all  kinds  ;  as  also  the  ordi- 
nary condiments,  mustard  and  vinegar. 

Cheese. 

Chesnuts,  filberts,  wTalnuts,  almonds,  raisins,  and  indeed  the  entire 
complement  of  a  dessert,  except  what  has  been  mentioned  in  Aliments 
allowed,  under  Fruit.    (See  also  article  Regimen.) 

The  above  regulations  are  subject  to  considerable  modifications  in 
particular  cases,  both*as  regards  the  articles  allowed,  and  those 
which  are  prohibited.  Regularity  in  the  hours  of  meals  should  be 
observed ;  and  too  long  fasting,  as  well  as  too  great  a  quantity  of 
food  at  one  time  should  be  avoided. 


PART  I. 

ON  THE  SYMPTOMS,  CHARACTER,  DISTINCTION,  AND 
TREATMENT  OF  DISEASES. 


FEVERS.     Febres. 


GENERAL  CONSIDERATION  OF  FEVER. 
CAUSES,  TREATMENT,  AND  DIET  TO  BE  OBSERVED. 

Perhaps  no  form  of  disease  has  more  occupied  the  attention  of 
pathologists,  or  given  rise  to  a  greater  number  of  theories  than 
Fever.  Many  authors  consider  fever  and  inflammation  as  synony- 
mous terms,  others  as  mere  modifications  of  the  same  pathological 
state  of  the  system.  The  investigation  is  certainly  one  possessing 
peculiar  interest ;  but,  fortunately,  in  the  homoeopathic  system,  no 
theory  can  in  the  slightest  degree  affect  the  practice,  since,  in  the 
treatment  of  this  class  of  disease,  the  external  phenomena  present 
sufficient  indications  for  the  selection  of  the  proper  remedies. 

Acute  diseases  have  always  been  considered  as  the  true  touchstone 
of  every  system  of  therapeutics.  Homoeopathy  has  been  submitted 
to  the  test,  and  the  results  have  at  once  proved  the  bold  assertion 
of  its  founder,  that  its  principle  is  a  law  of  Nature, — the  minute 
doses  act  in  these  cases  wdth  a  promptness  and  certainty  scarcely  to 
be  credited,  except  by  those  who  have  either  witnessed  or  experienced 
their  power :  under  this  system,  the  disease  is  brought  to  a  salutary 
crisis,  before  any  great  expenditure  of  vital  energy  has  taken  place  ; 
and,  from  this  circumstance,  combined  wdth  the  absence  of  debili- 
tating measures,  the  period  of  convalescence  is  greatly  shortened,  and 
in  many  instances  scarcely  perceptible,  the  patient  being,  as  it  were, 
at  once  restored  from  a  state  of  disease  to  one  of  perfect  health. 

Although  I  shall  avoid  entering  into  any  of  the  theories  respecting 
fever  and  inflammation,  I  cannot  but  render  the  tribute  of  my  admi- 


6  FEVERS. 

ration  to  the  gifted  men  who  have  devoted  so  much  of  their  time  and 
energies  to  the  elucidation  of  this  difficult  pointy  since  every  new 
pathological  discovery  serves  to  throw  light  upon  the  specific  action 
of  medicinal  substances.  Practically  speaking,  when  we  find  a  medi- 
cine produce  a  change  of  health  resembling  that  present  in  fevers, 
we  know  that  in  such  fevers  it  is  curative ;  still  it  would  be  a  satis- 
faction to  be  enabled  to  trace  the  connexion  more  closely,  and  to  show 
the  perfect  affinity  between  medicinal  and  morbid  action.  There  is 
no  doubt,  that,  if  a  perfect  theory  of  fever  be  ever  given  to  the  world, 
it  will  be  found  in  perfect  accordance  with  the  homoeopathic  law. 

In  all  forms  of  acute  disease  fever  is  present ;  in  fever,  properly  so 
called,  there  is  generally  functional  disturbance,  accelerated  action  of 
the  vascular,  with  the  participation  of  the  nervous  system,  and  a 
tendency  to  increased  development  of  heat.  The  symptoms  common 
to  most  fevers  are,  at  first,  a  feeling  of  coldness  or  shivering,  then 
heat,  accelerated  pulse,  thirst,  restlessness,  and  languor.  Fever  also 
possesses  the  property  of  passing  from  one  species  into  another. 
Thus  inflammatory  fever  may,  by  severe  antiphlogistic  measures,  be 
altered  into  a  low  typhus ;  or,  on  the  other  hand,  a  simple  fever,  by 
injudicious  treatment,  may  be  changed  into  an  inflammatory  one ; 
and  that  again  assume  the  intermittent  form ;  also,  one  attack  may 
present  all  these  different  phases. 

Fevers,  terminating  fortunately,  and  running  a  regular  course,  may 
be  divided  into  five  stages :  the  accession,  increase,  crisis,  decrease, 
and  convalescence.  When  the  result  is  fatal,  it  may  arise'  from  a 
metastasis,  the  exhaustion  of  the  vital  energy  of  the  patient,  or  the 
disorganization  of  some  important  function. 

The  belief  in  critical  days  is  of  very  ancient  origin,  though  there 
is  some  difference  in  the  calculations  of  physicians  upon  this  point : 
some  counting  from  the  day  the  shiverings  declare  the  onset,  others 
from  the  first  hot  fit;  except  in  cases  where  a  marked  periodicity 
exists,  as  in  quotidian  and  other  forms  of  ague,  such  distinctions 
are  of  little  value,  inasmuch  as  the  homoeopathic  treatment  is  directed 
to  forwarding  the  crisis,  and  thereby  materially  shortens  the  duration 
of  the  disease.  Statistics  prove  that  the  average  continuation  of  acute 
affections  is  much  shorter  under  the  homoeopathic  system,  than  it  is 
where  they  are  treated  allopathically,  or  left  to  nature ;  consequently, 
any  calculations  based  upon  other  modes  of  treatment  are  not  to  be 
depended  upon,  and  the  best  plan  for  the  physician  to  follow  is  to 
watch  attentively  the  disease  before  him,  and  apply  the  remedies  his 


FEVERS.  7 

knowledge  and  experience  point  out  as  best  calculated  to  conduct  it 
to  a  satisfactory  issue. 

A  crisis  may  declare  itself  by  diarrhoea,  profuse  perspiration, 
hemorrhage,  or  increase  or  alteration  of  other  secretions,  or  by  the 
appearance  of  an  eruption,  after  which,  if  salutary,  the  skin  becomes 
moist  and  resumes  its  functions,  and  the  pulse  returns  to  usual 
standard. 

Fevers  have  been  differently  classified  by  various  medical  writers. 
The  arrangement  we  shall  adopt  is  as  follows :  simple  irritative  fever, 
inflammatory  fever,  typhus,  putrid,  and  gastric  or  bilious  fevers, 
intermittent  fevers,  and  then  eruptive  fevers,  such  as  scarlatina, 
measles,  &c. 

Although  this  mode  of  classification  is  adopted  for  the  sake  of 
convenience,  the  author  has  no  intention  of  generalizing  disease : 
every  febrile  attack  presents  peculiar  features,  and  is  to  be  treated  as 
an  individual  affection,  and  according  to  the  nature  of  the  symptoms 
presenting  themselves,  not  by  a  blind  adherence  to  the  nomenclature 
of  disease. 

Causes  of  Fever.  It  cannot  be  denied  that  there  exists  in  cer- 
tain individuals,  a  particular  predisposition  to  acute  diseases,  and,  as 
before  remarked  in  the  Introduction,  the  sanguine,  nervous,  and 
bilious  temperaments  possess  this  susceptibility  in  a  far  more  marked 
degree  than  the  phlegmatic. 

The  exciting  causes  are  numerous.  Miasms,  epidemic  influences, 
contagion,  powerful  mental  emotions,  derangement  of  some  important 
organ,  external  lesions,  excess  or  errors  in  diet,  heat  or  cold,  or  alte- 
rations of  temperature,  exposure  to  cold  or  damp,  repercussed  erup- 
tions— in  fact,  anything  that  causes  derangement  of  the  equilibrium 
of  the  system  may  produce  fever. 

GENERAL  TREATMENT  IN  FEVER,  AND  DIET. 

The  great  essentials  in  the  treatment  of  fever  are  : 

Perfect  rest,  mental  and  bodily. 

Pure  air  and  a  cool  apartment ;  the  temperature  of  the  patient's 
room  should  never  exceed  55  degrees. 

Feather-beds  should  be  discarded  and  mattresses  substituted,  when 
practicable,  and  the  bed-clothes  be  light  but  sufficient. 

Nature  herself  generally  prescribes  the  regimen  to  be  observed 
by  taking  away  appetite,  while  the  thirst  present,  as  an  eminent 


b  FEVERS. 

medical  writer  lias  well  observed,  may  be  considered  as  her  voice 
calling  for  fluid.  Water  is  the  best  diluent ;  no  solid  food,  broth,  or 
even  gruel  and  the  like,  should  be  permitted  in  cases  where  the  in- 
flammation runs  excessively  high ;  and  the  utmost  caution  is  to  be 
observed  in  allowing  gruel  or  weak  broths  during  the  decrease :  an 
error  in  this  respect  often  causes  irreparable  mischief,  and  it  is  always 
safer  to  err  a  little  on  the  side  of  abstinence  than  on  that  of  in- 
dulgence. 

Toast-water,  or  wreak  barley-  or  rice-water,  sweetened  with  a  little 
sugar  or  raspberry  or  strawberry  syrup,  or  orangeade,  may  be  allowed 
when  the  fever  is  somewhat  abated,  though  then  we  must  still  care- 
fully avoid  incurring  the  risk  of  a  relapse,  by  giving  any  aliment  likely 
to  tax,  in  however  slight  a  degree,  the  digestive  powers.  Fruits, 
such  as  those  which  have  been  enumerated  in  the  Rules  for  Diet  (see 
Introduction),  are  very  generally  allowable  in  most  forms  of  fever, 
unattended  with  diarrhoea.  Drinks  ought,  for  the  most  part,  to  be 
given,  in  preference,  frequently,  and  in  small  quantities,  than  in  large 
draughts. 


SIMPLE  OR  EPHEMERAL  FEVER. 

Febris  simplex. 

The  disease  seldom  presents  any  distinct  character,  and  generally 
runs  its  course  in  twenty-four  hours  ;  as,  however,  it  frequently  forms 
the  initiative  of  other  more  serious  disorders,  it  deserves  attention. 
Before  attacks  of  scarlatina,  measles,  smallpox,  &c.,  it  is  generally 
present,  although  occasionally  showing  itself  as  a  distinct  affection. 

Diagnosis.  Shivering,  followed  by  heat,  restlessness,  thirst,  acce- 
lerated pulse,  general  uneasiness  and  lassitude,  terminated  by  profuse 
perspiration. 

In  allopathic  practice,  unless  the  immediate  cause  of  the  affection 
can  be  traced, — for  instance,  indigestion,  — the  treatment  is  occasionally 
hazardous ;  for,  if  the  simple  fever  be  merely  the  commencement  of 
an  attack  of  severe  inffammation,  the  allopathic  physician  incurs 
either  the  risk  of  increasing  it  by  using  stimulants,  under  the  idea  of 
its  being  a  precursor  of  typhus;  or,  acting  upon  the  opinion  of  its 
being  a  forerunner  of  inflammation,  of  weakening  the  constitution  by 
antiphlogistic  methods,  if  it  should  unfortunately  run  on  to  the  former. 
In  this  case,  the  safer  plan  was  to  wait  quietly  the  development  of  the 


INFLAMMATORY  FEVER.  V 

affection,  in  order  to  see  if  it  would  terminate  in  a  crisis,  or  take  upon 
it  a  more  virulent  form,  and  then  deal  with  it  accordingly. 

Treatment,  Throughout  this  work  the  disease  will  be  found 
treated  of,  both  when  arising  from  indigestion  or  cold,  and  when 
appearing  as  the  precursor  of  other  affections ;  but  when  it  is  encoun- 
tered along  with  the  symptoms  already  detailed,  and  cannot  be  traced 
to  any  particular  exciting  cause,  and  particularly  when  hot  dry  shin 
is  present,  Aconite  should  be  prescribed,  which,  if  it  be  simple  fever 
properly  so  called,  will  speedily  dissipate  all  the  symptoms ;  and,  if  it 
be  the  forerunner  of  any  more  severe  disorder,  either  at  once  check 
its  further  progress  or  materially  modify  its  malignancy.  The  former 
is  more  peculiarly  the  case  with  purely  inflammatory  attacks :  the 
latter  holds  good  as  far  as  relates  to  typhus,  exanthematic  diseases, 
and  some  other  affections,  which  run  a  regular  course. 


INFLAMMATORY  FEVER.     SYNOCHAL  FEVER. 

Febris  inflammatoria  simplex.    Spwcha.     Febris  synochalis. 

Diagnosis,  Rigors  (generally  considerable),  followed  by  burning 
heat;  pulse  strong,  hard,  and  greatly  accelerated;  dryness  of  the 
skin,  mouth,  lips,  and  tongue ;  the  latter  generally  of  a  bright  red,  in 
some  cases  slightly  coated  with  white ;  thirst ;  urine  red  and  scanty ; 
constipation;  respiration  hurried,  in  accordance  with  the  pulse; 
amelioration  of  symptoms  as  the  pulse  assumes  a  more  normal 
state.  It  runs  its  course  with  rapidity,  rarely  exceeding  fourteen 
days,  and  progressing  with  regularity  to  a  crisis,  which  shows  itself 
in  profuse  perspirations,  critical  urine,  diarrhoea  or  hemorhage,  prin- 
cipally epistaxis.  The  period  mentioned  is  its  ordinary  average  of 
duration,  but  under  homoeopathic  treatment,  the  perfect  crisis  is  con- 
siderably hastened  without  the  long  convalesence  entailed  by  the  usual 
antiphlogistic  means. 

It  is  peculiarly  apt,  if  not  carefully  treated,  to  change  into  typhus, 
or,  by  metastasis,  to  fix  upon  some  important  organ. 

Causes.  Sudden  chill,  or  check  of  perspiration,  exposure  to  damp 
or  wet,  dry  easterly  winds,  violent  mental  emotion,  high  living,  ex- 
ternal injury  or  lesion,  locai  inflammation,  and  slight  febrile  attacks 
mismanaged. 

Individuals,  of  what  is  denominated  a  plethoric  habit,  are  particu- 


10  FEVERS. 

larly  subject  to  this  disease ;  it  generally  attacks  between  the  ages  of 
i  5  and  30  years. 

Under  the  diagnosis  we  have  given  the  pathognomonic  symptoms 
of  synocha ;  we,  however,  find  it  complicated,  in  the  majority  of  cases 
with  more  or  less  cerebral  disturbance,  which  we  shall  consider  more 
in  detail  under  Inflammation  of  the  brain  or  its  tissues. 

Treatment.  Although,  throughout  this  work,  the  author  pur- 
poses to  confine  himself  to  pointing  out  the  remedies  most  valuable 
in  disease,  without  entering  into  any  disquisition  upon  their  efficacy, 
or  the  principle  of  their  employment,  yet  he  cannot  refrain,  in  this 
instance,  from  briefly  noticing  a  medicament,  which  has  so  success- 
fully superseded  all  the  antiphlogistic  measures  of  the  old  school, 
subduing,  as  it  does,  the  inflammation,  without  lowering  the  vital 
energy.  No  one,  who  compares  the  pathogenetic  symptoms  of  Aco- 
nite given  in  the  Materia  Medica  Bur  a  of  Hahnemann,  and  carries 
in  mind  the  principle  of  its  application,  can  forbear  being  struck  with 
the  close  resemblance  which  they  present  to  those  of  pure  inflamma- 
tory disease ;  and  by  this  powerful  auxiliary,  the  author  has  no  hesi- 
tation in  declaring,  that  disease  of  the  said  description  is  brought  so 
fully  under  the  control  of  the  physician,  as  to  be  in  a  great  measure 
divested  of  its  malignancy,  and  in  no  case  is  the  superiority  of 
Homoeopathy  more  strongly  evidenced. 

When,  therefore,  the  symptoms  above  mentioned  are  present,  we 
may  at  once  prescribe  Aconite  as  follows : — 

R  Tinct.  Aeon.  3,  gtt.  iij. 
Aq.  pur.  Jiij.  M. 

Dose.  |ss  every  three  to  six  hours,  according  to  the  intensity  of  the 
fever.  The  pulse  should  be  carefully  watched,  and  also  the  appear- 
ance first  of  simple  moisture  of  the  skin,  and  subsequently  of  copious 
sweating,  which  generally  takes  place  after  the  first  or  second  dose  of 
Aconite.  The  intervals  between  the  doses  must  be  lengthened  as 
soon  as  this  favorable  crisis  sets  in. 

A  slight  degree  of  delirium  is  frequently  present  in  this  affection, 
chiefly  at  night,  which — unless  it  threatens  to  run  on  to  inflammation 
of  the  brain,  in  which  case  Belladonna  must  be  had  recourse  to — Aco- 
nite of  itself  is  sufficient  to  subdue.  When,  however,  during  the 
course  of  the  affection,  other  symptoms,  besides  those  mentioned, 
develop  themselves,  we  may  find  it  necessary  to  have  recourse  to 
different  remedies,  such  as  Belladonna,  Bryonia,  &c. 

Belladonna  is  especially  useful  after  the  previous  employment 


INFLAMMATORY  FEVER.  11 

of  Aconitum  ;  but  it  may  be  prescribed  at  the  commencement  of  the 
attack  in  all  cases  when  the  cerebral  system  seems  prominently  affected, 
and  there  is  great  heat  in  the  head,  with  violent  cephalagia,  particu- 
larly in  the  forehead,  and  redness  of  the  face;  distension  of  the  arteries 
of  the  neck  and  temples  ;  nocturnal  sleeplessness,  with  furious  delirium  ; 
eyes  red,  shining  and  fiery ;  general  internal  and  external  heat ;  burn- 
ing thirst  and  agonizing  restlessness. 

R  Tinct.  Bellad.  6,  gtt.  ij. 
Aquse  purae,  ^ij* 

Dose.  Jss  every  four  hours,  until  amelioration  supervenes,  or  we 
observe  unequivocal  symptoms  of  medicinal  aggravation ;  in  which 
latter  case  we  must  cease  to  prescribe  altogether,  until  the  reaction 
has  taken  place ;  and  in  the  former,  lengthen  the  intervals  of  repeti- 
tion, as  the  improvement  advances.* 

Bryonia.  When  the  orgasm  is  chiefly  concentrated  in  the  tho- 
racic viscera,  or  when  there  is  gastric  complication,  and  the  fever 
inclines  to  degenerate  into  synochus.  This  medicament  is  accord- 
ingly indicated  when,  in  addition  to  the  usual  symptoms  of  inflam- 
matory fever  already  given,  Ave  find  a  heavy  stupefying  headache,  with 
a  sensation  as  if  the  head  would  burst  at  the  temples,  much  aggra- 
vated by  movement,  vertigo  and  giddiness  on  rising  up  or  moving  ;  burn- 
ing heat  of  the  head  and  face,  with  redness  and  swelling  of  the 
latter ;  delirium ;  oppression  at  the  pit  of  the  stomach  ;  excessive  thirst, 
sometimes  followed  by  vomiting;  constipation;  aching  or  shooting 
pains  in  the  limbs,  short  cough,  oppression  at  the  chest,  and  laborious 
breathing. 

R  Tinct.  Bryon.  3,  gtt.  iij. 
Aq.  purse,  Jiij. 

Dose.  Jss  every  six  or  eight  hours ;  few  cases  are  so  particularly 
urgent,  as  to  require  more  frequent  administration  of  this  remedy ; 
indeed,  when  the  virulence  of  the  disease  has  been  subdued,  a  single 
dose  is  generally  found  sufficient,  and  no  further  exhibitions  should 
take  place,  as  long  as  the  patient  manifestly  continues  improving. 

Cantharis  has  been  recommended  in  irritative  fever  bearing  a 
close  resemblance  to  pure  synocha,  and  especially  when  the  follow^- 
ing  symptoms  become  developed :  the  fever  is  very  intense  during  the 
night,  and  is  accompanied  by  burning  heat  of  skin,  strong  accelerated 
pulse,  general  redness  of  the  surface,  dryness  of  the  mouth,  and  violent 
thirst.  Further,  when  pains  are  complained  of  in  the  right  side  of 
*  See  remarks  on  medicinal  aggravation,  in  the  Introduction. 


12  FEVERS. 

the  body,  attended  with  great  anxiety  and  raving.  Chamomilla  is 
useful  in  pseudo  synochal  fever,  with  burning  heat  and  bright  redness 
of  the  cheeks,  tremulous,  anxious,  palpitation  of  the  heart,  extreme 
irritability  of  temper,  and  over  sensibility  of  the  senses,  alternate 
heats  and  chills,  and,  sometimes,  spasmodic  attacks,  &c.  Chamo- 
milla is  peculiarly  applicable  when  the  above  symptoms  have  been 
excited  by  a  fit  of  passion  or  vexation.  A  dose  or  two  of  Aconite 
is,  however,  generally  requisite,  in  the  first  place,  when  the  derange- 
ment has  been  excited  by  the  aforesaid  cause. 

When  inflammatory  fever  seems  to  arise  from  a  primary  inflamma- 
tion of  some  important  organ,  such  as  the  Head,  Lungs,  Liver,  or 
Stomach  and  Bowels,  the  treatment  will  be  found  under  the  head  of 
Inflammation  of  the  function  most  evidently  the  seat  of  the  dis- 
order. 

It  is  sometimes  the  result  of  severe  lesion,  in  which  case  the  patient 
is  to  be  treated  as  prescribed  under  External  Injuries. 

NERVOUS  FEVER.     SLOW-FEVER. 

Febris  nervosa.     Typhus. 

It  is  sometimes  extremely  difficult,  particularly  when  the  disease 
arises  from  some  local  affection  of  the  more  important  viscera,  to  dis- 
criminate, at  the  commencement,  between  a  nervous  and  inflammatory 
attack,  so  as  to  give  a  decided  diagnosis.  However,  in  such  cases 
the  marked  advantage  of  the  homoeopathic  system  is  again  showTn ; 
for,  by  exhibiting  medicines  in  accordance  with  the  symptoms  that 
declare  themselves,  we  run  no  risk  either  of  weakening  the  vital 
energies,  should  we  err  in  our  diagnosis,  and  treat  it  on  its  first 
appearance  as  an  inflammatory  attack, — or  of  stimulating  the  inflam- 
mation by  what  is  commonly  denominated  an  anti-nervous  treatment, 
should  the  precursory  symptoms  lead  us  to  consider  it  typhus,  and  it 
afterwards  assume  the  inflammatory  form. 

Diagnosis.  Typhus  rarely  sets'  in  with  such  marked  symptoms 
as  announce  the  approach  of  inflammatory  fever ;  instead  of  severe 
chills  or  shiverings,  we  first  find  a  complaint  of  general  uneasiness,  a 
sensation  of  chilliness,  occasionally  followed  by  a  greater  or  less  de- 
gree of  heat.  The  patient  either  complains  but  little,  or  of  pains  in 
his  head,  chest,  and  abdomen,  and  frequently  an  unusual  degree  of 
drowsiness  is  present,  arising  from  a  comatose  state  of  the  brain — - 
there  is  also  occasionally  a  slight  dyspnoea — after  various  alternations 


NERVOUS  FEVER.  13 

of  cold  and  heat,  the  former  sensation  predominates  in  the  feelings  of 
the  patient,  while  to  those  around  him  he  appears  hot ;  the  extremities* 
however,  on  examination,  are  found  cold.  Different  characters  of 
pulse  present  themselves;  sometimes  it  is  full  and  soft,  at  others 
accelerated,  frequently  about  the  natural  standard  or  below  it,  or  quick 
and  weak,  but  not  strong  and  hard  as  in  inflammatory  fever :  the  fre- 
quent difference  between  the  action  of  the  pulse  and  heart  is  worthy 
of  notice,  the  former  may  be  so  weak  as  scarcely  to  be  perceptible,  and 
the  action  of  the  latter  strong ;  the  pulse  also  may  be  hurried  and 
the  respiration  natural.  As  the  disease  progresses,  the  tongue,  at  first 
moist,  becomes  thickly  coated,  dry,  glazed,  and  tremulous ;  there  is 
faintness,  cephalalgia,  giddiness,  and  vertigo :  the  delirium,  at  first 
slight,  and  manifesting  itself  only  at  night,  becomes  unintermitted, 
and  is  characterized  rather  by  wandering  and  low  muttering,  than 
fury  and  violence  :  we  may  also  meet  wdth  spasms  and  convulsions. 
All  these  symptoms,  if  the  disease  be  allowed  to  gain  ground,  increase 
in  malignancy,  the  evacuations  become  involuntary,  the  weakness  and 
lassitude  excessive,  and  the  patient  sinks  down  to  the  bottom  of  the 
bed — an  evidence  of  complete  prostration  of  strength,  while  all  endea- 
vours to  rouse  him  are  fruitless,  and  he  is  perfectly  blind  to  all  around. 
Tenderness  of  the  abdomen,  or  pain  in  the  region  of  the  caecum  is 
also  frequently  met  with. 

Some  only  of  the  above  symptoms  may  be  present,  or  the  fever  may 
be  complicated  with  others :  when  only  a  few  of  the  less  virulent 
symptoms  declare  themselves,  it  is  called  mild  typhus ;  when  compli- 
cated with  considerable  disturbance  of  the  vascular  system,  great  heat, 
and  quick  hard  pulse,  inflammatory  typhus  :  a  distinction  is  also  found 
in  the  type,  as  in  continuous  and  intermittent  typhus ;  in  the  acci- 
dental circumstances  or  exciting  causes  present,  as  for  instance  in  the 
gastric  and  catarrhal  complications,  which,  although  generally  treated 
as  gastric  or  catarrhal  fevers,  with  typhoid  symptoms,  may  be  con- 
sidered as  modifications  of  this  affection;  this  difference  in  arrange- 
ment can,  however,  make  none  in  practice,  as  we  must  be  guided  by 
the  symptoms  that  present  themselves  in  selecting  our  remedies. 

The  congestive  fever  of  some  authors  may  be  considered  as  a 
variety  of  typhus,  in  w7hich  from  the  balance  of  the  circulation  being 
destroyed,  the  blood  is  determined  to  some  particular  organ,  the  ex- 
ternal heat  of  the  body  diminished,  and  the  pulse  becomes  slow  and 
oppressed.  The  symptoms  vary  according  to  the  organs  attacked. 
It  may  be  remarked  that  in  most  forms  of  this  malady,  the  course  is 


14  FEVERS. 

extremely  irregular — the  precursory  symptoms  may  precede  the  dis- 
ease only  a  few  days  or  several  weeks,  and  its  duration  is  also  uncertain. 

Death  may  take  place  from  exhaustion  of  the  vital  energies,  para- 
lysis of  the  whole  system,  or  of  the  brain,  apoplexy,  disorganization 
of  some  of  the  nobler  viscera,  or  a  change  to  the  putrid  form. 

Causes.  Densely  populated  neighbourhoods,  where  a  number  of 
individuals  are  crowded  into  small  apartments,  and  the  air  rendered 
impure  by  exhalations  from  decomposed  animal  and  vegetable  matter, 
stagnant  water,  and  a  want  of  circulation,  are  the  very  hotbeds  of 
typhus ;  a  deficiency  and  improper  quality  of  food  are  often  added  to 
the  above,  and  are  of  themselves  sufficient  to  produce  it :  other  causes 
are,  over- exertion,  either  of  body  or  mind,  or  excesses  of  any  kind, 
the  prevalence  of  cold,  damp  weather,  mental  emotions,  and  contagion. 

In  fact,  anything  tending  to  depress  the  vital  energies  may  be  pro- 
ductive of  typhus ;  it  may  consequently  arise  after  inflammatory  fever 
treated  by  bloodletting  or  other  severe  antiphlogistic  measures,  or  even 
by  the  reaction  of  the  organism,  or  an  imperfect  crisis  after  the  same 
affection. 

The  prognosis  in  typhus  is  to  be  formed  by  the  type  of  the  fever, 
the  regularity  of  its  course,  the  local  complications,  the  greater  or 
lesser  intensity  of  the  symptoms,  and  the  tendency  to  a  dissolved 
state  of  the  fluids ; — continued  delirium  and  stupor ;  carpologia,  sub- 
sultus  tendinum,  impeded  speech  and  deglutition,  tremulous  or  para- 
lytic state  of  the  tongue  ;  a  fetid  exhalation  from  the  body ;  excessively 
offensive,  dark,  dysenteric  stools ;  effusions  of  blood  under  the  skin, 
or  the  early  appearance  of  miliary  eruption ;  involuntary  evacuation 
of  faeces  and  urine  ;  hemorrhages  and  hiccough  are  highly  unfavor- 
able signs.  On  the  other  hand,  the  absence  of  stupor  and  delirium, 
or  abatement  of  febrile  heat  and  thirst,  returning  strength  of  pulse,  a 
gentle  transpiration  over  the  wrhole  body,  loose  bilious  stools,  gradual 
clearing  of  the  previously  turbid  urine,  or  moderate  cloudiness  in 
place  of  the  former  clear  or  colourless  urine,  and  deposition  of  a  late- 
ritious  sediment,  are  to  be  held  as  favorable  indications.  Typhus 
fever  generally  begins  to  subside  in  this  and  other  temperate  or  cold 
climates  about  the  fourteenth  or  sixteenth  day,  but  is  frequently  pro- 
tracted to  a  much  longer  period.  In  warm  climates,  again,  the  fever 
commonly  terminates  in  six  or  eight  days. 

The  following  remedies  have  been  found  the  best  adapted  to  the 
different  forms  of  typhus: 

Aeon.,  Bella.,  Bryon,.,  Rhus,  Nwc,  Acid,  m.,  Lycop.,  Hyoscy.,  Slram.y 


NERVOUS  FEVER.  15 

Cham.,  .  Natrum  m.—\VL  nervous  fever,   characterized   by   erythismus 
(Febris  nervosa  versatilis.) 

Bella.,  Rhus,  Arsenic,  Bryony  Qp*,  Hyosc,Stram.,  China,  Cocc,  Nux  v., 
Veratr.,  Am.,  Nitr*  sp. — in  Febris  nervosa  stupida,  or  slow  typhus. 

Aeon.,  Bella.,  Hyoscy.,  Bry.,  Bach.,  Op.,  Straw.,  Rhus,  Acid.phosp.,  Cupr. 
ac. — in  Typhus  cerebralis. 

Bryon.,  Rhus,  or  Aeon.,  Merc.,.  Cham.,  Nux,  Feratr.,  Bella.,  Hyoscy., 
Arsenic,  China,  Sulph.,  and  Senega,— in  Pneumo-typhus,   Typhus 

PULMONALIS. 

Ipecac,  Puis.,  Cham.,  Bryon.,  Nux,  Ignat.,  Cocc,  Am.,  China,  Digit., — • 
in  Typhus  bil,iosus  s.  Typhus  gastricus. 

Rhus,  Bryon.,  or  Arsenic,  Merc,  China,  Carb.  v.,  Phosph.,  Canth.,  Puis., 
Sulph.,  Calc,  Acid,  nitr.,  Nux  mosch.—m  Typhus  abdominalis, 
Typhus  gravior  {malignant,  putrid,  or  petechial  fever.) 

During  the  period  of  incubation  the  development  of  the  disease  may 
sometimes  be  prevented,  or  the  attack  rendered  much  milder  by  the 
employment  of  Bryonia  or  Rhus,  or  both  of  these  remedies  in  alterna- 
tion (see  the  indications  given  further  on).  In  the  inflammatory  period 
Bryonia  is  one  of  the  most  important  remedies,  but  it  will  not  unfre- 
quently  be  found  necessary  to  select  one  or  more  of  the  following  in 
this  stage  :  Aeon.,  Bella.,  Cham.,  Hyoscy.,  Nux  v.,  Bycopod.,  Stram. 

In  the  period  of  debility,  Rhus  is  almost  always  of  a  greater  or 
less  degree  of  utility,  and  is  often  alone  sufficient  to  effect  such  a 
favorable  change  as  to  render  it  a  comparatively  easy  task  to  conduct 
the  fever  to  a  successful  issue.  The  other  remedies,  which  are  often 
required  at  the  debile  stage,  are,  Arsenicum,  Carbo  vegetabilis,  Acidum 
muriatieum,  Mercurius,  and  Ci,nchona ;  or,  Acid,  phosph.,  Bach.,  Am., 
Nux  mosch.,  and  Sulph. 

In  ileo-typhus,  with  ulcerations,  Carbo  v.,  Rhus,  Acid,  nitr.,  Phosphor*, 
and  Bycop.  are  the  most  deserving  of  attention. 

Carb.  v.  is  occasionally  of  service  in  cases  which  seem  utterly 
hopeless;  the  pulse,  from  being  almost  imperceptible,  becoming 
stronger,  and  the  sinking  energies  rallying  in  such  a  manner,  after 
the  employment  of  this  remedy,  that  the  patient  is  readily  placed  out 
of  danger  by  the  aid  of  one  or  more  of  the  medicaments  above 
enumerated,  and  particularly  such  as  Rfais,  China,  Arsenic*,  &c 

At  the  commencement  of  typhoid  fever,  where  gastric  symptoms 
set  in,  such  as  headache^  giddiness,  nausea,  vomiting,  watery,  yellow, 
or  greenish,  slimy  evacuations ;  particularly  when  attended  with 
slight  chills,  alternately  with  heat,  or  considerable  shivering  with 


16  FEVERS. 

slight  heat,  or  marked  heat  with  but  little  shivering,  we  may  admi- 
nister Ipecacuanha.  Or  Pulsatilla  maybe  selected  at  this  stage 
of  the  disorder,  when  there  is  frequent  shivering,  bitter  taste,  whitish 
tongue,vloss  of  appetite,  nausea,  vomiting  of  mucus,  slimy  evacua- 
tions, febrile  heat,  intermingled  with  chills,  and  particularly  when 
the  above  symptoms  occur  in  mild,  temperate,  or  phlegmatic  subjects, 
with  extreme  depression  of  spirits,  and  tearfulness  ;  in  a  more 
advanced  stage  of  the  disease,  with  slight  delirium,  tears  and  lamen- 
tations, alternating  with  somnolency,  Pulsatilla  is  still  of  consider- 
able service.  (Acid,  phosphoricum  is  sometimes  required  after  Pul- 
satilla.) 

Digitalis  is  indicated  when  febris  nervosa,  or  rather  typhus 
biliosus  is  ushered  in  by  yellow,  jaundiced  hue  of  the  skin;  violent, 
bilious  vomiting,  spasmodic  pains  in  the  stomach  ;  sensibility  of  the 
left  hypochondrium  on  pressure ;  frequent  desire  to  make  water,  par- 
ticularly at  night,  with  scanty,  bilious  urine;  burning  heat  of 
the  head  and  face ;  anxiety  of  mind,  and  dread  of  some  imaginary 
impending  misfortune;  urination  painful  and  difficult,  or  entirely 
suppressed. 

Nux  vomica.  Gastric  or  bilious  symptoms,  constipation,  with 
frequent  inclination  and  ineffectual  efforts  to  evacuate.  Nux  vomica  , 
is  further  indicated  when  the  spasms,  which  not  unfrequently  accom- 
pany this  disease,  are  confined  to  the  stomach  and  intestines,  parti- 
cularly the  rectum — a  frequent  cause  of  the  above-mentioned 
constipation ;  painful  and  difficult  emission  of  urine ;  painful 
pressure,  and  tension  in  the  epigastrium  and  hypochondria;  sensa- 
tion as  if  the  limbs  were  bruised ;  general  nervous  excitability, 
with  great  nocturnal  restlessness  and  slight  delirium  ;  weakness,  and 
exacerbation  of  the  symptoms  in  the  morning.  Temperament,  san- 
guine or  bilious  ;  disposition,  irritable  and  impatient. 

When  the  disorder  assumes  the  asthenic  form  of  abdominal  typhus, 
or  when  the  inflammatory  diathesis  is  more  lymphatic  than  arterial, 
from  the  occurrence  of  the  disease  in  venous-lymphatic  subjects, 
with  pale  or  yellowish  appearance  of  the  face,  severe  headache,  or 
sensation  as  if  a  tight  band  were  across  the  forehead ;  thickly-coated 
tongue;  bitter  or  foul  taste;  little  thirst;  sensibility  of  the  scrobi- 
culus  or  umbilical  region  to  the  touch,  and  distension  of  the  abdo- 
men; evacuations  copious,  watery,  flocculent,  and  even  bloody,  some- 
times attended  with  tenesmus ;  at  first,  dry  burning  skin,  followed  by 
profuse  debilitating  sweats  ;  depressed  pulse,  and  great  prostration ; 


NERVOUS  FEVER.  17 

extreme  restlessness  and  anxiety  with  constant  tossing  about  in  bed; 
disturbed  unrefreshing  sleep,  with  anxious  dreams— Mercurius 
will  be  found  a  most  efficient  medicine. 

Cinchona.  This  remedy  is  frequently  of  service  in  the  first 
stage,  or  when  there  is  paleness  of  the  face,  lancinating,  rending, 
aching,  or  pressive  headache,  cloudiness  of  vision,  buzzing  or  roaring 
in  the  ears,  dullness  of  hearing;  yellow  or  white  coating  on  the 
tongue,  dryness  of  the  mouth,  insipid,  clammy,  or  bitter  taste ; 
inclination  to  vomit;  sensibility  and  distension  of  the  abdomen; 
thin,  yellow,  watery  motions,  occasionally  intermixed  with  undigested 
substances ;  urine  scanty,  pale  or  dark  coloured,  and  cloudy ; 
oppression  at  the  chest ;  dragging  shooting  pains  in  the  limbs ; 
anxiety,  sleeplessness,  and  general  coldness  and  shivering.  In  an 
advanced  stage  of  the  disease,  moreover,  China  is  occasionally  of  con- 
siderable value,  especially  when  the  attack  has  become  lengthened 
and  tedious,  and  the  following  symptoms  have  set  in  :  nocturnal 
sweats,  obstinate  diarrhoea,  but  with  clean  tongue,  and  absence  of 
abdominal  pain,— followed  by  Sulphur  should  the  sweats  not  yield ; 
or  by  Acidum  sulph.,  if  the  sweating  be  very  profuse  when  lying  still, 
and  diminished  by  movement. 

When  inflammatory  symptoms  declare  themselves  at  the  com- 
mencement, Aconite  and  Belladonna  are  the  best  remedies  ;  but  when 
the  disease  becomes  more  developed,  and  still  retains  the  inflamma- 
tory character,  Bryonia  and  Rhus  will  generally  be  found  more  useful. 
For  the  employment  of  Aconite,  we  have  given  the  characteristic 
indications  under  Inflammatory  Fever,  and  in  all  cases  where  these 
decided  symptoms  are  present,  it  is  imperatively  called  for,  and 
should  be  administered  as  there  prescribed.  The  following  symptoms 
indicate  Belladonna: 

Alternate  heat  and  chills,  or  general  heat  externally  and  internally, 
with  redness,  burning  heat,  and  bloated  appearance  of  the  face, 
or  alternations  of  coldness  and  paleness,  and  heat  and  redness  of 
the  face,  violent  throbbing  of  the  carotids ;  redness,  sparkling,  and 
protrusion  of  the  eyes,  with  dilatation  of  the  pupils,  extreme  sensi- 
bility to  light,  and  strabismus ;  singing  or  noises  in  the  ears  to  a 
greater  or  less  degree;  wild  expression  of  the  countenance,  with 
uneasy  glancing  around,  as  if  from  fear,  sometimes  attended  with  a 
marked  inclination  to  run  away ;  violent  shooting  pains  in  the  fore- 
head, or  dull  heavy  pain,  causing  the  patient  to  put  his  hand 
frequently  to  his  head;  sopor;  furious  delirium  or  loss  of  conscious- 

2 


18  FEVERS. 

ness ;  delirium  and  carpologia,  or  spasmodic  or  convulsive  attacks  ; 
parched  lips,  soreness  of  the  corners  of  the  mouth,  redness  and 
dryness  of  the  tongue,  which  is  also  sometimes  foul,  and  covered  with 
yellow  fur;  skin  hot  and  dry;  bitter  taste  in  the  mouth,  intense  thirst, 
difficulty  of  deglutition,  especially  of  liquids,  nausea,  pressure  at 
the  pit  of  stomach ;  meteorismus  ;  constipation,  or  watery  motions  ; 
scanty  and  red  or  amber-coloured  urine ;  rapid  respiration ;  pulse 
full  and  accelerated,  or  quick,  hard,  and  wiry;  parotid  glands 
inflamed  and  tumid. 

Stramonium  may  be  given  when,  in  addition  to  the  above 
symptoms,  we  find  twitching  of  the  muscles  of  the  face,  subsultus, 
strabismus,  trembling  of  the  extremities,  tremulous  motion  of  the 
tongue  on  protrusion,  burning  heat  of  the  body,  suppression  of  the 
urine,  fantastic  gesticulations,  and  risus  sardonicus. 

Hyoscyamus,  with  similar  symptoms,  and  moreover,  twitching 
of  the  tendons,  strong  full  pulse,  fulness  of  the  veins,  burning  heat 
of  the  skin,  sensation  of  pricking  all  over  the  body,  and  constant 
delirium;  frequent,  but  ineffectual  urging  to  urinate. 

We  shall  now  proceed  to  the  consideration  of  two  medicines,  R7ius 
and  Bryonia,  whose  value  in  typhus,  in  the  form  in  which  it  appeared 
in  Germany  in  1813,  was  proved  by  Hahnemann's  treatment  of  183 
patients,  not  one  of  whom  died,  while  thousands  perished  under  the 
means  employed  by  the  professors  of  the  old  system  of  medicine. 
The  two  medicines  above  mentioned  possess  many  striking  points  of 
similarity,  but  also  many  of  difference;  they  may,  on  some  occasions, 
be  administered  alternately,  with  great  advantage.  For  their  indi- 
vidual employment  the  indications  are  as  follows : 

Bryonia.  More  particularly  when  the  disorder  assumes  the  cha- 
racter of  a  Febris  nervosa  versatilis,  or  Typhus  cerebralis,  with  violent 
stupefying  headache,  as  from  a  blow,  and  pain  across  the  forehead,  and 
at  the  temples,  as  if  the  head  w- ould  burst ;  frequent  raising  of  the 
hands  to  the  head.  Aggravation  of  these  sensations  by  movement — con- 
tinuous violent  delirium  with  excessive  febrile  heats;  foul,  thickly* 
coated,  yellowr  tongue,  or  dry  cracked  tongue,  with  parched  mouth, 
and  great  thirst,  and  vesicles  on  the  mouth  or  tongue>  furred  lips ; 
nausea,  inclination  to  vomit,  or  vomiting  of  mucous  and  bilious 
matter ;  tenderness  of  the  scrobiculus  when  touched ;  general  heat  of 
the  whole  body,  dryness  of  the  skin,  redness  of  the  face,  and  profuse 
perspiration  during  the  fever ;  sensibility  of  the  epigastric  regions  ; 
distended  abdomen,  oppression  at  the  chest,  and  frequent  sighing  and 


NERVOUS  FEVER.  19 

moaning,  indicative  of  threatening  miliaria  (alba) ;  constipation ,  or  re- 
laxed stools ;  urine  of  a  deep  orange  colour  or  bright  yellow,  with 
yellow  sediment ;  sensation  as  of  a  plug  in  the  throat ;  stitches  in  the 
side  ;  drowsiness  or  disposition  to  sleep  during  the  day  ;  sleeplessness, 
fugitive  heat,  and  excessive  restlessness,  or  continued  drowsiness  or 
coma,  with  startings  and  unpleasant  dreams;  painful  shooting  and 
aching  in  the  limbs,  aggravated  by  movement ;  trembling  of  the  hands  ? 
pulse  quick,  soft,  frequent,  or  irregular,  small  and  intermitting  ;  miliaria, 
petechiae  ;  irritability,  irascibility,  despair  of  recovery.  (Crocus  has  in  some 
instances  been  found  of  unequivocal  service  in  alternation  with  Bryonia.) 
In  the  period  of  incubation,  Bryonia  and  Rhus  are,  as  has  already  been 
remarked,  frequently  of  great  service,  either  in  arresting  the  fever  at 
its  onset,  or  of  giving  it  a  milder  character  throughout  its  future 
course.  The  indications  for  Bryonia  in  this  stage  are  chiefly  as  follows : 
after  a  slight  cold  the  patient  complains  of  aching  pains  over  the  whole 
body,  which  admit  of  no  relief  from  a  change  of  posture ;  there  is 
severe  throbbing,  bursting  frontal  headache,  aggravated  by  opening  or 
turning  the  eyes  ;  the  scalp  is  tender  to  the  touch,  and  the  head  burn- 
ing hot,  yet  the  forehead  is  nevertheless  frequently  bathed  with  a  cold 
sweat ;  the  sitting  or  the  recumbent  posture  is  rendered  compulsory, 
by  the  prevalence  of  debility,  languor,  and  heaviness  of  the  limbs,  and 
there  is  an  aversion  to  cold  air ;  the  nights  are  disturbed,  more  espe- 
cially in  the  fore  part  of  the  night,  by  ebullition  or  congestion  of 
blood,  heat  and  anxiety ;  the  patient  sighs  and  moans  during  sleep, 
and  is  often  aroused  by  agonizing  or  frightful  dreams,  which  continue 
to  haunt  him  even  whilst  awake.  Symptoms  of  deranged  digestion 
are  also  prominently  developed,  as  bitter  taste,  yellow,  furred,  dry 
tongue,  disgust  at  food,  nausea  and  inclination  to  vorm%  pressure  or 
weight  and  pricking  in  the  scrobiculus  cordis,  with  sensation  of  dis- 
tension in  the  hypochondria,  costiveness.* 

Rhus  toxicodendron.  This  medicine  is  more  peculiarly  suit- 
able to  the  debile  form  or  stage,  the  Febris  nervosa  stupida,—  Bryonia 
being  more  applicable  to  the  inflammatory, — but  will  frequently  be 
found  serviceable  in  all  the  stages  of  the  disease,  particularly  when 
there  is  diarrhcea,  congestion  to  the  head,  oppression  at  the  chest,  and 
great  weakness.  The  headache  is  generally  of  a  stupefying  nature, 
with  a  feeling  as  if  from  a  bruise,  but  not  so  severe  as  that  of  Bryonia  ; 
the  tongue  presents  nearly  the  same  character,  less  nausea  and  iriclina- 

*  Hartman's  Therapie,  Ister  Bd.,  2te  Auflage,  p.  219. 


20  FEVERS. 

tion  to  vomit  exists ;  violent  pain  is  felt  at  the  epigastrium,  especially 
when  touched.  Constipation  as  in  Bryonia,  but  more  particularly, 
copious  yellowish,  ox  loose,  sanguineous  evacuations,  with  severe  cutting 
pains  in  the  abdomen ;  the  symptoms  of  general  heat,  and  those  of 
the  face  resemble  those  given  under  Bryonia,  but  without  the  perspira- 
tion, or  at  most,  a  clammy  feeling  of  the  skin.  The  urine  is  hot, 
dark  coloured,  or  at  first  clear,  and  afterwards  turbid ;  the  symptoms 
of  the  ears  the  same ;  sleep  also  the  same ;  difficult  deglutition  of  solids, 
as  if  from  contraction  of  the  throat  and  oesophagus ;  general  trembling, 
debility  and  prostration,  almost  amounting  to  paralyticjwea&ness  of  the  dif- 
ferent limbs ;  shooting  pains  in  various  parts  of  the  body,  aggravated 
when  at  rest  or  at  night,  and  momentarily  relieved  by  moving  the  part 
affected;  pulse  quick  and  small,  or  weak  and  slow;  in  the  morale  we 
may  notice,  excessive  anguish,  anxiety,  extreme  lowness  of  spirits,  and 
disposition  to  weep. 

In  Typhus  abdominalis,  characterized  by  continued  heat  and  dryness 
of  the  skin,  violent  delirium  ^oppression  at  the  heart,  with  sighing 
and  moaning;  pains  in  the  limbs  ;  extreme  debility;  tongue  and  lips 
dry,  or  covered  with  a  brown  or  blackish  tenacious  fur ;  red,  burning 
cheeks,  subsultus  tendinum ;  carpologia ;  coma  somnolentum,  with 
muttering  and  stertor;  weak,  accelerated  pulse;  anxious  expression 
of  countenance ;  sleep  disturbed,  or  prevented  by  the  frequent  recur- 
rence of  sudden  starts  ;  eyes  inflamed,  watery,  and  insensible;  features 
collapsed ;  breath  highly  offensive ;  involuntary  evacuation  of  faeces 
and  urine ;  coldness  of  the  extremities  ;  sinking  energies ;  petechias ; 
miliaria — Rhus  is,  moreover,  a  most  efficient  medicament. 

During  the  period  of  incubation,  or  the  premonitory  stage  of  typhus 
(particularly  of  Febris  nervosa  stupida),  it  is  also  of  great  value.  Its 
employment  is  called  for  here  when,  either  after  exposure  to  a  thorough 
wetting,  or  without  any  assignable  reason,  the  patient  is  seized  with 
diarrhoea,  accompanied  by  colic,  and  complains  of  chilliness  even  when 
seated  close  by  the  fire;  further,  when  aching  pains  (or  pains  as  if 
arising  from  the  effects  of  contusions)  are  experienced  in  particular 
parts  of  the  body,  or  when  a  painful  sensation  is  experienced  as  if  the 
flesh  had  been  torn  from  the  bones ;  the  tongue  is  furred  white,  and 
there  is  giddiness,  inclination  to  vomit,  or  actual  vomiting  of  mucus ; 
the  patient  is  tormented  by  numbness,  creeping  and  tingling  in  the 
parts  of  the  body  on  which  he  lies,  together  with  lancinations,  draw- 
ing pains,  and  stiffness  in  the  nape  of  the  neck  and  in  the  back,  rigi- 
dity and  feeling  of  paralysis  in  the  extremities  ;  all  the  symptoms  are, 


NERVOUS  FEVER.  21 

generally  speaking,  exacerbated  during  rest  and  at  night.  Again,  in 
the  period  of  convalescence,  it  is  a  remedy  of  considerable  importance, 
especially  when  the  progress  towards  recovery  proceeds  slowly,  the 
pulse  retaining  a  febrile  character,  the  appetite,  although  improved, 
being  capricious,  the  bowels  prone  to  become  relaxed,  and  the  chest 
not  yet  exempt  from  feelings  of  oppression.* 

In  many  cases  it  will  be  found  useful  to  give  Bryonia,  and  Rhus  in 
alternation,  at  intervals  of  from  three  to  six  hours. 

Camphora  frequently  proves  useful  after  Rhus  (according  to  the  ex- 
perience of  some  of  the  Continental  homoeopathists) ;  it  is  indicated 
especially  when  the  symptoms  are  chiefly  as  follows :  heat  of  the  head, 
with  confusion  of  ideas  ;  or  violent  delirium  ;  giddiness ;  throbbing 
headache  ;  burning  heat  in  the  forehead  ;  cold  and  clammy  skin;  con- 
tinuous coldness  of  the  hands  and  feet ;  debilitating  and  clammy 
sweat ;  tendency  to  diarrhoea;  scanty,  cloudy  urine,  which  deposits  a 
thick  sediment;  great  weakness,  and  feeble,  scarcely  perceptible 
pulse.  Dose.  A  drop  of  the  tincture  every  quarter  of  an  hour  until 
symptoms  of  amendment  supervene,  and  a  change  of  prescription  is 
called  for. 

Cocculus  is  often  serviceable  after  the  previous  employment  of 
Rhus  or  Camphora,  especially  when  the  great  debility  continues,  and 
the  patient  complains  of  giddiness  and  headache ;  or  when  there  is 
a  tendency  to  syncope,  or  paralysis  of  the  limbs,  and  when  there  are 
prominent  symptoms  of  gastric  disturbance.  Arnica  is  also  of  some 
importance  infebris  nervosa  stupida;  with  coma  somnolentum,  or  deli- 
rium and  carpologia;  or  when  the  patient  lies  in  a  state  of  uncon- 
sciousness, as  if  he  had  been  stunned  by  a  concussion  of  the  brain. 

Arsenicum.  This  is  decidedly  one  of  the  most  important  remedies 
in  abdominal  typhus,  especially  in  the  second  and  third  stages,  some- 
times restoring  the  patient  when  almost  beyond  the  reach  of  hope, 
aud  renovating  the  vital  spark.  The  chief  indications  for  its  employ- 
ment are:  extreme  prostration  of 'strength,  falling  of  the  lower  jaw,  open 
mouth,  dull  and  glassy  eyes,  bitter  taste,  inclination  to  vomit,  pres- 
sure and  aching  at  the  scrobiculus  cordis,  pain  in  the  caecal  region, 
bursting  headache,  giddiness,  violent  or  low7  muttering  delirium,  sopor, 
tympanitis,  burning  thirst,  dry  hot  skin,  giddiness,  parched,  cracked, 
sometimes  blackish-looking,  clammy  tongue,  and  colliquative  diar- 
rhoea, pulse  scarcely  perceptible  and  intermittent. 

*  Hartman's  Therapie,  3te  Auflage,  p,  222. 


22 


FEVERS. 


Feratrum  is  occasionally  useful  after  or  in  alternation  with  Ars., 
when  the  inferior  extremities  become  cold  and  covered  with  cold 
sweat. 

Carbo  vegetabilis  is  another  remedy  which  often  proves  of 
utility  in  these  desperate  cases ;  it  is  indicated  where  we  find  drow- 
siness with  rattling  respiration,  face  pinched,  sunken,  and  deathlike, 
pupils  insensible  to  light,  pulse  scarcely  perceptible,  and  the  vital 
power  rapidly  sinking,  cold  perspiration  on  the  face  and  extremities, 
involuntary  and  offensive  evacuations,  deep  red  urine,  with  a  cloud 
floating  in  it  or  rising  towards  the  surface.  In  Ileo-typhus,  with 
symptoms  of  incipient  ulceration,  or  with  signs  of  so-called  putre- 
scency,  and  tendency  to  metastases,  Carb.  v.  is,  moreover,  a  most 
serviceable  remedy ;  and  in  the  second  stage  of  malignant  typhus,  or 
typhus  abdominalis,  it  may  be  employed  with  decided  advantage 
when  the  symptoms  are  as  follows  :  Burning,  lancinating  pains  in 
th  e  epigastrium  and  deep  in  the  abdomen,  which  become  renewed 
after  partaking  of  nourishment  of  any  kind,  and  are  accompanied  by 
great  anguish,  excessive  flatulency,  and  the  evacuation  of  burning, 
light-coloured,  fetid,  watery,  sanguineous  stools  with  tenesmus; 
desire  for  salt  food,  and  for  coffee,  but  aversion  to  meat, — the  patient4 
however,  generally  dreads  to  satisfy  any  inclination  which  he  may 
have  for  food,  on  account  of  the  above-mentioned  sufferings  which 
such  indulgence  entails ; — anxiety  and  burning  heat  of  skin,  arising 
from  congestions  to  the  head  and  chest ;  agglutination  of  the  eyelids 
during  the  night ;  deafness  and  tinnitus  aurium,  as  also  bleeding 
from  the  nose  and  obstruction  of  the  latter  from  the  formation  of 
incrustations ;  eruption  around  the  nose,  and  the  brown  or  blackish- 
looking  cracked  lips ;  the  legs  are  drawn  up  during  sleep,  which  is 
restless  and  disturbed  by  frequent  waking. 

Acidum  phosphoricum.  When  at  the  very  commencement  of 
the  disease,  Ave  find  great  exhaustion  and  prostration,  with  wandering 
even  when  awake ;  or  in  almost  hopeless  cases,  this  medicine  may  be 
administered  either  alone,  or  still  better,  in  alternation  with  B/ms, 
when  the  patient  is  always  found  lying  on  the  back  in  a  comatose 
state,  and  either  gives  no  reply  when  talked  to,  or  if  he  does,  it  is  in 
an  incoherent  manner;  constant  loquacious  delirium,  or  low  mut- 
tering ;  carpqlogia,  fixed  look ;  seeming  efforts  to  escape  from  some 
alarming  object;  black  incrustations  on  the  lips;  dry,  hot  skin, 
continual  copious  ivatery  diarrhoea  ;  the  motions  are  generally  passed 
involuntarily;    sanguineous  evacuations;    frequent,  weak,  and  occa- 


NERVOUS  FEVER.  23 

sionally  an  intermitting  pulse.  Should  the  debilitating  sanguineous 
evacuations  continue,  Acid,  nitricum  should  be  administered/  or 
Cantharides,  if  strangury  also  be  present.  Acidim  nitricum,  in  addition 
to  being  useful  against  hemorrhage,  is  also  efficacious  where  there  is 
sensibility  of  the  abdomen,  with  diarrhoea  and  slimy,  acrid,  greenish- 
coloured  stools  ;  tenesmus,  aphthae,  intestinal  ulcerations  ;  sensibility 
of  certain  parts  of  the  abdomen  on  pressure ;  shooting  pains  in  the 
rectum;  tenesmus,  greenish  slimy  diarrhoea;  scalding  micturition; 
tendency  to  collapse. 

Sulphur  has  been  found  useful  when  Bryonia,  Rhus,  or  Acicfam 
johosphoricum  have  been  fruitlessly  administered ;  f  but  particularly 
when  the  following  symptoms  were  encountered :  pale  and  collapsed 
countenance,  burning,  itching  eruptions  on  the  lips,  dryness  of  the 
mouth ;  foul,  dry  tongue ;  bitter  taste ;  slimy  or  bilious  vomiting  ; 
tenderness  of  the  epigastrium,  and  pain  as  from  excoriation  in  the 
umbilical  region,  increased  on  pressure ;  borborygmus ;  frequent, 
watery,  flocculent  or  yellow  evacuations  ;  cloudy  urine,  depositing  a 
reddish  sediment ;  miliaria,  miliaria  purulenta ;  epistaxis ;  stitches 
in  the  chest,  oppressed  breathing ;  dry  cough,  worse  towards  evening 
and  at  night ;  sleeplessness^  or  whining  during  sleep ;  dry  heat 
during  the  day,  with  moderately  quick  pulse,  and  profuse  sweating 
at  night. 

Opium.  (Fe&ris  nervosa  stupida.)  Great  drowsiness,  or  coma  with 
stertorous  breathing,  open  mouth,  half-closed  eyes,  or  fixed  look, 
slight  delirium  or  muttering;  carpolqgia;  the  patient  is  in  a 
continual  state  of  sopor,  from  which  it  is  extremely  difficult  to  rouse 
him,  and  is  scarcely  aroused,  ere  he  relapses  into  his  former  state ; 
dry  offensive  stools,  which,  together  with  the  urine,  are  passed 
involuntarily. 

Nitri.  spir.  In  desperate  cases  of  febris  nerv.  stup.,  with  com- 
plete apathy  or  insensibility,  and  fixed,  expressionless,  or  haggard 
eyes;  dry,  brown,  or  blackish  lips;  sopor,  with  low  muttering 
delirium.  As  soon  as  signs  of  improvement  set  in  from  the  employ- 
ment of  this  remedy,  it  will  in  general  be  found  requisite  to  follow 
up  the  treatment  by  prescribing  some  one  or  other  of  the  remedies 
mentioned  above,  such  as  Rhus,  Acid,  phosph.,  Nux,  Bella.,  etc.  J 

Calcarea  c.  may  sometimes  be  administered  advantageously, 
alternately  with  Belladonna,  Arsenic,  or  Rhus,  according  to  the  symp- 

*  Gtt.  iv — vi,  in  an  enema,  sometimes  necessary.     Baertl.  Arch.,  XX  Bd.,  2tes  Heft. 
f  Baertl.  Archives,  XX  Bd.,  2tes  Heft.  %  Hartman's  Therapie. 


24  FEVERS. 

toms;  it  is  further,  occasionally  a  most  efficient  remedy  in  cases  in 
which  debilitating  diarrhoea  or  epistaxis  will  not  yield  to  such 
remedies  as,  Ac.  phosph.,  Rhus,  Cinchona,  etc. ; *  when  the  nasal 
hemorrhage  fails  to  be  arrested  by  Calcarea,  Hepar  sulphuris  is  gene- 
rally the  most  appropriate  remedy  to  follow  up  with,  provided  all 
the  symptoms  of  the  disease  are  not  better  embraced  by  Pulsatilla, 
Belladonna,  Rhus,  or  Sulphur :  lastly,  Calc.  c.  may  be  exhibited  with 
advantage  where  there  are  symptoms  of  impending  miliaria,  jerkings, 
or  twitchings  in  the  limbs,  particularly  in  children,  tendency  to 
meningitis,  delirium,  etc. 

Lycopodium  is  often  a  valuable  remedy  after  Calc.  in  the  second 
stage  of  typhus,  when  miliaria  is  slowly  and  scantily  developed,  and 
there  is  sopor  with  muttering  delirium ;  confounding  of  words ; 
stammering ;  subsultus  tendinum ;  carpologia ;  meteorismus,  with 
constipation  ;  affections  of  the  bladder;  or,  when  there  are  shiverings 
alternating  wdth  heat ;  circumscribed  redness  of  the  cheeks ;  debili- 
tating sweats;  excessive  debility;  complete  hanging  of  the  lower 
jaw ;  half-closed  eyes ;  slow  respiration ;  or,  state  of  excitement 
without  heat  or  congestion  in  the  head  or  face ;  redness  of  the 
tongue ;  constipation ;  burning  urine ;  tranquil  and  resigned  state 
of  mind,  or  surliness  and  malevolence,  especially  on  waking. 

Lachesis  is  spoken  of  as  being  likely  to  prove  serviceable  in 
typhoid  fever,  attended  with  vertigo  on  rising  or  sitting  up  ;  muttering 
delirium;  hanging  of  the  lower  jaw;  vacant  expression  of  counte- 
nance ;  sunken  features ;  bitter  taste ;  yellowish  tongue,  with  bright 
red  margins;  cracked  tongue;  smooth  dry  tongue;  or  furred,  white 
slimy  tongue;  heaviness  of  the  tongue,  with  difficulty  of  protruding  it, 
and  inarticulate  speech ;  seeming  paralysis  of  the  eyelids;  lethargic 
sleep,  and  tendency  to  lie  in  the  prone  position  :  thirst,  with  disin- 
clination to  drink  ;  browrnish-red,  copious  urine. 

Sec  ale  cornutum  is,  in  like  manner  with  Natrum  m.  and  Helle- 
bonis,  recommended  by  many  homoeopathists  who  have  had  frequent 
opportunities  of  treating  nervous  fevers,  particularly  in  cases 
occurring  in  the  wake  of  other  diseases;  but  is  more  especially 
appropriate  where  the  symptoms  developed  clearly  proceed  from 
irritation  of  the  spinal  nerves,  with  wandering,  fugitive,  spasmodic 
pains  extending  from  the  dorsum  and  sacrum  into  different  parts  of 
the  body ;  the  spasms  which  affect  the  face,  become  subsequently 

*  Baert-L  Archives,  XX  Bd.,  2tes  Heft. 


NERVOUS  FEVER.  25 

chronic ;  whilst  those  that  have  their  seat  in  the  hands  and  feet 
partake  of  a  tonic  character.  This  remedy  is  further  indicated  by 
dry  heat  of  skin,  insatiable  thirst,  accelerated  pulse,  great  restlessness 
and  sleeplessness ;  excessive  languor ;  aversion  to  food.  Should  the 
spasmodic  affections  readily  yield  to  the  employment  of  secale,  but 
the  febrile  symptoms  continue,  some  other  remedy  appropriate 
thereto  must  be  prescribed. 

Phosphorus  is  of  great  service  where  we  find  great  dryness  of  the 
tongue,  heat  of  skin,  small,  hard,  quick  pulse,  painless  diarrhoea,  with 
excessive  borborygmus;  or  when  the  disease  becomes,  as  it  were, 
concentrated  in  the  lungs,  and  there  is  consequently  congestion,  with 
extremely  laborious  breathing  and  excessive  anxiety,  dullness  on  per- 
cussion, mucous  rale,  stitches  during  respiration  ;  cough,  with  copious 
expectoration  of  mucus  mixed  with  blood,  or  even  offensive  pus ;  more 
benefit  may  be  looked  for  from  this  than  from  any  other  remedy.  Pkos- 
jphorus  is  also  serviceable  when,  notwithstanding  the  pneumonic  con- 
centration, there  is,  moreover,  sensibility  and  rumbling  in  the  cse.caj 
region,  or  when  there  is  continued  heat  of  skin,  with  small  hard 
accelerated  pulse,  throbbing  of  the  carotids,  and  nocturnal  sweats; 
sleep  disturbed  by  crowding  of  ideas,  weeping,  whimpering,  sudden 
cries,  and  restlessness.  The  patient  awakes  from  sleep  complaining 
of  great  thirst  and  dryness  of  the  mouth,  excessive  heat,  and  aching 
of  the  whole  body.  In  addition  to  these  symptoms,  there  is  burning 
sensation  in  the  abdomen  and  anus,  with  frequent  semifluid  stools 
streaked  with  blood  ;  giddiness,  confusion,  and  throbbing  pains  in  the 
head ;  deafness,  frequent  discharge  of  blood  on  blowing  the  nose,  and 
heat  in  the  face ;  tongue  and  lips  dry  and  cracked ;  bitter  taste ; 
copious  evacuation  of  urine,  which  deposits  a  whitish  or  reddish 
sediment ;  venereal  orgasm  ;  delirium  ;  obstupefaction. 

Acidum  muriaticum.  Weakness,  with  a  constant  tendency  to  sink 
down  in  the  bed,  with  groaning  during  sleep,  almost  paralytic  state  of 
the  tongue,  rendering  it  nearly  impossible  for  the  patient  to  speak, 
even  when  in  a  collected  state,  and  great  dryness  of  the  mouth. 

Natrum  muriaticum  is  recommended  in  nervous  fevers  with 
great  debility,  insatiable  thirst,  dryness  of  the  tongue,  and  loss  of 
consciousness,  and  particularly  when  they  follow  in  the  course  of 
antecedent  debilitated  diseases. 

Helleborus  has  also  been  found  of  very  great  utility  in  febris 
nervosa,  occurring  after  other  febrile  affections,  such  as  scarlatina, 
rubeola,  febris  gastrica,  febris  verminosa,  and  cholera,  with  pain  as 


26  FEVERS. 

from  contusion,  combined  with  tumefaction,  in  the  integuments  of  the 
head  ;  disposition  to  somnolency,  with  confusion  of  ideas  and  extreme 
restlessness ;  dark,  cloudy  urine ;  heaviness,  or  feeling  of  stiffness  and 
powerlessness  in  the  limbs ;  depression  of  spirits,  and  obtuseness  of 
faculties. 

In  prescribing  the  above  remedies,  it  will  generally  be  found  neces- 
sary to  order  the  dose  to  be  repeated  every  three  or  four  hours,  but  as 
soon  as  an  amendment  sets  in,  or  even  if  the  symptoms  become 
stationary,  the  medicine  should  be  discontinued  for  a  time,  and  only 
resumed  (or  changed,  if  called  for  by  the  invasion  of  new  symptoms 
requiring  a  different  remedy)  when  the  slightest  signs  of  a  relapse  or 
an  alteration  for  the  worse  can  be  detected. 

Against  the  following  sequela  .-—Decubitus,  compresses  with 
diluted  alcohol,  or  a  very  weak  lotion  of  Arnica,  may  be  employed  at 
the  commencement ;  but  when  there  is  violent  inflammation  Bella- 
donna, sometimes  in  alternation  with  Sulphur,  should  be  had  recourse 
to  :  when  sphacelus  supervenes,  Card,  v.  internally  and  externally,  or 
Arsen.  or  Cinchona  ;  where  the  bones  are  implicated  Silicea,  and  when 
granulation  is  retarded— Sulphur  and  Cinchona  will  generally  prove  the 
most  useful  medicaments.  Metastatic  Abscess,  Bella.,  and  Hepar 
sulph.  Furunculi  :  Arnica,  Bella.,  and  Sulph.,  or  Lycopod.,  or  Silicea. 
Frequent  tendency  to  Diarrhcea  ;  China.  Obstinate  nights-sweats, 
sometimes  writh  dry  nocturnal  cough,  Sulph,  CEdema  of  the  feet: 
Bryonia,  Lycopod.,  Puis.,  China,  Sulph.,  according  to  the  concomitant 
symptoms.  Intestinal  ulcerations :  Acid,  nitr.,  Arsenic,  Phosph., 
Card,  v.,  Sulph.,  Calc,  Puis.,  Bella. 

After  severe  cases  of  Typhus,  a  period  of  debility  generally  super- 
venes, of  greater  or  less  duration,  according  to  the  violence  of  the 
attack.  In  such  instances  the  invigorating  effects  of  pure  air  is  for 
the  most  part  preferable  to  all  other  roborants ;  the  patient  ought, 
therefore,  under  favorable  circumstances,  to  get  out  of  doors  as  soon 
as  possible.  In  some  cases,  however,  a  dose  or  two  of  Cinchona  may 
prove  serviceable,  particularly  if  the  patient  has  suffered  much  from 
diarrhoea  during  the  course  of  the  disease.  In  others,  Valeriana, 
Cocculus,  N^ux  v.,  or  Veratrum,  may  be  better  indicated.  Ferrum  c.  in 
repeated  doses,  is  often  more  efficacious  than  China,  where  the  pulse 
continues  very  weak  and  frequent  after  the  cessation  of  profuse 
hemorrhage,  particularly  in  the  case  of  chlorotic  females,  or  those  wTho 
have  previously  suffered  from  chlorosis.  Again,  when  the  fever  has 
completely  subsided,  as  also  the  diarrhoea,  and  there  remains  only 


PUTRID  FEVER.  27 

great  debility  with  slow,  small,  feeble  pulse,  with  profuse  sweating 
towards  evening,  Ruta  and  Sulph.,  in  alternation,  are  of  great  utility. 
When  debilitating  sweats  supervene,  Cinchona  should  be  administered, 
followed  by  Sulphur  if  required.  Magnes.  m~  is  useful  when,  in  nervous 
subjects,  general  aching  pains  remain  behind,  with  great  weariness 
and  weakness  of  the  limbs,  and  lowness  of  spirits  ;  disturbed  nights  ; 
giddiness ;  feeling  of  weight  and  confusion  in  the  head. 

Should  symptoms  of  deranged  digestion,  with  headache,  palpitation 
of  the  heart,  Sec,  remain  after  the  fever  has  been  subdued,  Nux 
vomica,  Pulsatilla,  and  Spigelia  will  be  found  most  serviceable,  accord- 
ing to  the  temperament  of  the  individual,  and  the  symptoms  present. 
(See  article  Indigestion.)  The  other  medicaments  mentioned  under 
the  head  referred  to,  may  also  be  advantageously  consulted. 

Diet.  In  a  disease  that  presents  so  many  varieties,  it  is  difficult 
to  give  any  rules  upon  this  head,  applicable  to  all  cases.  When  a 
marked  inflammatory  character  is  present,  the  same  abstinence  should 
be  enjoined  as  already  noted  under  Fevers ;  and  in  all  cases,  either 
during  the  progress  of  the  disease  or  the  period  of  convalescence,  the 
greatest  possible  care  should  be  taken  to  avoid  tasking  the  digestive 
functions ;  the  diet  should  be  light  and  simple,  and  the  patient  never 
allowed  to  indulge  the  appetite  to  its  full  extent. 

PUTRID  FEVER,  PESTILENTIAL  FEVER,  OR  MALIGNANT  TYPHUS. 

Typhis  putridus.     Typhus  abdominalis. 

We  have  already  alluded  to  this  form  of  the  disease  under  Typhus, 
particularly  in  the  indications  given  for  the  employment  of  Arsenicum, 
Carlo  vegetabilis,  Rhus,  Merc,  &c,  but  consider  it  of  sufficient  impor- 
tance for  separate  remark.  This  fever  sometimes  rages  as  an  epidemy, 
but  it  more  frequently  appears  in  the  wake  of  nervous  fever,  or  the 
latter  degenerates  into  the  malignant  type  in  consequence  of  improper 
general  treatment,  uncleanliness,  or  the  impurity  of  the  air  by  which 
the  unfortunate  patient  is  surrounded.  Indeed,  almost  any  fever 
may  terminate  in  malignant  typhus  under  the  favouring  circumstances 
just  quoted. 

Diagnosis.  The  symptoms  of  Nervous  Fever  already  given, 
running  on  to  the  colliquative  state ;  extreme  debility,  pulse  exceed- 
ingly small  and  weak,  so  as  to  be  scarcely  perceptible ;  a  peculiar 
sensation  of  burning  pungent  heat,  communicating  itself  to  the  hand^ 
when  placed  upon  the  body  of  the  patient,  heavy  cadaverous  smell  of 


28  FEVERS. 

the  whole  body,  putrid  odour  of  the  breath,  perspiration,  and  secre- 
tions in  general ;  profuse  oily  and  clammy  sweats :  involuntary  evacua- 
tions ;  colliquative  or  sanguineous  diarrhoea ;  dark  or  bloody  urine, 
epistaxis,  petechias,  and  other  marked  tendencies  to  organic  dissolu- 
tion. The  patient  is  always  found  lying  on  his  back,  and  continually 
shrinks  down  to  the  foot  of  the  bed,  a  siga  of  utter  helplessness  and 
prostration. 

Treatment.  In  the  premonitory  stage  of  epidemic  Typhus 
putridus,  the  most  appropriate  remedies  are  those  which  we  have 
enumerated  under  Typhus  gastricus  et  liliosus,  and  at  the  commence- 
ment of  Nervous  fever,  (which  see  ;)  but  when  the  disease  has  reached 
the  second  stage,  Arsenicum,  Card,  v.,  Merc,,  Acid,  phosph.,  Acid,  mur., 
Cantharis,  Rhus,  &c.  Arsenicum  corresponds  closely  to  the  symp- 
toms, and  is,  therefore,  our  principal  remedy  when  the  disease  assumes 
this  malignant  form,  particularly  when  we  find  involuntary  and 
sanguineous  evacuations  and  tenesmus.  Carlo  vegetabilis  may  be 
advantageously  alternated  with  it,  when  the  symptoms^  already  given 
under  Typhus  for  the  exhibition  of  that  medicine,  are  present ;  Mer- 
curius  is  called  for  where  there  is  great  tenesmus,  and  when  the  dis- 
charge of  blood  is  principally  alvine,  followed  by  Acid,  phosph.,  Acid. 
nitr.,   or    Cantharis,  should   sanguineous    diarrhoea   continue.      (See 

NERVOUS    FEVER.) 

Cinchona  will  frequently  be  found  useful,  when  the  more  dan- 
gerous symptoms  have  been  in  a  great  measure  subjugated,  but  at  the 
same  time  great  weakness  remains  from  the  loss  of  humours;  it  is 
also  useful,  when  the  little  nutriment  the  patient  may  have  partaken 
of  passes  off  undigested. 

In  those  cases  where  Arsenicum  and  Carlo  vegetalilis  fail  to  produce 
any  amendment,  the  employment  of  the  Mother  Tincture  of  Rhus 
[Bosis.  Gtt.  j,  ter  quateme,  vel  smpius  quotidie,)  has,  in  a  number  of 
instances,  been  found  most  efficacious.* 

*  Many  of  the  remedies,  along  with  the  indications  for  their  employment,  which  have  been 
given  in  the  preceding  chapter,  but  more  particularly  the  following:  Ipecac. ,  Bella.,  Hyoscy., 
Op.,  Nuoc,  Camph.,  etc.,  will  also  be  found  equally  appropriate  in  particular  cases,  or  in  cer- 
tain stages  of  so-called  putrid  fever — the  attention  of  the  practitioner  is  therefore  particu- 
larly called  to  them  in  such  circumstances. 


TYPHUS  FEVER.  29 

CONTAGIOUS  TYPHUS,  CAMI^  FEVER,  JAIL  FEVER,  PETECHIAL  FEVER. 

Typhus  Contagiosus. 

Diagnosis.  The  symptoms  of  nervous  or  putrid  fever  caused  by 
infection  or  contagion. 

Treatment.  The  same  as  already  given  under  Febris  nervosa, 
but  especially  Bryon.,  Rhus,  Ars.,  Secale,  &c.  We  may  here  add  another 
remedy  of  much  value  in  this  form  of  the  disease,  namely,  Opium,  in- 
dicated by  coma, — coma  somnolentum,  especially, — stertorous  breath- 
ing, mouth  partly  open,  eyes  open  or  partially  closed,  loss  of  speech, 
rigidity  of  the  limbs,  smallness  or  intermission  of  the  pulse,  meteo- 
rismus,  involuntary  evacuations,  or  constipation. 

When,  in  addition  to  the  above-mentioned  paralytic  affection,  we 
find  jerkings  in  individual  limbs,  we  should  have  recourse  Lo  Hyoscyamus 
or  Stramonium,  choosing  the  remedy  which  more  closely  approximates 
to  the  symptoms  we  have  given  for  their  individual  use,  under  Febris 
nervosa. 

ACCESSORY  TREATMENT.       PROPHYLAXES,  ETC. 

We  need  hardly  insist  upon,  what  every  practitioner  knows  to  be 
an  essential  auxiliary  in  the  treatment  of  this  affection,  a  constant 
supply  of  fresh  and  continually  renewed  air. 

Prophylaxes,  during  the  prevalence  of  Typhus.  Cool  pure  air, 
thorough  ventilation,  the  avoidance  of  dark  or  dismal-looking  apart- 
ments, into  which  the  genial  day-light  does  not  freely  penetrate ;  and 
the  removal  of  all  causes  generating  the  disease,  such  as  stopped 
sewers,  or  collections  of  decaying  vegetable  and  animal  matter ;  a  plain 
wholesome  diet,  with  moderation  in  the  use  of  fermented  liquors  or 
wine,  and  total  abstinence  from  spirits ;  the  refraining  from  late 
hours,  intense  study,  and  excessive  mental  or  corporal  exertion ; 
exercise  in  open  situations,  with  proper  precautions  against  exposure 
to  cold  or  damp ;  and  finally,  the  preserving  a  healthy  tone  of  mind 
and  cheerful  temper. 

The  absurd  practice  of  keeping  the  bowels  constantly  open  by 
means  of  aperient  medicines,  and  the  use  of  sudorifics,  cannot  be  too 
strongly  reprobated;  both  these  practices  weaken  the  system  and 
predispose  it  to  the  disease. 

Standing  between  a  fire  or  open  window  and  the  bed  of  the  patient 
is  to  be  avoided,  as  unnecessarily  increasing  the  risk  of  taking  the 
infection. 


30  FEVERS. 

The  safest  plan  for  the  physician  to  pursue,  in  epidemic  or  endemic 
typhus,*  is  to  form  an  aggregate  of  the  symptoms  by  carefully  collat- 
ing those  of  individual  sufferers,  so  as  to  present  a  perfect  image  of 
the  existent  malady,  and  to  choose  his  remedies  accordingly,  which 
should  be  administered  directly  on  the  premonitory  symptoms  declar- 
ing themselves,  without  waiting  for  the  further  development  of  the 
disease. 

It  may  be  remarked  that  Bryonia  and  Rhus  cover  a  great  number  of 
the  symptoms  of  typhus,  as  met  with  in  this  country ;  when,  there- 
fore, the  point  just  mentioned  has  been  ascertained,  they  may  be  given 
alternately,  and  will  often  either  check  the  malady  at  its  outset,  or 
materially  modify  its  virulence — in  some  cases,  one  of  these  remedies 
is  of  itself  sufficient^  according  to  the  leading  symptoms  of  the  reign- 
ing epidemic;  in  a  great  variety  of  instances,  Arsenicum  may  prove 
a  valuable  prophylaxis;  but  at  the  same  time,  the  indications,  we  have 
already  given  of  the  several  medicaments,  should  be  carefully  con- 
sulted, as  the  same  rule  holds  good  for  them  all. 

Febris  lenta  nervosa. 

Lingering  nervous  fever  is  characterized  by  a  predominance  of  fever 
chills  and  coldness  over  heat,  little  or  no  sweats,  or  only  fugitive  sweats  ; 
pulse  variable,  but  generally  small  and  quiet.  The  fever  commonly 
becomes  increased  in  the  morning,  or  while  the  patient  is  fasting,  and 
is  attended  with  great  depression  of  spirits.  After  a  meal  it  generally 
subsides,  and  leaves  the  patient  in  a  more  cheerful  mood.  Head- 
ache, spasmodic  sufferings,  and  general  uneasiness  are  frequent 
attendants  on  this  form  of  fever.  The  causes  of  the  disease  are  gene- 
rally attributable  to  those  influences  which  exercise  a  debilitating 
effect  upon  the  nervous  system,  as  over-indulgence  in  venery,  or  self- 
abuse  ;  the  excessive  loss  of  blood,  either  by  artificial  or  natural  means ; 
protracted  blenorrhcea;  the  weakening  effects  of  nervous  and  other 
fevers ;  severe  and  prolonged  mental  and  corporal  exertion ;  care ; 
grief,  &c.  The  fever  developes  itself  slowly  and  gradually,  and  con- 
tinues for  months  without  giving  rise  to  any  inflammatory  appearances. 
The  treatment  must  be  regulated  by  the  cause,  and  the  nature  of  the 
symptoms.  When  the  former  is  unknown,  we  must  direct  our  atten- 
tion carefully  and  minutely  to  the  symptoms,  and  select  a  remedy  in 
accordance  therewith 

*  Or  any  other  epiclemy,  &c. 


INTERMITTENT  FEVER.  31 

When  vexation,  care,  or  debility  from  venereal  excess,  has  given 
rise  to  the  disease,  Acid.  _phospk.  will  rarely  fail  to  effect  a  greater  or 
less  degree  of  improvement.  The  alternate  employment  of  Arsenicum 
and  Acid,  phosph.  has  proved  useful  in  some  cases.  When  deep  and 
concealed  grief  has  been  the  exciting  cause,  Ignatia  will,  if  adminis- 
tered early,  generally  succeed  in  arresting  the  disease,  and  will  be 
found  more  or  less  useful  in  cases  of  long  standing  proceeding  from 
the  aforesaid  cause.  Cinchona  will  prove  very  useful,  when  constitu- 
tional debility,  arising  from  the  excessive  loss  of  blood,  or  from  pro- 
longed self-abuse  (onanism),  has  developed  the  fever.  {Acid.  phosph. 
Nux,  Sulph.,  Calc  may  be  required  after  China.)  In  cases  resulting 
from  debilitating  acute  diseases,  Veratrum,  China,  Hepar,  Silic,  or  Acid, 
phosph.,  Calc,  Lachesis,  and  Natrum  m.,  will  usually  answrer  best.  In 
other  casesj  Ipecac,  Camph.,  Relied-,  CoccuL,  Merc,  Plumb.,  Lycop.,  Can., 
Cupr.,  Stann*,  may  be  called  for. 


INTERMITTENT  FEVERS— AGUE, 

Fehres  Intermittentes* 

We  have  now  to  enter  upon  a  class  of  fevers,  differing  essentially 
from  those  already  considered,  in  possessing  a  marked  character  of 
their  own,  in  the  simplicity  of  their  form,  the  periodicity  of  the 
different  stages,  and  the  uncertainty  of  their  duration. 

Diagnosis.  A  chill  or  cold  fit,  followed  by  heat,  and  terminating 
by  perspiration,  more  or  less  profuse ;  these  three  stages  constitute  a 
paroxysm;  after  which,  for  a  certain  period,  (the  Apyrexia,)  the 
patient  is  generally  free  from  suffering. 

These  periods  are  generally  of  definite  duration  ; — if  the  paroxysms 
return  at  regular  intervals  of  twenty-four  hours,  the  fever  is  termed  a 
Quotidian, — of  forty-eight,  a  Tertian, — of  seventy-two,  a  Quartan  ;  even 
longer  intervals  have  been  observed  between  the  attacks,  hence  the 
Octanae  of  some  writers, — if  twro  paroxysms  take  place  within  each  pe- 
riod, the  ague  is  said  to  be  doubled,  as  a  double  Quotidian,  or  Tertian. 

These  fevers  are  sometimes  found  existing  in  the  simple  form 
above  noted,  and  at  others  complicated  with  other  forms  of  disease, 
as  in  intermittent  catarrhal  or  gastric  fevers. 

They  are  exceedingly  indefinite  in  duration,  and  frequently  assume 
a  chronic  form.  An  individual,  once  attacked  with  ague,  is  fre- 
quently liable  to  a  return  in  after-life,  if  the   disease  has  not  been 


32  FEVERS. 

radically  cured  at  the  commencement;  nay  more,  any  attacks  of 
disease  he  may  be  hereafter  subjected  to,  are  peculiarly  apt  to  assume 
the  intermittent  form. 

Nervous  or  inflammatory  fever  may  change  into  an  intermittent, 
or  the  latter  take  upon  itself,  if  it  continue,  the  character  of  either 
of  the  two  former,  or  become  remittent ;  this  frequently  happens  in 
hot  climates. 

Ague  is  rarely  dangerous  in  this  country,  except  when  of  long 
continuance,  by  the  weakness  it  occasions  and  the  injury  it  inflicts 
upon  the  constitution;  it  may,  however,  lead  to  obstructions  and 
indurations  of  the  more  important  viscera,  particularly  of  the  liver 
and  spleen,  or  induce  dropsical  affections. 

But  in  hot  climates,  or  in  low  marshy  countries,  this  disease  is 
exceedingly  fatal ;  and  on  dissection,  the  brain  and  its  tissues,  the 
mucous  coat  of  the  stomach  and  bowels,  the  lungs,  and  peritoneum 
have  been  found  affected ;  in  such  instances,  when  the  disease  gains 
ground,  the  patient  loses  strength  and  becomes  emaciated,  every 
fresh  paroxysm  entails  an  increase  of  suffering,  and  the  perspiration 
fails  to  relieve ;  he  complains  of  a  sense  of  weight  in  the  hypochon- 
dria, particularly  the  right,  with  griping  pain  in  the  bowels,  flatulent 
distension  of  the  abdomen,  diarrhoea,  or  constipation,  and  constant 
thirst ;  or  of  headache,  cough,  and  dyspnoea ;  the  tongue  is  furred, 
and  dry  at  the  tip  ;  the  skin  hot,  harsh,  and  dry ;  the  urine  scanty, 
the  abdomen  tumid,  the  extremities  become  dropsical,  and  sleep  is 
restless  or  broken. 

Death  may  ensue  from  collapse  in  the  cold  stage,  from  the  absence 
of  perspiration,  and  from  the  disease  passing  into  continued  or 
remittent  fever,  or  from  disorganization  of  some  important  function, 
such  as  the  brain,  lungs,  spleen,  or  liver. 

We  shall  now  proceed  to  a  general  consideration  of  the  three 
stages  of  the  disease,  premising  that  the  various  modifications  of  the 
symptoms  will  be  found,  more  in  detail,  under  the  medicaments, 
when  we  enter  into  the  therapeutic  treatment. 

Premonitory  symptoms.  Sense  of  languor,  or  general  uneasiness ; 
yawning,  headache,  stupor,  pains  in  the  limbs  or  dorsal  region,  the 
toes  and  fingers  becoming  numb,  and  the  nails  blue. 

Cold  Stage  {Congestive  Stage).  Coldness  of  the  extremities,  with  a 
feeling  as  of  a  stream  of  cold  water  running  down  the  back,  and 
extending  itself  to  the  chest  and  abdomen  ;  general  prostration  of 
strength,    insupportable    coldness,    external    and    internal   tremors, 


INTERMITTENT  FEVER.  33 

chattering  of  the  teeth,  respiration  laboured  and  hurried,  with 
inability  to  draw  a  full  inspiration,  and  oppression  at  the  chest.  The 
head  is  variously  affected,  sometimes  with  headache,  at  others  with 
coma,  stupor,  or  delirium ;  the  pains  noticed  in  the  premonitory 
symptoms  are  generally  present,  and,  in  some  instances,  the  patient 
complains  of  pain  all  over  :  the  tongue  is  moist,  the  eyes  are  heavy 
and  sunken,  the  features  pinched,  and  the  lips  and  cheeks  livid :  the 
rigors  sometimes  run  on  to  convulsions. 

The  pulse  is  weak  and  oppressed,  sometimes  slow,  at  others  quick, 
and  frequently  intermitting,  and  often,  from  the  severity  of  the 
rigors,  scarcely  perceptible. 

The  heat  of  the  body,  except  at  the  extremities,  is  generally  above 
the  natural  standard,  while  the  patient  complains  of  cold. 

Sometimes  the  patient  feels  only  a  slight  degree  of  cold,  without 
tremors,  but  accompanied  with  symptoms  of  functional  derange- 
ment, and  in  a  few  hours  the  hot  fit  declares  itself.  The  duration  of 
the  cold  stage  is  from  an  hour  to  four  hours ;  and  it  runs  into  the 
hot  without  any  marked  interval. 

The  Hot  Stage  presents  all  the  characteristics  of  a  modified  inflam- 
matory attack,  with  hot,  dry  skin,  and  thirst,  oppression  at  the  chest, 
hurried  and  anxious  breathing,  and  acute  pains  in  the  head,  region 
of  the  spleen,  liver,  &c;  there  is  also  occasionally  a  degree  of  cere- 
bral disturbance,  or  even  delirium. 

The  general  duration  of  the  hot  fit  is  from  four  to  twelve  hours, 
when  it  terminates  in  the  sweating  stage ;  when  this  does  not  take 
place,  it  is  apt  to  run  on  to  continuous  fever,  or  take  the  form  of  a 
remittent, —a  not  uncommon  issue  of  this  disease  in  warm  climates. 

Sweating  Stage.  After  the  hot  fit  has  continued  a  longer  or  shorter 
period,  profuse  perspiration  sets  in,  commencing  in  the  forehead  and 
extremities,  and  quickly  diffusing  itself  over  the  whole  body;  as 
soon  as  it  makes  its  appearance,  the  uneasiness  and  other  symptoms 
begin  to  disappear,  and  the  patient,  in  simple  ague,  continues  free 
from  suffering  until  the  next  paroxysm. 

Causes.  Marshy  districts  are  noted  as  being  the  hotbeds  of  this 
malady  ;  a  continuance  of  fish  or  farinaceous  diet  is  also  apt  to 
produce  it ;  it  may,  moreover,  arise  from  taking  cold,  indigestion, 
internal  obstructions,  peculiar  constitutional  tendency,  or  local 
irritation. 

3 


34  FEVERS. 

The  medicines  should  generally  be  administered  in  the  apyrexia  or 
interval  between  the  paroxysms,  but  when  the  intervals  are  extremely 
short,  or  when  they  are  attended  with  after-pains  of  the  preceding 
paroxysms,  they  should  be  administered  when  the  sweats,  or  other 
concluding  features  of  the  attacks,  begin  to  subside. 

In  the  treatment  of  ague,  the  type,  although  by  no  means  to  be 
held  as  unimportant,  is  yet  of  very  secondary  consideration  to  the 
other  features  of  the  malady.  The  following  remedies  have  been 
found  most  appropriate  in  ordinary  cases. 

Against  marsh  fevers  the  principal  remedies  are,  Cinchona, 
Arsenicum,  and  Ipecacuanha;  but  the  following  are  also  useful  in 
particular  cases  :  Carb.  v.,  Rhus,  Veratrum,  Natr.  m.,  Fer.,  Arnica,  and 
in  some  severe  and  very  obstinate  cases,  Cimex  lectul. 

Against  intermittents  which  prevail  in  spring  or  summer,  and  in 
warm  climates :  Bella.,  Ipecac,  Veratr.,  Caps.,  Am.,  Lach.,  Cole,  Cine:, 
Sulph.  ;  Bryon.,  Carb.  v.  et  a.,  Puis.,  Digit.,  &c. 

Those  in  which  cold  predominates  require  chiefly  the  following 
remedies :  Veratr.,  Ipecac,  Puis.,  Diad.,  Sabad.,  JPhosph.,  Carlo  v.,  Bry., 
Capsicum,  Staph. ;  those  with  prevailing  heat  :  Nux,  Cocc,  Ign., 
■Sulph.,  Ars.,  Aeon.,  Bella.,  Bry  on.,  Ipecac,  Sabad.,  Valer.,  Veratr.,  Silic  ; 
and  those  in  which  sweating  predominates :  Cocc,  Caps.,  China,  Merc, 
Ars.,  Bry  on.,  Nux,  Samb. 

Intermittents  which  consist  in  shiverings,  heat,  and  sweat- 
ing, (or  a  cold,  a  hot,  and  a  sweating  stage),  are  most  frequently  to 
be  cured  by  Ipecac,  Nux  v.,  Ars.,  China,  Veratr.,  Bella.,  Bry  on.,  Caps., 
Cham.,  Puis.,  Rhus,  &c. 

In  those  which  consist  in  shiverings  and  heat,  the  principal 
medicines  are,  firstly,  when  the  heat  precedes :  Nux,  Caps.,  Calc  ; 
secondly,  when  the  shivering  precedes :  Aeon.,  Am.,  Bry  on.,  Caps.,  Carb.  v., 
Ign.,  Ipecac,  Cine,  Natrum  m*,  Nux  v.,  Puis.,  Rhus,  Sabad.,  Sulph., 
Veratr. ;  thirdly,  when  the  shivering  and  heat  precede  or  follow  in 
alternation  :  Bella.,  Calc,  Lycopod.,  Merc,  Natrum  m.,  Nux  v.,  Sabad., 
Sil.,  Spig*,  Sulph.,  Veratr. ;  and  fourthly,  when  they  occur  simulta- 
neously :  Aeon.,  Arsenic,  Bella.,  Cham.,  Ignatia,  Ipecac,  Lye,  Nux, 
Rheum,  Rhus,  Sabad.,  Sulph. 

In  those  which  consist  of  heat  and  sweating,  the  most  im- 
portant medicaments  are,  when  the  heat  is  accompanied  by  sweating  : 
Bella.,  Bryon.,  Caps.,  Cham*,  Cin.,  Hep.,  Ign.,  Merc,  Nux  v.,  Op.,  Puis*, 
Rhus,  Sabad.  ;  and  when  'the  sweating  sets  in  after  the  heat :  Ars., 
%,  Cin.,  Hep.,  Ign.,  Ipec,  Puis.,  Rhus,  Veratr. 


INTERMITTENT  FEVER.  3  5 

Fevers  which  consist  only  in  rigors  and  sweating  call  for  Lyco- 
podium,  Pulsatilla,  and  Sulphur  principally,  if  the  shivering  and  sweat- 
ing are  simultaneous  ;  and  Caps.,  Carb.  v.,  Lycop.,  Natr.  m.,  Rhus,  Sabad., 
Thuj.,  Veratr.,  if  the  sweating  follows  the  shivering. 

When  there  is  thirst  before  the  attack :  China,  Am.,  Puis.; — during  the 
cold  stage:  Ipecac,  Bella.,  China,  Carbo,  Phosph.,  Sabadilla,  Pry  on., 
Cham.,  Cina,  Ign.,  Caps.,  Rhus,  Ars.,  Veratr. ; — after  the  cold  stage  : 
Sabad.,  Puis.,  Ars.,  China; — after  the  hot  stage,  China; — during  the 
hot  stage,  Cham.,  Puis.,  Rhus,  Veratr.,  Nuxv.;  and  when  there  is 
adypsia  during  the  hot  stage  :  Puis.,  Ars.,  Veratr.,  China,  Nux  v'., 
Ipecac,  Carb.  v.,  Ignatia,  Rhus,  Sabad.,  are  the  principal  remedies.  In 
intermittent  fevers,  attended  with  somnolency  during  the  paroxysms, 
Opium,  Nux  vomica,  Tartarus  stibiatus,  and  Cocculus;  or,  in  some  in- 
stances, Bella.,  Hyosc,  and  Stramon.,  are  amongst  the  most  important 
remedies.  In  those  with  apoplectic  and  paralytic  symptoms  during 
the  paroxysm,  Nux  v.,  Cocculus,  Opium,  Aconitum,  and,  perhaps,  also 
Arsenic  or  Coffea,  are  chiefly  indicated. 

Those  with  syncope  during  the  paroxysms,  Veratrum  album,  and 
possibly  also,  Ipecac,  Puis.,  Sulph.,  Sep.,  Lye,  Graph.,  Sec. 

With  respect  to  the  type  of  the  fever :  Pulsatilla,  Ipecacuanha,  Nux 
vomica,  Caps.,  Diadem.,  Calc,  Sabad*,  may  be  instanced  as  being  parti- 
cularly useful  in  simple  quotidian  fevers.  Ant.,  Calc,  Caps,,  Cham., 
Bros.,  Lye,  Mez.,  Staph.,  in  tertian  ;  and  Arsen.,  Aeon.,  Lye,  Nux  m., 
Sabad.,  in  those  of  a  quartan  type. 

Against  double  quotidians  :  China,  Bella.,  Graph.,  Stram.,  Puis. 
And  against  double  tertians  :  Nux  v.,  Arsenic,  Rhus,  have,  princi- 
pally, been  recommended. 

Intermittent  fevers  which  recur  every  year  have,  for  the  most  part, 
been  treated  most  successfully  by  means  of  Nux  v.,  Arsenic,  Rhus, 
Sulph.,  Lye,  Calc,  Sep.,  &c. 

In  reference  to  the  period  of  the  day  at  which  the  ague-fit  generally 
comes  on,  Am.,  Cham.,  Sabad.,  Staph.,  Calc,  have  repeatedly  cured 
those  which  appear  in  the  morning  {^matutinal fevers).  Ign.,  Sabad.,  Staph., 
Carb.  v.,  Am.,  Lye,  Sep.,  Mere,  against  those  which  set  in  towards 
evening ;  and  Carb.  v.,  Cham.,  Mere,  those  which  make  their  appearance 
at  night  [nocturnal fevers). 

But  as  has  already  been  observed,  the  entire  morbid  picture  must 
be  taken  into  consideration  in  the  selection  of  the  remedies,  and  not 
merely  a  single  peculiarity.  Remedies  which  have  proved  useful  in 
quartans  or  tertians,  will,  nevertheless,  be  found  efficacious  in  other 


36  FEVERS. 

types,  if  they  correspond  accurately  to  the  characteristic  accompany- 
ing symptoms. 

The  following  medicaments  are  especially  useful  in  intermittents 
presenting  the  train  of  symptoms  enumerated : 

Cinchona,  Arsenicum,  Ipecacuanha,  Nux  vomica,  Pulsatilla,  Antimonium 
crudum,  Bryonia,  Veratrum  album,  Cocculus,  Sabadilla,  Ignatia,  and  Carlo 
vegetalilis,  Ant.  crud.,  Bella.,  Caps.,  Canth.,  Ign.,  Bach.,  Puis.,  Sep.,  Digit., 
Natr.  m.,  Bye,  &c. 

Cinchona.  This  well-known,  but  too  frequently  abused  remedy 
is  undoubtedly  of  great  efficacy  in  those  fevers  which  owTe  their 
origin  to  the  influence  of  marsh  miasm,  and  are  peculiarly  preva- 
lent, at  particular  seasons  of  the  year.  It  may  be  given  when  the 
fever  commences  with  a  sense  of  languor  or  general  uneasiness  of  the 
heart,  anxiety,  headache,  sneezing,  great  thirst,  bulimy,  or  nausea, 
and  pain  in  the  bowels.  It  is  also  indicated  when  the  fever  has  set  in 
by  adypsia  during  the  cold  stage— but  thirst  is  experienced  after  the 
heat  and  dtiring  the  sweating,  or  thirst  between  the  hot  and  the  cold 
stage.  It  is  contra-indicated  when  thirst  exists  during  the  hot  stage. 
Turgidity  of  the  veins,  with  heat  in  the  head,  with  natural  wrarmth  or 
increased  heat  of  the  body,  wTith  or  without  increased  heat  of  the  sur- 
face. Or,  again,  determination  of  blood  to  the  head,  commonly  with 
redness  and  heat  in  the  face,  frequently  with  chilliness  of  all  the  other 
parts  of  the  body,  and  even  external  coldness,  or  only  a  feeling  of  in- 
ternal heat  in  the  face,  with  coldness  of  the  cheeks  to  the  touch,  and 
cold  sweat  on  the  forehead,  are  further  indications  for  the  employ- 
ment of  this  medicament.  In  many  cases,  Cinchona,  although  not 
capable  of  effecting  a  radical  cure,  is  yet  of  great  utility  as  a  pallia- 
tive :  it  should,  under  such  circumstances,  be  exhibited  immediately 
before  the  cold  stage.  {Arsenicum  Carlo  v.,  Veratr.,  Arnica,  Sulph., 
Pulsatilla,  or  Calcarea,  are  often  required  to  complete  the  cure  after 
the  previous  employment  of  Cinchona.) 

Arsenicum  is  one  of  the  most  important  remedies  in  intermittent 
fevers.  It  is  indicated  when  the  different  stages  are  not  definitely 
marked,  but  the  fever  and  heat  and  shivering  appear  simultaneously, 
—or  when  we  find  cold  shuddering  alternately  with  heat,  or  a  sensation 
of  cold  internally  with  heat,  or  an  imperfect  development  of  the  paroxysms; 
or  burning  heat,  as  if  molten  lead  were  coursing  through  the  veins, 
communicating  an  unpleasant  sensation  of  heat  (color  mordax)  to  the 
hand,  when  placed  upon  the  body  of  the  patient :  great  restlessness ; 
excessive,  almost  insatialle  thirst,  obliging  the  sufferer  to  drink  con- 


INTERMITTENT  FEVEIt.  37 

stantly,  although  but  little  at  a  time;  depression,  marked  prostration  of 
strength  and  anxiety ;  nausea,  desire  to  vomit,  retching,  and  even  vomit- 
ing ;  severe  and  burning  pains  in  the  stomach,  and  insupportable  pains 
all  over  the  body,  especially  in  the  limbs. 

One  marked  characteristic  of  Arsenicum  is,  that  all  the  sufferings  of 
the  patient,  pains  in  the  limbs,  &c,  increase  in  intensity  during  the 
paroxysms,  and  others  develop  themselves;  another  is,  its  marked 
periodicity,  usually  either  Tertian  or  Quartan,  and  the  rigors  generally 
setting  in  towards  evening. 

It  is  therefore  called  for  in  these  cases,  where  wre  meet  with  a  well- 
marked  periodicity  of  imperfectly  developed  paroxysms,  with  some  or  any 
of  the  symptoms  above  mentioned. 

A  few  globules  of  this  medicament,  given  during  the  apyrexia,  will 
be  generally  found  a  sufficient  dose;  however,  in  some  cases,  when 
the  vital  energies  of  the  patient  seem  too  weak  to  rally,  and  the  cold 
fit  continues,  two  drops  of  the  tincture  may  be  added  to  an  ounce  of 
water,  and  a  dessert- spoonful  given  every  four  or  two  hours,  or  every 
quarter  of  an  hour,  according  to  the  exigency  of  the  case.  Such  cases 
are  happily  rare  in  this  country,  but  we  have  thought  it  advisable  to 
touch  upon  the  means  to  be  employed  when  they  do  occur ;  in  such 
instances  Veratrum  (which  see)  is  also  occasionally  useful. 

Ipecacuanha.  This  remedy  has  been  found  more  or  less  useful 
in  most  cases  of  marsh  fever,  and  although  not  always  competent  to 
effect  the  entire  removal  of  the  complaint,  yet,  when  administered  at 
the  commencement,  it  is  often  of  considerable  benefit,  and  in  many 
instances,  when  judiciously  selected,  is  alone  sufficient  to  perform  a 
cure.  Striking  benefit  has  frequently  been  derived  from  its  employ- 
ment with  Nux  v.,  by  giving  three  to  four  doses -of  Ipecac,  at  equal 
intervals  during  the  apyrexia ;  then  Nux  v.,  one  dose,  in  the  succeed- 
ing apyrexia. 

Either  of  these  remedies  is  sometimes  alone  sufficient  to  shorten  the 
duration  of  the  disease;  the  indications  for  Ipecacuanha  are  as  fol- 
lows :  much  shivering,  with  but  little  heat  or  vice  versa ;  increase  of  the 
shivering  by  external  warmth  ;  oppression  at  the  precordial  region ;  adyp- 
sia,  or  at  least,  little  thirst ;  dryness  of  the  mouth,  nausea,  vomiting, 
and  other  symptoms  of  deranged  digestion. 

For  Nux  vomica  :  Excessive  weakness  at  the  commencement  of 
the  fever ;  the  horripilation  mixed  with  or  immediately  followed  by 
heat ;  warmth  of  the  cheeks,  with  internal  chilliness ;  feeling  of  heat 
in  the  face*  with  horripilation  in  the  remaining  parts  of  the  body ;  heat 
in  the  head  with  coldness  of  the  body ;  burning  pain  in  the  eyes;  or, 


38  FEVERS. 

giddiness,  with  feeling  in  the  head  as  if  from  intoxication,  desire  to  lie< 
down,  with  trembling  of  the  limbs,  syncope,  or  a  sensation  of  para- 
lytic weakness  and  prostration,  with  cramps  in  the  different  extremities, 
particularly  the  calves  of  the  legs  and  feet,  difficulty  of  breathing, 
palpitation  of  the  heart,  anxiety,  irascibility,  fear  of  death,  and  even 
violent  delirium.  (Febris  intermittens  apqplectica  so  called) ;  gastric 
derangements,  such  as  anorexia;  dislike  to  bread;  bitter  and  sour 
eructations,  tension  of  the  abdomen,  or  spasm  of  the  abdominal  muscles, 
and  constipation;  burning  itching  miliary  eruption,  and  burning  itching 
sensations  over  the  whole  body.  During  the  fever :  coldness  and 
blueness  of  the  skin,  desire  to  be  constantly  covered,  even  during  the 
access  of  heat  and  perspiration ;  occasionally  stitches  in  the  side, 
shooting  pains  in  the  abdomen,  aching  in  back  and  limbs,  and  dragging 
pain  in  abdomen  during  the  rigors.  During  the  hot  fit  particularly : — 
headache,  buzzing  in  the  ears,  heat  in  the  head,  or  face,  with  redness 
of  the  cheeks,  and  thirst.  Bryonia,  Verat.,  Puis.,  Cocc,  Bella.,  also 
deserve  attention  in  intermittent  fevers  accompanied  by  constipation. 

Pulsatilla,  like  the  two  remedies  last  mentioned,  and  also 
Antimonium  crudum,  Bryonia,  and  Ignatia,  is  an  excellent  remedy  in 
Agues  complicated  with  gastric  or  bilious  symptoms,  whenever  the 
slightest  dyspeptic  attack  brings  on  a  relapse.  Its  more  peculiar 
indications  are :  vomiting  of  mucus  at  the  commencement  of  the  cold 
stage ;  adypsia,  all  through  the  fever, — or  thirst,  only  during  the  hot 
fit ;  simultaneous  heat  and  shivering — aggravated  in  the  afternoon  or 
towards  evening ;  shivering  when  uncovered ;  anxiety  and  oppression  of 
the  chest  during  the  shivering.  During  the  hot  stage:  redness  and 
swelling  of  the  face,  or  redness  of  the  cheeks  only,  and  perspiration 
on  the  face.  The  presence  of  diarrhoea,  and  the  patient  being  of  a 
mild  disposition,  are  corroborative  indications  for  its  employment. 

Antimonium  crudum.  The  indications  for  this  remedy  closely 
resemble  those  of  Pulsatilla,  but  it  is  particularly  called  for  when  the 
perspiration  breaks  out  simultaneously  with  the  accesses  of  heat,  and  then 
suddenly  disappears,  leaving  the  skin  dry  and  hot.  It  may  be  exhibited 
in  the  same  manner  as  Pulsatilla. 

Cina  is  of  great  efficacy  in  quotidian  agues,  which  are  ushered  in 
by  vomiting  of  ingesta,  followed  by  bulimy ;  as  also  when  the  cold 
stage  is  attended  with  thirst. 

Bryonia  is  indicated  by  headache  and  vertigo,  with  dry  heat 
preceding  the  attacks  of  shivering ;  by  the  predominance  of  cold  or 
shivering,  with  redness  of  the  cheeks,  heat  in  the  head,  and  headache  ; 
or  marked  heat  followed  by  shivering;    by    stitches  in  the   side, 


INTERMITTENT  EEVER.  39 

excessive  thirst,  thickly  coated  tongue,  bitter  taste  in  the  mouth, 
disgust  at  the  sight  of  food,  nausea  or  vomiting,  and  constipation. 

Veratrum  album  is  indicated  by  the  predominance  of  external 
coldness,  with  heat  internally ',  cold  clammy  perspiration,  especially  on  the 
forehead,  or  general  coldness  of  the  body  ;  or  by  shivering,  followed 
by  heat  and  perspiration,  and  then  relapsing  into  shivering  ;  coldness, 
great  thirst,  deep-coloured  urine,  diarrhoea  with  griping,  or  constipa- 
tion, sometimes  nausea  or  vomiting  and  vertigo,  and  pains  in  the 
dorsal  and  lumbar  regions.  Tart.  emet.>  has  also  been  recommended 
in  such  cases,  and  especially  when  the  nervous  system  becomes  pro- 
minently affected,  as  indicated  by  sopor,  insensibility,  with  coldness 
of  the  extremities,  rigidity  of  the  whole  body,  or  twitchings  of  the 
muscles  of  the  face  and  limbs,  and  almost  imperceptible  pulse. 

Belladonna.  Severe  headache,  with  giddiness,  or  heat  and 
redness  of  the  face,  pulsation  of  the  carotids,  and  excessive  exacerba- 
tion of  pain  from  meditation;  partial  shivering  and  shuddering,  with 
heat  in  other  parts;  great  heat,  with  slight  shivering;  or  violent 
shivering  with  moderate  heat ;  adypsia,  or,  on  the  contrary,  intense 
thirst;  extreme  susceptibility,  tearfulness,  or  depression  of  spirits, 
and  desire  for  death,  particularly. when  the  sufferings  are  at  their 
height. 

Cocculus  maybe  employed  when,  in  addition  to  the  usual  symp- 
toms of  Ague,  we  find,  during  the  apyrexia,  symptoms  of  spasmodic 
affections,  particularly  of  the  stomach  and  abdomen,  such  as  cramp- 
like pains  at  the  epigastrium,  or  constrictive  pinching,  or  tearing, 
burning,  colic-like  pains  in  the  hypogastrium. 

Sabadilla  has  been  found  useful  in  cases  where  the  attacks 
return  always  at  the  same  hour,  with  chills  of  short  duration,  then 
thirst  followed  by  heat;  also,  where  thirst  is  present  just  at  the 
close  of  the  cold  stage,  and  in  such  affections  as  consist  entirely  of 
chills. 

Ignatia  is  indicated  when,  with  heat  of  some  parts  of  the  body, 
there  is  coldness,  chill,  and  shuddering  of  others  ;  also  where  the  heat 
is  only  external.  Its  best  characteristic  is,  when  the  chills  are  easily 
relieved  by  external  warmth,  and  attended  with  thirst. 

Opium  has  chiefly  been  recommended  mfebris  intermittens  sqporosa,. 
with  stertor,  convulsive  movements  in'  the  limbs  and  suppressed 
evacuations.  Tartarus  stibiatus  may,  however,  be  found  more  generally 
appropriate  in  cases  of  this  description.  Nux.  v.,  Cocc,  Bella.,  Hyosc, 
JStramon.,  and  Cham.,  are  likewise  worthy  of  attention  here. 


40  FEVERS. 

Natrum  m.  Ague  fits  commencing  with  headache,  general  aching 
pains  ;  predominant  or  prolonged  shivering  ;  great  thirst  during  the 
hot  fit,  and  nearly  to  the  same  extent  during  the  cold  stage  ;  also 
dryness  of  the  mouth  and  tongue;  tenderness  of  the  scrobiculus  to 
the  touch ;  bitter  taste  and  loss  of  appetite ;  debility,  sallow  com- 
plexion ;  soreness  of  the  corners  of  the  mouth ;  (sequelae  of  the  abuse 
of  Cinchona  hark,  or  of  Quinine). 

Carbo  vegetabilis,  is  particularly  indicated,  when  throbbing 
at  the  temples,  aching  in  the-  teeth  and  in  the  bones  of  the  extre- 
mities, and  the  coldness  of  the  feet  precede  the  paroxysm ;  when 
thirst  is  present  only  during  the  shivering ;  and  there  are  rheumatic 
pains  in  the  teeth  or  limbs  before  or  during  the  attack,  or  nausea, 
giddiness,  and  redness  of  the  face  during  the  hot  fit ;  further,  when 
an  intense  burning  pain,  occupying  the  right  frontal  protuberance  and 
the  orbit,  accompanies  the  fever. 

Capsicum.  Excessive  thirst  during  the  cold  stage;  predominating 
cold,  followed  by  burning  heat ;  accumulation  of  mucus  in  the  mouth 
and  throat,  or  vomiting  of  mucus ;  diarrhoea ;  slimy  and  burning 
stools ;  headache,  restlessness,  sensibility  to  noise ;  ill-humour, 
anxiety,  and  giddiness,  which  increase  during  the  cold  stage ;  aching 
pains  in  the  back  and  limbs;  painful  swellings  of  the  spleen  (after  the 
abuse  of  China). 

When  the  hot-fit  continues  long  without  perspiration  supervening, 
and  the  intermittent  fever  threatens  to  become  remittent  or  inflam- 
matory, we  must  have  immediate  recourse  to  Aconite,  of  which  wre 
may  give  two  globules,  and  if  no  relief  follows  in  three  or  four  hours, 
add  six  globules  to  an  ounce,  of  water,  and  administer  a  dessert- 
spoonful every  hour  until  perspiration  sets  in,  or  the  pulse  is 
reduced. 

In  intermittent  fevers  of  various  types,  which  become  developed 
after  a  thorough  wetting,  Rhus  toxicodendron  is  of  great  use ; 
and  in  those  which  are  accompanied  by  very  copious  and  sour,  or 
otherwise  offensive-smelling  sweat,  with  palpitation  of  the  heart; 
mixed  heat  and  shivering,  anguish  and  thirst  during  the  hot  stage, 
Mercurius  does  good.  Agues  which  have  become  altered  in  character, 
and  rendered  much  complicated  \>j  the  abuse  of  Cinchona  in  large 
and  long- continued  doses,  are  in  general  very  difficult  to  cure. 
The  following  remedies  have  been  employed  with  more  or  less 
success  in  such  cases :  Belladonna,  Ipecac,  Verair.,  Arsenic,  Arnica, 
Bryonia,  Caps.,  Pulsatilla,  Natr.  m.,  Sulph.,  Sep.,  Calc,  Carb.  v.,  Merc. 


RAPHANIA.  43 

Cina,  Nux>  Loch.,  Hell.,  Fer.  Against  oedema  of  the  feet  and  hydrops 
abdominis,  arising  from  a  similar  cause,  Bry.,  Helleb.,  Arsen.,  Acid' 
hydr.,  may  be  found  of  great  service. 

Inveterate  intermit  tents,  occurring  in  bad  habits  of  body,  are  most 
likely  to  be  relieved  by  such  medicaments  as  the  following :  SulpJi^ 
Calc.y  Lycopod.,  Sepia,  Calc.  sulph.,  Carlo  v.,  Hepar  s.,  Cimex  lent., 
JVatr.  m.y  Mez.,  etc. 

The  preceding  are  the  medicines  that  have  been  found  useful  in 
ordinary  cases  of  this  affection ;  but,  as  it  is  frequently  found  com- 
plicated with  other  complaints,  it  has  only  been  found  practicable 
to  give  a  general  statement  of  the  course  to  be  pursued  when  the 
disease  occurs  in  its  more  simple  forms,  and  merely  to  allude  to  the 
others — there  being  scarcely  a  disease  known,  that  may  not  assume 
the  intermittent  type,  as  there  is  scarcely  a  proved  medicine  that 
does  not  also  partake  of  the  same  character.  All  the  author  has 
endeavoured  to  do,  in  the  preceding  pages,  is  to  give  a  clear  idea  of 
the  treatment  of  ague,  commonly  so  called,  as  frequently  met  with ; 
as  he  feels  it  would  be  vain  to  attempt  to  enter  upon  the  many 
various  forms  and  appearances  which  this  malady  presents. 


RAPHANIA. 

Morbus  cerealis,  Cannulsio  cerialis.     Eclampsia  typhoides. 

The  term  Raphania  has  been  given  to  this  disease  from  its  being 
saidto  be  produced  by  eating  a  species  of  radish.  A  residence  in 
damp,  ill- ventilated  dwellings,  combined  with  insufficient,  indiges- 
tible, or  otherwise  unwholesome  food,  seems,  however,  to  be  the 
general  predisposing  cause.  Most  authors  have  divided  it  into  two 
forms,  the  acute  and  chronic.  The  acute  variety  is  of  the  severest 
and  most  dangerous  character,  and  though  not  so  frequently  ushered 
in*  by  premonitory  symptoms  as  the  chronic  form,  is  yet  occasionally 
preceded  by  indications  of  considerable  gastric  and  nervous  disturb- 
ance, such  as,  moist,  foul  tongue,  insipid  nauseous  taste,  eructation, 
inclination  to  vomit,  spasm  of  the  stomach,  vomiting  of  dark  or 
blackish  brown-coloured  bile;  confusion  in  the  head,  giddiness, 
tremor,  and  slight  creeping  sensations  (formication)  of  the  limbs,  etc. 
The  disease  itself  commences  with  cold  chills  and  lassitude,  head- 
ache, and  praecordial  anxiety.  These  symptoms  are  succeeded  by 
burning  heat,  intense,  almost  insatiable  thirst,  violent  fever,  delirium, 


43  FEVERS. 

feeling  of  suffocation,  frequently  attended  with  spasmodic  palpitation 
of  the  heart,  convulsions  of  various  kinds,  which  latterly  terminate 
in  frightful  tonic  spasms.  The  cutaneous  transpiration  is  either 
suppressed  or  the  skin  is  covered  with  a  cold  clammy  sweat,  and  the 
countenance  wears  an  expression  somewhat  similar  to  that  in  febris 
nervosa  stupida.  After  a  few  days  the  nervous  state  assumes  a 
putrid  type,  the  vital  powers  begin  to  sink,  the  spirits  become 
extremely  depressed,  the  face  pale,  the  features  distorted,  the  hearing 
obtuse,  and  stupor  with  fits  of  fainting  supervene. 

At  length  the  pujse  becomes  almost  imperceptible,  purple  exan- 
themata break  out,  or  rigidity  of  all  the  joints,  or  tabes,  succeeds;  and 
finally,  dry  gangrene  sometimes  sets  in,  affecting  either  the  fingers  and 
toes  alone,  or  entire  limbs.  The  chronic  variety  is  chiefly  distinguished 
from  the  acute,  by  its  marked  exacerbations,  paroxysms,  remissions, 
and  longer  duration.  It  is,  moreover,  oftener  introduced  by  pre- 
monitory symptoms,  which  generally  partake  of  the  following 
character :  general  languor,  a  distressing  feeling  of  chilliness  in  the 
abdomen,  back,  and  extremities;  anxiety,  headache,  disturbed 
sleep,  frightful  dreams,  rending,  aching  pains  in  the  joints,  and 
sensation  of  crawling  in  the  extremities.  Along  with  these,  there  are 
various  signs  of  gastric  derangement,  such  as  eructation,  pyrosis, 
nausea,  vomiting  of  viscous  mucus,  gastrodynia,  etc.  When  the 
paroxysm  itself  comes  on,  the  creeping  and  painful  sensations  in  the 
extremities  increase  in  severity.  Spasmodic  contractions  in  various 
parts  take  place  at  the  same  time,  the  fingers  being  bent  backwards, 
the  eyes  convulsed,  and  the  pupils  contracted ;  the  patient  is  seized 
with  tremor,  contorts  the  limbs  in  different  directions,  stammers  in 
his  speech,  and  speaks  feebly  and  incomprehensibly. 

Constipation  is  an  occasional  concomitant  symptom,  as  also  colic, 
hiccough,  asthmatic  sufferings,  and  even  epistaxis  and  hemoptysis. 
In  other  cases  diarrhoea  with  discharge  of  worms,  and  vomiting 
take  place.  When  the  attack  is  of  a  protracted  nature,  the  clonic 
become  converted  into  tonic  spasms.  The  duration  of  the  paroxysm 
varies  from  one  to  several  hours.  The  recurrences  take  place  at  least 
once  a  day,  and  commonly  end  in  a  fit  of  copious  sweating  followed 
by  sleep,  and  subsequent  insensibility  of  the  affected  limbs.  The 
patients  are  not  wholly  exempt  from  abnormal  conditions  during  the 
remissions,  experiencing  great  languor,  numbness  of  the  extremities, 
especially  of  the  fingers  and  toes.  The  skin  becomes  bluish,  corru- 
gated, and  deprived  of  its  sensibility;  or  colliquative  sweats,  petechia, 


RAPHANIA.  43 

and  the  other  morbid  states  enumerated  under  the  acute  variety, 
succeed  and  put  a  period  to  the  mournful  scene. 

Therapeutics.  Hahnemann  was  the  first  to  recommend  the  em- 
ployment of  Solanum  nigrum  in  this  serious  malady,  and  the  opinion 
which  he  formed  of  its  specific  property,  both  in  the  acute  and  chronic 
forms  of  the  malady,  was  amply  confirmed  by  the  successful  result  of 
subsequent  trials.  Secale-cornutum  has  also  been  favorably  spoken  of  by 
some  writers.  The  following  remedies  have,  moreover,  been  mentioned 
as  likely  to  prove  useful  in  particular  cases  :  Belladonna,  Rhus,  Hyoscya- 
mus,  Stramonium,  Aconitum,  Arsenicum,  Ignatia,  Cina,  Cuprum  aceticum, 
Cinchona. 

Belladonna,  when  there  is  burning,  heat  of  the  skin,  excessive 
thirst,  trembling  of  the  limbs,  slight  convulsions,  contracted,  im- 
movable pupils,  muscse  volitantes.  Rhus,  when  the  nervous  appear- 
ances form  a  prominent  feature  of  the  disease,  and  the  symptoms 
approximate  to  those  of  a  febris  nervosa  stupida.  Hyoscyamtis  and 
Stramonium  correspond  better  than  the  foregoing  to  the  convulsions, 
the  former  particularly  to  those  which  come  on  in  the  earlier  stage 
of  the  disorder,  and  the  latter  to  those  of  a  more  violent  character, 
such  as  occur  at  a  later  period,  and  in  the  severer  forms  of  the 
affection. 

Arsenicum  may  be  of  service  in  chronic  cases  attended  with 
anxious  and  oppressive  respiration,  spasmodic  palpitation  of  the  heart, 
quick,  nervous,  small,  and  occasionally  intermittent  pulse,  foul,  brown- 
coated  tongue,  extreme  prostration  of  strength.  Ignatia  amara  is  well 
adapted  to,  and  has  proved  useful  in  some  of  the  milder  chronic  forms 
of  the  complaint,*  more  especially  when  the  convulsive  movements 
resembled  those  which  are  met  with  in  St.  Vitus's  dance.  Cina,—> 
spasmodic  sufferings  chiefly  confined  to  the  abdomen,  vomiting,  with 
discharge  of  worms.  Cuprum  aceticum  afforded  signal  service  in  a 
species  of  Raphania  chronica,  in  which  the  convulsions  increased  in 
intensity  at  every  succeeding  paroxysm.t 

*  Hartman's  Therapie,  vol.  ii,  2d  edit.  p.  67.         f  Ibid. 


44  FEVERS. 

THE  PLAGUE. 

Pestis.     Pestis  bubonico.     Typhus  pestilentialis. 

The  term  Plague  is  employed  to  designate  a  malignant  disease 
which  frequently  prevails  on  the  coast  of  the  Levant,  and  which 
appeared  in  this  country  about  200  years  ago.  It  is  characterized  by 
highly  contagious  typhus  fever,  buboes  and  carbuncles  which  have  a 
strong  tendency  to  take  on  a  gangreneous  character,  petechiae,  hemor- 
rhage, colliquative  diarrhoea,  and  prostration  of  strength.  Most 
authors  who  have  written  on  the  subject  consider  the  plague  to  be  a 
pestilential  contagion,  which  is  propagated  almost  solely  by  contact 
either  with  a  diseased  person,  or  with  porous  substances,  such  as 
wool  and  woollen  cloths,  which  have  absorbed  and  retained  the  spe- 
cific poison  ;  but  it  would  seem  that  it  occasionally  prevails  also  as  an 
epidemic  disease.  No  certain  statements  have  yet  been  made  as  to 
howT  long  an  individual  who  has  been  affected  with  the  disease  is 
capable  of  communicating  it  to  others,  nor  how  long  the  contagion 
may  adhere  to  a  non-susceptible  person  without  developing  the  disease 
in  the  said  party,  and  may  yet  be  communicated,  and  the  malady 
produced  in  habits  more  susceptible  to  its  influence.  It  has,  however, 
been  observed,  that  the  disease  generally  appears  so  soon  as  the  fourth 
or  fifth  day  after  infection.  Sometimes  premonitory  symptoms,  in 
the  form  of  slight  headache,  and  some  degree  of  languor,  are  ex- 
perienced by  the  patient,  for  many  days  previous  to  the  outbreak  of 
the  disease;  but  it  more  frequently  happens  that  great  depression  of 
strength,  anxiety,  palpitation  of  the  heart,  fainting,  giddiness,  violent 
headache,  delirium,  and  stupor,  together  with  a  weak  and  irregular 
pulse,  very  soon  supervene.  Nausea,  and  vomiting  of  a  dark  bilious 
substance  are  shortly  superadded ;  and,  as  the  disease  proceeds  on  its 
course,  buboes  form  in  the  axillary,  parotid,  cervical,  maxillary,  and 
inguinal  glands;  carbuncles  also  arise,  or  petechiae  make  their  appear- 
ance ;  or  hemorrhages  and  a  colliquative  diarrhoea  ensue. 

The  disease  is  always  regarded  as  serious  and  pregnant  with  danger 
when  it  presents  itself  in  a  severe  form. 

Much  appears  to  depend  upon  the  particular  character  of  the  epi- 
demy.  When  accompanied  by  buboes,  it  is  commonly  less  fatal  than 
when  unattended  by  these  inflammations.  The  invasion  of  healthy  sup- 
puration in  the  buboes  is  always  held  as  critical,  and  conducive  to  reco- 
very. The  breaking  out  of  a  gentle  perspiration  has  also  been  known 
to  prove  critical.     Petechiae,  hemorrhages,  colliquative  diarrhoea,  and 


THE  PLAGUE.  45 

a  tendency  to  gangrenous  degeneration  of  the  carbuncles  or  buboes, 
have  hitherto  been  regarded  as  positive  indications  of  a  fatal  termina- 
tion. 

Therapeutics.  We  are  not  aware  of  any  detailed  homoeopathic 
writings  on  the  treatment  of  plague,  and  presume  that  no  homoeo- 
pathic practitioner  has  as  yet  had  an  opportunity  of  treating  the 
disease.  We  have  every  reason  to  believe,  however,  that  this  frightful 
malady  will  in  time  be  found  perfectly  tractable  under  homoeopathic 
treatment,  and  thereby  bereft  of  much  of  the  terror  which  its  invasion 
inspires  in  those  parts  wThere  it  so  frequently  and  so  destructively 
rages.  The  following  remedies  may  be  named  as  likely  to  prove  more 
or  less  useful :  Arsenicum,  Lachesis,  Cinchona ;  Carlo  v.  et  a.,  Veratrum, 
Rhus  toxicodendron,  Merc,  Acidum  nitr.,  Kreosotum,  and  Silicea. 

The  leading  indications  for  these  remedies  against  the  typhoid 
fever,  will  be  found  in  the  chapter  on  Nervous  fever,  to  which,  there- 
fore, we  beg  to  refer  our  readers. 

Arsenicum,  in  addition  to  being  appropriate  to  the  fever,  is,  more- 
over, either  alone  or  in  alternation  with  Veratrum,  well  adapted  to  the 
excessively  irritable  state  of  the  stomach,  with  rejection  of  everything 
that  is  partaken  of,  or  vomiting  of  blackish  bilious  matter,  the  great 
prostration,  and  the  colliquative  diarrhoea  which  so  frequently  accom- 
pany the  disease.  It  is,  further,  well  calculated  to  be  of  essential  ser- 
vice in  warding  off  a  tendency  to  gangrenous  degeneration  when 
carbuncles  arise,  and  may  even  prevent  a  fatal  issue  when  gangrene 
has  already  commenced.  In  the  latter  case,  Lachesis  and  Cinchona 
are  also  capable  of  being  of  some  service,  and  may,  perhaps,  be 
advantageously  given  in  rapid  alternation  with  Arsenicum. 

When  buboes  form,  and  threaten  to  become  indurated,  although  they 
do  not  assume  a  livid  appearance,  after  the  employment  of  Arsenicum, 
Veratrum,  or  any  of  the  other  remedies  which  may  have  been  called  for 
by  the  typhoid  fever,  such  as  Rhus,  Cinchona,  or  Lachesis, — Mercurius 
may  be  useful,  particularly  when  the  parotid  glands  are  affected,  and 
the  region  of  the  liver  is  much  distended. 

Acidum  nitricum,  Carlo  v.,  or  Silicea  may  be  required  after  Merc. 

When  the  integuments  over  the  buboes  present  a  purple  or  livid 
aspect,  or  when  the  buboes  suppurate  and  discharge,  but  instead  of 
showing  a  disposition  to  heal,  exhibit  a  gangrenous  tendency, — Silicea 
may  possibly  succeed  in  bringing  about  a  healthy  action ;  but  Lachesis, 
Arsenicum,  and  China  may  claim  a  preference  even  here,  provided  they 
are  better  indicated  by  the  entire  morbid  picture. 


46  FEVERS. 

When  petechias  break  out,  Arsenicum  and  Rhus  will  deserve  the 
most  attention. 

When  there  is  colliquative  diarrhoea,  Arsen.,  Veratr.,  and  China. 

When  debilitating,  sanguineous,  alvine  evacuations  take  place 
Acid.  nitr. ,  Rhus,  Arsenicum,  China,  and  Kreosotum. 

And  when  excessive  epistaxis  results,  Cinchona  and  Rhus ;  or  per- 
haps Sulph.,  Calc,  or  Hepar  s. 

It  is  probable  that  Add.  hydrojod.,  Acid,  phosph.,  Phosph.,  Bryon., 
Bella.,  Hyosc,  Lycopod.,  Spirit,  nitr.,  &c,  may  also  be  worthy  of  notice 
in  the  treatment  of  plague. 

REMITTENT  FEVER.    YELLOW  FEVER. 

Febris  flava.     Typhus  icterodes. 

This  fever  is  a  disease  of  warm  climates,  and  has  obtained  the 
name  of  yellow  fever  from  the  hue  w7hich  the  skin  of  those  affected  by 
it  very  frequently  acquires.  The  more  constant  symptoms  of  the  dis- 
ease are :  violent  vomiting,  first  of  bilious  and  subsequently  of  brown- 
ish black  matter,  which  is  also  passed  by  stool ;  great  anxiety  and 
prostration,  intense  fever.  Remarkable  remissions  take  place  in  the 
course  of  the  fever,  succeeded  in  a  few  hours  by  exacerbations.  The 
outbreak  of  the  malady  is  generally  preceded  by  sudden  debility  and 
restlessness,  which  are  soon  followed  by  headache,  giddiness,  faint- 
ness,  and  slight  chilliness,  to  which  are  added  praecordial  oppression, 
want  of  appetite,  and  deranged  digestion.  In  other  cases,  the  seizure 
is  sudden  and  unattended  with  premonitory  symptoms,  and  the  course 
of  the  disease  exceedingly  rapid,  and  a  fatal  termination  not  unfre- 
quent  within  thirty-six  hours  from  the  accession  of  the  attack.  The 
more  usual  form  which  the  disease  takes  is,  however,  as  follows: 
Immediately  after  the  fit  of  chilliness  and  horror,  violent  reaction 
sets  in,  announced  by  a  high  degree  of  fever,  with  great  heat  of  skin, 
strong  throbbing  of  all  the  arteries  of  the  body,  and  determination  of 
blood  to  the  head.  The  respiration  is  hurried  and  often  laborious, 
attended  with  deep  sighing  and  gasping  for  air.  The  face  is  flushed, 
the  eyes  heavy,  sensitive  to  light,  and  affected  with  burning  pains ; 
the  tongue  white,  furred,  and  sometimes  red,  but  soon  becomes 
parched  and  dark-coloured,  and  tinged  with  yellow  after  the  vomitings 
come  on ;  the  thirst  is  excessive.  A  burning  pain  is  sometimes 
experienced  in  the  scrobiculus;  an  excessive  sensibility  to  the  touch 
in  the  right  hypochondrium ;  and  the  stomach,  irritable  from  the  first, 


REMITTENT  FEVER.  47 

is  rendered  so  much  so  as  the  disease  advances,  that  everything  which 
is  taken  into  it  is  almost  immediately  rejected,  along  with  a  quantity 
of  bilious  matter.  Severe  darting  pains  traverse  the  head,  the  small 
of  the  back,  and  even  extend  down  the  thighs.  The  pulse  is  subject 
to  variations,  being  in  some  cases  quick  and  strong,  in  others  quick, 
low  and  irregular ;  in  plethoric  individuals,  who  have  not  been  long 
exposed  to  the  relaxing  effects  of  the  warm  climate,  it  is  accelerated^ 
full,  and  bounding,  for  some  hours  after  the  development  of  the 
reaction ;  the  urine  is  suppressed,  or  scanty  and  offensive ;  the  stools 
have  likewise  a  most  disagreeable  fetor ;  the  patient  is  excessively  rest- 
less, tormented  writh  spasms  in  the  abdomen  and  legs,  and  tosses  about 
with  anguish.  These  symptoms  constitute  the  first  or  inflammatory 
stage  of  the  fever,  and  may  continue  from  twenty-four  to  sixty  hours 
and  upwards,  according  to  the  severity  or  mildness  of  the  attack. 
The  second  stage  commences  with  the  abatement  of  several  of  the 
preceding  symptoms,  and  the  increase  or  substitution  of  others.  The 
skin  and  eyes  present  a  yellow  tinge ;  the  head  is  confused,  or  deli- 
rium supervenes,  and  the  eyes  look  glassy.  The  fits  of  vomiting  are 
more  violent,  and  the  matter  ejected  becomes  thicker  and  darker ;  the 
patient  occasionally  drops  asleep,  but  instantly  awakes  in  a  fright, 
and  sometimes  he  springs  out  of  bed  in  a  state  of  furious  delirium, 
but  instantly  sinks  to  the  ground  in  a  state  of  tremor  and  exhaustion; 
the  pulse  flags,  but  is  sometimes  soft,  at  others  high ;  the  tongue  is 
generally  parched,  harsh,  and  discoloured,  but  sometimes  moist  and 
covered  with  a  dark  fur ;  there  is  frequent  hiccough,  and  the  skin  is 
soft  and  clammy.  The  duration  of  this  stage  is  also  variable;  rarely 
if  ever  longer  than  forty-eight  hours,  sometimes  only  twelve.  The 
first  and  second  stages  terminate  by  a  remission  of  the  more  alarming 
symptoms,  and  a  hope  of  recovery  is  entertained,  but  it  is  too  often 
doomed  to  disappointment  by  insidious  degeneration  of  the  disease 
into  the  third  stage,  in  which  the  pulse  sinks,  becomes  irregular  and 
intermittent,  yet  sometimes  increases  in  frequency ;  the  vomiting 
becomes  incessant,  and  is  attended  with  great  straining  and  noise^ 
from  the  violent  belching  of  flatus ;  the  matter  vomited  is  grumous, 
resembling  coffee-grounds,  and  is  named  the  black  vomit.  The 
breathing  becomes  more  laboured;  the  tongue  black,  or  shrunk  dry  and 
red ;  the  eyes  hollow  and  sunk,  and  the  features  shortened.  A  gradual 
aggravation  of  the  symptoms  then  ensues,  attended  with  startings 
or  twitchings  of  the  tendons,  the  limbs  become  deadly  cold,  and  the 
hiccough  distressingly  constant.  Hemorrhage,  or  oozing  of  blood  takes 


48  FEVERS. 

place  from  different  parts  of  the  body ;  the  urine  is  deep-coloured,  the 
stools  black  or  sanguineous ;  the  abdomen  often  tense  and  tympanitic ; 
vibices  make  their  appearance,  and  death  slowly  or  suddenly  termi- 
nates the  scene. 

Therapeutics.  From  the  scantiness  of  the  information  which 
is  at  present  to  be  gleaned  from  homoeopathic  authors  respect- 
ing the  treatment  of  the  disease,  we  are,  in  the  absence  of  any 
personal  experience,  precluded  from  giving  even  a  brief  sketch  of  the 
characteristic  indications  for  the  employment  of  the  appropriate 
remedies.  Under  such  circumstances  we  can  but  simply  offer  a  list 
of  those  medicaments  which  will,  in  all  probability,  be  found  of  the 
greatest  value  in  remittent  fevers.  They  are  chiefly  as  follows : 
Aconitum  and  Sella.,  (in  the  inflammatory  stage,)  Nux  v.,  Bryonia, 
Pulsatilla,  Digitalis,  Crotalus,  China,  Lachesis,  Rhus,  Arsenicum,  Veratmm, 
Carlo  v.  (the  three  last  named  particularly  in  the  third  stage,  but  also 
in  the  second,  in  malignant  cases),  and  perhaps  also  Arnica,  Amon.  m., 
Sulph.,  &c.  When  the  disease  partakes  of  the  character  of  a  highly 
congestive  or  malignant  typhus,  which  it  would  appear  to  be  prone  to 
do  when  it  occurs  in  situations  where  the  marsh  miasm  is  unusually 
concentrated,  or  where  its  effects  are  aggravated  by  the  depressing 
influences  of  unhealthy  locality,  damp,  ill-ventilated,  crowded 
dwellings,  together  with  deficient  or  unwholesome  nutriment,  the 
same  medicaments  that  we  have  given  in  the  chapter  on  Nervous 
Fever  (which  see)  may  be  resorted  to.  (See  also  art.  Cholera,  where, 
as  well  as  in  that  on  Nervous  Fever,  a  few  of  the  leading  indications 
for  Ars.,  Teratr.,  Card,  v.,  in  some  of  the  forms  of  this  disease  will  be 
met  with.) 

HECTIC  FEVER. 

Febris  hectica. 

Hectic  fever,  properly  so  called,  may  be  defined  to  be  febrile 
symptoms  occurring  in  the  course  of,  and  depending  on  the  existence 
of  some  internal  or  local  chronic  disease.  It  usually  commences 
slowly  and  insidiously,  the  only  symptoms  which  present  themselves, 
for  some  months,  being  lassitude  after  a  short  walk,  or  any  trivial  cor- 
poreal exertion,  failure  of  appetite,  and  emaciation.  Subsequently,  the 
debility  becomes  excessive ;  the  blood  forsakes  the  skin,  which  accord- 
ingly looks  pale,  except  the  cheeks,  which  display  what  has  been  deno- 
minated the  hectic  flush  ;  the  appetite,  impaired  from  the  first,  grows 
more  and  more  fastidious,  and  the  stomach  becomes  extremely  irri- 


HECTIC  FEVER.  49 

table,  frequently  rejecting  all  the  aliment  introduced,  the  pulse  quick 
and  weak,  the  artery  giving  from  ninety  to  a  hundred  and  twenty 
strokes  in  a  minute,  even  at  the  incipient  stage  of  the  fever,  and 
sweating  takes  place  spontaneously  at  night  in  bed,  but  is,  moreover, 
at  all  times  readily  excited  by  any  exertion.  Diarrhoea  sets  in  during 
the  course  of  the  disease  in  a  large  number  of  cases,  and  the  dis- 
charge from  the  bowels  is  always  exceedingly  offensive.  The  breath- 
ing is  anxious,  the  patient  commonly  very  restless,  and  often  com- 
plains of  pains  bearing  a  resemblance  to  those  of  rheumatism.  The 
disease  is  subject  to  exacerbations,  and  from  the  circumstance  that 
each  paroxysm  begins  with  chilliness,  followed  by  reaction,  which 
is  soon  succeeded  in  turn  by  copious  perspirations,  it  has  been  mis- 
taken for  intermittent  fever ;  but  the  history  of  the  case,  together 
with  the  appearance  of  the  patient,  the  greater  irregularity  of  the 
different  stages,  and  the  almost  unremitting  quickness  of  the  pulse, 
sufficiently  distinguish  the  hectic  fever. 

Therapeutics.  As  hectic  fever  rests  upon  a  morbid  state  of 
some  portion  or  structure  of  the  body,  the  treatment  must  be 
directed  to  the  cure,  or,  if  incurable^  the  removal,  where  practicable, 
of  the  part  diseased.  It  frequently  happens,  however,  that  the 
source  of  all  the  mischief  is  involved  in  impenetrable  obscurity,  and 
we  are  compelled  to  attack  the  disorder  solely  as  it  is  manifested  by 
its  symptoms.  Here,  as  in  many  other  similar  instances,  it  is,  that 
the  homoeopathist  possesses  such  unequivocal  advantage  over  the 
allopathist ;  for,  by  dint  of  a  faithful  collation  of  every  symptom,  from 
the  most  important  to  the  apparently  most  trivial,  he  is  generally 
enabled  (where  the  affection  is  not  already  beyond  the  reach  of  art), 
by  assiduously  consulting  his  Materia  Medica,  and  comparing  the 
pathogenetic  symptoms  therein  detailed  with  those  of  the  disease,  to 
select  a  remedy  specific  to  the  case.*  It  is  of  unquestionable  advan- 
tage to  the  homoeopathist,  however,  to  pay  due  regard  to  the  actual 
cause  of  the  disease  where  that  is  discoverable,  as  by  so  doing  he  will 
materially  facilitate  his  search  after  the  appropriate  remedy. 

*  The  present  imperfect  and  incomplete  condition,  comparatively  speaking,  of  our  Materia 
Medica,  renders  it  sometimes  a  difficult  task  to  meet  with  the  remedy  purely  homoeopathic 
to  the  case,  or  the  stage  of  the  case,  under  treatment ;  but  there  is  every  reason  to  conclude 
that  the  labours  of  zealous  and  untiring  homoeopathic  practitioners  will  eventually  surmount 
the  aforesaid  drawback. 

4 


50  FEVERS. 

The  following  remedies  have  repeatedly  proved  efficacious/ and  in 
other  instances  been  strongly  recommended  in  hectic  fevers.  First, 
in  hectic  fevers,  with  internal  or  local  affections  such  as  chronic  inflam- 
mations,— particularly  of  the  mucous  membrane  of  the  stomach  and 
bowels,  —  extensive  suppurations,  etc.  :  Phosphorus,  Acid,  phosph., 
Sulphur,  Calc,  Acid,  nitr.,  Lachesis,  Merc,  Arsenicum,  China,  Bella., 
Puis.,  Sanguin.  canad.,  Cham.,  Ipecac,  Colocynth,  Secale  c,  Ant.,  Scilla, 
Nux  v.,  Hepar  s.,  Silicea,  Lycopodium.  Second,  against  those  arising 
from  excessive  depletion  from  loss  of  blood,  immoderate  indulgence  in 
venery,  &c. :  China,  Acid,  phosph.,  Nux  v.,  Stdphur,  Calc,  Staph., 
Lachesis,  Cin.,  Artemisia  absinthium,  Carl,  v.,  Con.,  Arnica,  Anacard., 
Natrum  m.,  Cocculus,  Merc,  Sepia,  Nux  moschata.  Third,  those  pro- 
ceeding from  the  effects  of  severe  acute  diseases,  such  as  typhoid 
fevers,  cholera,  scarlatina,  measles,  &c. :  Cocculus,  Belladonna,  Ilyoscyawiis, 
Helleborus  n.,  and  Acid,  phosph.,;  or,  Pulsatilla,  Sulphur,  Arsenicum,  Vera- 
trum,  China,  &c.  Fourth,  those  which  have  been  developed  by 
depressing  emotions  :  Acid,  phosph.,  Staphysagria  ;  or,  Ignatia,  Lachesis, 
Merc,  and  Hyoscyamus,  Arsenicum,  or  Graphites.  In  so-called  nervous 
hectic  fevers  {slow  nervous  fevers) :  Arsenicum,  China,  Merc,  Coc- 
culus, Nux  v.,  Phosph.  ac,  Staph.,  and  Veratrum  have  chiefly  been 
recommended.  And  in  hectic  fevers  proceeding  from  dyscrasia,  such 
as  scrofula,  &c,  or  from  disease  of  the  brain,  liver,  or  lungs,  or  else 
from  the  suppression  of  habitual  discharges,  normal  or  morbid,  see 
the  treatment  pointed  out  for  these  affections  in  their  respective 
chapters.  The  following  characteristic  indications  for  a  few  of  the 
leading  remedies  may  here  be  given,  but  in  all  where  the  symptoms 
are  multifarious,  or  where  no  real  cause  for  the  disease  can  be  traced, 
reference  must  be  made  to  the  Materia  Medica. 

Phosphorus,  when  we  encounter  colliquative  diarrhoea;  colliqua- 
tive, clammy,  nocturnal ;  chilliness  and  shivering  towards  evening,  suc- 
ceeded by  dry  heat ;  emaciation  /extreme  lassitude  ;  shortness  of  and 
laborious  respiration. 

Silicea,  which  is  often  very  efficacious  after  Phosphorus,  and  some- 
times in  alternation  with  Phosphorus,  Sulphur,  and  Calcarea,  is  especially 
called  for  where  there  is  great  weakness,  particularly  of  the  joints ; 
paleness  of  the  surface,  emaciation  ;  anorexia;  short,  anxious  respira- 
tion, febrile  heat  towards  evening,  or  in  the  morning. 

Sulphur.  Dryness  and  paleness  of  the  skin  during  the  day, 
when  at  rest,  with  night  sweats  or  perspiration  towards  morning  or 
after  any  exertion;  hectic  flushes  on  the  cheeks  (especially  the  left  cheek) 


HECTIC  FEVER.  51 

and  feverish  heat  in  the  evening ;  thirst ;  dry,  or  relaxed  and  slimy  mo- 
tions ;  palpitation  of  the  heart ;  short,  oppressed  respiration. 

Calcarea.  Dryness  and  flabbiness  of  the  skin ;  great  emaciation 
and  debility ;  constant  heat  of  skin  with  little  thirst ;  or  frequent 
flushes  of  heat,  with  anxiety  and  palpitation  of  the  heart ;  or  continued 
chilliness,  but  particularly  in  the  evening,  with  redness  of  the  cheeks  ; 
apathy ;  extreme  dejection  after  speaking ;  perspiration  after  the 
slightest  exertion,  or  spontaneously  during  the  night ;  anorexia,  weak 
and  sluggish  digestion  ;  great  anxiety  and  uneasiness  respecting  the  state 
of  the  health, 

Arsenicum.  Excessive  emaciation,  with  great  debility  ;  dry,  burn- 
ing heat  of  shin  ;  thirst,  with  inclination  to  drink  frequently,  but  in  small 
quantities  at  a  time ;  palpitation  of  the  heart;  restless,  unrefreshing 
sleep,  frequently  disturbed  by  sudden  jerks  and  starts ;  constant  de- 
sire for  the  reclining  posture ;  anorexia,  with  impaired  digestion ; 
vomiting  of  all  food ;  irritability  of  temper,  and  fastidiousness. 

Cinchona.  Dryness  and  laxness  of  the  cutaneous  surface ;  sunken 
cheeks ;  paleness  of  the  face  ;  dryness  and  looseness  of  the  skin  ;  but 
tendency  to  perspire  after  the  most  trivial  exertion,  and  spontaneous 
sweating  at  night ;  anorexia,  with  desire  for  delicacies  only,  or  excessive 
hunger  and  voracity,  with  weakness  of  digestion,  indicated  by  uneasi- 
ness, distension  of  the  abdomen,  and  other  derangements  after  par- 
taking of  food,  diarrhoea,  sometimes  with  ingesta;  sleeplessness,  or 
restless  unrefreshing  sleep,with  anxious  dreams;  great  apathy,  ill-humour. 

Cocculus.  Great  debility,  with  tendency  to  break  out  into  per- 
spiration after  the  slightest  exertion,  attended  by  dejection  and  trem- 
bling; frequent  flushes  of  heat,  especially  at  the  cheeks  ;  dryness  of 
the  mouth  and  tongue ;  anorexia ;  nausea  after  eating,  and  at  other 
times;  oppression  at  the  chest,  with  ebullition  of  the  blood,  and 
anxious  respiration ;  sleep  disturbed  by  disagreeable  dreams  and  fre- 
quent sudden  starts ;  extreme  depression  of  spirits ;  mildness  of 
temper.  (^Pulsatilla,  Sulphur,  and  Calcarea  are  sometimes  required 
after,  or  in  alternation  with,  Cocculus.) 

Ipecacuanha  is,  occasionally,  of  considerable  utility  in  alterna- 
tion with  Arsenicum,  or  Nux  v.,  or  as  an  intermediate  remedy  during 
the  employment  of  other  remedies,  when  the  following  symptoms 
predominate:  anorexia,  with  desire  for  dainties  exclusively;  nausea 
after  every  meal,  and  sometimes  vomiting  of  the  contents  of  the  sto- 
mach; dry  heat,  particularly  in  the  evening,  accompanied  with  thirst; 
great  restlessness,  burning  in  the  palms  of  the  hands,  and  nocturnal 


52  FEVERS. 

sweats  ;  apathy ;  indifference  ;  shortness  of  breath  after  the  slightest 
exertion. 

Nux  vomica.  Want  of  appetite,  with  bitter  or  sour  eructations  after 
a  meal,  or  vomiting  of  ingesta  ;  great  debility  ;  perspiration  excited  by 
any  slight  exertion,  or  coming  on  spontaneously  early  in  the  morning  ; 
paleness  or  sallowness  of  the  face ;  partial  heat ;  coldness  and  shiver- 
ing, with  pains  in  the  back  and  loins ;  constipation  ;  or  constipation 
alternately  with  diarrhoea ;  desire  for  the  recumbent  posture ;  dread  of 
the  open  air ;  ill-humour. 

The  diet  should  be  light  and  of  easy  digestion ;  and  regular  hours, 
with  gentle  exercise,  ought  to  be  enjoined. 


MUCOUS  FEVER. 

Fehris  pituitosa.      Febris  mucosa. 

This  is  a  form  of  continued  fever  which  chiefly  attacks  persons  of 
lymphatic  temperament ;  is  characterized  by  irritation  of  the  gastro- 
enteric mucous  membrane,  with  excessive  secretion  of  mucus  from 
this,  and  sometimes  from  the  other  mucous  membranes.  The 
premonitory  symptoms,  which,  for  the  most  part,  precede  the  attack 
for  a  considerable  period,  consist  in  loss  of  appetite,  insipid  taste,  or 
even  complete  loss  oi  taste,  moist,  slimy,  white  furred  tongue,  nausea, 
fulness  in  the  epigastric  region,  irregular  stools,  paleness  of  face, 
languor,  &c.  These  symptoms  rarely  create  any  serious  feelings, 
uneasiness,  or  anxiety,  particularly  as  the  patient  has  occasional 
intermissions  of  somewhat  improved  health.  As  the  disorder  pro- 
gresses, vomiting  of  a  tasteless  white  mucus  supervenes,  the  stomach 
becomes  deranged  and  distressingly  distended  after  the  smallest 
quantity  of  food ;  the  tongue  which  was  previously  uniformly  white, 
and  coated  with  mucus,  is  now  free  of  mucus  at  the  tip  and  margins, 
arid  of  a  somewhat  dark  red  colour,  which  indicates  the  tendency  to 
typhoid  degeneration-  Sometimes,  however,  the  tongue  remains 
white  though  it  becomes  dry,  throughout  the  entire  course  of  the 
disease,  especially  towards  evening:  the  taste  is  disagreeable,  the 
mouth  and  fauces  are  besmeared  with  mucus,  and  in  the  morning 
the  patient  hawks  up  and  even  vomits  a  white  tenacious  mucus. 
Costiveness  or  constipation  is  generally  present ;  though  when  the 
affection  extends,  the  bowels  are  opened  several  times  a  day,  accom- 
panied with  borborygmus  and  griping,  the  stools  consisting  of  white, 


MUCOUS  FEVER.  53 

bilious,  stringy  mucus  mixed  with  ingesta,  and  sometimes  fragments 
of  worms ;  the  urine  is  straw-coloured  and  turbid,  and  deposits  a 
mucous  sediment.  The  fever  is  at  first  marked  with  remissions,  but 
these  subsequently  become  imperceptible;  the  pulse  is  rather  soft 
and  weak,  seldom  frequent;  thirst  and  sweat  generally  moderate  ; 
there  is  considerable  prostration  of  strength ;  drowsiness,  pressive 
aching  frontal  pains,  restless  night?,  dull  lustreless  eyes  and  an 
indifferent,  indolent,  morose  disposition  are  almost  always  in 
existence. 

The  duration  of  the  disease  varies  considerably.  In  favorable 
cases  it  runs  its  course  in  fourteen  days. 

Recovery  is  generally  preceded  by  the  breaking  out  of  a  gentle 
sweat ;  or  a  profuse  discharge  of  straw-coloured  urine,  which 
deposits  a  thick  sediment ;  or  it  is  ushered  in  by  a  gentle  sleep. 
When  the  disease  terminates  fatally,  it  is  either  from  the  formation 
of  aphtha  which  extend  over  the  mucous  lining  of  the  alimentary 
canal  and  bronchial  tubes,  and  become  gangrenous,  or  in  consequence 
of  the  repercussion,  or  non-appearance  of  miliaria,  or  through 
paralysis  of  the  abdominal  nervous  system,  with  meteorismus,  invo- 
luntary putrid-smelling  stools,  and  small,  weak,  and  trembling  pulse; 
or  from  superadded  paralysis  of  the  brain. 

Therapeutics. — In  the  treatment  of  this  disorder  it  is  of  great 
importance  to  check  it  by  means  of  appropriate  remedies  at  the 
commencement  of  the  attack,  before  the  complete  development  of 
the  fever,  as  by  so  doing  we  are  thereby  frequently  enabled  to  arrest 
it  with  facility;  whereas,  when  the  disease  is  allowed  to  attain  a  more 
advanced  stage  it  assumes  a  most  obstinate  character,  and  is  with 
difficulty  conducted  to  a  happy  termination.  The  principal  remedies 
which  have  been  recommended  in  the  first  or  premonitory  stage 
(status  pituitosus)  are  Pulsatilla,  Nux  vomica,  Ipecacuanha  (the 
leading  indications  for  which,  will  be  found  under  Derangement 
of  the  stomach  and  Dyspepsia,  which  see),— Ammonium  mwria- 
ticum,  Mercurius,  Dulcamara,  Ignatia,  Staphysagria* 

Ammonium  m.  is  chiefly  indicated  by  the  following  symptoms  : 
tongue  coated  with  whitish  mucus,  incessant  clearing  of  the  throat  in 
order  to  rid  it  of  an  accumulation  of  tenacious  mucus ;  disagreeable 
taste,  with  flow  of  limpid  fluid  into  the  mouth,  nausea,  aversion  to 
food,  eructation,  risings  of  a  sourish-bitter  watery  fluid,  sensation  of 
vacuity  and  hunger  in  the  stomach,  uneasiness  or  qualmishness,  and 


54  FEVERS. 

warmth  or  heat  in  the  stomach,  evacuation  of  tenacious  slimy  stools, 
&c. 

Dulcamara  is  particularly  recommended  when  the  attack  has 
been  excited  by  exposure  to  cold,  and  the  disorder  is  manifested  by 
insipid  or  soapy  taste,  great  thirst,  dryness  of  the  tongue,  increased 
secretion  of  saliva,  disinclination  for  food,  dirty  white  coating  on  the 
tongue. 

Ignatia  frequently  proves  of  much  efficacy  at  the  commencement 
of  the  disorder,  when  the  feelings  of  the  patient  vary  considerably ; 
when  there  is  great  disinclination  to  exertion  and  desire  to  retain  the 
recumbent  posture ;  when  there  is  headache,  with  a  feeling  of  weight 
and  pressure  in  the  sinciput,  pain  in  the  scrobiculus,  and  alternate 
paleness  and  redness  of  the  face ;  dry,  cracked,  or  chapped  lips,  white 
tongue,  insipid  or  disagreeable  taste,  disgust  at  food  and  drink,  and 
bitter  regurgitations ;  further,  when  there  are  frequent,  white,  slimy 
stools  accompanied  by  sudden  general  flushes  of  heat,  with  small, 
accelerated  pulse. 

Merctjrius  is  one  of  the  most  important  medicaments  in  the  treat- 
ment of  this  disease,  both  in  its  incipient  and  in  its  more  developed 
form.  It  corresponds  especially  when,  along  with  increasing  loss  ot 
appetite,  the  tongue  is  coated  with  a  white  fur,  and  covered  with 
mucus ;  the  act  of  swallowing  is  accompanied  by  a  painful  feeling  ot 
dryness  in  the  throat  and  gullet,  the  taste  putrid,  and  the  breath 
offensive ;  further,  when  there  is  nausea,  with  tearing  burning  pains 
in  the  temples,  pressive  aching  or  weight  and  tension  in  the  scro- 
biculus, stomach,  and  region  of  the  liver;  risings  into  the  mouth 
consisting  of  an  acrid  fluid ;  cloudy  slimy  urine,  with  deposition  ot 
sediment ;  irregular  alvine  evacuations,  with  frequent  inclination  for 
stool ;  pale,  earthy,  yellow  face  ;  great  debility ;  inanimate,  indolent 
disposition. 

The  characteristic  indications  are,  thick,  dirty,  slimy  coating  on 
the  tongue ;  insipid,  pap-like,  soapy  taste;  longing  for  highly 
seasoned  food;  sensation  of  dryness  in  the  mouth  and  throat; 
aphthae,  sluggish  stools,  or  constipation ;  or  relaxed,  slimy,  very 
offensive  alvine  evacuations;  extreme  mental  and  physical  depression. 

Staphysagria.  This  remedy  has  been  found  of  great  utility  in 
the  height  of  disease ;  but  it  may,  like  Ignatia^  also  prove  of  service 
in  the  first  stage,  more  particularly  when  mental  emotion  has  given 
rise  to  disease.  (See  Ignatia  and  StapJiysagria  under  art.  Mental  Emo- 
tions.)    As  already  remarked,  however,  it  is  chiefly  in  the  advanced 


MUCOUS  FEVER.  55 

stage  of  mucous  fever,  and  even  when  it  has  degenerated  into  a 
nervous  or  putrid  type,  that  this  remedy  is  especially  serviceable. 

Senega  has  chiefly  been  recommended  against  the  following 
symptoms  :  slight  rigors  and  heat,  accompanied  by  pulsating  head- 
ache ;  oppressed  and  anxious  respiration,  shooting  panis  in  the  chest, 
general  aching  of  the  body,  and  considerable  thirst,  with  accelerated 
pulse ;  accumulation  of  tenacious  mucus  in  the  throat,  and  constant 
efforts  to  expel  it.  Senega  is  like  Pulsatilla  and  Capsicum,  peculiarly 
adapted  to  persons  of  phlegmatic  temperament  and  soft,  flabby  muscu- 
lar system.  In  fully-developed  mucous  fever  Digitalis  is  a  valuable 
remedy,  especially  with  extreme  depression  of  the  vital  powers,  slow, 
languid  pulse,  great  prostration  of  strength,  pressure  and  fulness 
in  the  pit  of  the  stomach,  incessant  nausea,  and  frequent  fits  of 
vomiting,  thirst,  diarrhoea,  frontal  headache,  especially  over  the 
orbits,  short,  disturbed  sleep.  In  cases  which  become  protracted, 
but  without  assuming  a  serious  character,  with  predominant  plethora 
venosa  abdominalis,  Sepia  is  deserving  of  attention.  Lycopod/bum, 
Natrum,  Kali  c,  Magnesia  c,  and  Calcarea  are  also  well  adapted  to  those 
cases  which  take  an  obstinate  character.  Arnica,  Spigelia,  Dulcamara, 
Cina,  Valeriana,  on  the  other  hand,  have  been  spoken  of  as  most 
suitable  to  those  forms  of  mucous  fever,  which,  after  a  longer  or 
shorter  interval  of  improvement,  relapse  into  their  previous  state. 
If  signs  of  invermination  accompany  the  disorder,  the  principal 
remedies  to  be  had  recourse  to  are,  Merc,  Cina,  Cicuta,  Spigelia, 
Sulph.,  Sil.,  Nux  v.,  Digital.,  EJyos.,  Valerian,  Stram.,  Stann.,  &c.  When 
the  fever  assumes  a  torpid  character,  ana  nervous  symptoms  make 
their  appearance,  Bryonia,  Rhus,  Belladonna,  Veratrum,  or  Phosphorus  are 
commonly  the  most  appropriate  remedies.  Bryonia  is  indicated  by 
violent  congestion  to  the  head,  dry  burning  heat  of  skin,  dry  lips, 
dry  red  tongue,  pressure  in  the  scrobiculus,  constipation,  slight 
delirium,  &c.  Rhus  is  indicated  by  a  similar  train  of  symptoms,  but 
with  great  depression  and  extreme  feebleness  of  pulse. 

Belladonna  is  to  be  preferred,  if  signs  of  cerebral  irritation 
predominate,  the  pulse  is  quick  and  hard,  the  skin  dry  and  hot, 
and  the  tongue  parched.  Phosphorus  is  called  for  when  the 
increased  secretion  of  mucus,  extends  over  the  bronchial  tubes  as 
wTell  as  the  entire  alimentary  canal,  and  is  accompanied  by  ex- 
pectoration of  mucus,  rattling  in  the  chest,  and  diarrhoea ;  further, 
when  the  patient  lies  motionless,  with  the  mouth  open,  the  lips  and 
tongue  being  at  the  same  time  dry,  cracked,  and  blackish ;  lastly, 


56  FEVERS. 

when  there  is  oppressed  respiration,  delirium,  and  carpologia, 
Veratrum  will  often  be  found  useful  in  the  torpid  form  of  mucous 
fever,  with  tinnitus  aurium,  dullness  of  hearing,  and  delirium. 

In  the  event  of  threatening  miliaria,  announced  by  a  peculiar 
sighing  respiration,  Ipecacuanha  is  chiefly  recommended.  And 
when  the  miliary  eruption  has  made  its  appearance,  or  has  been 
driven  in,  Arsenicum  is  the  remedy  on  which  we  must  place  our 
chief  reliance ;  the  usual  symptoms  in  such  a  case  are,  sopor,  cold 
sweat,  sordes  on  the  lips  and  teeth,  offensive  breath,  dry,  tremulous 
tongue,  insatiable  thirst,  meteorismus,  involuntary  stools  and  urine, 
oppressive  respiration,  stertorous  breathing,  small,  tremulous,  much 
accelerated  pulse,  nocturnal  delirium.  (Acid,  phosph.  and  Carlo  v.  are 
also  deserving  of  attention  here.)  Arsenicum  is  further  indicated 
when  aphthae  form,  and  are  either  of  a  simple  kind  or  disposed  to 
become  gangrenous,  and  extend  throughout  the  entire  alimentary 
tube.  Mercurius,  as  has  already  been  observed,  is  well  adapted 
to  cases  attended  with  the  development  of  aphthae,  nocturnal  exacer- 
bations of  fever,  offensive  breath,  and  sometimes  swelling  of  the  parotis. 
Acid,  nitricum  may  frequently  be  employed  with  advantage  after 
Mercurius. 

Acid,  suljphuricum  and  Mezereum  may  also  be  found  applicable  to  some 
cases  with  the  formation  of  aphthae.  When  mortification  seems  in- 
evitable, China,  Carho  v.,  Baryta  c>  and  Acid,  muriaticum,  are,  in  addition 
to  Arsenicum,  the  remedies  which  are  mainly  to  be  depended  on.  (See 
Fehris  nervosa.) 

The  diet  must,  both  in  the  first  stage  of  the  fever,  and  in  that  of 
convalescence,  be  light  and  of  easy  digestion,  chiefly  fluid,  and  only 
in  small  (quantities  at  a  time;  plenty  of  cold  water  should  be  drank, 
or  rice-  or  barley-water,  to  which,  during  the  period  of  convalescence^ 
it  has  been  found  advantageous  to  add  a  little  wine. 


GASTRIC  FEVER.    BILIOUS  FEVER. 

Fehris  gastrica  biliosa. 

This  is  a  form  of  fever  in  which,  as  its  name  implies,  the  digestive 
organs  are  chiefly  affected  ;  it  has  some  degree  of  affinity  with  typhus, 
but  is  distinguished  from  the  latter  by  the  absence  of  nervous  symp- 
toms, although,  when  it  assumes  a  torpid  character,  these  are  occa- 
sionally developed, — by  the  absence  of  the  pressive  aching  pains  in 


GASTRIC  FEVER.  57 

the  occiput ;  and  by  the  absence  of  disturbance  or  derangement  in  the 
senses  of  sight  and  hearing ;  further,  that  the  pain  in  the  caecum,  which 
is  so  constant  a  symptom  in  typhus,  is  not  a  feature  of  this  disease. 

The  following  are  the  principal  symptoms  of  gastric  fever :  sensa- 
tion of  fulness  and  weight  in  the  epigastrium ;  flatulent  distension  of 
the  epigastric  region,  with  inclination  to  vomit ;  eructations  of  offen- 
sive flatus,  and  sometimes  vomiting  of  ingesta  and  tenacious  mucus 
mixed  with  bile  ;  thickly  furred,  dirty  yellow  tongue;  abdomen  soft ; 
bowels  costive ;  but  in  the  advanced  stage  of  the  disease  the  evacua- 
tions are  often  very  offensive,  and  contain  portions  of  undigested  food; 
frontal  headache;  languor;  sickly  and  distressed  expression  of  coun- 
tenance, with  yellow  discoloration  of  the  albuginea;  more  or  less 
chilliness,  succeeded  by  heat  and  dryness  of  skin ;  pulse  quick  but 
soft,  sometimes  intermitting  or  irregular,  particularly  the  latter  ;  urine 
thick,  cloudy,  and  dark  coloured. 

When  bilious  symptoms  are  predominant  (Febris  biliosa),  all  the 
symptoms  commonly  appear  in  an  aggravated  form ;  the  heat  of  the 
skin  is  very  considerable,  the  restlessness  and  thirst  excessive  (the 
patient  expressing  a  constant  desire  for  acid  drinks).  The  epigas- 
trium is,  as  in  gastric  fever,  much  distended  with  flatus,  but,  in  addi- 
tion to  this  symptom,  the  following  are  more  or  less  marked :  the 
tongue  is  coloured  at  first  with  a  pale  yellow  fur,  which  gradually 
assumes  a  deeper  or  brownish  colour;  the  taste  and  eructations  are 
bitter,  and  the  substance  vomited  consists  of  a  greenish,  bilious 
matter ;  the  bowels  are  either  confined  or  relaxed,  presenting  in  the 
latter  case  a  yellow,  green,  or  brown  colour;  the  face  exhibits  an 
earthy,  somewhat  jaundiced  aspect ;  sometimes  there  is  also  a  greater 
or  less  degree  of  sensibility,  hardness,  tension,  burning  in  the  hepatic 
region;  the  urine  is  dark  brown,  bilious ;  the  pulse  full,  accelerated, 
intermitting  or  double. 

Therapeutics.  The  following  remedies  are  those  which  are  most 
required  in  simple  gastric  fever :  Pulsatilla,  Nuw  vomica,  Ipecacuanha  j 
Antimon.  c,  Bryon.,  Cham.,  China,  Cocc,  Tart.,  Rhus,  Sulph.,  Arsen.,  Ve- 
ratrum,  Colocyn.,  Acid.  j)hosph.  The  principal  indications  for  the  selec- 
tion of  these  will  be  found  in  the  chapters  on  Derangement  of  Di- 
gestion and  Dyspepsia,  which  see.  When  mental  emotions  have 
given  rise  to  the  disorder,  Chamomilla,  Bryonia,  Colocynth,  and  Acid.phosph. 
are  the  most  appropriate  remedies.  Chamomilla  and  Bryonia  particu- 
larly, if  in  consequence  of  a  fit  of  passion  ;  Colocynth,  from  indignation, 
or  mortification.  Stafthysagria  is  sometimes  preferable  to  Colocynth3  when 


58  ERUPTIVE  FEVERS. 

vexation  is  combined  with  indignation.  Acid.  phosph.,  if  grief,  care,  or 
anxiety  have  been  the  chief  exciting  causes.  (See  Mental  Emotions.) 
In  Bilious  fever  the  most  important  remedies  are,  Aeon.,  Cham.,  Puis., 
Nuxv.,  China,  Cocculus,  Digit.,  Bella. ;  Arsenic,  Colocynth,  Mercurius, 
Staph.,  Colch,,  Taraxac,  Ignatia,  Asar.  (See  Derangement  of  Diges- 
tion, Dyspepsia,  Hepatitis,  and  also  Mental  Emotions,  when 
the  disorder  has  been  developed  by  such  influences.) 

When  gastric  or  bilious  fevers  partake  of  a  somewhat  inflammatory 
character,  Bella.,  Bryon.,  or  Cham,  will  generally  be  required  sooner 
or  later  in  the  disease.  When  the  fever  degenerates  into  a  nervous 
character,:  Bryonia,  Rhus,  Cocculus,  Veratrum,  Bella.,  or  Arsenic.,  Carbo 
v.,  China,  Hyos.,  Ipecac,  Puis.,  Nux  v.,  &c,  will  especially  be  called 
for  in  the  majority  of  cases*     (See  Nervous  and  Putrid  Fevers.) 


ERUPTIVE  FEVERS. 

Under  this  head  we  intend  to  treat  of  those  diseases  which 
possess  the  common  property  of  febrile  symptoms,  preceding  an 
eruption  which  is  present  during  a  part  of  their  course,  such  erup- 
tion varying,  in  character,  according  to  the  nature  of  the  affection. 

In  this  class  are  comprised,  scarlet  fever,  measles,  smallpox, 
chickenpox,  miliary  fever,  and  nettle-rash. 

SCARLET  FEVER. 

This  disease,  in  its  simple  generic  character,  consists  of  a  conta- 
gious fever,  with  swelling  of  the  face  and  a  scarlet  appearance  of 
the  skin — (hence  its  name) — which  is  of  a  bright  raspberry  colour, 
or  of  a  hue  resembling  a  boiled  lobster,  smooth  and  glossy,  upon  which 
the  finger,  being  pressed,  leaves  a  white  imprint  which  almost 
immediately  disappears.  In  the  present  day  we  seldom  meet  with 
it  in  this  simple  form,  but  more  frequently  complicated  with  severe 
or  ulcerated  sore  throat,  delirium,  congestive  or  violent  inflammatory 
symptoms,  and  often  with  more  or  less  deviation  from  the  charac- 
teristic efflorescence  above  described. 

Diagnosis.  Fever,  with  extreme  quickness  of  pulse;  a  feeling 
of  soreness  or  pain  in  the  throat ;  and,  in  one,  or  more  days,  the 
appearance  of  an  eruption,  of  the  colour  above  mentioned,  in  large, 
indefinitely  marked  patches,  gradually  growing  paler  towards  their 


SCARLET    FEVER.  59 

margins,  and  often  overspreading  entire  limbs  with  a  uniform  scarlet 
colour;  the  efflorescence  disappears  in  five  or  six  days,  when  the 
skin  desquamates,  and  comes  off  in  large  pieces. 

We,  sometimes,  find  scarlet  fever  with  scarcely  any,  or  even  no 
external  redness,  but,  at  the  same  time,  marked  angina  and  bright 
redness  of  the  tongue  ;  in  such  cases,  the  disease,  instead  of  showing 
itself  on  the  skin,  has  fixed  upon  the  mucous  membrane ;  and  even 
the  angina  and  redness  of  the  tongue,  present  in  most  cases  of  this 
disease,  may  be  considered  indicative  of  an  internal  scarlatina. 

Scarlatina  was  formerly  confounded  with  measles,  from  the  resem- 
blance which  the  two  eruptions  bear  to  each  other,  at  their  com- 
mencement ;  but  they  are  easily  distinguishable,  even  without  taking 
into  consideration  the  peculiar  appearance  of  the  skin  above  men- 
tioned— characteristic  of  the  disease, — by  the  eruption,  in  scarlet 
fever,  generally  developing  itself  in  from  twenty-four  to  forty- eight 
hours  after  the  commencement  of  the  fever,  whereas  that  of  measles 
rarely  sets  in  before  the  third  or  fifth  day ;  the  absence  of  catarrhal 
symptoms,  such  as  cough,  sneezing,  lacrymation.  the  usual  precursors 
of  measles,  constitutes  another  mark  of  differerice.  The  greatly 
accelerated  pulse,  which  denotes  the  approach  of  *  scarlatina,  is  also 
never  met  with,  to  the  same  extent,  in  any  other  disease. 

Therapeutics.  In  those  cases,  in  which  this  disease  appears  in  its 
simple  form,  the  skin  presenting  the  characteristic  hue,  with  a  smooth 
and  glossy  surface,  [Scarlatina  levigata  s.  plana),  Belladonna  is  a  spe- 
cific remedy. 

Even  in  the  severer  forms  of  scarlatina,  when  the  throat  is  con- 
siderably affected  (Scarlatina  anginosa),  and  high  fever  or  congestive 
symptoms  set  in,  and  which,  if  not  properly  treated,  or  if  they  occur 
in  a  bad  habit  of  body,  may  assume  the  malignant  type  (Scarlatina 
maligna)^  attended  with  ulcerated  sore  throat,  extension  of  the 
inflammation  to  the  air-passages,  delirium,  spasm,  &c, — Belladonna 
is  a  valuable  remedy. 

In  scarlatina  anginosa,  the  fever  and  sore  throat  increase  with  the 
eruption,  in  mild  cases,  and  cease  with  its  decline,  but,  in  the  more 
severe,  continue ;  it  is  when  the  disease  appears  principally  to  attack 
the  head,  throat,  thoracic,  or  abdominal  viscera,  that  it  becomes  dan- 
gerous.* The  eruption  frequently  does  not  appear  before  the  third 
day,  and  then  only  in  isolated  patches. 

*  When  scarlatina  anginosa  is  complicated  with  bronchitis,  phrenitis,  or  enteritis,  the 
remedies  mentioned  under  these  different  heads  must  be  had  recourse  to. 


60  ERUPTIVE  FEVERS. 

Belladonna  should  be  administered,  as  soon  as  the  throat  and 
tongue  become  affected  with  dryness  and  burning,  and  there  is  a 
desire,  but  complete  inability,  to  swallow  even  drinks  or  saliva ;  with 
sense  of  suffocation;  further,  when  the  throat  is  of  a  bright  red 
colour,  having  its  surface  excoriated,  or  covered  with  white  specks, 
or  stringy  mucus,  or  presenting  the  appearance  of  thrush;  the  tonsils 
swollen,  and  the  tongue  of  a  bright  fiery  reel  hue,  sometimes  interspersed 
with  dark  red  patches  at  a  later  period  in  the  disease ;  also  when  deli- 
rium exists. 

If  the  disease  have  taken  a  favorable  turn,  we  may  allow  the 
Belladonna  to  continue  its  action;  but  if,  after  the  second  or  third 
repetition  of  Belladonna,  the  inflammation  and  swelling  increase 
instead  of  diminish,  as  is  frequently  the  case  in  strumous  consti- 
tutions, or  if  we  clearly  perceive  an  appearance  of  ulceration  com- 
mencing, with  increase  of  mucus,  we  must  have  immediate  recourse 
to  Mercurius.#  If,  on  the  other  hand,  the  ulcers  present  a  livid 
appearance  about  the  edges,  and  emit  an  offensive  odour,  or,  when 
there  is  excessive  thirst,  with  great  dryness  of  the  mouth,  and  extreme 
prostration  of  strength,  we  must  have  recourse  to  Arsenicum,  in 
preference  to  Mercurius  ;  and  if  this  medicine  prove  inadequate  to 
complete  the  cure,  we  should  follow  it  with  Nux  vomica.  (Vide 
Ulcerated  sore  throat.)  Nux  v.  is,  moreover,  of  considerable 
efficacy,  when  a  large  quantity  of  viscid  mucus  is  secreted  from  the 
inflamed  and  tumefied  lining  of  the  fauces,  which  adheres  so  tena- 
ciously, that  it  is  with  difficulty  expelled,  and,  sometimes,  even  threatens 
suffocation.  [Pulsatilla  is  also  useful  in  such  cases.  See  Sore  throat.) 

When  the  fever  assumes  a  clearly  inflammatory  type,  and  the 
pulse  runs  high,  we  may  administer  Aconite,  in  the  same  manner 
as  already  given  under  Inflammatory  fever,  which  see. 

When  the  quickness  of  pulse  and  other  inflammatory  febrile 
symptoms  are  subdued,  and  the  affection  of  the  throat  again  appears 


*  The  exudations  of  various  colours,  or  aphthous  crusts,  as  they  have  been  termed,  which 
appear  on  the  tonsils,  anterior  pillars  of  the  velum  palati  and  the  fauces,  in  scarlatina 
anginosa  are  often  mistaken  for  ulcers  and  eschars.  They  are,  however,  readily  discovered, 
on  attentive  examination,  to  consist  of  a  thick  viscid  fluid,  or  floculi  or  concretions  of  gray, 
yellowish-white,  or  blackish-looking  matter,  differing  from  coagulable  lymph  by  being  softer. 
They  are  easily  removed,  and  the  parts  which  they  covered  present  no  trace  of  ulceration  or 
loss  of  substance.  Mercurius  is  the  most  useful  remedy  here,  but  Acid,  nitricum,  Lachesis, 
&c,  are  sometimes  required.     (See  Sore  Throat.) 


SCARLET  FEV&R.  Ql 

prominent,  we  may  return  to  Belladonna,  especially  if  the  skin  retain 
the  peculiar  scarlatina  hue. 

Opium  may  follow  the  administration  of  Belladonna,  when  there  is 
burning  heat  of  the  skin,  drowsiness,  stupor,  stertorous  breathing,  open 
mouth,  eyes  half  closed,  restlessness  with  vomiting,  or  convulsions. 

We  may  here  remark  that  Dr.  Schmidt  of  Vienna  states  that  he 
has  found  Cuprum  aceticum  particularly  efficacious,  in  a  peculiar 
affection  to  the  brain,  that  frequently  declares  itself  in  cases  of  reper- 
cussed  exanthemata,  and  which,  if  not  speedily  checked,  may  terminate 
in  paralysis  of  that  organ. 

Dr.  Schmidt  is  of  opinion,  that  when  the  eruption,  during  efflo- 
rescence, is  suddenly  repercussed,  the  result  of  which  is  frequently 
fatal,  Cwpmm  aceticum  may  be  almost  considered  specific  ;  or,  at  least, 
the  medicament,  which,  with  the  greatest  degree  of  certainty,  can  save 
the  patient ;  if,  in  this  condition,  death  should  happen,  it  is  in  conse- 
quence of  paralysis  of  the  brain. 

Symptoms  indicating  its  employment:  "Quick,  small,  weak, 
irregular  pulse ;  temperature  of  the  skin  considerably  reduced,  in 
more  severe  cases,  chilly,  and  covered  with  perspiration.  Affections  of 
the  nervous  system  are  never  absent;  to  this  belong  convulsive  movements 
of  various  parts  of  the  body,  distortion  of  the  eyes,  face,  mouth, 
head,  &c.,  spasmodic  affection  of  the  chest,  sometimes  even  eclampsia ; 
as  well  as  great  restlessness,  frequent  change  of  position,  sopor, 
delirium,  &c." 

It  displays  its  efficacy  in  reproducing  the  eruption,  when  the 
cerebral  affection  disappears,  and  the  disease  runs  its  usual  course.* 

Pulsatilla  is  indicated,  when  derangement  of  the  stomach  and 
digestive  organs  is  a  prominent  symptom,  the  face  pale,  red,  or 
bloated;  also  constipation — or  looseness,  especially  at  night, — occa- 
sionally with  pains  in  the  bowels,  and  shivering ;  disposition  fretful 
and  sensitive,  or  melancholy. 

When  the  eruption  is  very  intense,  and  extends  over  the  entire 

*  The  remarks  made  on  this  medicine  are  taken  from  the  translation  of  Dr.  Schmidt's 
paper  on  the  subject,  in  the  '  British  Journal  of  Homoeopathy/  No.  Ill,  page  233,  to  which 
the  reader  desirous  of  further  information  is  referred.  The  following  is  Dr.  Schmidt's 
formula  :  one  grain  of  the  Cuprum  aceticum  triturated  with  one  hundred,  one  hundred  and 
fifty,  or  two  hundred  grains  of  sugar  of  milk,  previously  triturated  so  as  to  feel  as  fine  as 
flour ;  the  process  should  occupy  from  twenty  to  thirty  minutes.  Of  this  preparation  take 
from  three  to  four  grains,  dissolve  in  a  tumbler  of  pure  water,  and  administer  in  tablespoon- 
fuls,  every  quarter  of  an  hour,  half  hour,  one,  or  two  hours,  according  to  the  violence  of  the 
disease. 


62  ERUPTIVE  FEVERS. 

frame,  and  particularly  when  the  patient  affected,  is  of  the  scrofulous 
diathesis,  Sulphur,  in  repeated  doses  has  been  strongly  recommended. 
Aconitum,  as  intermediate  remedy  after  SulpL,  when  great  restlessness 
and  dry  heat  of  skin  prevail.  After  the  employment  of  SulpL  and 
Aconit.  other  remedies,  such  as  Puis.,  Calc,  Arsenic,  &c,  maybe 
called  for. 

We  frequently  find  this  affection,  in  a  complicated  form,  distin- 
guishable from  pure  scarlet  fever  by  the  absence  of  the  peculiar  hue 
of  the  skin,  of  which  We  have  spoken  at  the  commencement,  and  by 
the  pressure  of  the  finger  leaving  no  white  imprint.  This,  so 
widely  different  type  of  the  disorder,  will  be  found  treated  of,  in  the 
succeeding  chapter, under  the  denomination  of  Purpura  miliaris  or 
Scarlatina  miliaris. 

The  accession  of  laryngitis  is  one  of  the  most  serious  and  fatal 
complications  which  is  liable  to  be  encountered  in  scarlet  fever.  The 
remedies  on  which  we  must  place  the  greatest  reliance  as  soon  as  we 
have  detected  this  dangerous  state  of  matters,  are  :  Aconite ',  Spongia, 
Hepar  s.,  Lachesis,  Merc,  Ars.,  Carlo,  &c.     (See  Laryngitis.) 

In  strumous  habits,  or  in  instances  where  the  disease  has  been 
allopathically  treated  from  the  commencement,  many  troublesome 
sequelae  are  frequently  left.  And  we  may  remark  that,  even  after  the 
desquamatory  process  is  completed,  the  whole  of  the  danger  is  not 
altogether  passed,  any  exposure  to  cold,  or  infringement  of  dietetic 
rules,  being  likely  to  entail  unpleasant  and  even  dangerous  conse- 
quences. 

Chamomile  a.  may  be  employed  with  advantage,  either  alone,  or 
alternately  with  Belladonna,  against  excoriation  of  the  face,  &c. 

Aurum.  Against  the  offensive  and  purulent  discharge  from  the 
nose,  with  soreness  and  swelling  of  the  interior. 

Mercurius  vivus  is  a  good  remedy  against  soreness  of  the  nose 
and  face,  with  swelling  of  the  submaxillary  glands ;  followed  by 
Hepar  sulp/mris,  SiUcea,  Sulphur,  and  Calcarea,  if  necessary. 

Against  the  following  symptoms.  Belladonna  is  extremely  efficacious : 
puffiness  of  the  face,  swelling  of  the  hands  and  feet,  lingering  fever  in 
the  evening,  glandular  enlargements,  chaps  about  the  mouth,  severe 
headaches,  stammering,  &c. ;  and  may  frequently  be  advantageously 
alternated  with  the  medicines  just  mentioned. 

Dropsical  swelling  of  the  whole  body  is  not  an  unfrequent  sequela, 
sometimes  requiring  a  most  careful  and  discriminating  treatment. 
The  following  remedies  will  generally  be  found  the  best  adapted  to 


SCARLET  FEVEU.  68 

the  successful  treatment  of  the  same:  Hellehoms,  Arsenicum,  Bryonia, 
Rhus ;  of  these  Helieb.  is,  generally,  the  most  appropriate  when  the 
whole  body  has  become  suddenly  anasarcous  :  Rhus,  when  the  .inferior 
extremities  are  more  especially  affected,  and  Arsenicum,  when  Hettehorus 
does  not  speedily  produce  a  favorable  impression.  Bryonia  has  been 
recommended  as  the  best  remedy  when  the  dropsical  infiltration  is 
detected  early,  and  the  effused  fluid  is  small  in  quantity.  In 
obstinate  cases,  Arnica,  Bella.,  Phosphoric  acid,  Digitalis,  Baryta 
m.,  '  Sulph.,  Lycopod.  Against  Otitis,  or  Otorrhcea:  Belladonna,  Hepar 
stdphuris,  or  Pulsatilla  are  the  best  remedies  ;  and  in  the  case  of  Boils, 
Arnica,  followed  by  Bryonia  and  Sulphur,  when  necessary;  and  for 
Deafness,  Belladonna,  Pulsatilla,  Dulcamara,  Sulphur,  are  to  be  chiefly 
recommended. 

It  may  here  be  added,  that  Ammonium  carbonicum,  Arsenicum,  Secale 
cornutum,  and  Acidum  phosphoricum,  have  been  found  very  useful  in 
scarlatina,  when  it  assumes  the  typhoid  fornl;  and  Arsenicum  in  fre- 
quently repeated  doses, — or  Acidum  nitrictim,  Aconitum,  Lycopodium, 
and  Belladonna,  alternately,  a  dose  of  each  remedy  being  given  every 
hour,  or  oftener  if  necessary,  for  several  successive  hours,  to  rouse 
the  vital  force  to  new  efforts,— in  the  severe  and  dangerous  sore  throat 
which  accompanies  malignant  scarlatina,  the  amygdalae  being  swollen 
into  hard  tumours,  often  as  large  as  apples,  attended  with  snorting 
and  difficult  breathing,  enlargement  of  the  neighbouring  glands,  re- 
mitting pulse,  and  sopor.*  Against  Parotitis :  Mercurius,  Carlo  v., 
Calcarea  c,  and  Kali  c,  will  generally  be  found  the  most  important 
remedies. 

Belladonna  is  valuable  as  a  preservative  against  pure  scarlatina,  when 
epidemic,  and  moreover^  greatly  assists  in  modifying  the  character  of 
the  disease,  in  such  individuals  as  do  not  wholly  escape  its  attacks,  f 

*  Brit.  Jour,  of  Horn.  No.  xii.    Vide  also  Ulcerated  Sore  Throat. 
f  There  are  various  methods   of  employing   Belladonna  as   a  prophylaxis.     We   have 
repeatedly  used  the  following  prescriptions  with  advantage : 
R  Tinct.  Bellad.  3,  gtt.  vj. 
Aq.  destil.  J  vj. 
Dose,    To  robust  children  of  ten  years  of  age  a  dessert-spoonful  twice  a  day  ;  to  those  of 
about  five  years  of  age  a  teaspoonful  daily ;  and  to  those  of  and  below  three  years,  a  tea- 
spoonful  every  third  day.     Or,  in  the  case  of  delicate  children,  or  those  who  are  very  sensi- 
tive to  the  action  of  the  homoeopathic  medicines : 

R  Bellad.  30,  glob.  3. 
Aq.  destil.  Jj. 
Dose.  A  teaspoonful  every  third,  or  only  every  fifth  day,  when  there  is  inactivity  of  the  skin, 
with  great  susceptibility  to  the  medicinal  effects.     A  little  pure  alcohol  may  be  added  to  the 


64  ERUPTIVE  FEVERS. 

Should  the  disease  continue  to  rage,  the  treatment  may,  in  some 
instances,  be  renewed.  If,  however,  the  ruling  epidemic  be  scarla- 
tina in  an  unusual  or  complicated  form,  the  remedies  employed  as 
preservatives  must  be  such  as  possess  pathogenetic  properties,  corre- 
sponding to  the  entire  morbid  picture  of  the  disease.  Aconitum  and 
Belladonna  in  alternation,  (allowing  twelve  to  twenty-four  hours  to 
elapse  after  the  administration  of  Aconitum  before  Belladonna  is  given, 
and  from  two  to  four  days  after  Belladonna,  before  Aconitum  is  repeated, 
and  so  on,)  have  been  employed  successfully  in  epidemics  not  possessing 
the  clear  scarlatina  hue,  with  a  smooth  and  glossy  surface.  While 
taking  Belladonna  or  Aconitum  the  patient  must  adhere  strictly  to  the 
homoeopathic  diet,  particularly  avoiding  wine  and  acids.  We  must,  in 
administering  prophylaxes,  carefully  watch  their  effects  and  if  a  medicinal 
action  set  in  discontinue  immediately. 

Diet.  During  the  course  of  this  malady,  the  greatest  possible 
attention  must  be  paid  to  this  point.  In  the  more  severe  accesses  of 
fever,  no  other  nourishment  must  be  given  than  toast-water,  or  weak 
barley-water ;  and  even  after  the  fever  has  abated,  every  care  must 
be  taken,  and  a  return  be  gradually  made  to  a  more  nourishing  diet, 
as  negligence  in  this  respect  may  be  productive  of  the  most  serious 
consequences.  In  mild  attacks  the  patient  may  be  allowed  gruel  or 
weak  broths. 

SCARLET  RASH. 

Purpura  Rubra  s.  Miliaris  Hahnemanni.     Scarlatina  miliaris,  miliformis, 

papulosa.     Miliaria  purpurea* 

This  affection  is,  by  many  authors,  regarded  as  a  mere  modification 
of  the  exanthema  we  have  treated  of  in  the  preceding  chapter,  {scarla- 
tina pur  a,  scarlatina  levigata  seu  plana.) 

It  is  easily  distinguishable  from  pure  scarlet  fever,  by  the  dark 
redness  of  the  efflorescence,  by  the  slight  pressure  of  the  finger 
leaving  no  white  imprint,  and  by  the  small  granular  elevations,  the 
cause  of  the  dark  red  hue,  which  are  felt,  on  passing  the  hand 
over  the  affected  cutaneous  surface.  Some  parts  of  the  skin 
are  perfectly  free  from  the  miliary  papulae,  and  consequently 
present     a    brighter    hue    than    those    which     are    studded    with 

water  when  the  weather  is  very  warm,  or  when  it  is  required  to  keep  the  prophylactic 
liquid  for  a  longer  period  than  usual.  A  fortnight  to  three  weeks'  use  of  the  Belladonna  is 
generally  sufficient  to  obviate  any  risk  of  infection. 


SCAULATINA  MILIAEIS.  65 

them.  In  confluent  scarlatina  miliaris,  or  that  in  which,  on  some 
parts  of  the  cutaneous  surface,  several  papulae  run  into  one  another, 
the  affection  has  received,  from  the  appearance  which  the  eruption 
then  assumes,  the  term  of  scarlatina  _p7ilycttenosa,  vesicularis  jpustulosa. 

This  eruptive  fever  does  not  run  a  defined  and  regular  course,  like 
other  exan thematic  fevers.  The  efflorescence  often  disappears  sud- 
denly, and  is  then  productive  of  extreme  danger,  frequently  termi- 
nating in  a  fatal  result.  The  extent  of  the  efflorescence  does  not 
necessarily  add  to  the  danger,  as  the  latter  is  often  greatest,  when 
the  efflorescence  is  scarcely  perceptible. 

Sweat  is  only  met  with  on  the  surfaces  affected  with  the  eruption, 
and  it  is,  consequently,  only  when  the  eruption  covers  the  whole 
body,  that  the  sweat  is  general. 

Those  who  have  been  once  affected  with  the  disorder,  are  by  no 
means  exempt  from  future  attacks.  Soreness  of  the  throat  is  chiefly 
encountered,  when  the  eruption  is  altogether  wanting,  but  it  is  also 
frequently  met  with  before  the  outbreak  of  the  rash,  becoming 
trivial  during  the  full  bloom,  and,  again,  very  severe  on  the  dis- 
appearance of  the  same. 

This  disease  requires  a  totally  different  treatment  from  scarlatina 
levigata  (scarlatina  pur  a,  scarlatina  simplex),  and  Belladonna,  the  spe- 
cific remedy  in  the  latter,  will,  in  this  case,  neither  be  found  to  be  a 
preventive  nor  an  indispensably  curative  medicine,  but  simply  an 
auxiliary  in  some  complicated  cases. 

Aconitum.  When  the  disorder  occurs  in  an  idiopathic  form, 
there  are  few  exceptions,  in  which  any  other  remedy  than  Aconite  is 
required,  for  the  entire  removal  of  the  disorder.  Sometimes  it  is 
found  necessary  to  administer  a  dose  of  Cqffea,  a  few  hours  after  the 
first  or  second  dose  of  Aconite,  when  the  patient  complains  of  severe 
pain  in  the  head,  trunk,  or  extremities,  and  is  extremely  restless, 
fretful,  agitated,  and  disposed  to  shed  tears,  and  then,  again,  to 
return  to  Aconite  after  a  similar  interval :  and  so  on,  alternately, 
until  the  cure  is  completed ;  which,  under  favorable  circumstances, 
is  speedily  accomplished  by  means  of  these  remedies.* 

When,  however,  this  eruptive  fever  occurs  in  complication  with 
smallpox,  or  measles,  or,  when  it  breaks  out  in  unfavorable  sea- 
sons, during  the  prevalence  of  one  or  more  of  the  said  exan- 
themata, it  generally  becomes  a  much  more  serious  disorder,  and 
requires  the  aid  of  other  remedies,  in  addition  to  the  above  men- 

*  Sulphur  may  be  substituted  for  Coffea,  in  cases  where  the  fever  continues  to  run  high, 
notwithstanding  the  employment  of  Aconitum. 

5 


66  ERUPTIVE  FEVERS. 

tioned.  Among  these,  Ipecacuanha,  Pulsatilla,  Bryonia,  Dulcamara, 
Belladonna,  Arsenicum,  Phosphorus 9  and  Rhus  are  the  most  important, 
preceded  by,  and,  where  necessary,  alternated  with  Aconite,  when 
signs  of  inflammatory  fever,  or  the  following  symptoms  present 
themselves: — Slight,  general  fever  chills,  with  rapidly  alternating 
redness  and  paleness  of  the  face ;  quick  full  pulse ;  slight  confusion 
of  ideas,  increasing  to  a  mild  degree  of  delirium  at  night,  combined 
with  dryness  of  the  mouth  and  lips,  and  thirst;  eyes  somewhat 
inflamed  ;  oppression  at  the  chest,  short  cough,  sometimes  attended 
with  reddish  sputa,  and  followed  by  a  shooting  pain  under  the  ribs ; 
occasional  vomiting ;  angina  pharyngea.  In  all  such  cases,  a  dose  or 
two  of  Aconite,  at  intervals  of  four  hours,  will  be  found  of  consider- 
able service,  if  not  sufficient  to  put  a  check  to  the  further  progress 
of  the  affection. 

Ipecacuanha.  In  many  instances,  either  at  the  commence- 
ment of  the  attack,  before  the  appearance  of  the  eruption,  or  during 
its  full  development,  but  particularly  the  former,  this  is  a  most 
efficient  remedy.  It  is  indicated  when  there  is  a  sensation  of  dis- 
tressing tightness  of  the  chest,  with  laborious  breathing,  and  heightening 
of  the  febrile  action  towards  evening ;  with  symptoms  of  nausea,  or 
even  vomiting;  extreme  restlessness  and  agitation :  deep  sighing  or 
moaning;  disposition  to  tearfulness,  or  whining  in  children ;  diar- 
rhoea, or  colic. 

When  the  oppression  of  the  chest,  and  excessive  restlessness  have 
been  removed  by  Ipecacuanha,  but  considerable  nausea  or  frequent 
fits  of  vomiting  remain,  these  symptoms  will,  generally,  soon  yield  to 
Pulsatilla. 

Bryonia  is  frequently  more  efficacious  than  either  Coffea  or  Ipeca- 
cuanha, in  relieving  the  extreme  anxiety,  restlessness,  deep  sighing  or 
moaning,  which  so  generally  attend  this  affection ;  it  should,  there- 
fore be  had  recourse  to  in  all  cases  in  which  these  remedies  fail  to 
afford  speedy  relief.  In  some  rare  cases,  even  Bryonia  is  not  suffi- 
cient, and  it  is  then  found  necessary  to  administer  Cinchona,  followed 
by  Phosphorus.  Bryonia  is  further  indicated,  when  the  accompanying 
fever  partakes  of  a  nervous  character,  attended  with  delirium  and 
other  symptoms  mentioned  under  Bryonia,  in  the  article  on  Nervous 
fever — which  see.  The  excessive  and  continual  urging  to  urinate, 
which  sometimes  sets  in,  in  the  course  of  the  disease,  is  often  very 
readily  subdued  by  Bryonia  or  by  Conium. 

Belladonna.     When  the  disorder  is  met  with  during  the  preva- 


SCARLATINA  MILIARIS.  67 

lence  of  Scarlatina  pura>  (as  also  when  symptoms,  more  or  less  cha- 
racteristic of  the  latter  affection,  make  their  appearance  in  the  course 
of  scarlatina  miliaris,)  this  remedy  is  a  most  efficient  auxiliary ;  it  is, 
moreover,  a  most  important  remedy,  when  symptoms  of  cerebral 
disturbance  exhibit  themselves ;  or  when  the  patient  complains  of 
his  throat,  which,  on  being  examined,  is  found  to  be  in  a  state  of 
phlegmonous  inflammation.  Mercurius  may  follow  Belladonna,  when 
the  tonsils  become  much  inflamed  and  tumefied,  or  ulceration  super- 
venes ;  in  the  latter  instance,  however,  Arsenicum  or  Acid,  nitricum 
may  become  necessary  under  particular  circumstances.  (Vide  Scar- 
latina, Sore  throat,  and  Scarlatina  maligna.) 

Phosphorus.  This  remedy  is  very  useful  in  cases  in  which 
there  are  symptoms  of  congestion  in  the  chest,  with  extreme  anxiety 
and  oppression,  and  also,  when  there  is  considerable  cerebral  irrita- 
bility, characterized  by  over-excitability  of  the  senses ;  further,  when 
the  patient  appears  extremely  listless  and  apathetic,  and  complains 
of  burning  sensations  in  isolated  parts,  rendering  a  frequent  change 
of  posture  necessary.  Phosphorus  is  often  of  great  utility  after 
Bryonia  or  Belladonna. 

Dulcamara.  When  severe  aching  or  gnawing  (rheumatic)  pains 
are  complained  of  in  the  back  or  extremities,  either  in  the  course  of 
the  disease,  or  at  its  termination,  Dulcamara  is  useful. 

Arsenicum,  may  be  had  recourse  to  in  an  advanced  stage  of  the 
complaint,  if  the  vital  power  seems  rapidly  sinking,  and  the  organs, 
which  perform  the  act  of  deglutition,  are,  as  it  were,  paralysed,  so 
that  the  patient  is  incapacited  from  swallowing ;  or  when,  from  a 
metastasis  to  the  throat,  the  latter  has  become  so  rapidly  and 
seriously  affected,  as  to  have  assumed  a  gangrenous  aspect.*  (See 
Ulcerated  sore,  throat.) 

When  the  disease,  in  cases  of  a  bad  type,  puts  on  a  nervous,f  or 

*  Compare  these  symptoms  with  those  described  under  Calcarea  carbonica  at  the  end 
of  this  chapter. 

f  Rhus  and  Sulphur  may  also  be  mentioned  as  having  been  found  useful  in  this  disorder; 
the  former,  when  the  exanthema  had  degenerated  into  a  species  of  vesicular  erysipelas, 
attended  with  lethargy,  great  thirst  and  strangury ;  and  the  latter,  in  cases  where  Belladonna 
had  failed  to  effect  all  that  could  be  expected.  Antimonium  tartaricum  may  prove  of  con- 
siderable service  in  the  vesicular  or  pustular  form  of  the  exanthema.  Against  the  convulsions 
which  precede  the  evolution  of  scarlet  rash,  or  the  efflorescence  of  scarlet  fever,  as  well  as 
confluent  smallpox,  Tart.  emet.  is  also  indicated.  In  the  event  of  repercussion  of  the  eruption, 
Bryonia,  Phosphorus,  Sulphur,  and  Cuprum  aceticum  have  been  recommended  as  the  most 
useful.  Opium  proves  very  useful  when  the  following  symptoms  present  themselves: 
burning  heat  of  skin,  extreme  agitation  and  anxiety,  vomiting,  diarrhoea,  or  obstinate  con- 
stipation, convulsions,  and  excessive  drowsiness. 


68  ERUPTIVE  FEVERS. 

even  a  putrid  character,  with  extreme  offensiveness  of  all  the 
excretions,  and  hemorrhage  from  the  nose,  mouth,  &c,,  the  medicines, 
already  mentioned  under  fevers  of  the  said  description,  (which 
see  p.  32,)  must  be  employed.  Owpmm  aceticum  and  Kreosote  have 
been  found  useful  in  some  of  these,  almost  hopeless,  but  fortunately 
somewhat  rare  cases ;  the  former  particularly,  when  the  efflorescence 
repeatedly  appears  and  disappears  suddenly  in  the  course  of  the 
disease. 

To  show,  however,  how  very  essential  it  is  to  make  a  careful  selec- 
tion of  the  remedy,  in  the  strictest  possible  accordance  with  the  law 
similia  similibus,  instead  of  blindly  pursuing  the  path  of  routine,  and 
prescribing  remedies  solely  in  consequence  of  their  having  been  found 
useful  in  other  epidemies  of  the  same  name,  we  add  the  following 
account  of  a  severe  epidemy  which  was  described  by  Dr.  Elbe,  of 
Dresden,  in  the  'Allg.  Horn.  Zeitung/  No.  15,  21ster  Band : 

"The  scarlet-fever  epidemy  of  1 845,  which  raged  not  only  in  Dresden 
and  its  environs,  but  also  in  many  other  remote  parts  of  Germany, 
was  unquestionably  of  a  more  violent  character  than  has  appeared  for 
a  long  time.  There  were  but  few  families  that  entirely  escaped  its 
ravages,  and  the  number  that  fell  victims  to  it  was  very  large.  It  is 
well  known,  that  in  many  families  as  many  as  from  three  to  four 
children  died  of  it ;  in  one  case,  indeed,  seven  children  out  of  a  family 
of  eight ;  and  from  this  great  mortality  a  conclusion  may  be  drawn  of 
the  violence  and  malignity  of  the  fever. 

It  will  perhaps  not  be  wholly  superfluous  to  remark,  that  a  rubeo- 
loid  epidemy,  but  which  wras  not  exactly  of  a  malignant  character,  pre- 
vailed here  in  1844.  After  it  had  passed  over,  the  scarlet  fever  appeared 
in  the  spring  of  1845,  sporadic,  but  of  slight  character,  and  continued 
thus  till  August ;  in  the  said  month,  however,  the  epidemy  assumed 
a  malignant .  character,  which  may  perhaps,  in  a  great  measure,  be 
ascribed  to  the  excessive  heat  we  had  in  July  (frequently  32°  Reaum. 
in  the  shade).  So  much  is  certain,  that  a  great  number  of  children 
died  from  that  time  forward  of  scarlet  fever,  although  there  were  also 
slight  cases  which  occurred  during  the  course  of  the  epidemy,  which 
were  readily  cured  by  Aeon,  and  Belladonna,  or  recovered  by  the  un- 
aided efforts  of  nature.  This,  however,  happens  in  all  epidemies,  and 
as  nothing  of  interest  is  to  be  elicited  from  it,  either  as  regards  patho- 
logy or  therapeutics,  I  shall  pass  these  over,  and  confine  myself  to 
pointing  out  the  characteristics  of  the  more  malignant  cases,  and  to 
mentioning  those  remedies  which  proved  specific  thereto. 


SCARLATINA  MILIARIS.  69 

The  exanthema  itself,  appeared  in  many  cases  very  suddenly,  with- 
out any  precursors  ;  in  others,  a  fever  preceded  the  eruption  for  several 
days,  which  possessed,  however,  in  the  absence  of  all  local  disturb- 
ance, no  determined  character.  The  only  circumstance  worthy  of 
notice  being,  that  the  skin  was  usually  more  dry,  and  of  higher  tem- 
perature, than  it  commonly  is  in  fevers,  and  that  Aeon,  had  no  effect. 
In  some  cases,  headache,  hemorrhage  from  the  nose,  sore  throat, 
vomiting,  and  diarrhoea  showed  themselves  as  precursors.  Neither  the 
nature  of  the  precursory  symptoms,  nor  the  character  of  the  exan- 
thema justified  the  prognostication  that  the  disease  would  take  a 
malignant  course ;  cases  turned  out  dangerous,  with  a  scanty  as  well 
as  with  an  abundant  efflorescence,  and  vice  versa.  This  alone  I  ob- 
served, that  those  cases  wTere  more  dangerous,  in  which  the  single 
patches  were  confluent  and  more  elevated  than  usual ;  frequently  also 
these  larger  patches  had  not  the  proper  scarlet  red,  but  more  of  violet 
colour.  The  violence  of  the  angina  wras,  likewise,  a  certain  criterion 
of  a  malignant  case ;  on  the  other  hand,  the  intensity  of  the  fever 
(although  even  some  cases,  wrhere  almost  no  fever  existed,  suddenly 
terminated  with  death),  with  an  asthenic  character,  which  appeared 
usually  with  the  first  eruptions,  sometimes  also  with  the  following, 
was  an  almost  infallible  prognostic ;  the  skin  was  at  the  same  time 
burning  hot,  partly  dry,  partly  covered  with  colliquative  swTeat ;  the 
pulse  small,  weak,  and  very  quick  (130  to  above  160);  the  face 
bloated;  the  tongue  mostly  dry,  at  first  furred  yellow,  afterwards 
brown ;  the  tip  red,  and  the  papillae  swollen  ;  the  lips  dry,  and  browrn, 
as  in  typhus;  the  teeth  often  covered  writh  a  viscid  brown  mucus; 
thirst,  usually  excessive ;  the  difficulty  in  the  performance  of  the  act 
of  deglutition  was  not  always  uniformly  great ;  in  some  cases  it  pro- 
ceeded from  the  swelling  of  the  tonsils,  in  others,  the  cause  appeared 
to  be  an  inflammation  of  the  throat,  and  again,  in  others,  it  mani- 
fested itself  only  during  the  febrile  exacerbations,  which  mostly  took 
place  in  the  evening;  strangury  was  not  unfrequently  an  unfavor- 
able symptom;  the  urine  which  was  voided,  often  emitted  an  ammo- 
niacal  or  putrid  smell,  and  was  as  clear  as  water.  So  far,  the  more 
malignant  cases  were  analogous,  but  from  here  they  can,  as  regards 
the  affected  organs,  the  brain  or  lungs,  be  divided  into  two  classes. 
The  affection  of  the  brain  was,  as  usual,  accompanied  by  violent  deli- 
rium, periodical  or  continuous  unconsciousness,  involuntary  evacua- 
tions of  the  urine  and  fasces,  which  latter  were  mostly  of  a  light 
colour ;  the  skin,  which  had  previously  been  hot,  became  cool,  the 


70  ERUPTIVE  FEVERS, 

pulse  thready,  the  efflorescence  scanty  and  violet-coloured ;  death 
followed  from  paralysis  of  the  brain.  The  affection  of  the  chest  be- 
trayed itself  not  only  by  short,  but  also  by  difficult  and  laborious 
breathing,  by  mucous  rattling  in  the  bronchi,  and  sometimes  also  by 
an  efflux  of  pus  from  the  nostrils.  In  this  variety,  also,  involuntary 
evacuations  took  place  latterly ;  the  excretions  were  in  almost  all 
cases  clayey,  as  in  icterus  in  adults,  but  the  urine  clear,  like  water. 
Delirium  was,  moreover,  not  wholly  absent,  but  certainly  not  so  violent 
as  in  the  affections  of  the  brain ;  the  disease  terminated  with  paralysis 
of  the  lungs. 

I  have  drawn  the  distinction  between  the  two  forms  thus  promi- 
nently, from  the  circumstance,  that  it  was  of  importance  in  conducting 
their  respective  treatment.  In  most  cases,  death  ensued  on  the  third, 
but  often  not  before  the  fifth  day,  and  in  rarer  instances,  already  on 
the  first  day  of  the  disease.  I  may  transitorily  mention  that  many 
other  symptoms,  such  as  convulsions,  &c,  made  their  appearance 
towards  the  close  of  the  disease,  but  all  danger  was  usually  over  when 
once  the  period  of  desquamation  had  commenced.  The  epidemy 
continued  with  almost  unabated  intensity  till  February,  1846,  when 
it  suddenly  assumed  a  milder  character,  and  then  gradually  disap- 
peared. 

The  sequelae  of  the  disease  consisted  chiefly  in  hydrops  anasarca, 
ascites,  hydrocephalus,  glandular  swellings,  and  abscesses,  which 
always  yielded  readily  to  the  usual  remedies. 

Before  I  enter  upon  the  treatment,  I  must  add,  that  I  by  no  means 
found  the  prophylactic  power  of  Belladonna  so  very  generally  con- 
firmed. I  had,  it  is  true,  cases,  where  children,  to  whom  I  gave  Bel- 
ladonna as  a  palliative,  escaped  the  scarlet  fever,  even  when  it 
was  in  the  family;  but  I  as  often  found  that  others  were  attacked 
by  the  fever  although  they  had  taken  Belladonna  for  many  weeks, 
and  that  notwithstanding  the  long-continued  use  of  the  same,  the 
subsequent  disease  was  not  in  the  least  mitigated  by  it.* 

Of  the  treatment  of  the  milder  cases  I  shall  say  nothing  here,  since, 
as  mentioned  above,  Aconitum  and  Belladonna  perfectly  sufficed.  That 
these  remedies,  however,  had  no  effect,  and  could  have  none,  in  the 

*  Belladonna  may  only  be  expected  to  act  as  a  preservative  when  it  happens  to  be  specific 
tothe  prevailing  epidemy.  Had  the  remedies  (  Calcarea  and  Zincum)  which  were  subsequently 
employed  with  such  striking  success  in  the  treatment  of  this  epidemy,  been  used  as 
prophylaxes,  there  is  every  reason  to  surmise  that  these  remedies  would  not  have  failed  to 
exert  a  preventive  effect. — J.  L. 


SCARLATINA  MILIAR1S.  71 

more  malignant  cases,  may  be  accounted  for  by  the  fact,  that  in  these 
the  fever  was  not  sthenic.,  or  similar  to  the  inflammatory;  that 
the  tendency  to  paralysis  was  occasioned  by  pure  nervous  weakness, 
i.  e.,  by  prostration  of  the  vital  power  ;  that  Aeon,  and  Belladonna,  on 
the  other  hand,  can  only  prove  beneficial  against  erethic  and  inflam- 
matory fever,  and  although  unquestionably  also  against  paralysis, 
they  are  only  so  when  the  latter  has  originated  in  congestion  ; 
consequently  that  their  curative  power  in  febrile,  congestive,  and 
inflammatory  states,  rests  upon  their  capability  of  suppressing  abnor- 
mally excited  vital  power,  but  which  must,  in  cases  of  the  description 
noticed  here,  by  all  means  be  avoided ;  on  the  contrary,  we  must 
endeavour  to  invigorate  the  already  but  too  much  depressed  vitality, 
the  lowered  condition  of  which  presented  so  much  difficulty  in  the 
treatment  of  the  epidemy  in  question. 

The  remedies  employed  in  typhus,  viz.,  Bryon.,  Aeid.  phosph., 
Phosphor.,  Card,  veg.,  Acid,  muriat.,  Arsen.,  Rims,  and  Amnion,  carl., 
appeared  to  correspond  to  the  indication  just  mentioned,  as  also  to 
all  the  other  symptoms,  and  yet  none  of  them  had  any  unequivocal 
beneficial  effect,  for  although  single  cases  took  a  favorable  course, 
still,  the  fatal  termination  was  unfortunately  the  more  frequent :  it 
was  therefore  much  to  be  doubted  whether  the  more  rare  favorable 
termination  was  to  be  ascribed  to  these  remedies  or  to  nature. 

Amongst  the  remedies  quoted,  Rhus  and  Amnion,  card,  undoubtedly 
appear  the  best  suited  against  scarlet  fever.  Still  Rims  has  no  specific 
relation  to  this  disease,  for,  although  we  certainly  know  it  to  be 
appropriate  in  erysipelatous,  phlyctaenous,  pustular,  scabby,  and 
herpetic  forms  of  eruptions,  it  is  not  so  in  any  which  are  analogous 
to  the  efflorescence  of  scarlatina.  The  observation  of  Dr.  Kreussler 
(Allg.  Homoeopath.  Zeitung,  29.  8),  that  Rhus  proved  a  specific 
remedy  against  scarlatina,  combined  with  an  intense  vascular  fever,  I 
did  not  see  confirmed ;  it  is  moreover  well  known  that  the  intense 
vascular  fever  abates  as  soon  as  the  eruption  has  fulfy  taken  place,  and 
before  this  period  it  will  hardly  be  possible  to  mitigate  the  fever. 
According  to  my  opinion,  a  beneficial  effect,  and  that  with  some  cer- 
tainty, can  only  be  expected  from  Rhus  in  scarlet  fever,  if  the  latter  is 
complicated  with  a  typhoid  state.  Ammon.  carl.,  therefore,  appeared 
to  hold  out  the  most  favorable  expectations,  especially  as  it  had 
been  already  successfully  employed  by  many ;  this  year,  however,  no 
advantage  followed  its  employment,  and  this  no  doubt  arose  from  the 
circumstance    that   every  epidemy  possesses  its  peculiarities,  as  is 


72  ERUPTIVE  FEVERS. 

shown  in  that  described  by  Schron  (Hyg.  21,  1),  in  which  he 
prescribed  Amnion,  card,  with  great  success  ;  for,  in  the  first  instance, 
the  frequency  of  the  pulse,  in  the  cases  described  by  Schron,  was  not 
above  130,  whilst  it  rose  here  to  164,  consequently  a  difference  of 
more  than  30  pulsations  in  the  minute ;  secondly,  in  Schron' s  cases, 
danger  was  indicated  by  the  intensity  of  the  redness  and  the  extent 
of  the  efflorescence,  whilst  in  our  cases  this  was  not  of  any  prognostic 
moment ;  and  lastly,  in  Schron's  cases,  paralysis  of  the  brain  usually 
took  place  after  vomiting,  and  in  cases  where  the  eruption  was  scanty, 
whilst  it  was  here  mostly  unpreceded  by  any  perceptible  precursory 
symptoms,  and  could  only  be  recognized  by  its  consequences,  viz., 
by  the  diminished  temperature  of  the  skin,  by  the  retrocession  of  the 
exanthema,  and  by  involuntary  evacuations.  Schron  makes  no  men- 
tion of  cases  in  which  the  lungs  were  implicated.  These  may  be 
considered  as  the  principal  distinguishing  characteristics  of  the  two 
epidemies,  and  may  account  for  the  circumstance,  that  remedies 
declared  as  curative  by  Schron,  were  of  no  avail  in  the  epidemy 
which  occurred  in  this  place. 

All  the  remedies  mentioned  having  failed,  I  was  compelled  to 
search  for  others,  and  I  found  Calcarea  carbonica,  and  Zincum  to  be 
the  most  suitable  according  to  the  entire  morbid  picture  of  the 
disease.  We  shall,  however,  proceed  first  to  attempt  to  compose, 
from  the  pathogenetic  symptoms  which  can  be  produced  by  Calc.  carb., 
a  form  of  disease  which  presents  a  strong  resemblance  to  the  state 
described  above. 

We  find,  as  the  effects  of  Calc,  Carb.,* 

With  regard  to  the  JExanthema  : 
Symptoms.— 293,  394,  415.   Red,  hot,  turgid  countenance. 

417.  Small  painless  rash  on  the  face. 

418.  Eruption  on  the  face  resembling  miliaria. 

443.  A  fine  eruption  about  the  neck  and  chin  attended  with 
itching. 

1364.  Red  streaks  on  the  shin-bone,  which  consist  of  miliary 
vesicles,  with  violent  itching  and  burning  after  being  rubbed. 

1403.  Burning  in  the  palms  of  the  hands  and  soles  of  the  feet. 

With  regard  to  Fever. 
1502.  Difficulty   in  falling   asleep   in    consequence    of    excessive 
heat,  in  a  cold  room. 

*  Materia  Medica  (Homoeop.,> 


SCARLATINA  MILIARIS.  73 

1555.  Restless  dozing,  during  the  night,  with  excessive  heat  and 
confusion  in  the  head,  as  in  fever. 
1585.  Accelerated  pulse. 

Concomitant  Symptoms. 
a.  Affections  of  the  Throat. 
5 1 2-52 1 .      Difficulty  of  deglutition. 

528-29-30.     Swelling  and  inflammation  of  the  palate  and  tonsils. 
525-27.  Indicate  inflammatory  action  in  the  pharynx. 

b.  Trachea  and  Lungs. 
1025.  Loud  rattling  in  the  windpipe,  during  the  act  of  expiration, 
as  if  from  an  accumulation  of  mucus  in  the  chest. 
1053.  Hot  breath,  with  heat  in  the  mouth. 
1069-76.  Difficulty  of  breathing. 
1109-10.  Precordial  anxiety. 
1023.  Mucus  in  the  chest,  without  cough. 

■  c.  Cavity  of  the  Mouth,  and  intestinal  Tube. 
531-33.  Dry  tongue. 
564-70.  Thirst. 
517.  The  faeces  perfectly  white. 

d.   Urinary  System. 

871—74,  76,  78.  Strangury. 

877.  Wetting  the  bed  (involuntary  emission  of  urine). 

884.  Copious  emission  of  watery  urine. 

895.  Offensive,  acrid  smell  of  the  urine,  which  is  very  clear  and 
pale. 

e.  Nervous  Symptoms. 

1505-8,  10,  12.  Involuntary  exuberance  of  ideas,  with  visions 
during  sleep. 

1544-46.  Indications  of  delirium. 

1561.  Decided  delirium  in  the  case  of  a  child. 

1435-36-79.  Weakness,  debility. 

If  we  take  the  sum  of  these  symptoms,  we  shall  find  that  it  yields  as 
distinct  indications  of  the  applicability  of  Calcarea  c.  to  the  treatment  of 
scarlet  fever,#  as  may  be  gleaned  from  the  pathogeny  of  Belladonna 

*  Scarlatina  miliaris. — J.  L. 


74  ERUPTIVE  FEVERS. 

and  Ammon.  carb.>  and  more  so  than  can  be  met  with  in  that  of  any 
of  the  other  remedies ;  the  angina,  the  constant  attendant  on  scar- 
let fever,  is  also  clearly  to  be  recognized.  We  certainly  find  here  but  a 
small  number  of  febrile  symptoms,  only  a  few  times  iC  heat  during 
the  night,  restlessness,  and  quick  pulse  •"  experience,  however,  has 
long  proved  that  Calc.  is  of  great  use  in  rather  violent  fevers,  e.  g.  in 
fever  accompanying  dentition,^ — the  usus  in  morhis  is,  therefore,  in  its 
favour.  It  is  moreover  known  that  every  febrile  state  will  yield,  if 
the  rest  of  the  morbid  picture,  the  source  of  the  fever,  corresponds 
with  the  remedy  employed.  Thus  far  we  might  already  expect  a 
curative  effect  from  Calcarea  in  scarlet  fever ;  but  it  is  chiefly  to  be 
recommended  in  an  epidemy  of  the  character  of  that  which  is  at 
present  under  our  notice,  by  its  so  distinctly  marked  symptoms  of 
paralysis  of  the  lungs ;  it  possesses  also  the  nervous .  symptoms, 
which  wrere  never  absent  in  the  more  malignant  cases,  "and  even  the 
faeces  and  the  urine,  with  the  peculiar  smell  of  the  latter,  are  of  the 
same  nature.  There  was,  therefore,  reason  to  conclude  that  a  bene- 
ficial effect  might  be  looked  for  from  the  employment  of  Calcarea;  and 
my  expectations  were  realized  in  the  most  striking  manner,  for  of  all 
those  children,  to  whom  I  gave  this  remedy,  I  did  not  lose  a  single 
one.  At  the  same  time  it  wTill  be  seen  from  wrhat  I  have  stated,  that 
Calc.  is  only  indicated  in  that  form  of  the  disease,  where  affections 
of  the  chest  take  place,  and  where  paralysis  of  the  lungs  is  to  be 
feared.  I  gave  it  in  the  first  instance,  in  these  bad  cases  only, 
and  invariably  effected  a  speedy  cure  by  means  of  it;  afterwards, 
however,  I  employed  it  in  all  cases  without  exception,  from  the 
commencement  of  the  attack,  and  the  disease,  under  such  circum- 
stances, always  assumed  a  mild  character,  at  least  symptoms  of 
threatening  paralysis  of  the  lungs  never  appeared  after  its  use ;  the 
fever,  however  violent  it  might  be,  diminished  so  rapidly,  that  on  the 
third  day  it  wras  hardly  perceptible;  the  development  of  cerebral 
symptoms,  indicative  of  threatening  paralysis  alone,  could  not  be 
prevented  by  it,  and  as  soon  as  these  appeared  I  discontinued  the 
Calc.  and  proceeded  as  I  shall  hereafter  describe. 

I  gave  Calc.  only  once  every  twenty-four  hours,  and  usually  gr.  j. 
of  the  third  or  fourth  trituration.  It  may  probably  be  asked,  why  I 
repeated  the  medicine  so  seldom  in  such  precarious  cases.  But  I 
must  confess,  that  I  have  seen  a  decidedly  better  effect  from  these 
rare  doses  than  from  more  frequent  repetitions.  Moreover,  the 
curative  effect  of  the   Calc.    develops  itself  with  considerable  quick- 


SCARLATINA  MILIARIS.  75 

ness,  as  I  often  had  occasion  to  observe  ;  for  example,  I  have  even 
succeeded  in  arresting  incipient  paralysis  of  the  lungs  (a  state  which 
decidedly  requires  the  promptest  assistance),  by  one  dose  of  the 
third  trituration ;  and  in  a  case,  which  occurred  in  a  child  of  one 
year  old,  where  difficulty  of  deglutition  appeared  in  the  evening, 
during  the  febrile  exacerbation,  to  such  a  degree  that  suffocation 
was  to  be  apprehended,  relief  was  so  far  afforded  in  the  space  of  a 
few  minutes  by  Calc.  4,  gr.  j,  that  the  child  was  enabled  to  drink 
with  ease,  although  the  symptoms  had  existed  for  upwards  of  an 
bour  before  my  arrival.  The  attack  returned  for  several  evenings  in 
succession  with  equal  intensity,  but  as  Calc.  was  then  immediately 
administered,  it  never  lasted  above  ten  minutes.  But  great  as  was 
the  curative  power  of  Calc.  in  the  above-mentioned  form  of  this 
epidemy,  it  was  inadequate  to  cope  with  the  other  variety,  viz.  that 
with  threatening  paralysis  of  the  hrain  ;  here  Zinctim  was  indicated,  its 
pathogenetic  properties  bearing  not  only  a  similitude  to  scarlatina  in 
general,  but  with  the  form  in  question  in  particular,  as  the  following 
catalogue  will  render  manifest. 

The  eruption  is  indicated  by  : 

Symptoms  : — 276.  Efflorescence  in  the  face.  297.  Violent  itching 
in  the  knee,  and  redness  of  the  same.  921.  Itching  between  the 
shoulder-blades,  with  extensive  eruptions.  991.  Miliaria  at  the  bend 
of  the  left  elbow.  1035.  Red,  small,  round  spots  on  the  hands  and 
fingers.  1231.  Pricking  itching  of  the  skin  with  miliary  eruption 
after  rubbing.  1232.  Itching  miliary  eruption  in  the  popliteal  space 
and  the  joint  of  the  elbow.  1234-35.  Small  red  efflorescence  with 
itching,  disappearing  after  scratching. 

Fever. — 157.  Sensation  of  heat  in  the  head,  and  redness  of  the 
face.  158.  Heat  in  the  head,  during  the  evening^  with  increased 
temperature  of  the  cheeks. 

1266.  Whilst  in  a  sitting  posture,  almost  burning  heat  is  felt 
in  single  small  spots.  1358-68.  Fever  consisting  only  of  heat. 
1357.  Describes  a  febrile  paroxysm  with  trembling  of  the  limbs, 
which  was  characteristic  in  this  variety  of  the  epidemy.  1371. 
Quick  pulse,  sometimes  with  a  sensation  of  increased  temperature. 

Angina. 
370.  Pressive  pain  in  both  tonsils    during    deglutition,    in    the 
evening  and  throughout  the  night.      373.  Feeling  of  contraction  in 


76  ERUPTIVE  FEVERS. 

the  throat  whilst  swallowing.  374.  Pain  in  the  throat,  as  if  caused 
by  internal  swelling.  376.  Pain  in  the  throat  whilst  swallowing, 
with  swelling  of  the  external  parts,  and  of  the  tonsils. 

Lungs, — 807.  Tightness  of  chest,  two  successive  evenings,  with 
small  quick  pulse. 

Mouth,  and  intestinal  canal.     352.  Dryness  of  the  tongue. 

390-96.  Much  thirst.     391.  Dry,  cracked  lips. 

613.  Viscid,  light  yellow  stools. 

622.  Solid,  light- coloured  stools. 

627.  Thinner  and  easier  stools  than  ordinary. 

1288,  In  the  morning  on  awaking  involuntary  discharge  of  liquid 
stools. 

Urinary  System. 

673.  Diminished  emission  of  urine,  of  a  pale  colour. 

666-68.  Strangury. 

675.  Frequent  and  somewhat  increased  emission  of  urine,  varying 
from  the  clearness  of  water  to  lemon  colour. 

677.  Frequent  but  not  copious  emission  of  scanty,  very  light- 
coloured  urine. 

679.  Involuntary  emission  of  urine  whilst  blowing  the  nose. 

Nervous  Symptoms. 
a.  Delirium. 
11.  Fear  of  thieves,  or  horrible  visions  whilst  waking,  as  in  febrile 
delirium. 

48.  Unconnected  ideas. 

1310-29.  Restless  sleep  with  anxious  dreams,  and  delirium. 

b.  Indications  of  Paralysis  of  the  Brain  ; 

49.  Diminished  faculty  of  comprehension,  and  difficulty  of  col- 
lecting the  thoughts. 

50.  Absence  of  thoughts,  and  mental  torpor. 

51.  Oblivion  of  what  has  transpired  during  the  day. 

52.  Great  forgetfulness. 

55.  Sensation  of  weakness  in  the  head. 
217.  Transfixed,  motionless  eyes,  with  absence  of  mind. 
Further,  with  regard  to  the  symptoms  combined  with  suppressed 
activity  of  the  brain  : — 

263-64.  Pale  countenance ;  and  1029.  Cold  hands. 


SCARLATINA  MILIARIS,  77 

Rademacher  also  mentions,  as  the  primary  effect  of  zinc,  cc  great 
disposition  to  sleep,  and  a  state  between  dreaming  and  sleeping/5 
and  employs  it  for  this  reason  in  delirium ;  he,  at  the  same  time, 
admits  its  usefulness  against  sleeplessness  in  acute  diseases  of  the 
brain,  and  considers  its  principal  effect  to  be  on  the  brain.  When 
we  come  to  compare  the  ensemble  of  these  symptoms  with  the 
first  variety  of  scarlet  fever  above  described,  wTe  find  a  reflection  of 
the  whole  picture  of  the  disease ;  we  see  an  eruption  not  dissimilar 
to  that  of  scarlet  fever,  a  febrile  state,  which  consists  only  of  dry 
heat,  with  a  quick  pulse  and  excessive  thirst,  as  also  the  symptoms 
of  difficult  deglutition,  (not  merely  those  which  are  spasmodic,  but 
likewise  those  which  arise  from  swelling  of  me  tonsils.)  These  are  the 
reasons  in  general  that  are  calculated  to  determine  us  to  employ  Zincum 
in  scarlet  fever ;  but  that  which  chiefly  points  out  the  sphere  of  its 
operation  is  its  influence  upon  the  brain,  with  incipient  signs  of 
paralysis  of  that  organ,  giving  rise  to  the  following  concomitant  phe- 
nomena: involuntary  evacuations  of  faeces  and  urine,  diminished 
temperature  of  the  skin,  accelerated  pulse,  trembling  or  paralytic 
state  of  the  extremities.  On  the  other  hand,  with  the  exception  of  the 
single  symptom  of  oppression,  we  do  not  meet  with  any  indications 
of  a  paralytic  affection  of  the  lungs.  From  what  has  been  stated, 
it  is  sufficiently  obvious  that  Zincum  can  only  be  beneficial  in  those 
cases  which  are  complicated  with  affections  of  the  brain ;  the  efficacy 
of  Zinc,  in  analogous  states,  e.  g.,  in  paralytic  states  of  the  medulla 
spinalis,  has  been  long  known.  I  found  it  necessary  to  prescribe 
Zincum  in  large  and  frequently  repeated  doses  (gr.  /3. — gr.  j  of  the 
first  trituration, — at  the  commencement  every  hour,  afterwards 
every  two  to  three  hours),  from  the  circumstance  that,  in  consequence 
of  the  prostration  of  activity  in  the  central  organ  of  the  nervous 
system,  the  organism  is  neither  readily  nor  lastingly  acted  upon 
by  external  agency. 

As  we  have  just  seen,  both  forms  of  the  disease  possess  exactly 
those  symptoms  in  common,  in  which  Calc.  and  Zinc,  resemble  one 
another,  and  both  differ  in  those  in"  which  Calc.  and  Zinc,  do  not 
coincide.  But  in  order  to  substantiate  theory  by  practical  evidence, 
may  I  be  allowed  to  communicate  at  least  two  cases  of  cure  by  means 
of  these  remedies. 

Oskar  Graf,  3  years  old,  scrofulous,  but  strong,  formerly  afflicted 
for  a  long  time  with  hydrocephalus  chronicus,  had,  on  the  31st  of 
December,  been  affected  with  general  dry  burning  heat  during  the 


78  ERUPTTVE  FEVERS. 

whole  day.  January  1st  he  complained,  after  a  sleepless  nighty 
of  headache  and  colic,,  and  vomited  once ;  in  the  course  of  the  morn- 
ing the  scarlet  efflorescence  began  to  appear,  and  spread  over  the 
whole  body  before  the  close  of  the  day ;  the  skin  was  burning  hot, 
the  pulse  small,  weak,  and  could  not  be  counted ;  there  was 
also  profuse  sweat.  The  child,  usually  so  cheerful,  lay  still  and 
quiet,  with  closed  eyes,  and  answered  only  reluctantly  if  spoken 
to ;  the  face  was  bloated,  the  thirst  excessive,  and  the  patient  drank 
often,  but  little  at  a  time  ;  in  addition  to  these  symptoms,  grinding  of 
the  teeth  and  convulsions  of  the  face  took  place  almost  every  half 
hour  (both  symptoms  in  this  case  probably  arising  from  the  presence 
of  ascarides) ;  delirium  subsequently  supervened.  I  prescribed,  in 
the  forenoon,  Calc.  3,  gr.  j.  The  child  remained  in  much  the  same 
state  throughout  the  day,  only,  in  the  afternoon,  the  heat  became 
diminished,  and  the  gnashing  of  the  teeth  less  frequent;  in  the 
evening,  however,  both  returned,  with  increased  restlessness  and 
delirium.  In  the  night,  between  January  1  st  and  2d,  the  patient 
slept  little,  and  was  very  restless,  particularly  between  12—1,  and 
in  the  morning  he  passed  the  faeces  and  urine  involuntarily ; 
the  paroxysms  of  teeth-gnashing  had  not  returned  so  frequently,  and 
the  child  appeared  to  be  in  a  less  soporous  state,  but  was  boring 
rather  more  with  his  head  into  the  pillow;  the  heat  was  no  longer 
so  excessive ;  the  pulse,  towards  evening,  could  at  least  be  counted 
152,  and  was  consequently  also  no  longer  so  small;  the  efflorescence 
looked  well,  (another  dose  of  Calc.  had  been  given  that  morning.) 
On  January  3d  the  child  was  no  better,  and  had  passed  a  rather  sleep- 
less and  restless  night ;  the  gnashing  of  the  teeth  was  more  violent 
and  more  frequent ;  the  patient  went  on  boring  witli  the  occiput 
into  the  pillows ;  and  there  was  great  anxiety,  with  oppressed  respi- 
ration, and  mucous  rattling;  the  pulse  as  it  was  the  day  preceding. 
Calc.  was  repeated,  whereupon  the  attacks  ceased  entirely  during 
the  day,  the  restlessness  subsided,  the  respiration  was  no  longer  so 
difficult,  and  in  the  afternoon  the  child  slept  for  a  short  time ;  in 
the  evening  the  fever  had  not  increased.  During  the  following 
night  the  restlessness  was  not  great,  and  the  sleep  continued  for 
half  an  hour  at  a  time  ;  in  the  morning,  an  involuntary  alvine 
evacuation  occurred,  but  there  was  perfect  consciousness,  no  sopor, 
no  delirium,  no  difficult  respiration,  and  no  mucous  rhonchus ;  the 
exanthema  still  looked '  well.  Calc*  repeated.  In  the  evening  the 
fever  did  not  increase,  the  temperature  of  the  skin  moderate,  and  the 


SCARLATINA  MILIARIS.  79 

pulse  no  longer  small,  142.  January  5th,  the  child  had  passed  a 
quiet  night,  sitting  cheerfully  on  the  bed ;  no  dangerous  symptoms 
were  present,  the  eruption  was  receding,  the  temperature  of  the 
skin  little  increased,  the  pulse  115,  no  involuntary  evacuations,  and 
the  child  responded  perfectly  sensibly  to  all  inquiries;  no  febrile 
exacerbation  ensued  in  the  evening.  1  accordingly  discontinued  the 
medicine,  and  the  disease  proceeded  on  its  course,  as  free  from  danger 
as  usual  under  the  employment  of  Calcarea. 

Oskar  Wagner,  4  years  old,  an  uncommonly  tall,  stout,  over-fed, 
flaccid,  scrofulous  boy,  was  attacked  with  several  fits  of  vomiting  in 
the  night,  between  December  20-21.  On  the  following  morning  the 
vomiting  had  ceased,  the  child  was  very  restless,  the  surface  of  the 
body  cool,  and  the  exanthema  made  its  appearance.  Cede.  card. 
3,  gr.  j.  During  the  evening  much  heat,  in  the  night  delirium,  and 
two  involuntary,  but  liquid  alvine  evacuations.  On  the  morning  of 
the  22d  very  violent  fever,  the  exanthema  fully  developed  and  very 
much  raised,  the  single  points  or  elevations  standing  together  in 
groups ;  Calc.  repeated.  During  the  day,  delirium,  great  thirst,  dry 
brown  lips ;  the  state  of  the  tongue  could  not  be  discovered,  as  the 
child  could  not  be  induced,  during  its  whole  illness,  to  show 
it;  periodical  unconsciousness  and  delirium,  the  latter  continuing 
during  the  night  with  restlessness.  Calc.  repeated.  On  the  23d, 
early  in  the  morning,  intense  fever  with  delirium.  Calc.  repeated. 
In  the  evening  the  child  was  in  a  state  of  complete  sopor,  pulse 
collapsed,  small,  152;  extremities  cool, — Zincum  1,  gr.  j,  every  2 
hours  ;  the  night  very  restless,  much  delirium.  After  midnight  the 
child  appearing  quiet,  the  parents  discontinued  the  medicine. 

This  supposed  quietude  was,  however,  a  bad  symptom,  for  on  the 
morning  of  the  24th  I  found  the  child  lying  perfectly  motionless ;  the 
pulse  very  small,  and  could  not  be  counted;  utter  unconsciousness ;  the 
extremities  icy  cold,  the  rest  of  the  body  cool,  and  the  whole  cutaneous 
surface  blueish-red,  except  about  the  eyes,  forehead,  and  chin,  these 
parts  being  white  ;  the  eruption  remaining  was  but  scanty.  Zinc.  1, 
gr.  j,  every  two  hours.  After  the  first  dose,  symptoms  of  returning 
consciousness  were  already  perceptible ;  in  the  evening  the  skin  was 
warm,  and  its  blueish-red  colour  had  disappeared;  the  pulse  was 
somewhat  strengthened,  150,  and  there  was  some  degree  of  sweat; 
the  night  passed  over  pretty  favorably,  now  and  then  delirium,  but 
also  several  hours5  sleep.  On  the  25th,  the  child  appeared  to  have 
recovered  more  consciousness,  he  recognized  his  parents  and  asked 


8  0  ERUPTIVE  FEVERS  * 

for  something  to  drink.  The  temperature  of  the  skin  was  some- 
what higher,  the  pulse  no  longer  weak,  140,  and,  for  the  first  time, 
the  urine  was  not  emitted  involuntarily.  Zinc,  continued  every  three 
hours.  The  following  night  he  slept  perfectly  quiet,  without  deli- 
rium ;  in  the  morning  he  was  in  full  possession  of  his  faculties,  and 
wished  to  play  ;  the  temperature  of  the  skin  was  natural,  the  pulse 
strong,  128,  and  the  skin  had  commenced  to  exfoliate.  Zinc,  three 
times  a  day.  On  the  27th,  the  child  was  well,  as  far  as  circumstances 
could  admit,  and  recovered  perfectly  without  taking  any  more 
medicine. 

The  difference  between  the  effects  of  Calc.  and  Zinc,  in  this 
epidemy,  not  only  as  elucidated  by  the  symptoms  enumerated  in  the 
Materia  Medica,  but  also  as  established  by  experience,  consists 
accordingly  in  the  following  *.  Calc.  operates  more  upon  the  organs 
of  the  chest,  Zinc,  more  upon  the  brain ;  Calc.  diminishes  the  immo- 
derate febrile  heat  and  the  frequency  of  the  pulse ;  Zinc,  does  not  affect 
the  frequency  of  the  pulse  which  is  associated  with  febrile  heat,  but 
removes  the  icy  coldness  of  the  skin,  (the  result  of  depressed  vitality), 
strengthens  the  small,  quick  pulse,  and  reduces  it  to  a  normal  state 
of  frequency;  Calc.  is  only  useful  in  slight  delirium,  but  very 
effective  in  violent  angina ;  Zinc,  is  as  beneficial  in  violent  delirium 
alternating  with  sopor,  ajs  in  paralysis  of  the  brain ;  Calc.  is,  on  the 
other  hand,  preferable  in  incipient  paralysis  of  the  lungs.  I  must 
guard  myself  here  against  the  imputation  of  any  intention  to  hold 
Zinc,  and  Calc.  curative  in  all  malignant  cases  of  scarlet  fever,  by  sta- 
ting, that  it  was  only  in  this  epidemy  that  I  found  them  of  such  great 
efficacy,  and  it  is  only  in  similar  instances  that  their  beneficial  effects 
may  be  looked  for.  I  was  induced  to  make  these  communications, 
chiefly  from  the  circumstance  that  I  consider  it  would  be  attended 
with  great  advantage  if  the  different  epidemies  were  carefully 
described  and  compared,  their  distinguishing  characteristics  pointed 
out,  and  the  remedies  mentioned  which  had  proved  most  serviceable 
in  each, — as  it  is  mainly  by  such  means  that  the  selection  of  the 
specific  remedy,  at  the  first  outbreak  of  the  disorder,  can  in  future  be 
facilitated,  and  a  number  of  sacrifices  thereby  avoided/5 

The  remedies  required  for  the  occasional  sequelae  of  scarlatina 
miliaris  are  the  same  as  those  enumerated  at  the  conclusion  of  the 
chapter  on  Scarlatina. 


MEASLES.  81 

MEASLES. 
Rubeola. 

This  disease  generally  reigns  as  an  infectious  epidemic,  and,  for 
the  most  part,  confines  its  attack  to  children,  in  which  cases  it  is 
seldom,  when  properly  treated,  either  severe  or  dangerous ;  wThen  it 
occurs  in  adults,  it  generally  assumes  a  more  critical  character,  It 
rarely  attacks  an  individual  a  second  time. 

Measles  is  not  to  be  so  much  dreaded  for  itself,  as  for  the  dele- 
terious consequences  it,  under  an  improper  mode  of  treatment, 
frequently  entails,  or  to  use  the  technical  term,  the  dreg  it  leaves 
after  it,  which,  in  many  constitutions,  develop  an  inherent  disposition 
to  consumption. 

Diagnosis.  Catarrhal  symptoms,  such  as  short,  dry  cough,  lachry- 
mation,  with  redness  of  the  eyes,  and  a  degree  of  fever,  more  or  less 
marked,  preceding  the  eruption  from  three  to  five  days,  and  generally 
continuing  as  long  after,  or  all  through  the  disease. 

Eruption  of  a  number  of  small  red  spots  (frequently  papular),  the 
skin,  in  thcintervals  between  them,  generally  preserving  its  natural 
colour,  and  sometimes  exhibiting  a  faint  reddish  hue.  We  often  find 
them  in  the  shape  of  small  irregular  arcs.  They,  for  the  most  part, 
make  their  first  appearance  on  the  face  and  neck,  become  confluent, 
and  extend  themselves  gradually  downwards  over  the  rest  of  the 
frame.  About  the  sixth  or  seventh  day  from  the  time  of  sickening, 
the  eruption  begins  to  turn  pale  on  the  face,  and  afterwards  on  the 
rest  of  the  body,  and,  generally,  entirely  disappears  about  the  ninth 
day,  with  a  bran-like  desquamation  of  the  epidermis,  a  distinguishing 
sign  of  this  disease. 

Therapeutics.  Aconite  has  been  regarded,  in  some  instances,  as 
almost  specific  against  measles,  and  in  its  mild  form,  will  frequently  be 
found  sufficient,  in  a  few  doses,  to  conquer  the  disease,  or  at  least  mate- 
rially to  shorten  its  duration.  This  remedy  is  particularly  indicated, 
when  the  fever  assumes  an  inflammatory  form,  attended  with  dry  heat 
of  the  skin,  heat  in  the  head,  with  confusion  and  giddiness,  redness  of 
the  eyes,  intolerance  of  light,  general  weakness  or  prostration ;  and  is 
more  or  less  useful,  throughout  the  course  of  the  malady,  either  alone 
or  in  alternation  with  Pulsatilla,  or  any  of  the  other  remedies  which 

6 


82  ERUPTIVE  FEVERS. 

may  be  better  indicated,  whenever  marked  febrile  or  inflammatory 
action  becomes  prominent.  [Coffea  or  Hepar  are  frequently  useful 
after  Aconite,  when  there  is  a  distressing,  dry  cough.) 

Pulsatil.l.a  is  also  very  efficacious,  and  even  specific  in  this 
disease,  and  is  frequently  indicated  at  the  commencement,  from  the 
strong  resemblance  which  some  of  its  pathogenetic  properties  bear 
to  the  catarrh  attendant  upon  measles,  together  with  the  characteristic 
exacerbation  of  the  symptoms  towards  evening,  &c*  This  remedy  is, 
moreover,  of  great  utility  in  bringing  out  the  eruption,  when  it  is 
longer  than  usual  in  making  its  appearance;  but,  whilst  the  fever  is 
high,  Aconitum  must  be  administered,  and,  if  the  febrile  irritation  does 
not  diminish  after  a  dose  or  two  of  Aconitum,  Sulphur  may  be  given, 
after  which,  if  the  fever  return  with  increased  force,  Aconitum  will 
rarely  fail  to  answer  our  expectations. 

When  there  is  great  oppression  at  the  chest,  before  the  eruption  is 
evolved,  a  dose  or  two  of  Ipecacuanha  is  very  useful. 

Pulsatilla  is  also  valuable  w7hen  any  gastric  derangement  is  present, 
or  when  the  cough,  which  so  generally  accompanies  the  disease,  is 
worse  towards  evening,  or  in  the  night,  and  is  attended  with  consider- 
able mucous  rhonchus,  or  copious,  thick,  yellowish  or  whitish  expec- 
toration, sometimes  followed  by  vomiting,  or  symptoms  ofepproaching 
suffocation ;  further,  when  there  is  coryza  with  a  thick,  yellowish  or 
greenish  nasal  discharge.  {Sulphur  is  frequently  of  considerable  ser- 
vice after  Pulsatilla,  particularly  in  strumous  subjects.  Where  there 
is  dry  nocturnal  cough,  Nux  v.  will  be  found  useful,  especially  in 
dark-complexioned  subjects.) 

Belladonna.  When  the  inflammation  attacks  the  throat,  pre- 
senting many  of  the  throat  symptoms  we  have  given  for  this  medicine 
under  Scarlet  Fever,  attended  with  great  thirst,  which  the  patient  is 
often  prevented  from  indulging  by  the  acute  shooting  or  pricking  pain 
in  the  throat  produced  by  swallowing ;  and  further,  when  there  is  a 
hoarse,  dry,  barking,  and  somewhat  spasmodic  cough,  worse  at  night, 
with  mucous  rhonchus,  great  restlessness,  and  high  nervous  excite- 
ment ;  also,  in  those  cases  of  measles,  where  no  eruption  declares 
itself,  but  simply  headache  arid  catarrh,  with  severe  inflammation  of  the 
eyes,  which  present  a  glassy  appearance,  are  bloodshot,  or  streaked, 
and   watery;   finally,    when  evident   signs   of  cerebral  irritation   set 

*  Pulsatilla  and  Bryonia  are  two  of  the  most  important  remedies,  when  there  is  promi- 
nent bronchitic  complication.     (See  also  Bronchitis.) 


MEASLES.  83 

in.     (Against  ulcerations  on  the  cornea,  Merc,  followed  by  Calc.  or 
Separ  s.) 

Bryonia  is  an  excellent  remedy,  when  the  eruption  is  faint,  or 
imperfectly  developed,  and  the  respiration  much  oppressed  and  labo- 
rious, attended  with  aching  in  the  limbs ;  also,  when  there  is  dry 
cough,  and  the  patient  complains  of  shooting  pains  in  the  chest, 
increased  by  a  full  inspiration. 

This  disease  has  frequently  terminated  fatally,  from  the  eruption 
being  driven  in  by  sudden  exposure  to  cold  or  change  of  tempera- 
ture ;  in  such  cases,  Bryonia,  administered  as  above,  is  generally 
found  efficacious  in  re-evolving  the  eruption,  and  preventing  this 
disaster ;  if  diarrhoea,  with  mucous  discharge,  follow  the  suppression, 
Pulsatilla  is  indicated ;  if  the  vomiting,  with  great  oppression  at 
the  chest,  be  the  more  prominent  symptom,  Ipecacuanha  should 
be  substituted,  and  followed  in  turn  by  Arsenicum,  if  symptoms  of 
improvement  do  not  speedily  show  themselves :. — In  the  case  of  chil- 
dren, Cliamomilla  is  to  be  preferred  to  Ipecacuanha,  when  there  is 
dyspnoea  and  diarrhoea  with  colic  and  vomiting.  When  symptoms  of 
cerebral  disturbance  supervene,  Cuprum  aceticum,*  Belladonna,  and 
Stramonium,  or  Sellelorus  niger,  Arsenicum,  and  Sulphur,  have  proved 
of  the  greatest  utility  ; — and  in  the  case  of  pulmonic  inflammation* 
Phosphorus,  t  Bryonia,  or  Sulphur,  should  Aconitum  and  Pulsatilla  not 
suffice.  In  those  comparatively  rare  cases  in  which  typhoid  symptoms 
manifest  themselves,  either  during  the  course  of  the  disease,  or  at  its 
termination,  Bryonia,  Arsenicum,  and  Phosphorus  will  be  found  useful, 
where  any  chance  of  recovery  remains.     (Vide  Typhus.) 

For  the  treatment  of  coughs,  which  sometimes  remain  after  measles, 
Sulphur,  Sepia,  Carlo  v.,  Conium,  Chamomilla,  Drosera,  Dulcamara, 
Syoscyamtis,  Ignatia,  Nux  v.,  Belladonna,  &c,  are  very  serviceable. 
(See  Coughs.)  Against  Laryngitis,  Aconitum,  Separ  s.,  Spongia, 
Belladonna,  Lachesis,  Arsenicum,  Mercurius,  &c.      (See  Laryngitis.) 

For  the  diarrhoea,  which  the  disease  sometimes  leaves  behind  it, 
Cinchona,  Pulsatilla,  Mercurius,  and  Sulphur  are  in  general  the  most 
appropriate  remedies  ;  for  their  several  indications,  see  Diarrhoea. 
For  otitis  or  otorrhcea,  Pulsatilla,  Carlo  v.,  Sulph.,  Merc,  and  Separ 
sulphuris  (chiefly) ;  for  parotitis,  Arnica,  and  Phos.  ;  for  tenderness  of 
the  skin,  Mercurius;  for  miliaria  alba  (chiefly),  Nux  v.;  and  for  burn- 
ing, itching  rash,  which  bleeds  after  scratching,  Arsenicum  and  Sulphur 
are  severally  indicated. 

*  Vide  Scarlatina,  p.  64. 


84  ERUPTIVE  FEVERS. 

As  a  precautionary  measure  agaist  the  attacks  of  this  disease,  when 
epidemic,  we  may  prescribe  a  few  globules  of  the  third  or  sixth 
potency  of  Pulsatilla,  in  a  little  water,  followed  by  Aconitum,  at 
the  same  potency,  three  days  after;  allow  the  latter  medicine  to  act 
for  twenty-four  hours,  and  continue  the  alternation  for  a  fortnight, 
renewing  it,  when  necessary,  at  the  termination  of  a  week  or  ten 
days.  This  treatment  will,  frequently,  be  found  sufficient  to  ward  off 
this  disease,  or  if  it  be  taken,  will  generally  reduce  it  to  an  extremely 
mild  form. 

Diet.  In  this  respect  we  may  follow  the  rules  given  under 
Scarlet  Fever. 


SMALLPOX. 

Variola. 

This  disease  is,  by  pathologists  of  the  present  day,  divided  into  two 
varieties — the  distinct,  when  the  pustules  on  the  face  are  clearly  defined, 
and  do  not  run  into  one  another ;  and  the  confluent,  when  they  coalesce 
and  form  one  continuous  whole. 

When  the  symptoms  are  less  severe  than  those  properly  character- 
istic of  the  disease,  and  the  eruption  on  the  face  slight,  it  is  called  the 
modified  smallpox.  We  generally  find  this  description  in  such  per- 
sons as  have  been  properly  vaccinated,  a  precaution  which,  although 
not  always  a  preservative  from  the  attacks  of  variola,  greatly  lessens 
its  virulence,  and  gives  a  milder  character  to  the  complaint,  when 
taken. 

Diagnosis.  The  disease  is  frequently  very  sudden  in  its  attacks, 
commencing  with  chilliness  and  shivering,  followed  by  febrile  symp- 
toms, headache,  severe  pains  in  the  small  of  the  back  and  loins, 
languor,  weariness  and  faintness ;  the  patient  also  complains  of  oppres- 
sion of  the  chest,  and  acute  pain  in  the  pit  of  the  stomach,  increased 
hy  pressure.  The  eruption  makes  its  appearance  at  the  close  of  the 
third  day,  first  on  the  face  and  hairy  scalp,  then  on  the  neck,  and 
afterwards  spreads  over  the  whole  body.  Catarrhal  symptoms,  as 
sneezing,  coughing,  wheezing,  and  frequently  difficulty  of  breathing, 
often  accompany  this  disease. 


SMALLPOX.  85 

The  eruption  first  displays  itself  in  the  shape  of  small,  hard-pointed, 
red  elevations,  which,  in  about  three  days,  present  a  vesicular  appear- 
ance, surrounded  by  an  inflamed  circular  margin,  and  become 
depressed  in  the  centre  as  they  enlarge.  About  the  sixth  or  eighth 
day,  the  lymph  in  the  pustule  becomes  converted  into  pus,  and  the 
depression  in  the  centre  disappears. 

When  the  pustules  are  very  numerous  on  the  face,  it  generally 
becomes  much  swollen,  and  the  eyelids  are  frequently  closed  up.  On 
the  first  day,  a  small  lump,  like  a  millet-seed,  may  be  felt  in  each  of 
the  elevations  above  noticed,  distinguishing  this  eruption  from  all 
other  exanthemata.  The  pocks  continue  coming  on  during  the  first 
three  eruptive  days,  and  each  pock  runs  its  regular  course ;  thus,  those 
which  first  appeared,  are  forming  into  scabs,  or  dying  off,  while  the 
others  are  suppurating.  The  general  desiccation  commonly  takes 
place  on  or  about  the  eighth  or  fourteenth  day,  according  as  the  pus- 
tules may  happen  to  be  distinct  or  confluent. 

When  the  pustules  have  attained  their  full  development,  they  gene- 
rally burst,  in  mild  cases  emitting  an  opaque  lymph,  which  dries  into 
a  crust  and  falls  off,  whilst  in  severe  ones,  we  find  a  discharge  of 
puriform  matter,  forming  scabs  and  sores,  M7hich  leave,  on  their  heal- 
ing, permanent  marks  or  pits.  Red  stains,  caused  by  increased 
vascular  action,  always  remain  for  a  while  after  the  eruption  ;  but  if 
no  ulceration  has  taken  place,  they  disappear  in  process  of  time. 

In  Confluent  Smallpox,  all  the  precursory  symptoms  are  more 
severe,  the  fever  runs  high,  and  frequently  continues  so  throughout 
the  course  of  the  disease  ;  the  pain  in  the  pit  of  the  stomach,  and 
difficulty  of  breathing,  are  more  complained  of,  and,  in  children,  the 
eruption  is  frequently  preceded  by  convulsions  and  delirium ;  the 
latter  symptom,  indeed,  is  frequently  present  with  adults,  during  the 
suppurative  or  secondary  fever,  which  frequently  assumes  a  typhoid 
character,  and  sometimes  carries  off  the  patient  on  the  eleventh  day. 
All  cases,  in  which  we  have  generally  a  deep-rooted  morbid  constitu- 
tional taint  to  contend  against,  require  the  utmost  skill  of  the  expe- 
rienced practitioner  to  ward  off  a  fatal  result.  An  extensive  erythe- 
matous efflorescence  of  the  face  or  trunk  almost  invariably  precedes 
the  confluent  variety  of  smallpox. 

Salivation,  with  soreness  of  the  throat  and  aphthae,  or  pustules  on 
the  tongue  and  pharynx,  frequently  declares  itself  in  both  forms  of 
this  disease,  but  more  particularly  in  the  confluent. 

Before  we  come  to  the  medicines  to  be  administered  in  the  different 


86  ERUPTIVE  EEVERS. 

stages  of  the  disease,  we  may  say  a  few  words  upon  the  general  treat- 
ment of  the  patient. 

Cool' and  fresh  air  are  our  best  auxiliaries,  the  variolous  virus  being 
of  a  nature  to  react  upon  the  organism,  and  warmth  being  calcu- 
lated to  increase  its  activity.  So  beneficial  is  cool  air  found  in  this 
malady,  that  taking  a  child  to  an  open  windowT  when  attacked  with 
convulsions,  will  generally  be  found  to  afford  immediate  relief. 
Great  cleanliness  must  also  be  observed,  and  the  linen  frequently 
changed. 

When  the  vesicles  declare  themselves,  and  begin  to  form  into  pus- 
tules, the  room  ought  to  be  kept  as  dark  as  possible,  to  aid  in  pre- 
venting the  risk  of  disfigurement,  a  precaution  deducible  from  common 
experience,  since  we  find  that  the  parts  of  the  frame  exposed  to  the 
action  of  light  are  always  those  most  strongly  marked  by  the  ravages 
of  the  disease. 

Therapeutics.  In  the  first  or  febrile  stage  of  the  disorder,  Co f- 
fea  is  valuable  in  allaying  the  nervous  excitability  generally  present. 

Aconite  may  either  follow  or  precede  this  medicine  when  the 
fever  runs  high,  and  visceral  congestion  threatens. 

Chamomilla  is  often  of  great  service  at  this  period,  or  during 
the  course  of  the  disease  in  children,  when  there  are  dyspnoea  and 
diarrhoea,  with  colic  and  vomiting;  or  when  starlings  or  convulsions 
set  in,  prior  to  the  appearance  of  the  eruption,  and  again,  during  the 
maturative  stage,  when  the  nights  of  the  little  patient  are  much 
disturbed  by  a  troublesome  cough.  Should  Chamomilla  afford  but 
slight  relief,  Belladonna  may  be  administered. 

When  considerable  tightness  and  oppression  at  the  chest,  some- 
times attended  with  nausea  and  vomiting,  are  experienced  before  the 
appearance  of  the  eruption,  the  alternate  use  of  Ipecacuanha  and 
Antimonium  tartaricum  affords  speedy  relief.  The  latter  remedy  is, 
moreover,  well  indicated  when  convulsions  precede  the  evolution  of 
variola;  and,  from  the  close  analogy  which  the  eruption  it  is  capable 
of  producing  bears  to  that  of  smallpox,  may  be  administered  with 
advantage  during  the  eruptive  and  maturative  stages  also,  unless 
some  other  remedies  should  be  more  urgently  called  for  by  the  nature 
of  the  symptoms ;  the  existence  of  a  hollow  sounding  cough,  with 
loud  mucous  rhonchus,  is  an  additional  index  for  the  employment  of 
Antimonium  tartaricum. 

Bryonia  is  sometimes  useful  in  assisting  the  natural  course  of 


SMALLPOX.  87 

the  eruption ;  it  is  also  indicated  when  symptoms  of  considerable 
gastric  derangement  are  present,  such  as  bitter  taste  in  the  mouthy 
foulness  of  the  tongue,  headache,  rheumatic  pain  in  the  limbs,  increased 
by  motion,  constipation,  and  irritability  of  disposition;  also,  when 
there  are  occasional  shooting  pains  in  the  chest,  especially  during 
inspiration. 

Rhus  is  equally  serviceable  at  this  stage  of  the  disease,  and  par- 
ticularly, when  the  acute  pains  in  the  head,  back,  and  loins  are 
aggravated  during  a  state  of  rest,  and  temporarily  relieved  by  move- 
ment. 

Belladonna.  This  remedy  may  follow  Aconite,  when  the  latter 
has  been  indicated,  should  symptoms  of  cerebral  disturbance  have  set 
in,  characterized  by  flushed  countenance,  intolerance  of  the  eyes  to 
light,  headache,  and  delirium,  great  thirst,  nausea,  and  vomiting ;  or, 
when  there  is  redness  of  the  tongue  at  the  tip  and  margins ;  abdomen 
tumid  and  painful,  particularly  at  the"  epigastrium,  with  sensibility 
on  pressure ;  prostration  of  strength,  stupor,  &c. 

For  additional  indications  for  the  employment  of  this  remedy,  see 
Inflammation  of  the  Brain  and  its  tissues. 

Opium  is  useful  when  there  are  symptoms  of  stupor  or  strong 
inclination  to  somnolence. 

If  Antimonmm  tartaricum  and  Ipecacuanha  do  not  succeed  in  allaying 
the  nausea  and  vomiting,  and  the  patient  complains  of  excessive  thirst 
and  dryness  of  the  mouth,  the  tongue  being  at  the  same  time  very  foul  and 
dark,  and  the  prostration  of-  strength  excessive,  we  may  prescribe 
Arsenicum — (the  dose  to  be  repeated  every  two  or  three  hours,  if 
required,  but  the  remedy  must  be  discontinued  as  soon  as  decided 
benefit  has  resulted  from  its  action).  The  last  symptom  generally 
occurs  after  the  maturation  of  the  eruption  and  secondary  fever.* 

Pulsatilla  is  occasionally  of  considerable  utility  in  confluent 
smallpox,  when  an  efflorescence,  similar  to  that  of  measles,  precedes 
or  accompanies  the  eruption,  attended  with  nausea  or  vomiting,  and 
aggravation  of  all  the  symptoms  towards  evening. 

An  occasional  dose  of  Stramonium,  two  globules,  is  sometimes  useful, 

*  In  some  cases,  and  especially  those  of  a  bad  type,  livid  spots,  or  diffused  ecchymoses  are 
observed  on  the  skin,  prior  to  the  evolution  of  the  eruption  {variola  nigrce).  Arsenicum  is 
here  also  of  considerable  service,  particularly  when  great  weakness  and  languor,  thirst, 
nausea,  or  vomiting,  with  pain  in  the  epigastrium,  are  present.  Acidum  muriaticum,  in  re- 
peated doses,  has  been  found  of  important  service  in  cases  of  a  similarly  bad  type,  with 
typhoid  fever,  and  constant  tendency  of  the  patient  to  sink  downwards  in  the  bed. 


88  ERUPTIVE  FEVERS. 

when  some  pustules  are  already  formed,  in  forwarding  the  eruption, 
and  shortening  its  duration. 

During  the  filling  up  of  the  pocks,  a  secondary  or  suppurative 
fever  frequently  sets  in,  particularly  when  the  pustules  are  thick, 
and  evince  a  disposition  to  run  into  the  confluent  form ;  when,  more- 
over, there  is  swelling  of  the  head,  inflammation  of  the  eyes,  throat, 
and  nose,  with  salivation,  hoarseness,  and  impeded  deglutition; 
tenderness  of  the  stomach  ;  diarrhoea,  with  tenesmus,  and  sometimes 
sanguineous  stools.  Having,  if  this  remedy  be  called  for,  first 
attacked  the  more  prominent  febrile  symptoms,  with  Aconite, 
we  should  have  recourse  to  Mercurius,  3—6,  a  few  hours  afterwards, 
in  repeated  doses,  until  amelioration  declares  itself.  When  the 
fever  runs  high,  in  confluent  smallpox,  and  threatens  to  continue 
so,  as  it  often  does  throughout  this  form  of  the  disease,  Aconite  must 
repeatedly  be  had  recourse  to,  and  given  in  alternation  with  Sulphur, 
when  not  sufficient  of  itself  to  mitigate  the  excessive  febrile  action. 

While  the  disease  is  running  its  course,  particularly  during  the 
distension  of  the  pustules  (should  no  other  remedies  be  imperatively 
called  for),  and  also  towards  the  period  of  their  bursting,  we  may 
safely  administer  an  occasional  dose  of  Mercurius  as  above,  and  in 
the  latter  case,  follow  this  medicine  with  a  dose  or  two  of  Sulphur, 
to  assist  in  the  desiccation. 

When  rheumatic  pains,  in  the  back  and  extremities,  which  become 
worse  at  night,  and  are  somewhat  relieved  by  movement,  are  com- 
plained of  at  this  period,  Rhus  may  be  advantageously  alternated 
with  Sulphur.  Rhus  is  moreover  extremely  serviceable  in  confluent 
smallpox,  when  the  fever  assumes  a  typhoid  type,  attended  with  the 
signs  ^denominated  putrescent ;  Mercurius  and  Arsenicum  are  also 
occasionally  useful  in  the  latter  case,  when  indicated  by  the  character 
of  the  symptoms.  (Vide  Typhus.)* 

During  the  period  of  desiccation,  frequent  laving  of  the  pustules 
with  tepid  water  and  bran,  and  gently  drying  them  afterwards,  will 
be  sufficient ;  cleanliness  being  then  the  great  requisite,  combined 
writh  a  careful  attention  to  diet. 

Repercussion  of  the  Eruption.     When  this  has  taken  place, 

*When  Pleuritis  or  Pneumonia  intervene  during  the  progress  of  the  disorder,  the 
remedies  mentioned  under  these  different  heads  must  be  had  recourse  to.  The  invasion 
and  progress  of  the  latter  disorder  are  sometimes  so  insidious,  that,  unless  the  aggregate 
signs  of  pneumonic  inflammation  be  narrowly  looked  for,  disorganization  of  the  lung 
may  take  place  before  the  existence  of  such  a  complication  is  detected. 


SMALLPOX.  89 

and  symptoms  of  cerebral  disturbance  have  set  in,  we  may  have 
immediate  recourse  to  Cuprum  aceticum,  provided  Belladonna,  Sulphur, 
Bryonia,  or  some  other  remedy  be  not  better  indicated.  Some  physi- 
cians, in  their  treatment  of  the  affection,  divide  it  into  two  distinct 
stages;  we  have,  however,  contented  ourselves,  when  necessary, 
with  slightly  referring  to  them.  Should  Laryngitis  supervene 
during  the  course  of  smallpox,  we  must  have  immediate  recourse 
to  Aconite,  Hepar  s.,  Spongia,  Belladonna,  Lachesis,  Arsenicum,  or  Mer- 
curius,  &c.  (See  Laryngitis.)  Against  the  cough,  which  some- 
times results  from  an  attack  of  smallpox,  Belladonna,  Mercurius, 
and  Arsenicum,  are  three  of  the  most  appropriate  remedies  in  most 
cases,  (the  particular  indications  for  which  will  be  found  in  the  article 
on  Coughs,  which  see;)  and  against  asthmatic  symptoms,  attended 
with  mucous  rattling  in  the  chest,  Tartarus  emeticus  should  be  em- 
ployed, and  followed  by  Senega,  if  insufficient  to  effect  a  cure.  When, 
in  the  suppurative  stage  of  confluent  smallpox,  the  pus  becomes 
sanious,  and  sphacelus  is  apprehended,  Arsenicum  and  Carlo  v.  may 
exert  a  beneficial  effect. 

Cinc/wna  and  Phosphorus  have  repeatedly  been  found  specific  against 
the  Diarrhoea,  which  occasionally  results  : — and  against  the  Ophthal- 
mia, Conium,  Belladonna,  Hepar  sitlphuris,  Euphrasia,  Sulphur,  Calcarea, 
Arsenicum,  Pulsatilla,  Mercurius,  Nux  vomica,  and  Rhus  toxicodendron, 
have  been  found  the  most  useful  remedies. 

Modified  Smallpox  is  merely  a  mild  description  of  the  above, 
and,  as  we  have  before  said,  is  the  form  the  disease  generally  assumes, 
when  it  attacks  those  who  have  been  properly  vaccinated.  We  must 
regulate  our  treatment  according  to  the  symptoms,  being  guided  in 
the  selection  of  the  remedies  by  the  indications  before  given.* 

Diet  should  be  regulated  by  the  virulence  of  the  attack ;  but,  in 
all  instances,  the  beverages  should  be  cold,  as  a  warm  regimen,  and 
neglect  of  the  precautions  before  mentioned,  may  convert  the  mild 
into  the  malignant  form.  After  recovery,  it  is  necessary  that  the 
patient  abstain,  for  a  considerable  time,  from  animal  food. 

*  I  have  given  in  detail  the  treatment  which  has  been  generally  adopted  by  Homoeopa- 
thists,  and  with  great  success.  But  it  may  here  be  added,  that  Vaccinine,  given  internally, 
has  obtained  much  repute,  as  an  important  and  eminently  successful  remedy,  in  the  treat- 
ment of  variola,  the  most  virulent  cases  having  been  reported  to  have  yielded  to  it,  with  a 
promptness  and  certainty,  that  would  afford  another  great  illustration,  if  such  were  needed, 
of  the  truth  of  the  homoeopathic  law. 


90  ERUPTIVE  FEVERS. 

It  may  be  remarked  that,  after  an  attack  of  malignant  smallpox, 
the  patient's  constitution  generally  requires  a  thorough  renova- 
tion,— he  should,  therefore,  be  put  under  a  course  of  medicine  best 
calculated  to  attain  that  result. 


CHICKEN-POCK. 
Variola  spuria,  Varicella* 

Diagnosis.  A  disease,  bearing  a  considerable  resemblance,  in  its 
external  character,  to  smallpox,  but  differing  in  its  duration,  and 
symptomatically,  being  considerably  milder,  generally  requiring  no 
medical  assistance,  but  merely  attention  to  diet,  and  but  rarely  becom- 
ing dangerous,  except  when  the  lungs  or  brain  become  involved.  The 
fever,  however,  occasionally  runs  high. 

When  this  affection  attacks  an  individual  during  the  prevalence  of 
smallpox,  which  is  not  unfrequently  the  case,  it  is  often  mistaken  for 
that  disorder,  but  it  soon  discovers  its  real  character,  by  the  rapidity 
with  which  the  eruption  declares  itself;  the  pustules  (in  many  instances 
closely  resembling  those  of  the  smallpox),  being  generally  fully 
matured  by  the  third  day,  and  the  whole  eruption  disappearing  at  the 
end  of  the  fourth  or  fifth,  without  leaving  any  mark. 

Therapeutics.  When  much  fever  is  present,  we  should  check 
it  by  the  administration  of  Aconite,  repeated  from  time  to  time  as 
required,  or  Coffea,  also  occasionally  repeated,  if  there  be  simply 
extreme  restlessness  and  anxiety.  When  cerebral  symptoms  threaten, 
Belladonna  must  be  given;  for  the  employment  of  this  medicine, 
see  Inflammation  of  the  Brain.  When  the  complaint  is  attended 
with  convulsions  in  children,  particularly  during  dentition  (see  Con- 
vulsions), Antimonium  tartaricum  may  be  given  to  accelerate  the 
eruption. 

Mercurius,  may  be  employed  when  the  lymph  of  the  pustules 
becomes  converted  into  pus,  as  in  the  smallpox,  and  is  also  bene- 
ficial if  strangury  be  present.  For  the  course  of  treatment  to 
be  adopted  when  the  eruption  has  been  driven  in,  see  Repercussion 
of  the  eruption' in  Smallpox.  In  anomalous  cases,  where  other 
symptoms  supervene,  more  closely  resembling  Smallpox,  we  may 
refer  to  the  remedies  mentioned  under  that  disease. 


MILIARY  EEVER.  93 

MILIARY  FEVER. 

Miliaria.     Miliaria  alba.     Miliaria  sudatoria.     Sudor  miliaris. 

Diagnosis.  The  primary  feature  of  the  disease  consists  of  a  great 
number  of  exceedingly  small,  round/ red  pimples,  which  are  soon 
converted  into  white  vesicles,  afterwards  become  opaque,  and  end  in 
scurf;  they  are  irregularly  scattered,  of  the  size  of  millet-seeds  (hence 
the  name  of  the  complaint),  and  when  the  hand  is  passed  over  the 
cutaneous  surface,  a  sensation  is  experienced  as  if  caused  by  the  pre- 
sence of  small  grains  of  sand  beneath  the  cuticle. 

This  affection  is  sometimes  idiopathic,  but  more  frequently  asso- 
ciated with  fever,  and  even  occasionally  accompanies  various  chronic 
diseases,  in  which  latter  instance,  it  may  generally  be  considered  as  an 
evidence  of  some  internal  constitutional  taint :  it  is  most  frequently 
met  with  in  women,  particularly  at  the  turn  of  life,  and  at  the  period 
of  confinement  (arising  from  the  room  being  kept  at  too  high  a  tem- 
perature—a  frequent  cause  of  this  malady).  This,  like  other  cutaneous 
affections  of  the  same  nature,  is  generally  preceded  by  febrile  symp- 
toms, the  eruption  appearing  on  the  fifth  or  sixth  day ;  from  the  com- 
mencement of  the  fever  we  frequently  find  profuse  perspiration,  with 
a  putrid  sour  odour;  previous  to  the  vesicles  evolving  themselves,  there 
is  a  tingling  or  itching  of  the  skin,  occasionally  attended  with  a  sen- 
sation of  burning,  together  with  a  numbness  of  the  extremities ; 
the  patient  complains  of  dyspnoea  or  a  sense  of  oppression  at  the 
chest,  sometimes  with  short  dry  cough,  and  stitches  in  the  side,  and  not 
unfrequently,  of  creeping,  tingling,  numbness,  weight  and  stiffness  in 
the  extremities,  or  severe  or  fugitive  rheumatic  pains  in  the  limbs  and 
teeth.  Low  spirits,  excessive  anxiety,  extreme  restlessness,  sighing, 
tinnitus  aurium,  violent  palpitation  of  the  heart,  irregular  pulse,  and 
the  emission  of  clear,  colourless  urine,  are  also  frequent  premonitory 
indications  of  approaching  Miliaria. 

Prognosis.  This  must  be  regulated  by  the  severity  of  the  accom- 
panying symptoms.  Death  often  takes  place  suddenly,  particularly 
on  the  shrinking  of  the  vesicles.  When  the  morbid  signs  decline 
after  the  appearance  of  the  eruption,  the  termination  of  the  disease 
will  commonly  be  favorable.  In  malignant  forms  of  the  complaint, 
a  fatal  issue  sometimes  takes  place  within  twenty-four  or  forty-eight 


92  ERUPTIVE  EEVERS. 

hours.  The  general  course  of  the  disease  varies  from  four  or  five 
days,  to  three  weeks.  Convalescence,  in  severe  cases,  rarely  sets  in 
before  the  fourth  week. 

Therapeutics.  In  consequence  of  the  numerous  diseases  with 
which  miliary  fever  is  complicated,  it  requires  a  variety  of  medicaments. 
When  it  appears  in  a  simple  and  apparently  idiopathic  form,  and  is 
attended  with  anxiety  and  restlessness,  which  seem  to  depend  upon 
an  accelerated  circulation  of  the  blood,  with  great  internal  and  external 
heat,  Aconite  is  a  specific  remedy.  When  the  above  symptoms 
seem  more  particularly  to  arise  from  high  nervous  excitability,  Cof- 
fea  is  indicated. 

Belladonna  should  be  administered  when  the  accelerated  circu- 
lation is  attended  with  considerable  determination  of  blood  to  the 
head,  and  delirium;  but  Arsenicum  is  the  most  appropriate  remedy 
when  the  eruption  is  accompanied  by  excessive  anxiety  and  oppression 
at  the  chest.  (Veratrum  is  sometimes  useful  after,  or  in  alternation 
with,  Arsenicum, 

When  the  disease  is  found  conjoined  with  puerperal  or  other  fevers, 
and  is  preceded  by  oppression,  lassitude,  anxiety,  and  a  sense  of 
weight  about ,  the  chest,  restlessness,  sighing,  &c. ;  it  is  generally 
speedily  subdued  by  Ipecacuanha  ;  M'hen,  however,  the  symptoms, 
which  precede  the  eruption,  are  accompanied  by  constipation,  or  shoot- 
ing pains  in  the  chest,  Bryonia  should  be  selected. 

Nux  vomica  is  useful  when  aching,  gnawing  pains  are  experienced 
in  the  epigastric  region,  attended  with  eructations,  constipation^  and 
other  signs  of  gastric  derangement. 

Calcarea  carbonica  is  a  most  valuable  medicament  in  critical 
miliary  fever,  especially  against  the  extreme  anxiety  which  is  so  fre- 
quently manifested,  or  against  the  convulsions  which  sometimes  take 
place  in  the  case  of  children,  and  finally  as  a  general  remedy  to  hasten 
the  development  of  the  eruption  when  it  is  tardy  in  making  its 
appearance. 

Chamomilla  (followed,  if  no  alteration  takes  place,  by  Tincture 
of  Sulphur)  is  also  useful  when  the  disease  occurs  in  children, 
brought  about  by  excessive  warmth,  or  even  errors  in  diet,  attended 
with  a  watery,  greenish  or  yellowish  diarrhoea. 

Puis.,  Tart,  stihiat.,  Straw.,  Acid,  phosph.,  Led.,  Cocc,  or  Carl,  v.,  may 
be  required  in  certain  cases. 

When  this  disease  is  benign  and  appears  in  an  idiopathic  form,  it 


MILIARY    FEVER.  93 

is  rarely  so  severe  as  to  require  a  very  frequent  repetition  of  the 
medicines  if  the  accessory  treatment,  about  to  be  pointed  out,  be 
carefully  attended  to — in  most  cases,  a  globule  or  two,  repeated  in 
from  four  to  twelve  hours,  according  to  the  intensity  of  the  disease, 
will  be  found  sufficient,  and,  in  some  instances,  a  single  dose  will 
dissipate  all  the  symptoms,  or  at  least  so  modify  them  that  we  may 
safely  trust  to  Nature  to  perfect  the  cure — but  it  is  otherwise  in  the 
severer  or  more  complicated  forms  of  the  malady.  (See  also  Scarla- 
tina miliaris.) 

Remarks.  When  it  exhibits  itself  in  complication  with  other 
affections,  Miliaria  may  be  either  symptomatic  or  critical,  and  the 
physician  should  always  bear  in  mind  that  an  improper  treatment  of 
other  affections  may  develop  it.  When  symptomatic,  it  may  be  recog- 
nised by  appearing  either  very  early  or  late  in  the  original  affection, 
which,  so  far  from  being  relieved  by  the  eruption,  is  frequently  exacer- 
bated by  the  excitement  of  the  nervous  system  consequent  on  its 
appearance.  Even  when  critical, — in  which  case,  after  the  eruption 
has  been  fully  developed,  amelioration  takes  place, — it  is  still  danger- 
ous from  its  liability  to  retrocede.  When  the  disease  is  very  prevalent, 
its  outbreak  amongst  lying-in  women  may  generally  be  prevented,  if 
proper  attention  be  paid  to  keeping  the  patient  cool  by  light  covering 
and  the  removal  of  feather  beds,  and  allowing  a  free  supply  of  pure  air. 
When,  however,  it  appears  critical,  we  must  be  most  careful  not  to 
check  it,  and  a  moderately  warm  temperature  must  be  kept  up. 

Repercussion  of  the  Eruption.  When  this  has  taken  place 
we  must  carefully  watch  the  result,  as  sometimes  Nature  herself 
provides  for  it  by  an  increase  of  some  other  secretion,  but  when 
symptoms  of  cerebral  disturbance,  &c,  present  themselves,  Cuprum 
aceticum,  Calcarea  <?.,  or  Belladonna,  &c,  must  be  had  recourse  to,  accord- 
ing to  circumstances.  (See  articles  Scarlet  FEVER,and  Scarlatina 
miliaris.) 

Diet.  Same  as  already  given  for  Fever,  modifying  it  according 
to  the  violence  of  the  symptoms ;  when  repercussion  threatens  to  take 
place,  the  patient's  beverages  should  be  given  moderately  warm. 


94  ERUPTIVE  FEVERS. 

NETTLE-RASH. 

Urticaria. 

Diagnosis.  Spots  or  wheals,,  flat  or  prominent,  and  of  a  dull 
white  colour,  like  the  sting  of  a  nettle,  or  redder  than  the  surrounding 
skin,  generally  encircled  with  a  rosy  areola,  disappearing  in  warmth, 
and  reappearing  when  exposed  to  cold,  evolved  suddenly  and  con- 
tinually changing  their  situation. 

This  eruption  is  brought  to  the  surface  by  various  causes,  not 
unfrequently  arising  from  indigestion,  caused  by  the  use  of  improper 
articles  of  food.  Before  the  eruption  discloses  itself,  the  patient  is 
affected  with  restlessness,  languor,  oppression,  and  want  of  appetite, 
derangement  of  the  digestive  functions,  and  fever.  When  the  erup- 
tion breaks  out  the  above  symptoms  become  relieved,  but  considerable 
suffering  arises  from  heat  and  itching,  sometimes  accompanied  with 
swelling  of  the  parts  affected.  This  disease,  in  almost  all  cases  arising 
from  a  constitutional  cause,  requires  for  its  total  eradication  a  regular 
course  of  treatment. 

Therapeutics.  In  acute  cases,  the  remedies  found  most  useful  are 
Dulcamara,  Aconite,  Nux  vomica,  Pulsatilla,  Antimonium  crndum,  Bella- 
donna, Hepar  sulp/mris,  Rhus  toxicodendron,  and  Bryonia. 

Dulcamara,  when  the  exciting  cause  has  been  cold  or  damp, 
when  the  affection  occurs  in  wet  weather,  or  when  we  find  con- 
siderable fever  with  bitter  taste  in  the  mouth,  foul  tongue,  diarrhoea, 
pains  in  the  limbs;  and  extreme  itching,  with  a  burning  sensation 
after  scratching. 

Aconite,  when  the  febrile  symptoms  are  more  intense,  the  pulse 
high,  the  skin  hot  and  dry,  and  great  restlessness  and  anxiety  are 
present. 

Nux  vomica,  when  there  is  considerable  gastric  derangement, 
with  constipation,  more  especially  when  arising  from  wine,  stimulants, 
or  indigestible  substances ;  it  may,  if  necessary,  follow  Aconite  in 
eight  or  twelve*  hours  after  the  febrile  symptoms  are  somewhat 
modified. 

Pulsatilla  deserves  a  preference,  under  similar  circumstances 
when  the  bowels  are  relaxed,  and  the  patient  is  of  a  quiet  disposition 
and  lymphatic  temperament,  and  the  attack  has  apparently  been 
excited  by  indigestible  food. 


NETTLE-RASH.  95 

Antimonium  crudum  may  follow  Pulsatilla,  should  the  latter 
have  failed  to  relieve  the  affection. 

Belladonna  is  indicated  when  the  affection  is  attended  with  a 
severe  throbbing  headache,  with  redness  of  the  face. 

Hepar  sulphuris  has  frequently  been  found  useful  in  urticaria 
accompanied  by  cold  in  the  head,  and  particularly  when  the  coryza 
was  confined  to  one  nostril. 

Hhus  toxicodendron  is  one  of  the  most  useful  remedies  in  a 
great  majority  of  cases  of  this  eruption,  and  especially  when  the 
affection  has  apparently  arisen  from  some  idiosyncrasy  of  constitution, 
in  which  the  eruption  has  been  thrown  out  by  the  use  of  some 
particular  article  of  food.     (See  Article  on  Diet  in  Introduction.) 

Prescription.  In  ordinary  cases,  we  may  prescribe  6—12  globules 
of  the  sixth  dilution  in  six  dessert-spoonfuls  of  water,  and  order  one 
to  be  taken  morning  and  evening,  except  in  the  case  of  Aconite,  which 
may  be  more  frequently  repeated,  when  the  febrile  symptoms  seem 
to  demand  it.* 

In  this,  as  in  every  other  cutaneous  eruption,  great  care  ought  to 
be  taken  against  driving  it  inward,  by  external  applications  or  lotions  ; 
a  sudden  retropulsion,  as  before  noted  under  Scarlatina  and 
Smallpox,  being  frequently  attended  with  fatal  consequences. 
When,  however,  from  improper  treatment,  we  have  reason  to  dread 
this  having  taken  place,  we  may  generally  succeed  in  re-establishing 
the  eruption,  and  thereby  averting  any  dangerous  consequences,  by 
the  employment  of  Bryonia  in  repeated  doses.  Should,  however, 
marked  cerebral  symptoms  declare  themselves,  the  complaint  should 
be  treated  as  before  described  under  Scarlatina,  &c, — Repercussion 
of  the  eruption,  which  see. 

Urtica  urens  has  been  found  useful  in  some  cases;  and  in  those 
of  a  chronic  or  extremely  obstinate  character,  Calcarea,  Lycopodmm,  Sul- 
phur, Card,  veg.,  Causticum,  Acid,  nitric,  Conium,Natr.mur.<i  &c;  the  last 
two,  particularly,  when  the  eruption  is  liable  to  reappear  after  violent 
exercise  or  exertion  of  any  kind ;  Calcarea,  when  exposure  to  cold 
fresh  air  produces  it ;  and  Acid,  nitricum  when  it  arises  from  the 
patient  going  into  the  open  air,  after  having  kept  within  doors  for  a 
day  or  two. 

*  See  the  directions  for  the  repetition  of  the  dose  in  the  Introduction. 


DISEASES  OF  ORGANS  CONNECTED  WITH  THE 
DIGESTIVE  SYSTEM. 


TOOTHACHE. 

Odontalgia. 


When  we  find  a  constant  disposition  to  this  distressing  nlalady,  on 
the  slightest  exposure  to  cold,  without  any  presumable  cause,  or  what 
is  generally  called  rheumatic  toothache,  we  are  warranted  in  concluding 
that  some  taint  lurks  in  the  constitution,  and  until  proper  measures 
are  adopted  for  its  eradication,  even  the  remedies  most  clearly  indi- 
cated under  other  circumstances,  fail  to  relieve  the  patients,  or  at 
most  but  temporarily  alleviate  his  sufferings.  Another  obstacle  to 
the  selection  of  the  proper  remedy  is  the  difficulty  we  find  in  obtain- 
ing from  the  patient  a  perfectly  clear  description  of  his  sensations. 
We  shall,  nevertheless,  mention  a  few  of  the  remedies  which  have 
proved  most  efficacious  in  the  relief  of  toothache,  and  when  the 
symptoms  of  the  sufferer  approximate  closely  to  the  indications  given 
for  the  several  medicines,  they  will,  in  very  many  cases,  afford  a 
prompt  relief. 

Therapeutics.  Among  these,  Belladonna,  Chamomilla,  Mercurius, 
Nux  vomica,  Pulsatilla,  Sulphur,  Carlo  vegetabilis,  Hepar  suVphuris,  and 
Arsenicum,  hold  a  high  rank. 

Administration.  The  medicine  selected  maybe  taken  dry,  or 
dissolved  in  a  little  water ;  and  if  an  aggravation  of  pain  is  expe- 
rienced soon  after  taking  the  medicine,  the  dose  must  not  be  repeated, 
as  this  is  generally  succeeded  by  considerable  relief;  but  when  the 
pain  threatens  to  get  worse  again,  the  same  remedy  may  be  repeated, 
provided  the  symptoms  are  of  a  similar  description  to  what  they 
were  before  taking  the  remedy ;  if  they  have  altered,  select  another 
medicine. 


TOOTHACHE.  97 

Belladonna  is  particularly  indicated  when  the  pains  are  very 
severe,  of  a  drawing,  tearing,  or  shooting  nature,  extending  to  the  face 
and  ears ;  becoming  aggravated  in  the  evening,  and  especially  at  nighty 
with  gnawing  or  boring  pain  in  the  carious  teeth,  swelling  of  the 
gums  and  cheeks,  dryness  of  the  mouth  with  excessive  thirst,  wTith  or 
without  salivation :  renewal  of  the  pains  from  intellectual  labour,  or 
after  eating ;  aggravation  of  suffering  when  masticating ;  also  in  the 
open  air  ;  congestion  to  the  head,  with  heat  and  redness  of  the  face,  also 
pulsation  in  the  head  and  cheeks. 

Chamomilla,  when  there  are  severe  drawing,  jerking,  pulsative 
or  shooting  pains ;  heat  and  redness,  especially  of  one  of  the  cheeks  ;  the 
pain  becomes  almost  insufferable,  especially  at  night  in  the  warmth  of  the 
bed;  shooting  and  pulsative  pains  in  the  ear  of  the  affected  side  ;  the 
pains  are  aggravated  by  eating  or  drinking  anything  hot  or  cold,  but  espe- 
cially the  former  ;  great  agitation  and  loss  of  self-control  from  pain,  or 
excessive  weakness,  sometimes  amounting  to  fainting;  great  irascibility, 
and  disposition  to  shed  tears  during  the  paroxysms,  Chamomilla  is 
useful  When  the  toothache  has  arisen  from  an  abuse  of  Coffee,*  in 
which  case  Nux  vomica  and  Pulsatilla  are  also  valuable,  when  indicated 
by  the  sj'mptoms.  Rhus  and  Dulcamara  frequently  answer  best  after 
Chamomilla  in  toothache  from  cold,  when  the  last-mentioned  remedy 
has  not  removed  the  attack.  And  when  the  toothache  returns  after 
every  exposure  to  cold,  Sulphur  is,  generally,  the  best  remedy,  but  in 
some  cases,  Cinchona. 

Mercurius  is  particularly  indicated  when  the  pains  affect  carious 
teeth,  or  exist  in  the  roots  of  the  teeth,  and  consist  of  tearing,  shooting 
pains,  occupying  the  whole  side  of  the  head  and  face  of  the  part 
affected,  and  extending  to  the  ears ;  loosening  of  the  teeth,  and  a 
feeling  as  if  they  were  too  long ;  the  pain  becomes  almost  insup- 
portable towTards  evening,  and  especially  at  night  in  the  warmth  of  the 
bed,  and  is  also  aggravated  by  eating  or  drinking,  particularly  after 
anything  cold  has  been  partaken  of,  and  likewise  by  exposure  to  cold 
or  damp  air ;  swelling  and  inflammation  of  the  gums  ;  nocturnal  per- 
spiration, peevishness,  and  inclination  to  tears  ;  this  medicine  is 
especially  useful  in  persons  who  are  subject  to  glandular  swellings. 

*  Those  who  are  subject  to  toothache  ought  to  abstain  from  coffee  altogether ;  as  also 
from  very  hot  or  cold  drinks,  stimulants  of  every  description,  sweetmeats  and  acids ;  they 
ought  farther  to  refraki  from  using  medicated  tooth-powders,  particularly  if  they  wish 
to  derive  any  benefit  from  homoeopathic  treatment ;  the  toothpick  ought  to  be  cautiously 
used  if  required,  and  the  mouth  well  rinsed  with  tepid  water  (or  about  the  same  tem- 
perature as  that  of  the  mouth),  night  and  morning,  and  after  each  meal. 

7 


98  DIGESTIVE  SYSTEM. 

Nux  vomica  is  useful  For  persons  who  are  habituated  to  wine, 
coffee,  or  other  stimulants,  or  addicted  to  a  sedentary  life,  or  to  severe 
study ;  of  lively  or  irritable  temperament,  dark  or  florid  complexion  ;  or 
whose  sufferings  are  increased  by  intellectual  labour.  The  pains 
generally  occur  in  carious  teeth,  and  are  of  a  drawing  and  jerking  or 
gnawing  description,  occasionally  diffusing  themselves  to  the  head 
and  ears,  sometimes  attended  with  painful  enlargement  of  the  sub- 
maxillary glands :  gums  swollen  and  painful,  accompanied  with 
throbbing  and  pulsation.  The  toothache  is  more  liable  to  come  at  night 
or  on  awaking  in  the  morning,  sometimes  also  after  dinner  or  in  the 
open  air. 

Pulsatilla  is  peculiarly  adapted  to  persons  of  a  mild  or  phlegma- 
tic disposition.  The  pains  are  digging  and  gnawing,  attended  with 
pricking  in  the  gums,  and  extending  to  the  face,  head,  eye,  and  ear  of 
the  side  affected ;  this  remedy  is  particularly  efficacious  in  toothache, 
when  accompanied  with  earache,  or  with  paleness  of  the  face,  when  the 
affection  has  been  excited  by  taking  cold,  and  when  we  find  shortness 
and  difficulty  of  breathing ;  the  pains  are  sometimes  of  a  drawing, 
tearing,  shooting,  or  jerking  description,  and  occasionally  produce  a 
sensation  as  if  the  nerve  were  drawn  tight,  and  then  suddenly 
relaxed ;  the  pain  is  much  aggravated  in  the  evening  or  after  midnight, 
generally  increased  by  warmth  and  when  the  patient  is  at  rest,  and 
mitigated  by  cold  air  or  cold  applications  to  the  mouth. 

Spirit,  sulphuris.  This  remedy  is  particularly  valuable  in 
strumous  habits,  with  a  tendency  to  constipation.  It  is  indicated  by 
pain,  sometimes  attended  with  swelling  of  the  cheek,  and  shooting 
pains  in  the  ears,  congestion  of  the  blood  to  the  head,  and  pulsative  head- 
ache ;  the  pain  is  of  a  tearing,  jerking,  pulsative  description,  affecting 
both  carious  and  sound  teeth ;  aggravated  in  the  evening  and  at  night. 
or  by  exposure  to  the  open  air,  also  by  the  application  of  cold  water 
or  by  mastication ;  sensation  as  if  the  teeth  were  loosened,  elon- 
gated, and  set  on  edge ;  the  gums  are  swollen,  affected  with  ptilsative 
pains,  and  bleed  easily. 

Bryonia  is  also  a  useful  remedy  in  this  affection,  particularly 
with  persons  of  a  lively,  choleric,  and  obstinate  disposition.  Its 
indications  are  loosening  and  sensation  of  elongation  of  the  teeth,  espe- 
cially during  or  after  eating ;  shooting  in  the  ears,  with  inclination  to 
lie  down,  pains  aggravated  by  taking  anything  hot  in  the  mouth, 
mitigated  by  lying  on  the  affected  side  or  exacerbated  by  the  con- 
trary position. 


TOOTHACHE.  99 

Carbo  vegetabilis  is  indicated  by  toothache,  with  dragging, 
tearing,  or  constrictive  and  throbbing  pains,  excited  by  anything 
hot,  cold,  or  salt ;  chronic  looseness  of  the  teeth  ;  receding,  ulcerated, 
and  suppurating  gums  (particularly  after  the  abuse  of  mercurial 
preparations,  such  as  calomel,  etc.),  bleeding  of  the  teeth  and  gums, 
with  tendency  of  the  teeth  to  decay  rapidly. 

Hepar  sulphuris  is  indicated  by  dragging,  jerking  toothache 
increased  by  approximating  the  teeth  (clenching),  by  masticating,  or 
from  sitting  in  a  warm  room ;  swelling  of  the  gums,  with  tenderness 
on  pressure,  or  abscess  in  the  gums.  This  medicine  is  especially 
useful  in  cases  where  hurtful  doses  of  Mercury  have  previously  been 
taken  under  allopathic  treatment. 

Arsenicum,  when  there  is  nocturnal  pain,  which  extends  into  the 
ear,  cheek,  bones  of  the  face,  and  temple;  aggravation  of  the  pain  by 
lying  on  the  affected  side  ;  amelioration  from  the  warmth  of  the  fire ; 
aching  in  the  teeth  so  excessive  as  almost  to  drive  the  patient  to  madness 
or  distraction ;  sensation  of  elongation  and  looseness  of  the  teeth  ; 
grinding  of  the  teeth,  and  bleeding  of  the  gums. 

Aconite,  Belladonna,  Chamomilla,  Coffea,  and  Ignatia,  are  the  most 
useful  in  affections  of  this  nature  with  children. 

Aconite,  when  the  pains  are  difficult  of  description,  or  are  de- 
scribed as  being  of  a  pulsative  nature,  attended  with  great  agitation, 
feverish  sensation,  blood  to  the  head,  heat  and  redness  of  the  face, 
and  when  the  pains  are  described  as  of  a  pulsative,  throbbing 
nature. 

Coffea,  against  violent  pains  with  great  excitability  and  almost 
distraction  in  adults ;  also  when  the  patient  is  conscious  that  the 
excitement  is  disproportionate  to  the  pain  suffered. 

For  Chamomilla  we  have  already  given  indications ;  if  it  prove 
insufficient,  and  the  toothache  has  been  caused  by  a  chill,  and  is 
attended  with  diarrhoea,  we  may  substitute  Dulcamara. 

Ignatia  is  suitable  for  such  cases  as  present  similar  indications 
to  those  of  Nux  vomica  or  Pulsatilla,  but  more  particularly  applicable 
to  mild  or  sensitive  dispositions,  with  alternation  of  high  and  low 
spirits. 

Tartarus  emeticus  will  often  be  found  beneficial  in  toothache 
occurring  during  cold,  wet  weather, — particularly  in  women, — with 
nocturnal  exacerbation,  or  aggravation  of  the  pain  when  drinking 
any  cold  liquid.* 

*  In  rheumatic  or  arthritic  toothache  with  nocturnal  aggravations,  or  increase  of  pain 


100 


DIGESTIVE  SYSTEM. 


Assafcetida  may  generally  be  prescribed  with  advantage  when 
the  pain  is  chiefly  of  a  subdued  description,  and  is  intermittent ; 
also  when  it  partakes  of  a  burning  or  shooting  character,  and  seems  to 
proceed  from  within  outwards. 


SORE  THROAT,  or  QUINSY.    APHTHOUS  SORE  THROAT. 

Angina  faucmm,  Tonsillitis  p/ilegmonoides,  Cynanche  tonsillaris. — 
Angina  apJithosa,  etc, 

Qcjinsy. — Diagnosis.  Inflammation  of  the  throat,  denoted  by 
swelling  and  red  colour  of  the  back  part  of  the  throat,  accompanied 
with  difficulty  of  swallowing,  impeded  respiration,  alteration  of  the 
voice,  and  fever. 

In  the  incipient  stage  of  this  affection,  there  is  a  sense  of  constric- 
tion about  the  throat,  with  a  feeling  of  soreness,  and  sometimes  of 
obstruction  in  the  act  of  swallowing  the  saliva ;  if  it  runs  its  course, 
the  difficulty  of  swallowing  and  breathing  increases,  the  tongue  swells 
and  becomes  foul,  the  tonsils  assume  a  redder  hue, 'occasionally  a 
number  of  small  yellow  eminences  appear  at  the  back  of  the  throat, 
particularly  on  the  tonsils ;  the  patient  complains  of  thirst,  and  the 
pulse  is  high,  strong,  and  frequent ;  sometimes  the  cheeks  swell  and 
become  florid,  and  the  eyes  inflamed,  and  in  severe  cases  delirium  is 
not  an  unfrequent  occurrence.  As  the  local  affection  progresses  the 
majority  of  the  foregoing  symptoms  become  aggravated,  and  the  ton- 
sils tumefied,  and  suppuration  ensues  if  resolution  be  not  speedily 
effected. 

When  suppuration  takes  places,  the  pain  is  instantly  relieved  on 
the  bursting  of  the  abscess;  it  sometimes  happens,  however,  that 
scarcely  has  the  patient  been  relieved  from  suffering  by  the  latter 
event,  before  the  state  of  the  other  tonsil  gives  indications  that  a 
similar  train  of  symptoms  are  about  to  be  encountered  there.  This 
affection,  occasionally  dangerous,  if  not"  properly  treated,  even  in  its 
simple  form,  becomes  particularly  critical  when  it  puts  on  the  putrid 

on  partaking  of  cold  or  warm  drinks,  but  with  temporary  relief  on  the  external  application 
of  heat ;  also  in  toothache  which  returns  every  spring  or  autumn  during  the  prevalence  of 
easterly  winds,  (and  then  continues  sometimes  for  several  weeks,)  the  pain  being  occasionally 
confined  to  one  tooth,  which  is  extremely  sensitive  to  the  slightest  touch,  and  often  accom- 
panied with  acute  shootings  into  the  ear,  Rhododendron  Chrysanthum.  is  a  useful  remedy, 
in  repeated  doses. 


101 

type.  In  such  instances,  the  attendant  fever  generally  assumes  a 
typhoid  character;  when  this  takes  place,  we  may  always  infer  a  pe- 
culiar constitutional  tendency. 

Therapeutics.  The  following  are  the  principal  remedies  used  in 
the  treatment  of  quinsy :  Aconitum,  Belladonna,  Mercurius,  Carlo  v., 
Acidum  nitricum,  Lachesis,  'Pulsatilla,  Nux  v.,  Arsenicum,  Chamomilla, 
Ignatia,  Dulcamara,  Hepar  sulphuris,  Silicea,  Stil/phur. 

When  this  disorder  is,  at  the  commencement,  attended  with  consi- 
derable fever,  thirst,  and  dry  heat,  deep  redness  of  the  parts  affected, 
painful  and  difficult  deglutition,  pricking  sensation  in  the  throat,  with 
aggravation  of  the  symptoms  when  speaking,  we  should  have  recourse 
to  Aconitum. 

The  next  medicament  we  shall  mention,  Belladonna,  as  may  have 
been  observed  in  the  treatment  of  Scarlatina,  Measles,  &c.,  is  one  of 
the  best  remedies  we  possess  against  phlegmonous  inflammation  of 
the  throat,  more  especially  when  it  occurs  in  plethoric  or  lymphatic 
subjects.  The  following  are  the  symptoms  by  which  it  is  particularly 
indicated  : 

Pain  in  the  throat  as  if  from  excoriation,  attended  with  scraping,  and 
a  sensation  of  enlargement,  and  burning  or  shooting  pains,  principally 
experienced  during  the  act  of  swallowing ;  these  pains  sometimes 
extend  to  the  ears.  Other  characteristic  indications  for  this  remedy 
are — a  sense  of  spasmodic  constriction  or  contraction  of  the  throat,  with 
constant  and  almost  uncontrollable  desire  to  sivalloiv  the  saliva;  occasionally 
there  is  violent  thirst,  with  dryness  of  the  throat,  but  a  dread  of  chink 
from  the  suffering  it  occasions.  Sometimes  a  complete  inability  to 
drink  exists,  and  the  liquid  returns  by  the  nostrils.  On  examination, 
the  throat  presents  a  bright  red  colour,  with  swelling  of  the  palate,  uvula, 
and  tonsils  ;  there  is  also  an  accumulation  of  slimy  whitish  mucus  in  the 
throat  and  on  the  tongue,  obliging  the  patient  to  spit  frequently ; 
swelling  of  the  muscles  and  glands  of  the  neck,  severe  headache,  chiefly 
confined  to  the  forehead,  sometimes  determination  of  blood  to  the 
head,  and  delirium.  (After  Belladonna, — Mercurius,  Lachesis,  or  Pul- 
satilla are  often  suitable.) 

This  remedy  frequently  succeeds  in  speedily  removing  the  whole 
of  the  above  group  of  symptoms,  or,  at  least,  so  far  subdues  them  as 
to  enable  Mercurhos  to  complete  the  cure. 

Mercurius  is  frequently  valuable  at  the  commencement  of  the 
disease,  and  forms  one  of  our  best  remedial  agents;  in  some  cases 


102  DIGESTIVE  SYSTEM. 

advantage  accrues  from  the  employment  of  Belladonna  in  alternation 
with  it.  The  indications  for  its  selection  are  :  violent  shooting  in  the 
throat  and  tonsils,  especially  when  swallowing, — these  pains  extend  to 
the  ears,  and  glands  before  the  ears,  and  under  the  jaw ;  inflammatory 
redness  and  swelling  of  the  affected  parts  of  the  throat,  burning  in 
the  throat,  desire  to  swallow,  attended  with  a  sensation  of  an  obstruc- 
tion existing  in  the  passage ;  accumulation  of  thick  and  tenacious 
mucus  in  the  throat,  difficult  deglutition,  especially  of  liquids,  which 
sometimes  escape  through  the  nostrils  ;  swelling  of  the  glands,  and 
muscles  of  the  neck,  and  of  the  posterior  part  of  the  tongue ;  occa- 
sional swelling  of  the  gums  ;  unpleasant  taste  in  the  mouth,  which  is 
filled  with  saliva  more  or  less  inspissated ;  throbbing,  and  formation  of 
matter  in  the  tonsils  ;  (confluent,  or  small,  isolated,  round,  white 
specks  or  vesicles  on  the  tonsils ;  indolent  ulcers  in  the  throat ;)  (An- 
gina  aphthosa) ;  offensive  odour  from  the  mouth  ;■  aggravation  of  the 
symptoms  at  night,  from  the  act  of  speaking,  and  in  the  evening  ; 
chills,  and  shivering,  sometimes  alternated  with  heat ;  nocturnal  sweat- 
ing. (Lachesis,  Hepar  sul/phuris,  Carl,  v.,  or  Ac.  nit.  are  often  suitable 
after  Merc. 

Lachesis.  One  of  the  characteristic  indications  for  this  remedy 
is,  aggravation  of  all  the  symptoms  on  awaking  from  sleep,  or  an  in- 
crease of  the  pain  in  the  throat  from  the  slightest  external  pressure  ;  it  is, 
moreover,  an  excellent  remedy  in  cases  of  tonsillitis  in  which  Bella- 
donna or  Mercurms  have  afforded  relief,  but  seem  incapable  of  effecting 
resolution ;  and  also  in  aphthous  sore  throat  with  considerable  ulcera- 
tion, when  Mercurms  has  afforded  only  partial  relief. 

Carbo  vegetabilis.  This  remedy  may  either  follow,  or  be 
selected  in  preference  to,  Mercurius, — after  a  previous  dose  or  two  of 
Aconite  when  necessary,— in  Aphthous  sore  throat  characterized  by 
the  appearance  of  small  white  specks  or  pimples  (which,  if  not 
checked,  become  confluent  and  spread  beyond  the  throat)  on  the  en- 
larged and  protuberant  tonsils,  when  the  patient  complains  of  severe 
burning  and  pricking  pain,  with  great  thirst. 

Acidum  nitricum  is  indicated  when  Aconite  and  Mercurius  have 
been  administered  in  Aphthous  sore  throat,  characterized  by  superficial 
ulcerations  in  the  throat,  and  the  small  white  or  grey  ulcers  refuse 
to  put  on  a  healing  appearance  a  few  hours  after  the  use  of  the  latter 
remedy. 

Nux  vomica.  This  remedy  is  especially  useful  when  the  sore 
throat  appears  to  arise  from,  or  to  be  accompanied  by,  symptoms  of 


SORE  THROAT,  OR  QUINSY.  103 

deranged  digestion,  and  when  a  sense  of  scraping  or  excoriation  exists 
in  the  throaty  and  also  when  a  feeling  of  contraction  is  experienced 
in  the  upper  part  of  the  throat  during  empty  deglutition ;  secretion  of 
viscid  mucus,  which  can  be  expectorated  only  with  great  difficulty, 
and  sometimes  accumulates  in  such  a  quantity  as  to  threaten  suffo- 
cation ;  or  there  is  swelling  and  elongation  of  the  uvula,  producing  a 
constant  desire  to  swallow ;  at  times  only  a  sensation  of  swelling,  with 
aching  pressive  pains ; .  or  when  cold  has  been  the  exciting  cause,  and 
the  affection  is  attended  with  dry  cough  and  headache,  chiefly  in 
the  morning,  and  pains  under  the  lower  ribs  during  the  cough. 
This  remedy  is  likewise  indicated  when  there  are  small  offensive 
ulcers  of  the  throat,  or  when  considerable  debility  is  present.  (Vide 
Ulcerated  Sore  Throat.  SulpJmr  is  frequently  useful  after  Nux 
vomica?) 

Pulsatilla  is  frequently  serviceable  after  Belladonna  when  there 
is  an  undue  secretion  of  viscid  mucus  in  the  fauces ; — but  it  is  more 
particularly  when  the  following  symptoms  are  met  with  that  this 
remedy  is  called  for:  gastric  derangement,  with  dark  livid  redness 
of  the  throat  and  tonsils  ;  a  sensation  as  if  the  parts  affected  were  much 
swollen,  or  a  feeling  of  enlargement  in  the  upper  part  of  the  throat,  as 
also  of  excoriation  and  scraping,  with  dryness  of  the  throat  without 
thirst;  shooting  pains  in  the  throat  when  not  swallowing;  aggravation 
of  the  symptoms  towards  evening,  attended  with  shivering  ;  also  accu- 
mulation of  adhesive  mucus  in  the  throat.  This  remedy  is  more  parti- 
cularly suitable  for  females,  or  for  individuals  of  a  mild  and  phlegmatic 
temperament. 

Chamomilla  is  a  remedy  particularly  useful  in  sore  throat  when 
it  occurs  in  children,  or  in  nervous  or  sensitive  females  who  suffer 
much  from  trivial  ailments,  and  especially  when  the  disease  has  been 
brought  about  by  checked  perspiration, — when  there  are  shooting  or 
burning  pains,  with  a  sensation  of  stvelling  in  the  throat,  deep  redness 
of  the  parts  affected,  inability  to  swallow  solid  food,  especially  when 
lying  down ;  thirst,  with  dryness  and  heat  of  the  mouth  and  throat, 
or  secretion  of  frothy  saliva  with  burning  heat  in  the  throat  and 
gullet ;  swelling  of  the  tonsils  and  glands  before  the  ear  and  under 
the  jaw ;  cough  excited  by  constant  tickling  in  the  throat,  attended 
with  hoarseness  ;  fever  towards  evening  ;  alternate  heat  and  shivering, 
redness  of  the  face,  hot  especially  of  one  cheek,  great  excitability  and 
tossing  about. 

Ignatia  is  indicated  when  there  is  a  sensation  as  of  a  plug  in  the 


104  DIGESTIVE  SYSTEM. 

throat  when  not  performing  the  act  of  deglutition,  with  red  and  inflam- 
matory swelling  of  the  tonsils  or  palate ;  burning  pains  during  the  act 
of  deglutition,  as  if  the  substance  being  swallowed  were  passing  over 
an  excoriated  surface,  or  partially  obstructed  by  some  foreign  body  in 
the  throat.  Liquids  are  more  difficult  to  swallow  than  solids ;  there 
are  also  shooting  pains  in  the  cheeks,  thence  extending  to  the  ears,  when  not 
performing  the  act  of  deglutition  j  induration  of  the  tonsils  or  evolution 
of  small  pustules  upon  them. 

Dulcamara  is  generally  a  most  useful  remedy  when  sore  throaty 
particularly  in  the  form  of  tonsillitis,  has  arisen  from  exposure  to  tvet. 
It  may  be  followed  by  Belladonna  or  Mercurius,  should  it  not  wholly 
remove  the  affection,  and  should  any  of  the  symptoms  given  under 
these  medicines  present  themselves. 

Coffea  cruda.  Sometimes  useful  as  an  intermediate  remedy 
when  many  of  the  symptoms  enumerated  under  Belladonna,  with  the 
exception  of  the  external  swelling  of  the  throat,  are  present ;  and  also 
when  there  is  a  sensation  as  if  the  uvula  were  elongated  or  loaded 
with  mucus,  causing  a  constant  inclination  to  swallow.  One  of  the 
best  indications  for  its  employment  in  this,  as  in  other  diseases,  is  an 
over- excitability  of  the  nervous  system,  characterized  by  sleeplessness, 
great  restlessness,  sensitiveness,  disposition  to  weep,  [and  peculiar 
impressionability  to  external  agents. 

When  the  disease  occurs  in  an  aggravated  form,  or.  when  it  has 
been  neglected,  and  all  the  parts  have  become  so  excessively  tumefied 
that  the  mouth  can  scarcely  be  opened,  the  breath  being  at  the  same 
time  extremely  offensive,  the  tongue  foul,  and  the  strength  much 
exhausted,  Arsenicum  may  be  given  with  advantage.  (See  also  the 
indications  for  the  employment  of  this  remedy  in  sore  throat,  which 
have  been  already  given  under  Scarlet  Fever,  and  will  also  be 
found  under  Malignant  Sore  Throat.) 

Hepar  sulphuris  is  valuable  in  bringing  the  matter  to  ahead,  when 
resolution  cannot  be  effected,  and  the  quinsy  has  attained  to  such  a 
height  that  its  bursting  is  desirable  from  the  painful  sense  of  suffoca- 
tion, arising  from  the  tumefied  condition  of  the  tonsils. 

Silicea.  This  remedy  is,  in  some  instances,  of  greater  efficacy 
than  Hepar  in  rapidly  fonoar  ding  the  suppurative  process,  and  causing  the 
ripened  abscess  to  burst.  It  generally  promotes  incarnation  more  effec- 
tually than  Hepar. 

Mercurius  may  follow  either  of  the  last-mentioned  medicines, 


SORE  THItOAT,  Oil  QUINSY.  105 

after  an  interval  of  a  few  hours,  to  facilitate  the  healing.  Silicea  and, 
in  some  cases,  Sulphur  may  be  called  for  after  Mercurius.  Bryonia  and 
Rhus  have  been  found  useful  in  some  forms  of  sore  throat,  the  former 
especially  when  attended  wTith  considerable  gastric  disturbance,  and 
where  there  was  great  dryness  of  the  throat,  with  redness  of  the  soft 
palate  and  tonsils,  but  no  swelling ; — the  latter  where  there  was  con- 
siderable fever  towards  evening,  hot  dry  skin,  aching  and  pricking 
pain  during  deglutition,  lowness  of  spirits,  and  excessive  anxiety. 
Bryonia  is  indicated  by  sore  throat,  with  difficult  deglutition  and 
hoarseness ;  pain  in  the  throat  as  from  excoriation ;  excessive  dryness 
of  the  throat,  and  pressure  in  the  throat  as  if  caused  by  a  hard  angular 
body ;  pain  and  pricking  in  the  throat,  which  is  also  experienced  on 
external  pressure  or  on  moving  the  head ;  accumulation  of  adhesive 
mucus  in  the  trachea,  temporarily  removed  by  coughing.  It  is  fur- 
ther called  for  when  there  is  marked  gastric  disturbance,  the  tongue 
covered  with  a  dirty  yellow  fur,  the  taste  insipid,  and  the  bowels 
confined  ;  when  there  was  severe  frontal  headache  and  very  disturbed 
sleep,  with  dryness  of  the  throat,  redness  of  the  tonsils  and  palate 
{vekcmpalati),  without  swelling.^  Rhus  toxicodendron,  when  the  pains 
seem  situated  lower  in  the  gullet,  the  disposition  of  the  patient  anxious, 
depressed,  or  disposed  to  tears ;  and  when  Bryonia  has  not  been  suffi- 
cient to  remove  the  complaint.  Where  there  is  difficulty  of  swal- 
lowing, and,  at  the  same  time  a  sensation  as  if  a  plug  or  some  kind  of 
foreign  substance  w7ere  in  the  throat, — Lachesis,  Nux  v.,  and  Arsenicum 
are  useful  when  otherwise  indicated.  Stdph.,  Bella,,  Baryta,  Merc, 
Sep.,  Ign.,  Graph.,  Am.  c.  and  Coccnlus  are  also  indicated  by  this  latter 
symptom.  In  obstinate  cases,  such  as  are  occasionally  met  with  in 
bad  constitutions,  the  healing  of  the  cavity,  after  the  matter  has  been 
discharged,  goes  on  very  unfavorably,  and  even  fresh  abscesses  form 
in  succession  :  Sulphur,  Ilepar  s.,  and  Bsoricum,  repeated  every  eight  or 
twelve  hours,  have  chiefly  been  recommended  to  subdue  these  fortu- 
nately rare  symptoms ;- — Sulphur  in  ordinary  cases,  Ilepar,  when  the 
patient  has  been  previously  subjected  to  an  abuse  of  Mercury  under 
allopathic  treatment,  and  Psoricum  when  Sulphur  has  been  taken  in 
excess.* 

Sepia  is  a  useful  remedy  in  obstinate  cases  of  angina,  with  pain 
in  the  fauces  as  if  the  parts  were  excoriated,  and  prickings  during  the 
act  of  deglutition. 

*  Brit.  Jour,  of  Homoeopathy,  No.  VII. 


106  DIGESTIVE  SYSTEM. 

Relaxed  sore  throats  generally  require  Nux,  Puis.,  Capsic,  Gentiana 
cruciana,  or  Stilph.,  &c.  (See  also  the  other  remedies  mentioned  in  the 
article  on  dyspepsia,  as  such  sore  throats  are  commonly  connected 
with  deranged  digestion.) 

The  following  remedies  may  also  be  mentioned  as  being  useful  in 
angina  when  the  symptoms  are  as  described  :  — 

Vbratrum  album  is  indicated  by  constrictive  and  suffocating 
pain  in  the  throaty  particularly  during  deglutition ;  sensation  of  con- 
traction in  the  gullet ;  sense  of  roughness  and  scrapings  or  of  extreme 
dryness  in  the  throat ;  intumescence  and  burning  in  the  gullet,  some- 
times attended  with  danger  of  suffocation. 

Cocculus,  indicated  by  great  dryness  and  sensibility  of  the  gullet, 
causing  everything  partaken  of  to  seem  pungent,  acid,  or  too  salt ;  by 
constriction  or  sensation  of  paralysis  in  the  gullet,  and  noisy  or  clucking 
deglutition. 

Capsicum  is  often  useful  in  sore  throat  from  cold,  when  Puis., 
Cham.,  Ign.,  Bry.,  or  Nux  v.  afford  little  relief,  particularly  when  a 
degree  of  fever  continues,  with  shiverings  and  thirst,  followed  by  heat; 
pressive  aching  pains,  accompanied  by  a  sensation  of  spasmodic  con- 
striction in  the  throat ;  distressing  cough  ;  constant  desire  for  the 
recumbent  posture  and  for  sleep,  with  dread  of  the  slightest  breath  of 
cold  air. 

In  gangrenous  sore  throat,  or  sphacelated  quinsy  : — Ars.,  Bach.,  Carlo  v., 
Am.  c,  China,  Conium,  Rhus,  or  Baryta  m.  are  the  remedies  which 
are  chiefly  to  be  relied  on  where  there  is  any  chance  of  recovery.  (See 
Ulcerated  Sore  Throat.) 

The  diet  of  the  patient  must  be  regulated  according  to  the  degree 
of  inflammation  present. 

If  required,  the  throat  may  be  gargled  with  a  little  warm  water, 
and  when  much  pain  is  present,  inhalation  of  the  vapour  from  boiling 
water  will  often  afford  considerable  relief^  but  at  the  same  time  it  may 
be  observed  that  all  medicinal  gargles,  blisters,  leeches,  or  other 
topical  applications  are  rendered  unnecessary  by  proper  homoeopathic 
treatment.  While  we  thus  free  the  patient  from  a  considerable 
degree  of  annoyance  and  needless  suffering,  we,  at  the  same  time,  by 
a  careful  attention  to  the  symptoms,  and  the  exhibition  of  the  proper 
remedy,  effect  a  speedy  cure.  In  overcoming  the  predisposition  to 
sore  throat,  Mercurius,  Sepia,  Baryta  m.  and  Graphytes  have  been  found 
useful.  The  latter  two  particularly,  when  sore  throat  results  after 
every  exposure  to  cold,  and  is  always  prone  to  terminate  in  sup- 
puration. 


ULCERATED  SORE  THROAT.  107 


ULCERATED  SORE  THROAT. 

Malignant  Quinsy.    Malignant,  putrid,  or  gangrenous  Sore  Throat. — Angina 
Maligna,  Tonsillitis  Maligna,  Cynanche  Maligna. 

This  serious  disease  is  also  known  by  the  name  of  Scarlatina  Maligna, 
from  the  eruption  with  which  it  is  frequently  attended.  It  is  usually 
epidemic,  of  a  highly  contagious  nature,  and  generally  occurs  in 
damp  and  sultry  autumnal  seasons. 

It  sets  in  with  coldness  and  shivering,  succeeded  by  heat  and  ac- 
companied with  great  languor  and  oppression  at  the  chest ;  nausea, 
or  vomiting,  and  sometimes  purging ;  eyes  inflamed  and  watery ;  deep 
red  colour  of  the  cheeks ;  the  nostrils  are  also  more  or  less  inflamed, 
and  secrete  a  thin  acrid  discharge,  frequently  causing  soreness  or  ex- 
coriation of  the  nose  and  lips ;  pulse  indistinct,  or  very  weak,  small, 
and  irregular ;  tongue  white  and  moist. 

The  deglutition  is  painful  and  difficult,  and  the  throat,  on  being 
examined  early  in  the  disease,  is  observed  to  be  of  a  bright  red  colour, 
and  much  tumefied ;  but  this  state  is  very  soon  altered,  and  nume- 
rous ulcers  of  various  sizes  will  then  show  themselves  interspersed 
over  the  parts,  which  become  covered  with  a  white,  grayish  brown, 
or' livid  coat.  In  some  cases,  these  ulcerations  spread  so  widely  as 
to  extend  over  the  whole  fauces  into  the  nostrils,  or  downwards  even 
to  the  glottis  and  gullet,  &c,  and  assume  a  sloughing  appearance  as 
they  increase  in  magnitude.  The  prostration  of  strength,  considerable 
from  the  first,  is  now  excessive ;  the  tongue,  lips,  and  teeth  are  covered 
with  brown  or  blackish  incrustations,  and  there  is  more  or  less  deli- 
rium; the  breath  is  extremely  fetid,  and  the  patient  himself  complains 
of  a  disagreeable  odour.  The  neck  appears  swollen  and  of  a  livid 
colour,  and  an  efflorescence  of  a  faint  scarlet  hue,  or  blotches  of  a 
dark  or  livid  red,  sometimes  intermixed  with  petechiae,  break  out  on 
various  parts  of  the  body,  and  usually,  though  not  necessarily,  add 
to  the  danger, — as  many  are  carried  off,  particularly  children  or  per- 
sons of  an  advanced  age,  without  any  eruption,  when  the  local  symp- 
toms are  severe  and  the  fever  high, — but  the  appearance  of  livid  spots 
or  petechiae,  and  other  indications  of  so-called  putrescency,  with 
frequent  shivering,  weak  fluttering  or  intermittent  pulse,  sunken  coun- 
tenance, severe  purging,  extreme  prostration,  and  bleedings  from  the 
nose,  mouth,  &c,  must  decidedly  be  regarded  as  symptoms  of  immi- 
nent danger. 


108  DIGESTIVE  SYSTEM. 

When  the  local  symptoms  are  mild,  the  danger  is  rarely  great ;  and 
even  in  the  severe  forms  of  the  disease,  when  a  gentle  sweat  breaks 
out  about  the  third  or  fifth  day,  when  the  sloughs  throw  off  in  a  fa- 
vorable manner,  leaving  a  clean,  florid,  healthy-looking  bottom,  and 
the  respiration  becomes  more  gentle  and  free,  the  expression  of  the 
face  more  lively,  and  the  pulse  stronger  and  more  equal,  a  salutary 
result  may  be  held  in  expectation. 

Therapeutics.  The  subjoined  remedies  will  frequently  be  found 
adequate  to  subdue  the  various  forms  which  the  malady  assumes, 
where  any  prospect  of  a  cure  may  reasonably  be  entertained  from 
the  commencement :  Aconitum,  Belladonna,  Mercurius,  Acidum  nitricum, 
Pulsatilla,  Arsenicum,  Lachesis,  Nux  v.,  Carlo  vegetabilis,  Sulphur,  &c. 

The  accompanying  fever  being  generally  of  a  low  typhoid  character, 
Aconite  is  rarely  necessary  in  this  complaint;  however,  there  are 
cases,  particularly  when  the  fever  runs  high  from  the  commencement, 
in  which  advantage  is  found  to  result  from  a  dose  or  two  of  this  re- 
medy, followed  by  Belladonna  as  soon  as  the  patient  complains 
of  dryness,  with  impeded  deglutition  and  a  sense  of  constriction  or 
choking  in  the  throat,  which,  on  examination,  is  observed  to  be  swollen 
and  to  present  a  florid  red  appearance. 

Belladonna  is  additionally  indicated  when  the  fever  continues  to 
run  high ;  when  the  face  is  bloated  and  the  eyes  much  inflamed ; 
when  the  patient  is  affected  with  considerable  delirium,  and  is,  occa- 
sionally, with  difficulty  to  be  restrained  from  leaving  the  bed,  or  com- 
mitting acts  of  violence  ;  or,  further,  when  the  rash,  which  sometimes 
breaks  out  in  this  disorder,  about  the  third  day,  presents  a  scarlet  hue, 
and  is  smooth  and  glossy. 

In  cases  in  which  the  symptoms  are  mild,  or  in  which  the  above- 
mentioned  symptoms  have  been  reduced  by  means  of  the  remedies 
quoted,  and  an  increased  secretion  of  mucus  supplies  the  place  of  the 
previous  dryness,  while  the  patient  is  at  the  same  time  afflicted  with 
nausea  and  bilious  vomiting, —  a  dose  or  two  of  Pulsatilla  may  be 
administered  with  good  effect.  The  progress  of  matters  in  the  throat 
must,  however,  be  carefully  watched,  and  as  soon  as  the  presence  of 
small  ulcers,  or  still  better,  their  incipient  formation,  can  be  detected, 
a  dose  of  Mercurius  should  be  prescribed,  followed  by  Acidum 
nitric um,  when,  from  the  increasing  size  and  painfulness  of  the 
ulcers,  Mercurius  does  not  promise  to  arrest  their  progress  or  cause 
them  to  assume  a  healthy  aspect. 


ULCERATED  SORE  THROAT.  109 

In  the  milder  forms  of  this  disease,  the  two  last-named  remedies 
will  frequently  be  found  sufficient  to  conduct  it  to  a  speedy  and  suc- 
cessful termination ;  but  in  those  much  more  dangerous  forms,  which 
the  complaint  so  readily  assumes  when  it  rages  as  an  epidemy,  and 
when  the  patient,  at  the  commencement,  is  seized  with  vomiting  and 
purging,  attended  with  such  prostration  of  strength  as  to  render  it 
impossible  for  him  to  leave  the  recumbent  posture  without  feeling 
faint,  and  compelled  to  fall  back   exhausted  by  his  efforts;  when, 
moreover,  the  ulcerations   spread  with  alarming  rapidity,  and  early 
take  on  a  sloughing  character. — In  such  cases,  the  conducting  of  the 
disease  to  a  happy  issue  becomes  obviously  a  much  more  serious  and 
difficult  task.     Here  the  symptoms  must  generally  at  once  be  at- 
tacked by  administering  Arsenicum, — sometimes,  however,  benefit 
will  be  found  to  result  from  a  dose  of  Pulsatilla  beforehand,  when 
there  is  an  excessive  degree  of  bilious  vomiting,-— but  Arsenicum  must 
unhesitatingly  be  had  recourse  to  when  there  is  that  marked  prostra- 
tion of  strength  so   characteristic  of  this  disease,  accompanied  with 
nausea  or  vomiting ;  or  when  the  ulcers  present  a  livid  hue.     This 
important  remedy  is  also  indicated  in  a  more  advanced  stage  of  the 
disease,  when  the  ulcerations  are   covered  with  dark   sloughs,  sur- 
rounded by  a  livid  margin ;  the  teeth  and  lips  incrusted  with  sordes ; 
the  tongue  parched,  cracked,  blackish,  and   tremulous;   the  pulse 
small  and  irregular ;  and  there  is  delirium  or  constant  muttering ; 
with  frequent  hanging  of  the  lower  jaw ;  laborious  respiration  ;  acrid 
discharge  from  the  nostrils,  causing  excoriations  ;  the  eyes  dull  and 
glassy  ;  the  skin  hot  and  dry,  and  the  thirst  excessive,  yet  the  patient 
drinks  but  little  at  a  time,  and  appears  to  perform  the  act  of  deglu- 
tition with  great  pain  and  difficulty ;  finally,  when  the  prostration  of 
strength  is  so  extreme  that  the  patient  seems  rapidly  sinking,  and  a  rash 
of  a  livid  colour  breaks  out  in  blotches,  here  and  there  intermingled 
with  petechiae. 

Lachesis  will  frequently  be  found  very  useful  after,  and  in  some 
cases  alternately  with,  Arsenicum,  should  the  patient  complain  of  great 
pain  in  the  throat,  which  is  aggravated  by  the  slightest  external  pres- 
sure ;  or  should  the  sloughs  seem  indisposed  to  cast  off,  and  the  neck 
become  much  swollen  and  discoloured.  Conium  has  been  recom- 
mended when  the  diseased  parts  assume  an  ash-gray  colour  and  a 
dark  brown  or  blackish  aspect,  paleness  and  puffiness  of  the  face,  swell- 
ing of  the  tongue,  inarticulate  speech,  loose,  sanguineous,  involuntary 
stools,  depression  of  strength  and  spirits,  evolution  of  a  whitish  erup- 


110  DIGESTIVE  SYSTEM. 

tion  on  various  parts  of  the  body.  When  the  tendency  to  gangrene 
continues,  and  the  patient  is  still  affected  with  considerable  prostra- 
tion of  strength,  accompanied  with  debilitating  sweats,  Cinchona  will 
often  be  found  of  service.  Nux  vomica  is  frequently  serviceable  after 
Arsenicum,  when  the  diarrhoea  has  been  checked,  but  numerous,  small, 
foul,  offensive  ulcers  are  seen  in  the  mouth  and  throat, — and  may  be 
succeeded  by  Carl,  v.,  should  a  copious  fetid  ichor  be  discharged 
from  the  ulcers,  attended  with  extreme  exhaustion,  and  small,  indis- 
tinct, or  scarcely  perceptible  pulse.  Secale  cornutum  may  sometimes 
be  administered  with  advantage  in  alternation  with  Ca/rb.,  when  the 
latter  appears  to  afford  but  temporary  benefit.  Rhus  is  occasionally 
useful  in  extreme  cases,  particularly  if  there  be  great  muscular  weak- 
ness, with  trembling  of  the  extremities,  especially  on  movement ; 
sopor,  and  other  symptoms  described  under  this  remedy  in  the  chapter 
on  Typhus. 

When,  from  the  beneficial  effects  of  Arsenicum,  or  any  of  the  other 
remedies  above  mentioned,  the  strength  of  the  patient  becomes  invi- 
gorated, the  countenance  more  animated,  and  the  sloughs  are  thrown 
off  in  a  satisfactory  manner,  yet  the  ulcers  threaten  to  become  indo- 
lent ;  these  will,  generally,  very  speedily  acquire  a  clean  and  florid 
bottom,  and  begin  to  cicatrize,  on  the  administration  of  Acid,  ni- 
tricum.  In  other  cases  the  aid  of  Sulphur  and  Silicea  will  be  found 
necessary. 

For  further  particulars  in  the  treatment  of  malignant  sore  throat, 
the  reader  is  referred  to  page  65  of  this  work.*  In  conducting  the 
cure,  the  utmost  cleanliness,  combined  with  free  ventilation,  ought  to 
be  strictly  observed,  for  the  double  purpose  of  removing  all  malignant 
excretions  and  effluvia, — and  thereby  putting  a  check  to  the  ready 
extension  of  the  contagion, — and  providing  for  the  comfort  and  well- 
being  of  the  patient. 

The  diet  should  consist  of  semolina,  sago,  gruel,  and  similar  articles 
of  food. 

Angina  Pharyngea.     Pharyngitis.     Oynanche  Pharingea. 

Inflammation  of  the  membrane  which  lines  the  pharynx  is  gene- 
rally an  attendant  on  tonsillitis ;  and,  in  like  manner,  when  phlegmo- 
nous inflammation  commences  in  the  pharynx,  it  for  the  most  part, 
extends  to  the  tonsils.     In  pharyngitis  simplex,  although  there  is 

*  See  also  Sore  Throat. 


INFLAMMATION  OF  THE  (ESOPHAGUS.  Ill 

usually  some  degree  of  inflammatory  fever,  it  rarely  attains  a  consi- 
derable height,  and  is,  together  with  the  local  affection,  with  facility 
subdued  by  means  of  a  dose  or  two  of  Aconite. 

When  the  inflammation  spreads  to  the  tonsils  and  neighbouring 
parts,  the  same  remedies  must  be  employed  which  have  been  enume- 
rated under  Tonsillitis,  which  see.. 

When  the  velum  palati  is  particularly  implicated,  Coffea,  Belladonna, 
Mercurius,  or  Nux  vomica  answer  best,  after  Aconitum,  where  the  latter 
has  been  called  for,  but  found  in  adequate  to  complete  the  cure.  If, 
on  the  other  hand,  the  uvula  participates  chiefly  in  the  pharyngeal 
inflammation,  Nux  v.,  Coffea,  Bella.,  Merc,  Sulphur  or  Calcarea  are,  in 
addition  to  Aconitum,  the  more  important  remedies. 

When  a  spasmodic,  almost  suffocating,  constriction  of  the  gullet 
takes  place  in  pharyngitis,  and  Belladonna,  Mercurms,  or  Lachesis  fail, 
Calcarea  c.  often  affords  rapid  relief. 


INFLAMMATION  OF  THE  (ESOPHAGUS.     (ESOPHAGITIS. 

Inflammation  of  the  gullet  is  more  frequently  met  with  as  a 
symptomatic  disease.  It  is,  accordingly,  sometimes  encountered  in 
strictures,  measles,  smallpox,  and  in  the  case  of  tumours  in  the 
neighbourhood  of  the  oesophagus. 

It  does,  however,  occasionally  occur  in  an  idiopathic  form,  either 
in  consequence  of  mechanical  or  chemical  irritants,  or  otherwise. 
The  disease  is  indicated  by  the  following  symptoms  :  a  sense  of 
burning  heat  is  experienced  in  the  oesophagus,  either  high  or  low  in 
the  tube,  according  to  the  seat  of  the  disease,  with  painful  and  difficult 
deglutition.  The  patient  can  almost  always  point  out  the  locality 
of  these,  generally  circumscribed,  sensations ;  and  consequently  refers 
them  either  to  the  neck  or  to  the  back,  between  the  shoulders^  and 
under  the  sternum. 

In  the  treatment  of  symptomatic  oesophagitis,  our  attention  must  be 
directed  to  the  removal  of  the  exciting  cause,  when  this  is  practicable. 
In  the  idiopathic  form  again,  we  must  be  guided,  in  the  selection  of 
our  remedies,  by  the  law  similia  similibus.  Amongst  the  medicines 
wThich  are  capable  of  producing  symptoms,  analogous  to  those  which 
characterize  the  disease  :  Belladonna,  Hyoscyarmis,  Cantharis,  Arsenicum, 
Mercurhis,  Arnica,  Carlo  v.,  etc.,  are  the  most  important.     In   some 


112  DIGESTIVE  SYSTEM. 

instances  it  may  be  found  requisite  to  commence  with  Aconitum,  but 
generally  speakings  the  attendant  fever  of  the  phlogistic  character,  will 
find  a  sufficient  antidote  in  Belladonna,  which  remedy  is,  moreover, 
better  adapted  to  the  collective  features  of  the  complaint.  Hyoscya- 
mus  frequently  succeeds  in  removing  any  signs  of  spasmodic  con- 
traction in  the  gullet  when  Belladonna  is  insufficient  to  remove  them  ; 
but  when  the  burning  heat  continues  unabated,  and  deglutition  is  still 
performed  with  great  pain,  Cantharis  should  be  resorted  to.  Mer- 
curius  is  especially  useful  when  symptoms  of  incipient  suppuration 
make  their  appearance ;  Arsenicum  when  "great  prostration  of 
strength  sets  in,  either  in  the  course  of  the  complaint,  or  at  the  com- 
mencement of  the  attack,  accompanied  by  intense  thirst  and  sleep- 
lessness. Should  only  partial  relief  result  from  Arsenicum,  Carbo  v. 
may  be  had  recourse  to.  In  other  instances  Veratrum  may  be 
required.  In  cases  arising  from  mechanical  lesion,  the  early  employ- 
ment of  Arnica  has  been  favorably  spoken  of.  The  remedy  selected 
in  any  case  will  rarely  require  to  be  repeated  earlier  than  six  to  eight 
hours  after  the  first  dose :  and  subsequently  at  Ignger  intervals,  if  the 
symptoms  are  found  to  yield.  When  the  symptoms  become  more 
unfavorable  after  an  interval  of  twenty-four  hours  from  the  taking  of 
the  first  dose,  another  medicament  must  be  prescribed. 

MUMPS. 

Parotitis,  Angina  Parotidea. 

Diagnosis.  Inflammation  with  swelling  of  the  parotid  and  sub- 
maxillary glands,  sometimes  running  high,  and  extending  to  the 
throat  and  tonsils,  with  danger  of  suffocation. 

This  complaint  generally  affects  individuals  under  the  age  of 
puberty,  and  frequently  declares  itself  as  an  epidemy,  during  the 
prevalence  of  cold  damp  weather.  When  properly  treated,  it  is 
rarely  dangerous,  but  particularly  apt,  if  not  carefully  attended  to,  to 
attack  some  more  important  organs  by  metastasis, — for  example, 
suddenly  disappearing  in  the  glands  mentioned,  and  painfully  affect- 
ing those  of  the  breast,  &c. :  these  metastases  may  occur  either  from 
fresh  exposure  to  cold,  or  from  the  application  of  saturnine,  campho- 
rated or  other  repellent  lotions. 

This  complaint  is  generally  ushered  in  by  the  ordinary  symptoms 
of  mild  catarrhal  fever,  after  which  the  swelling  declares  itself,  some- 
times interfering  with  the  motion  of  the  jaw,  and,  by  the  extension 


MUMPS.  113 

of  inflammation  to  the  tonsils,  affecting  the  hearing  and  impeding 
inspiration. 

Therapeutics.  Mercurius  may  almost  be  termed  the  specific 
remedy  in  the  idiopathic  form  of  this  disease. 

When  Mercurius  does  not  promise  to  produce  much  benefit,  after  a 
dose  or  two  (which  is  frequently  the  case  in  those  who  have  been 
formerly  salivated  by  Mercury  under  allopathic  treatment),  Carlo  vege- 
talilis  should  be  administered,  particularly  if  the  affection  be  accom- 
panied by  a  considerable  degree  of  hoarseness. 

When,  through  any  neglect  in  taking  proper  precautions  against 
cold,  a  metastasis  to  the  brain  has  taken  place,  characterized  by  a 
sudden  disappearance  of  the  swelling  of  the  glands,  followed  by  a  loss 
of  consciousness,  delirium,  or  other  symptoms  of  Inflammation  of  the 
Brain  (which  see),  we  should  have  immediate  recourse  to  Belladonna, 
Hyoscyamus,  or  Cuprum  aceticum,  etc. 

Belladonna,  is  moreover  indicated  when  the  swelling  is  red  and 
presents  an  erysipelatous  appearance.  If  the  inflammatory  symp- 
toms do  not  readily  yield  to  Belladonna,  Hyoscyamus  may  be  given ; 
and  after  the  latter  Rhus,  Bryonia,  Sulph.,  Arsenicum,  Lachesis,  or  Silicea, 
according  to  circumstances. 

Should,  however,  the  disease  in  the  same  manner  be  transferred  to 
the  stomach,  Carbo  vegetabilis  is  usually  a  most  useful  remedy; 
when  it  fails  to  afford  all  the  desired  relief,  Cocculms  may  be  had 
recourse  to. 

When  the  glandular  enlargement  occurs  as  a  sequela  of  any  of 
the  following  disorders,  the  remedies  thereafter  mentioned  will  ge- 
nerally be  found  the  best  adapted  to  effect  resolution  when  prac- 
ticable :  of  Typhus,  Bella,  Stclph.,  Calc.  c. ;  of  Measles,  Arnica,  Bry- 
onia, Rhus;  of  Scarlatina,  Hepar  s.,  Bulc,  Baryta,  Bella.,  Rims,  and 
Arsenicum. — Carl,  v.,  Silicea,  Lycopodium,  Hepar,  Conium,  Chamomilla, 
Aurum,  Sulph.,  and  Calc,  in  general  cases,  according  to  circum- 
stances. 

During  the  treatment  of  this  affection,  every  care  should  be  taken 
that  the  patient  be  kept  moderately  warm,  exposed  neither  to  damp, 
cold  draughts,  or  vicissitudes  of  temperature. 


114  DIGESTIVE    SYSTEM. 


INDIGESTION,  or  DYSPEPSIA. 

This  disease  appears  in  so  many  different  phases,  that  we  shall 
simply  content  ourselves  with  an  enumeration  of  some  of  the  principal 
exciting  causes,  and  refer  to  the  symptoms  given  under  the  different 
medicaments  for  its  Diagnosis.  The  following  may  be  considered 
the  chief  of  these  :-- 

Irregularities  in  diet — such  as  an  over-indulgence  in  the  pleasures 
of  the  table,  partaking  of  rich  and  indigestible  food  and  stimulating 
soups,  excessive  use  of  wine,  malt  and  spirituous  liquors,  strong  tea, 
coffee,  and  other  stimulants;  imperfect  mastication  of  food;  irregu- 
larity of,  or  too  long  fasting  between  meals ;  indolent  or  sedentary 
habits ;  exhaustion  from  intense  study ;  keeping  late  hours ;  mental 
emotions,  &c. 

The  foundation  of  this  disorder  is  frequently  laid  in  early  life,  by 
the  baneful  practice  of  administering  large  doses  of  calomel  and  other 
deleterious  drugs,  for  the  most  trivial  as  well  as  the  more  serious 
derangements  of  the  chylopoietic  viscera  ;  and  the  evil  is  perpetuated 
in  more  mature  age,  by  a  continuance  of  the  same  absurd  and  injurious 
system. 

Therapeutics.  The  principal  homoeopathic  remedies  for  the 
treatment  of  this  affection  are :  Nux  vomica,  Sulphur,  Pulsatilla,  Bryonia, 
Chamomilla,  Ipecacuanha,  Ignatia,  Carlo  vegetabilis,  Cinchona,  and  Hepar 
sulphuris. 

An  abuse  of  coffee  and  tea  is  a  frequent  cause  of  many  descriptions 
of  sick  and  nervous  headache,  attended  with  excitement  and  dys- 
peptic symptoms,  which  will  frequently  disappear  of  themselves  on 
the  disuse  of  these  beverages.  If,  however,  this  result  should  not 
speedily  ensue,  for  the  effects  of  coffee  we  may  have  recourse  to  Nux 
vomica,  Pulsatilla,  Chamomilla,  or  Ignatia,  according  to  the  character 
of  the  symptoms.  Against  the  effects  of  tea,  Cinchona  will  generally 
be  found  an  antidote,  followed  by  Ferrum  if  necessary ;  in  other  cases, 
Ipecacuanha,  Thuja,  or  Belgium  will  be  found  useful. 

Nux  vomica  covers  the  following  symptoms,  either  when  they 
have  arisen  in  consequence  of  sedentary  habits,  excessive  mental  ex- 
ertion, or  long  watching,  or  from  the  abuse  of  wine  or  ardent  spirits : 
the  head  confused  with  occasionally  a  feeling  as  if  resulting  from  intoxi- 
cation, and  giddiness  with  sensation  of  turning  and  wavering  of  the 


INDIGESTION  OR  DYSPEPSIA.  115 

brain;  headache,  unfitting  for,  and  increased  by,  mental  exertion; 
tearing,  drawing,  or  jerking  pains  in  the  head  or  cheeks,  and  pulsative 
pains,  and  a  sensation  as  if  a  nail  were  driven  into  the  brain  ;  congestion 
of  blood  to  the  head,  with  humming  in  the  ears.  The  headaches  are 
often  deeply  seated  in  the  brain,  or  in  the  back  part  of  the  head,  fre- 
quently confined  to  one  side,  or  over  the  eyes,  and  at  the  root  of  the 
nose,  coming  on  chiefly  in  the  morning,  after  a  meal,  or  in  the  open 
air.  Yellowness  of  the  lower  part  of  the  white  of  the  eyes,  with  a 
mist  before  them ;  a  sensation  as  if  one  were  about  to  fall ;  sparks,  or 
small  gray  or  black  spots  before  the  eyes ;  short-sightedness ;  pale  or 
yellowish  colour,  or  redness  of  the  face,  especially  about  the  mouth  and 
nose  ;  frequent  headache,  and  impaired  powers  of  digestion,  with  insi- 
pidity of  food ;  foul,  fary,  white  or  yellowish  tongue ;  thirst,  with  water- 
brash,  particularly  after  acids  or  rich  food ;  accumulation  of  slimy 
mucus,  or  water  in  the  mouth ;  metallic,  salt,  sulphureous,  herbaceous, 
mucous,  bitter,  sour,  sweetish,  or  putrid  taste,  chiefly  in  the  morning,  or 
after  meals;  bitter  eructations,  or  continued  nausea,  especially  after 
meals,  or  even  after  drinking  cold  water  or  milk,- — or  on  going  into  the 
open  air  after  a  meal,  or  after  partaking  of  acids ;  heartburn,  hiccough^ 
acidity,  flatulence,  frequent  and  violent  vomiting  of  food,  mucus,  or 
bile,  or  ineffectual  efforts  to  vomit ;  distension  and  fulness  in  the  epi- 
gastrium, with  excessive  tenderness  to  the  touch;  a  feeling  of  tight- 
ness of  the  clothes  round  the  upper  part  of  the  waist ;  cramps  in  the 
stomach ;  constipation ;  reddish  urine,  with  brick-dust  coloured  sedi- 
ment;  sleep,  unrefreshing  and  restless,  either  from  suffering  or  other- 
wise, with  disagreeable  dreams,  and  drowsiness  in  the  morning. 

One  of  the  most  distinctive  indications  for  the  employment  of  this 
remedy  in  preference  to  the  next  mentioned,  is  the  temperament, 
which  is  restless,  irritable,  lively,  arid  choleric.  A  disposition  to 
Hemorrhoids  is  also  a  good  indication  \ 

For  Pulsatilla  we  have  nearly  the  same  range  of  dyspeptic 
symptoms,  with  the  distinction  of  its  being  particularly  adapted  for 
females^  children,  individuals  with  light  hair,  and  a  marked  predispo- 
sition to  purulent  exudations  at  the  edge  of  the  eyelids,  or  to  styes, 
and  for  mild  or  phlegmatic  dispositions.  Amongst  its  characteristic 
indications,  we  more  frequently  find a  want  of  thirst  than  thirst;  a  re- 
pugnance to  fat  and  rich  meat,  and  suffering,  after  taking  pork  or  pastry  ; 
general  chilliness,  or  great  difficulty  in  keeping  the  hands  and  feet 
sufficiently  warm ;  deficient  sense  of  smell,  sometimes  accompanied 
by  increased  secretion  from  the  nostrils ;  frequent  and  loose,  or  diffi- 
cult and  loose,  or  sluggish  evacuations  ;  hypochondriasis,  hysteria. 


116  DIGESTIVE  SYSTEM. 

Bryonia  :  Headache,  burning  or  expansive,  particularly  after 
drinking,  attended  with  bewilderment  of  the  head  and  vertigo; 
tongue  dry  and  red,  or  covered  with  a  coated,  whitish-yellow  fur; 
sometimes  the  aversion  to  food  is  so  strong,  that  the  patient  cannot 
bear  the  smell  of  it;  loss  of  appetite,  alternately  with  unnatural 
hunger ;  craving  for  acid  drinks ;  great  thirst ;  insipid  clammy, 
putrid,  sweetish,  or  bitter  taste  in  the  mouth ;  acidity  and  flatu- 
lence, or  bitter  risings  after  every  meal,  or  after  partaking  of  milk. 
Hiccough,  nausea,  water-brash,  vomiting  of  food  or  bile,  particularly 
at  night ;  tenderness  of  epigastrium  to  the  touch,  sensation  of  swell- 
ing in  the  pit  of  the  stomach ;  especially  after  a  meal,  or  on  walking ; 
sensation  of  burning  in  the  pit  of  the  stomach,  especially  when  moving. 
Constipation ;  temper  restless,  irascible,  and  obstinate ;  also  when 
want  of  exercise  or  anger  are  frequently  the  exciting  causes  of  the 
derangement,  or  the  means  of  aggravating  the  symptoms.  The  dys- 
pepsia is  more  apt  to  manifest  itself  in  summer,  or  in  damp  weather, 
is  frequently  accompanied  with  chilliness.  {Rhus  is  often  of  service 
when  Bryonia  produces  little  or  no  improvement.) 

Chamomilla  :  Headache,  with  sometimes  semi-lateral  pulling, 
shooting,  and  beating  in  the  head ;  fulness,  giddiness,  and  staggering  in 
the  morning  when  getting  up,  oppressive  heaviness,  vertigo,  and  sen- 
sation of  a  bruise ;  headache,  felt  sometimes  during  sleep,  with  obscura- 
tion of  the  eyes  ;  and  yellow  colour  of  the  white;  tongue  dry  and 
cracked,  with  a  thick  and  yellowish  coating ;  mouth  dry,  with  the 
occasional  presence  of  frothy  mucus  ;  excessive  thirst  and  desire  for  cold 
drink  ;  bitter  taste  in  the  mouth  and  of  food;  want  of  appetite  and  dislike 
to  food.  Acidity  or  sour  risings,  regurgitation  of  food,  nausea,  vo- 
miting of  food,  mucus,  and  bile  j  acute,  oppressive  pain  in  the  region  of 
the  heart,  distension  at  the  epigastrium,  pit  of  the  stomach,  and  upper 
part  of  the  waist,  chiefly  after  eating,  and  at  night  attended  with  in- 
quietude and  terror ;  burning  pain  in  the  pit  of  the  stomach,  uneasi- 
ness and  feeling  of  sinking  in  the  stomach;  cramps  in  the  stomach, 
especially  when  traceable  to  coffee ;  sometimes  constipation,  but  ge- 
nerally relaxation  of  the  bowels.  This  remedy  is  valuable  in  indigestion, 
brought  on  by  aft  of  passion,  or  suppressed  perspiration. 

Ipecacuanha:  Face  pale  and  yellowish;  tongue  sometimes 
clean,  at  others  coated  white  or  yellow ;  aversion  to  food,  and  parti- 
cularly to  fat,  or  to  rich  indigestible  food,  such  as  pork,  pastry,  &c, 
or  dyspeptic  suffering  on  partaking  of  such ;  vomiting  of  food,  drink, 
mucus,  or  bile,  sometimes  after  a  meal ;  retching  or  easy  vomiting, 


INDIGESTION  Oil  DYSPEPSIA.  117 

generally  attended  with  coldness  of  the  face  and  extremities,  and 
sometimes  alternating  with  watery  diarrhoea ;  feeling  of  emptiness, 
and  flaccidity,  and  sensation  of  sinking  at  the  stomach.  Headaches, 
attended  with  nausea  and  vomiting ;  shooting  pains,  with  heaviness 
and  painful  pressure  on  the  forehead.  Both  this  medicine  and  Pulsa- 
tilla are  valuable  remedies  for  indigestion  in  children,  arising  from 
imperfect  mastication  or  improper  food. 

Ignatia  may  sometimes  follow  Pulsatilla  to  complete  a  cure,  or 
even  supersede  it,  when  there  is  a  tendency  to  constipation,  and  par- 
ticularly in  persons  who  are  subject  to  sudden  alternations  from  high 
to  low  spirits,  or  vice  versa  ;  it  is  especially  indicated  when  grief  has 
been  the  inducing  cause  of  dyspepsia,  hysteria,  and  hypochondriasis. 
In  chronic  cases,  these  remedies,  as  indicated,  are  chiefly  valuable 
in  the  commencement  of  treatment,  and  may  require  to  be  followed 
by  ether  remedies  to  complete  the  cure.  Sulphur,  or  Tincture 
of  Sulphur,  will  be  found  especially  useful  after  Pulsatilla  and  Nux 
vomica,  in  removing  any  symptoms  that  may  remain.  Hepar  sul- 
phuris  is  a  valuable  remedy  in  some  cases  of  dyspepsia,  but  particu- 
larly when  the  patient  has  previously  been  taking  blue-pill,  or  any 
other  mercurial  preparation  for  a  considerable  time. 

Acidum  sulphuricum  :  Dyspepsia  arising  from  excessive  study, 
drinking,  or  other  excesses,  with  the  following  symptoms :  great 
weakness  of  digestion ;  acrid,  foul,  putrid  taste  in  the  mouth,  dry 
tongue,  burning  and  smarting  sensation  in  the  throat,  sometimes  at- 
tended  with  pricking,  especially  at  night,  and  so  troublesome  as  to 
prevent  sleep  (Pyrosis) ;  offensive  breath,  especially  in  the  morning 
(aphtha) ;  renewal  or  aggravation  of  the  symptoms  from  drinking  cold 
water;  all  cold  drinks  appear  to  disagree,  unless  a  little  brandy  or 
some  other  ardent  spirit  is  added  to  them;  accumulation  of  water; 
saliva  in  the  mouth  ;  flatulence  ;  bitter  risings ;  vomiting  of  a  limpid 
fluid,  or  of  food.  It  may  be  here  remarked  that,  in  cases  where  Nux 
vomica  seems  indicated,  but  the  disposition  is  of  a  morose  or  hypo- 
chondriacal turn,  Cocculus  may  be  substituted  with  effect;  when, 
however,  the  indications  for  temperament  are  not  sufficiently  distinc- 
tive, Coccculus,  Nux  vomica,  and  Pulsatilla  may  be  advantageously 
alternated.  Finally,  Carbo  vegetabilis  will  frequently  remove  an\ 
symptoms  that  may  remain  after  Nux  vomica. 

Cinchona  is  a  valuable  auxiliary  in  the  treatment  of  this  derange- 
ment, when  there  is  impaired  appetite  with  great  weakness  of  diges- 
tion, which  is  more  liable  to  be  experienced  on  partaking  of  supper ; 


118  DIGESTIVE  SYSTEM. 

flatulence;  bitter  taste;  languor;  hypochondriacal  disposition;  and 
particularly  when  we  can  trace  the  affection  to  debilitating  losses  of 
fluids,  such  as  the  abstraction  or  loss  of  blood,  too  great  a  drain  upon 
the  resources  during  lactation,  prolonged  use  of  aperient  medicines, 
&c. ;  also  in  disorders  arising  from  the  abuse  of  tea,  or  from  a  resi- 
dence in  impure  atmospheres,  especially  such  as  are  overloaded  with 
the  exhalations  of  decayed  vegetable  matter. 

Natrum  c.  may  follow  Nux  v.,  Bryonia,  or  Cinchona,  with  advan- 
tage, when  a  degree  of  weakness  of  digestion  remains. 

In  chronic  cases  this  disorder  sometimes  takes  a  critical  turn,  when 
vomiting  becomes  excessive,  everything  taken  is  returned  from  the 
stomach,  the  skin  is  hot  and  dry,  the  patient  becomes  emaciated, 
and  the  countenance  cadaverous.  In  serious  cases  of  this  de- 
scription Arsenicum  and  Lachesis  will  tend  much  to  invigorate  the 
sinking  energies,  and  even,— with  the  occasional  aid  of  Bycopodium, 
Veratrum,  Baryta,  Phosphorus,  Conium,  or  some  one  or  other  of  the 
above-mentioned  remedies,  where  necessary, — eventually  effect  a  cure, 
provided  the  inroads  of  organic  lesions  have  not  already  placed  the 
unfortunate  sufferer  beyond  the  reach  of  art.  (See  also  Chronic 
inflammation  of  the  stomach.  Cardialgia.  Want  of  appetite.  Flatulency, 
and  Derangement  of  the  stomach.) 

The  following  are  frequent  additional  pathognomonic  signs  of  de- 
ranged digestion,  and  may,  when  taken  in  conjunction  with  others 
already  described,  facilitate  the  selection  of  the  remedies  placed  in 
juxtaposition  : 

Tongue,  swollen  :  Bach.,  Merc,  Ars.,  Bella.,  Kali,  Hell. ;  Calc,  China, 
Silic,  Big.,  Plumb.,  Anac,  Blect.,  Con.,  Thuj.,  Stram.,  Sec. 

Tongue  with  a  white  fur:  Puis.,  Sulph.,  Merc.  Tart.,  Am. ;—N%ix  v, 
Bry.,  Ant.  c,  Calc,  Sep.  Bism.,  Ign.,  Ipecac,  Big.,  Baph.,  &c. 

Tongue,  with  a  yellow  fur :  Nux,  Puis.,  China,  Ipecac,  Plumb. ; — ■ 
Cham.,  Bry.,  Cocc,  Veratr.,  Bella.,  Alum.,  Coloc,  China,  Sulph.,  Blect.,  he. 

Tongue,  with  a  slimy  fur :  Puis.,  Sulph.,  Merc,  Bella.,  Acid,  phosph.; 
Bach.,  Chin.,  Sulph.,  Verb.,  Nux  mosch.,  Cupr. 

Tongue,  with  a  brownish  fur :  Sulph.,  Bella.,  Phosph.,  Sil.,  Verb., 
Hyos.,  Sabin.,  &c. 

Tongue,  with  &  grayish  fur:  Tart.,  Amb.,  Cupr.  acet.,  Puis. 

Tongue  with  a  grayish-brown  fur  (whity-brown) :  Ambra,Puls.,  Nux, 
Bry on.,  Ipecac,  &c. 

Tongue  with  a  greenish  fur:  Phmibum. 

—        with  a  blackish  fur  :  Merc,  Chin.,  Phosph.,  Bach. 


INDIGESTION  OR  DYSPEPSIA.  119 

Tongue  :  with  a  dirty  fur:  Bry.,  Bye,  Glean.,  Anthraps. 

—  with  a  thick  fur :  Puts*,  Merc,  Bella. ;  —Nux  v.,  Cham.,  Sulph. 

—  vivid  red  at  the  margins  :  Bella.,  Nux  v. 

—  with  vivid  redness  of  the  papillae  :  Bella.,  Ammon. 

—  red  at  the  tip :  Elect. 

—  vivid  redness  of  the  whole   tongue:   Bella.,  Bry.,  Back., 
Hyos.,  Nux  v.,  Cham.,  Ban.  sc,  Rhus,  Ars.,  Sulph.,  Veratr.,  &c. 

Tongue  dry:  Nux  v.,  Sulph.,  Veratr.,  Bella.,  Merc,  Nux  mosch., 
Cham.  ;^—Bach.,  Bry.,  Rhus,  Sep.,  Carl,  a.,  Baryt.  m.,  Plumb.,  Sec. 

Tongue  glazed,  shining:  Bachesis ;;— - Bella.,  Sulph.,  Bry.,  Ars,, 
Veratr.,  Sec. 

Tongue  with  elevated papilla :  Elect.,  Crocus,  Oleand.,  Bella.,  &c. 

—  cr ached,  clefted,  or  split  into  furrows :  Nux,  Puis.,  Bach., 
Bella.,  China,  Plumb.,  Cham.,  Veratr.,  Ars.,  Baryt.,  Cic,  Ran.  sc,  Sulph. 

Tongue  tremulous :  Bella.,  Ars.,  Bry.,  Merc,  Big.,  Bulc,  Nux,  Coec, 
Ign.,  Veratr.,  Bach.,  Rhus. 

Saliva/ acrid:  Merc,  Bulc,  Veratr. 

—  alkaline :   Galv. 

—  bitter :   Ars.,  Sulph.,  Thuja. 

—  brownish:  Bism. 

—  cool :  Asar. 

Saliva,  frothy :  Bry.,  Plumb.,  Ran.  sc,  Sulph.,  Spig.,  Eng,,  Berb., 
Canth.,  Phell.,  Sab. 
Saliva,  hot :  Baph. 

—  of  a  mawkish,  insipid  taste  :  Bry.,  Puis.,  Ipec,  Ign.,  Nux  v., 
Cham.,  Bye,  China,  Caps.,  Sulph.,  Sec, 

Saliva,  of  a  metallic  taste :  Bism.,  Ran.  hi,  Zinc,  Cocc,Hepar,  Agn., 
Cup.,  Natr.  m.,  Sec. 

Saliva,  of  an  offensive,  fetid  smell :  Merc,  Big.,  Hydrarg.  subm. 

—  of  a  reddish  colour :  Sabin. 

—  of  a  saline  taste :    Sulph.,  Sep.,  Veratr.,  Euph.,  Merc  sol., 
Hyosc,  Phosph.,  Verb. 

Saliva,  of  a  sour  taste :  Ign.,  Sulph.,  Calc  ;  Gale  phosph.,  Galv.,  Alum., 
Bad.,  Natr.  s.,  &c. 

Saliva,  of  a  sourish-sweet  taste :  Zinc  oxyd* 

—  of  a  sweetish  taste:  Puis.,  Plumb.,   Big.,   Sabad. ;- — Alum., 
Gran.,  Sec. 

Saliva,  thick  :  Nux  mosch.,  Bism.,  Bella.,  Sec. 

—  thin,  serous  :    Puis.,  Magn.  m.,  Kreos.,  Mags,  ans.,   Galv., 
Bobel.,  Asar.,  Thea.,  Sec. 


120  DIGESTIVE  SYSTEM. 

Saliva,  tenacious:  Puis.,  Nux,  Lack.,  Phosph.,  Staph.,  Ars., 
Zinc,  Sec. 

Saliva,  of  white  colour:  Ran.  b.,  01.  an.,  Sabin.,  Spig.,  &c. 

Gums,  bleeding  of  the:  Nux  v.,  Carlo  v.,  Stilph.,  Natr.  m.,Acid.  nitr., 
Mere.,  Phosph.,  Sil.,  Staph.;  Cale.,  Graph.,  Baryt.  c.,  Am.  c,  Alum., 
Magn.  m.,  Acid,  sulph.,  Sep.,  Kali  c.,  etc. 

Gums,  redness  of  the:  Card,  v.,  Kreos.,  Nux  v.,  Mere.,  Kali, 
Natr.  m.,  Phell.,  Ran.  sc,  Hep.,  Aur. 

Gums,  spongy :  Nux  v.,  Caps.,  Natr.  m.,  Carl.  a.  et  v.,  Bry.,  Ars., 
Merc.,  Staph.,  Sulph.,  Kreos.,  China. 

Gums,  swollen  :  Nux  v.,  Natr.  m.,  Sulph.,  Merc,  Caps.,  Staph.,  Sep., 
Baryt.,  Am.  m.  et  c,  China.,  Ac  nitr.,  Lach.,  Lye,  etc. 

Gums,  tender  :  Nux  v.,  Lach.,  Natr.  m.,  Caps.  ;  Staph.,  Cole,  Agar., 
Amb.,  Acid,  nitr.,  Carbo  v.,  Hepar. 

Gums,  fetid :  Carb.  a.  et  v. ;  Acid,  n.,  Staph.,  Hepar,  China,  Natr.  m., 
Merc,  Graph. 

Gums,  shrinking,  or  separation  of  the  gums  from  the  teeth:  Carb.  v., 
Merc,  Sulph.,  Par.,  Cist. 

Gums,  paleness  of  the :  Staph.,  Phtmb.,  Acid,  nitr.,  Zinc,  Oleand., 
Merc 

Teeth,  discoloration,  aching,  decay  of  the :  Nux  v.,  Puis.,  Bryon., 
Cham.,  Merc,  Staph.,  Lach.,  China,  Sulph.,  Calc,  Plumb.,  Ars.,  Natr,, 
Veratr.,  etc. 

Lips,  vivid  redness  and  spongy  state  of  the  :  Nux  v.,  Bry.,  Carbo 
v.  et  a.,  Baryt.  c,  Bella.,  Hep.,  Lach.,  Caps.,  Merc,  Sil.,  Staph.,  Sulph., 
Alum.,  China,  Spig.,  etc. 

Lips,  blanched,  yellowish,  and  somewhat  indurated  :  Nux  v.,  Sulph., 
Calc,  Lycop.,  Ars.,  Lach.,  Can.,  Clem.,  Silic,  Aur.,  Natr.,  Alum.,  Spig. 

Throat,  sensation  of  excoriation,  roughness,  and  dryness :  Nux 
v.,  Lach.,  Carb.  v.  et  a.,  Sulph.,  Puis.,  Calc,  Merc,  Cham.,  Lgn.,  B?yon., 
Hep.,  Teuc,  Scilla,  Staph.,  etc. 

Throat,  redness  of  the,  with  swelling  of  the  uvula,  etc. :  Nux  v., 
Bryon.,  Ign.,  Cham.,  Caps.,  Puis.,  Lach.,  Sulph.,  Calc,  Baryt.,  China, 
Sep.,  Veratr.,  Cocc. 

Eyes,  bleared  and  suffused  :  Nux  v.,  Puis.,  Natr.  m.,  Staph.,  Graph., 
Cham.,  Calc  Lye,  Bism.,  Ant.,  Agar.,  etc. 

Eyes,  muscae  volitantes  :  Nux  v.,  Puis.,  China,  Lye,  Sulph.,  Sep., 
Agar.,  Merc,  Cocc,  etc. 

Eyes,  appearance  of  vapour   or  mist   before   the :    Puis.,  Plumb., 


INDIGESTION  OR  DYSPEPSIA.  121 

Sulph.,    Calc,-  Merc,-  Bell.,   Cyc,   Dig.,   Alum.,   Ign.,   JEnon.,  Am.  m., 
Ambr.,  etc. 

Eyes,  sparks,  flashes  of  flame  :  Nux  v.,  Lack.,  Lycop.,  Dig*,  Staph., 
Calc.  c,  Merc,  Natr.  m.,  etc. 

Eyelids,  thickened,  gorged,  and  inflamed  at  the  margins :  Nux  v., 
Puis.,  Cham.,  Merc,  Hep.,  Bry.,  Sulph.,  Buph.,  Veratr.,  Lye,  Ars., 
Baryt.  c,  Staph.,  Sep.,  Natr.  m.,  etc. 

Nose,  dryness  of  the  nostrils:  Sulph.,  Calc,  Sep.,  Graph.;  Bryon., 
Bella.,  Ign.,  Mag.  m.,  Phosph.,  Rhus,  Kali,  Sil.,  etc. 
,  Nose,  excessive  secretion  from  the  :  Ars.,  Bach.,  Ign.,  Lye,  Puis., 
Ipecac,  Hep.,  Bry.,  Nux  v.,  Sulph.;  Cocc,  Carbo  v.,, Alum.,  Ammon.  c, 
Calc,  Merc,  etc. 

Nose,  itching  in  the  nostrils:  Nux  v.,  Puis.,  Carl,  v.,  Ign.,  Am.  c, 
Agar.,  Spig.,  Teuc,  Cm.,  Sabad.,  Sulph.,  Calc,  etc. 

Nose,  imaginary  smells :  Nux  v.,  Puis.,  Sulph.,  Calc,  Ars.,  Graph., 
Alum.,  etc. 

Nose,  deficient  sense  of  smell:  Puis.,  Sep.,  Sulph.,  Calc,  Alum., 
Ipecac,  Natr.  m. 

Nose,  great  acuteness  of  smell :  Sulph.,  Lye,  Hep.,  Colch.,  Nux  v., 
Cham.,  Calc,  Kali  c,  etc. 

Ears,  dryness  of  the  (eustachian  tube)  :  Graph.,  Lach.,  Ac  nitr., 
Petr.,  Carb.  v.,  Ars.,  etc. 

Ears,  acuteness  of  hearing :  Lach.,  Ars.^  Lye,  Bry.,  Cham.,  Veratr., 
Sep.,  Plumb.,  Magn.,  Chin.,  Sil.,  etc. 

Ears,  dullness  of  hearing  :  Nux,  Puis.,  Sulph.,  Calc,  Carb.  v.,  Lach., 

Bell.,  Ars.,  Veratr.,  Ant.,  Anac,  Asar.,  Kal.,  Hep.,  Staph.,  Bry.,  Lye,  etc. 

Head,  frontal  headache  :  Nux  v.,  Puis.,  Bry.,  Ign.,  Natr.  m.,  Chin., 

Plumb.,  Sep.,  Natr.  m.,  Ant.,  Staph.,  Plat.,  Sulph.,  etc.      (See  also  Art. 

Cephalalgia.) 

Face,  flushes  of  heat  in  the :  Lye,  Graph.,  Cocc,  Kali  e,  Alum., 
Ambr.,  Kali  m.,  etc. 

Face,  pimples  on  the:  Nux  v.,  Carb.  v.  et  a.,  Lach.,  Sulph.,  Sep., 
Acid,  nitr.,  Acid,  m.,  Ambr.,  Alum.,  Hepar.,  etc. 

Face,  eruptions  various,  on  the  :  Nux  v.,  Rhus,  Sulph.,  Lach.,  Lye, 
Graph.,  Merc,Sep.,  Calc,  Am.  c,  Big.,  etc.,  etc, 

Face  (earthy  colour  of  the,  and  of  the  skin  in  general) :  Nux  v., 
Ars.,  Lach.,  Lye,  Ign.,  Ipecac,  China,  Natr.  m.,  Merc,  Bry.,  Silic 

Face,  pale  :  Nux  v.,  Puis.,  Carb.  v.,  Lye,  Sulph.,  Veratr.,  Magn.  m., 
Plumb.,  China,  Sep.,  Calc,  Anac,  Big.,  Graph.,  Ign.,  Am.  c,  Ambr., 
Olean.,  Merc,  etc. 


122  DIGESTIVE  SYSTEM. 

Face,  red:  Bry,,  Nux,  Cocc,  Lye,  Puis.,  Plat.,  Hep.,  Ign.,  Sulph., 
Calc,  Lack.,  etc. 

Face,  yellowish  :  Nux  v.,  Puis. ,  Lye. ,  Natr.  m.,  Magn.  m.,  Card,  v., 
Graph.,  Calc,  Merc,  Pry.,  Sulph.,  Sep.,  etc. 

Skin,  like  parchment:  Arsenicum;  Lye,  Graph.,  China,  Sep., 
Amir.,  Am.  c,  Calc,  Kali,  Natr.  c. 

Giddiness:  Nux,  Puis.,  Plumb.,  Natr.  m.,  Op.,  Pry.,  Calc,  Kali, 
Natr.m.,  Lach.,  etc.     (See  also  Art.  Vertigo?) 

Head,  confusion  in  the :  Pry.,  Nux,  Puis.,  Calc,  Sepia,  Plumb., 
Op.,  Rhod.,  Zinc,  Natr.,  Plat.,  Staph.,  Caps.,  Graph.,  Magn.  m.,  Calc 
ph.,  Nux  mosch.,  Rhus,  Ambr.,  Am.,  Sec. 

Upper  Extremities,  tremulousness  of  the:  Bry.,  Rhus,  Veratr,, 
Phosph.,  Silic,  &c. 

Upper  Extremities,  numbness,  (torpor);  Nux  v.,  Lye,  Cham., 
Croc,  Graph.,  Kali,  Sep.,  Sulph,  Verat.,  Silic,  Magn.  m.,  Ambr.,  Baryta, 
Sec. 

Upper  Extremities,/^^*  or  spasmodic  movements  of  the : 
Puis.,  China,  Ign.,  Lye,  Pry.,  Cham.,  Plumb.,  Cic,  Sabad.,  Bella.,  Op., 
&c. 

Hands,  tremulousness  of  the:  Lach.,  Stilph.,  Calc;  Phosph.,  Zinc, 
Agar.,  Cocc,  Kali,  Tart.,  Rhus,  Sabad*,  Bis.,  Sec. 

Hands,  numbness  of  the  hands  and  fingers :  Nux  v.,  Lye,  Puis.,  Croc, 
Carb.  a.,  Cocc,  Phosph.,  Lye,  Veratr.,  Zinc,  Calc,  Am.e,  Baryta  c,  Sep., 
Sil.,  Natr.  m.,  Kali,  Zinc,  Cham.,  Sulph.,  Sec. 

Hands,  jerkings  or  spasmodic  movements  :  Ign.,  Lye,  Bry.,  Cham., 
Kali,  Cic,  Merc,  Phosph.,  Sulph.,  Sec, 

Upper  Extremities,  tingling,  crawling,  or  creeping  sensations  in 
the:  Nux  v.,  Puis.,  Ign.,  Caps.,  Rhod,,  Sulph.,  Am.,  Magn.,  Bella., 
Sabad.,  Mgs.,  Mags,  ans.,  Sec. 

Hands  or  Fin gers,  tingling,  Sec,  of  the:  Veratr.,  Sulph.,  Rhod., 
Nat.  m.,  Magn.,  Colch.,  Lam.,  Calc,  Sil.,  Baryta  c,  Nux,,  Bry,,  Bella., 
Cocc,  &c. 

Fingers,  paleness  and  torpor  of  the,  as  if  dead :  Sulph.,  Calc, 
Thuja.,  Chel.;  Am.  c,  Am.  m.,  Lye,  Hep.,  Phosph.,  Acid,  phosph., 
Merc,  Acid,  m.,  Acid,  n.,  Hep.,  Cic,  Sec. 

Hands  or  Fingers,  coldness  of  the :  Nux  v.,  Sulph.,  Puis,,  Cocc, 
Ambr.,  Baryta  c,  Cham.,  Natr.  m,,  Phosph.,  Petr.,  Kali,  Ac.  nit.,  Ran.  b., 
Scilla,  Tart.,  Thuja*,  Sec. 

Hands  or  Fingers,  burning  heat  in :  Nux,  Lach.,  Lye,  Carlo, 
Staph.,  Phosph.,  Sec. 


INDIGESTION  .  OB  DYSPEPSIA.  123 

Lower  Extremities,  tremulousness  of  the:  Nux,  Cocc,  Puis., 
Bry.,  Lye.)  Calc,  Card,  v.,  Cham.,  Natr.,  Sec. 

Lower  Extremities,  numbness  of  the  (torpor) :  Nux  v.,  Graph., 
Petr.,  Ant.,  Carb.  v.,  Calc,  Lye,  Alum.,  Ambr.,  Cham.,  Platina,  Plumb., 
Kali,  Olean.,  Sulph.,  Sep.,  Silie,  Verat.,  Led.,  Thuja,  &c. 

Lower  Extremities, /^rife^s  or  spasmodic  movements  of  the: 
Ign.,  Puis.,  Carb.  v.,  Op.,  Lye.,  Kali,  Ipecac.,  Scilla,  Natr.  m.,  Plat., 
Sep.,  Am.  c.,  Baryta  c.,  Silie.,  Sulph.,  Cie.,  Sec. 

Lower  Extremities,  torpor  and  paleness  (deadness) :  Graph. 
chiefly. 

Lower  Extremities,  creeping,  crawling  or  tingling  in  the:  Plat., 
Rhod.,  Sulph.,  Caps.,  Bor.,  Sabad.,  Guai.^  Raph.,  &c. 

Feet,  creeping,  Sec,  in  the :  Caps.,  Sulph.,  Sep.,  Am.,  Par.,  Zinc,  ox., 
Croc.,  Ammomum,  Calc,  Sec,  Am.  m. 

Feet,  torpor  and  paleness  (deadness)  of  the :  Calc,  Nux  v.,  Rhus, 
Liic,  Chel.,  Sec 

Feet,  feeling  of  numbness  or  torpor  in  the:  Nux,  Cocc,  Lack, 
Plumb.,  Sep.,  Kal.,  Sil.,  Oland.,  Sec. 

Feet,  feeling  of  heat  in  the :  Puis.,  Staph.,  Phosph.,  Elect.,  Petr., 
Led.,  Sec. 

Feet,  coldness  of  the:  Sulph.,  Sep.,  Sil.,  Cocc,  Carbo  a.,  Graph., 
Kali  c,  Rhod.,  Colch.,  Con.,  Big.,  Lach.,  Lye,  Plat.,  Plumb.,  Acid,  mtr., 
Natr.  m.,  Sec. 

Lower  Extremities,  tottering, staggering,  (trembling)  or  giving  way 
of  the  legs  or  knees  :  Nux  v.,  Puis.,  Bry.,  Plat.,  Lach.,  China,  Ruta, 
Sulph.,  Sec. 

Lower  Extremities,  cramps  in  the  :  Nux  v.,  Sulph.,  Calc,  Lye, 
Bry.,  Cham.,  Acid,  nitr.,  Lach.,  Carb.  v.  et.  a.,  Baryt.  c,  Am.  c,  An., 
Colocy.,  Can.,  Magn.  m.y  Sec. 

Lower  Extremities,  cramps  in  the  feet :  Nux  v.,  Sulph.,  Lye, 
Carb.,  Plumb.,  Staph.,  Silie,  Rhus,  Natr.,  Ran.,  Graph.,  Am.  c,  Pefr.,  Sec. 

Drowsiness,  tendency  to :  Puis.,  Nux  v.,  Bry.,  Ant. ;  Cocc,  Carb.  v., 
Plumb.,  Staph.,  Ign.,  Am.,  Cham.,  Coloc,  Ars.,  Veratr.,  Zinc,  Sec. 

Emaciation  :  Nux  v.,  Puis.,  Sulph.,  Calc,  Ars.,  Veratr.,  Lye, 
China,  Natr.  m.,  Cham.,  Ant.,  Am.  c; — -Cocc,  Carb.  v.,  Per.,  Plumb., 
Graph.,  Hep.,  Lach.,  Merc,  Sec. 

Obesity  :  Calc,  Sulph.,  Baryt.  c,  Ant.  c,  Ars.,  chiefly. 

Asthma:  Nux  v.,  Carb.  v.,  Caps.,  Cham.,  China,  Sulph.,  Zinc,  Ars., 
Veratr.,  chiefly. 


124  DIGESTIVE  SYSTEM. 

Moral  Symptoms.  Hypochondriasis:  Nux,  Puis.,  Sulph., 
Calc,  China,  Bella. ; — Cham.,  Cocc,  Natr.  m.,  Staph.,  Rhus,  Zinc, 
Anac. ,  Ars.,  Aur.,  &c. 

Ill-humour,  irascibility :  Nux  v.,  Bryon.,  Cham.,  Carl,  v.,  Ars.y 
Natr.  m.,  Graph.,  Veratr.,  Kali,  Sulph.,  Sep.,  Sil.,  Ac.  nitr.,  Lye,  &c. 

Sadness,  depression,  dejection,  gloominess :  Ign.,  Puis.,  Coco., 
Bach.,  Bye,  Natr.  m.,  Sulph.,  Calc,  Plat.,  Nux  v.,  Veratr.,  Ars.,  Graph., 
Silic,  Sep.,  Ac.  sulph.,  Phimb.,  Am.  m.,  Anac,  &c.'. 

Suspicion,  mistrust :  Puis.,  Nix  v.,  Bach.,  Baryt.  c,  Merc,  Ac. 
sulph.,  Cic,  Bella.,  &c. 

Anxiety,  inquietude  :  Nux  v.,  Puis.,  Bryon.,  Bach.,  Cham.,  China, 
Carb.  v.,  Sulph.,  Calc,  Bye,  Merc,  Plumb.,  Acid,  nitr.,  Ars.,  Veratr., 
Am.,  Aur.,  Sabad.,  Cic ; — Alum.,  Amb.,  Am.  m.,  Anac,  Graph.,  Plat., 
Natr.  m.,  Bhus,  Sep.,  Staph.,  Acid,  sulph.,  Cocc,  Baryt,  c,  &c. 

Fickleness  :  Ign.,  Plat.,  Natr.  m.9  Zinc,  Cm.,  Caps.,  Puis.,  Sulph,, 
Vol.,  Carb.  a.,  Kali.,  Ars.,  Nux  musch.,  &c. 

Hysteria,  tendency  to:  Ign.,  Puis.,  Plat.,  Sep.,  Nux,  Sulph., 
Calc,  &c. 

Accessory  Treatment  and  Diet.  In  no  class  of  disorders 
is  it  more  requisite  to  adhere  strictly  to  dietetic  regulations,  than  in 
those  which  consist  of  derangement  in  the  digestive  system,  whether 
so  called  functional  or  organic  :  the  patient  should  therefore,  in  such 
cases,  regulate  his  regimen,  as  closely  as  possible,  by  the  rules*  laid 
down  at  the  commencement  of  this  treatise,  carefully  avoiding,  more- 
over, all  such  articles  as  he  may  find  disagree  with  him  even  if  they 
appertain  to  the  aliments  allowed.  He  should  generally  abstain 
from  soups,  and    everything    that   has   a  tendency  to  distend  the 

*  As  we  have  already  observed  at  the  conclusion  of  the  said  "  Rules, "  there  are  particular 
cases  in  which  the  regulations  given  are  subject  to  considerable  modifications.  Thus,  in 
some  severe  forms  of  dyspepsia,  it  is  necessary  to  allow  meat  only  every  other,  or  every 
third  day,  or  to  prohibit  it  entirely  for  a  time,  and  to  substitute  farinaceous  food,  or  fish, 
or  meat  which  is  of  a  less  stimulating  quality,  such  as  chicken.  In  other  forms,  particularly 
where  the  patient  suffers  much  from  flatulence,  vegetables  must  be  disallowed.  Again, 
there  are  cases,  but  especially  those  with  symptoms  of  biliousness,  or  rather  excessive  secre- 
tion of  bile,  in  which  milk,  eggs,  butter,  and  fat  rich  food  are  inapplicable.  The  use  of  unfer- 
mented  bread  will  frequently  be  found  of  more  easy  digestion  than  that  which  is  made  by 
the  ordinary  process.  There  are  instances,  however,  in  which  the  former  does  not  agree  with 
dyspeptics.  In  such  cases,  bread  made  by  means  of  the  German  yeast  will  often  prove  of 
easier  digestion. 


WANT  OF  APPETITE.  125 

stomach,  such  as  taking  large  quantities  of  warm  liquids ;  he  should 
not  indulge  his  appetite  to  its  full  extent,  and  carefully  avoid  late 
hours,  unnecessary  exposure,  and  severe  mental  exertion  or  anxiety ; 
he  should  also  take  sufficient  exercise  in  the  open  air,  and,  as  much 
as  possible,  keep  his  mind  from  dwelling  upon  his  complaint,  or  on 
gloomy  subjects. 


WANT  OF  APPETITE. 

Apepsia.     Anorexia. 

Want  of  appetite,  being  a  concomitant  symptom  of  many  diseases, 
is  treated  accordingly  in  other  parts  of  this  work  ;  but  we  now  propose 
to  look  upon  it  as  one  of  the  leading  symptoms  of  indigestion,  and 
in  this  character  deserving  a  particular  notice.  In  a  great  variety 
of  cases,  amongst  others  that  of  dyspepsia,  it  is  usually  attributable 
to  an  ill-regulated  regimen,  imperfect  mastication  of  food,  the  abuse 
of  tonics  and  other  medicines  in  large  doses,  sedentary  habits,  and 
the  neglect  of  sufficient  exercise  in  the  open  air. 

In  many  instances  the  removal  of  the  exciting  cause  will  cure 
this  disorder.  Sufferers  from  this  inconvenience  should  carefully 
avoid  creating  an  artificial  appetite,  and  also  partaking  of  the  smallest 
quantity  of  food,  until  the  previous  meal  has  been  assimilated ;  the 
habit  of  taking  tea,  and  even,  as  the  expression  is,  cc  making  a  meal 
of  it,"  within  a  couple  of  hours  after  removing  from  the  dinner-table, 
is  a  frequent  cause  of  apepsia  and  dyspepsia. 

Another  source  is  the  habit  of  drinking  frequently,  or  very  copiously 
during  meals — thereby  attenuating  the  saliva  and  gastric  juice,  and 
rendering  them  less  fitted  for  the  purpose  of  digestion. 

Other  causes  are  the  custom  of  sleeping  after  dinner,  partaking 
of  heavy  suppers,  before  retiring  to  rest,  and  the  indulgence  in 
fermented  vinous  or  spirituous  liquors,  or  in  tea  or  coffee,  particularly 
the  latter. 

An  alteration  in  the  hours  of  meals,  and  avoiding  too  long  fasts 
between  them,  will  frequently  remove  this  affection. 

In  other  cases,  early  rising,  great  attention  to  diet,  abstinence 
from  rich  or  highly-seasoned  food,  together  with  the  .daily  use  of 
pure,  cold  water, — drinking  a  tumblerful  an  hour  or  so  before  break- 
fast,  two  to  four  hours  after  dinner,  and  again  about  the  hour  of 


126  DIGESTIVE  SYSTEM. 

retiring  to  rest,-— will  suffice  to  restore  the  weakened  digestive  func- 
tions to  a  normal  condition. 

When,  however,  we  cannot  trace  this  disorder  to  some  of  the 
above,  or  any  other  probable  cause,  when  every  attention  to  regimen, 
and  even  an  alteration  of  diet,  according  to  individual  peculiarities  or 
idiosyncrasy,  has  failed  to  produce  any  good  effect,  we  generally  find 
the  want  of  appetite  accompanied  with  other  symptoms  of  derange- 
ment in  the  digestive  functions,  which  may  prove  useful  in  aiding  us 
to  select  a  proper  remedy  to  restore  the  natural  tone  of  the  stomach ; 
— this  will  be  found  among  the  medicines  most  useful  in  Dyspepsia 
and  Cardialgia  :  namely,  Nux  vomica,  Chamomilla,  Pulsatilla,  Cin- 
chona, Ipecacuanha,  Antimonium  crudum,  Bryonia,  Arnica,  Hepar  sul- 
phuris,  Lachesis,  Sulphur,  and  Calcarea,  etc. 

Nux  vomica  is  the  principal  remedy  when  the  want  of  appetite  can 
be  traced  to  late  hours,  the  habitual  use  of  wine  and  coffee,  or  to 
sedentary  and  studious  habits,  also  when  the  following  symptoms 
are  present :  dryness  of  mouth,  tongue  coated  white,  with  cracks  or 
slimy  mucus  in  the  mouth,  agustia,  pyrosis,  or  insipidity  of  aliments 
(particularly  meat),  accumulation  of  water  in  the  mouth,  aversion  to 
food,  costiveness  or  constipation,  confusion  in  the  head  or  giddiness 
(as  if  the  results  of  intoxication),  amnesia,  and  difficulty  of  fixing 
the  mind  to  a  train  of  application,  weight  in  the  occiput,  tinnitus 
aurium,  heaviness  and  aching  in  the  limbs,  uneasiness  and  a  feeling 
of  working  or  dragging  of  the  tendons  in  the  lower  extremities,  or 
cramps,  restlessness,  and  irritability  of  temper, — symptoms  aggra- 
vated in  the  morning. 

Chamomilla  is  frequently  found  useful  after  Nux  vomica,  when, 
although  considerable  benefit  has  been  derived,  the  whole  train  of 
symptoms  are  not  removed.  The  following  are  its  particular  indica- 
tions :  restless  sleep,  sensation  of  fulness  and  aching  in  the  head, 
heat  and  redness  of  the  face,  a  degree  of  fever,  tongue  thickly 
coated,  yellowish,  rough  and  cracked,  (anorexia  and  greenish  diar- 
rhoea,) and  general  sensibility  of  the  nervous  system.  This  remedy 
is  especially  called  for,  when  a  bitter  taste  in  the  mouth  (or  vomiting 
of  bile,  or  of  greenish  mucus)  ensues  after  eating. 

Pulsatilla.  This  remedy  is  specific  in  the  affections  arising 
from  partaking  of  over-rich  or  greasy  food,  for  instance,  pork  or  pastry  ; 
or  of  aliments  causing  flatulence,  such  as  vegetables ;  or  of  food,  in- 
the  preparation  of  which  rancid  butter  or  lard  has  been  used.     The 


WANT  OF  APPETITE.  127 

more  immediate  indications  are,  whitish,  cleft  or  fissured  tongue,  with 
bitter,  salt,  or  foul  taste  in  the  mouth,  sliminess  of  the  mouth, 
scraping,  roughness  or  acidity  at  the  pharynx,  bitter  eructations, 
aversion  to  warm  food  or  to  meat,  as  .well  as  butter,  and  all  rich  food; 
loss  of  taste  ;  distension  of  the  abdomen,  and  particularly  a  feeling 
of  tension  under  the  false  ribs,  borbory  gmus,  retarded  or  difficult 
defecation,  or  diarrhoea^  drawing^-in  of  the  limbs  (resembling  that 
presentment  in  ague),  exacerbation  of  symptoms  in  the  evening,  in 
contradistinction  to  Mux  vomica,  which  is  generally  indicated  by  this 
occurrence  in  the  morning.  This  remedy  is  well  adapted  to  the 
mild  lymphatic  temperament,  and  also  when  there  is  a  peculiar  sen- 
sibility^ with  a  dislike  to  conversation ;  it  is  likewise  valuable  when 
imperfect  mastication  is  the  cause  of  the  aflfection,  as  well  as  in 
cases,  where  there  is  a  marked  aversion  to  tobacco,;  even  wrheii  the 
patient  is  accustomed  to  its  use.  Moreover,  this  remedy  will  be 
frequently  found  of  benefit  in  some  cases  where  Chamomillahm  only 
temporarily  relieved  ;  but  should  a  considerable  degree  of  nervous- 
ness, or  even  irritability,  remain  after  Pulsatilla,  Nux  vomieamaybe 
had  recourse  to. 

Cinchona  is  highly  efficacious  in  anorexia  occurring  during  foggy 
weather,  when  the  air  is  charged  with  unwholesome  vapours,  or  in 
the  vicinity  of  marshy  lands.  The  following  are  its  indications  :  a  sen- 
sation of  constant  satiety,  with  general  indifference  to  food,  andadypsia ; 
tongue  cracked,  or  loaded  with  yellow  or  white  coating ;  sensation  of 
sinking  and  fluttering  in  the  epigastrium  (particularly  when  this 
symptom  can  be  traced  to  the  effects  of  tea) ;  eructation  after  eating; 
desire  for  highly-seasoned  food,  acids,  pepper,  and  other  condiments ; 
general  weakness^  with  inclination  to  assume  the  recumbent  posture, 
and  inability  tp  remain  long  in  one  position  ;  uncomfortable  feeling 
of  dry  heat,  or  shivering  and  sensitiveness  in  the  open  air ;  retarded 
or  interrupted  sleep ;  general  feeling  of  uneasiness,  with  moroseness 
and  peevishnesSi 

Ipecacuanha  is  indicated  by  the  following  symptoms :■■  Nausea 
or  vomitings  without  foulness  of  the  tongue,  with  dislike  to  food. 
Tobacco— even  to  smokers— has  a  nauseous  taste,  and  causes  vomit- 
ing. This  remedy  is  also  useful  when  the  impaired  appetite  has 
arisen  from  bolting  the  food,  particularly  in  children,  and  may  be 
followed  by  Pulsatilla,  when  only  partial  relief  has  been  obtained. 

Antimonium  crudum  will  prove  a  good  remedy  in  cases  where 
a  great  disposition  to  nausea  and  vomiting  with  foul  tongue  exists ; 


128  DIGESTIVE  SYSTEM. 

anorexia,  dryness  of  the  mouth  with  great  thirst,  particularly  during 
the  night ;  accumulation  of  phlegm  in  the  throat,  with  continual 
attempts  to  clear  the  throat ;  frequent  rising,  soon  after  meals,  of  the 
food  last  partaken  of;  pain  or  disagreeable  fulness  at  the  epigas- 
trium, frequently  with  sensibility  to  external  pressure.  In  cases  of 
recent  standing  with  the  above  symptoms  it  is  very  speedily  effica- 
cious ;  and  when  relief  does  not  quickly  follow,  the  next  mentioned 
remedy  should  be  had  recourse  to. 

Bryonia  in  recent  derangement  of  the  stomach  with  anorexia; 
when  we  find  thirst  more  during  the  day  than  through  the  night ; 
with  a  sensation  of  dryness  in  the  throat,  extending  down  the 
oesophagus ;  chilliness ;  yellow,  dark  brown,  or  white-coated,  cracked 
tongue,  with  constipation. 

Arnica.  This  remedy  is  valuable  when  the  loss  of  appetite  has 
arisen  from  sitting  up  at  night ;  watching  at  a  sick  bed ;  from  not 
having  devoted  a  sufficient  number  of  hours  to  the  period  of  rest ; 
from  intense  mental  exertion ;  or  from  provocation  or  excitement. 
When  from  these  causes  the  nervous  system  is  powerfully  affected  ; 
tongue  coated  yellow;  taste  foul,  bitter,  or  sour,  or  nauseous,  or 
chalybeate,  with  offensive  smell  from  the  mouth ;  rising  of  the  food, 
or  eructations  of  the  taste  or  smell  of  rotten  eggs  ;*  aversion  to 
smoking  and  desire  for  acids ;  sensation  of  fulness  in  the  scrobiculus 
after  meals,  with  inclination  to  vomit ;  distension  of  the  abdomen, 
with  pinching  colic,  relieved  by  doubling  up  the  body,  and  renewed 
by  drinking  the  smallest  quantity  of  wine,  or  passing  off  and  then 
coming  on  with  inclination  to  evacuate  the  bowels ;  general  irrita- 
bility and  impossibility  of  fixing  the  mind  upon  any  subject ;  incli- 
nation to  remain  lying  down,  as  this  position  relieves  a  heavy 
stupefying  headache,  which  the  least  motion  or  even  conversation 
increases. 

Hepar  sulphuris  is  useful  in  chronic  cases  of  want  of  appetite, 
with  indigestion  from  the  slightest  cause,  notwithstanding  the  most 
careful  observance  of  diet.  It  is  indicated  by  desire  for  high- 
seasoned  dishes,  acids,  and  wine  ;  nausea,  even  inclination  to  vomit, 
particularly  in  the  morning ;  and  constipation,  frequently  with  colic. 
This  remedy  is  one  of  our  chief  antidotes  to  Mercurius,  and  conse- 


*  (Tartarus  emet.,  Sulphur,  Valerian,  Sepia,  Stannum,  also  cover  the  latter  symptom) : 
the  practitioner  will  therefore  do  well  to  bear  the  said  remedies  in  mind,  when  this  particular 
symptom  is  a  prominent  one,  and  does  not  yield  to  Arnica, 


DERANGEMENT  OE  THE  STOMACH,   ETC.  129 

quently  one  best  adapted  to  those  affections  of  the  stomach  which 
have  arisen  from  the  long-continued  use  of  calomel,  or  other  mercurial 
preparations. 

Laches  is  is  a  valuable  remedy  to  follow  Hepar  sulphuris  in  ob- 
stinate cases,  particularly  when  long-continued  constipation  is  com- 
plained of,  and  the  symptoms  have  always  been  aggravated  by  acid 
drinks^  &c;  in  the  latter  case  Arsenicum  is  also  useful,  and  may 
sometimes  precede  or  follow  Lachesis  with  advantage. 

In  addition  to  the  two  last-mentioned  remedies,  we  may  observe, 
that  in  the  same  class  of  cases,  Belladonna,  Mercurius,  Sulphur,  and 
Calcarea  may  be  used  with  considerable  advantage,  when  the  former 
remedies  have  afforded  only  partial  relief. 

Acidum  sulphuricum  is  a  useful  remedy  in  cases  of  impaired  ap- 
petite, with  weakness  of  digestion,  arising  from  habitual  excess  in  the 
use  of  ardent  spirits,  or  from  debilitating  loss  of  fluids,  such  as  blood, 
or  in  consequence  of  excessive  study, — with  the  following  symptoms  : 
acrid  or  putrid  taste,  dry  tongue,  burning  and  smarting  sensation  in 
the  gullet  resembling  heartburn ;  offensive  breath,  especially  in  the 
morning ;  aphthae ;  disagreeable  sensation  of  pricking  in  the  throat, 
frequently  occurring  during  the  night,  and  disturbing  sleep.  In 
other  cases  the  practitioner  or  student  may  consult  the  subjoined  re- 
medies in  the  Materia  Medica  with  advantage,  either  as  applicable  to 
the  treatment  of  this  affection,  or  to  that  of  dyspepsia  and  cardialgia  : 
Sepia,  Colchicum,  Femim,  Silicea,  Buta,  Amnion  c,  Bhus,  Aurum,  Baryta  c, 
Acid,  nitr.,  Kali  c,  Natr.  m.  and  c,  Graphites,  Hyoscyamus,  Ignatia, 
Staphysagria,  Kreosotum,  Petroleum,  Anacardium,  Brosera,  N.  mosch.  Cap- 
sicum.    (See  also  Dyspepsia  and  Cardialgia.) 


DERANGEMENT  OF  THE  STOMACH,  ERUCTATIONS,  &c. 

Under  this  head  we  intend  treating  of  a  disorder  which  may  arise 
in  individuals  of  a  generally  unimpaired  digestion — the  characteristics 
of  eructations  will  assist  to  indicate  the  remedy  for  persons  subject  to 
this  unpleasant  affection. 

The  ordinary  causes  of  this  derangement  are :  hurried,  imperfect 
mastication ;  overloading  the  stomach  ;  fat,  greasy,  indigestible,  or 
tainted  food,  flatulent  vegetables,  ices,  stimulants,  &c. 

Therapeutics.     When  the  symptoms  of  approaching  stomachic 

9 


130  DIGESTIVE  SYSTEM. 

derangement  declare  themselves  immediately,  or  a  few  hours  after 
a  repast,  a  little  strong  black  coffee  is  frequently  a  sufficient  re- 
storative. 

Should,  however,  this  fail  to  relieve,  and  sick  headache  and  inclina- 
tion to  vomit  be  present,  we  should  assist  Nature  by  tickling  the 
fauces  with  a  feather,  and  giving  tepid  water  to  drink  until  the  sto- 
mach has  completely  evacuated  its  contents.  Should,  however,  on 
the  following  morning,  symptoms  of  deranged  digestion  continue, 
such  as  nausea,  inclination  to  vomit,  or  vomiting,  and  disagreeable  or 
offensive  eructations,  we  should  administer  Antimonium  crudum, — 
one  of  our  most  useful  remedies  in  this  affection,  and  which  rarely 
fails  to  afford  at  least  some  relief.  It  is  also  peculiarly  indicated 
when  the  affection  has  arisen  from  drinking  sour  or  impure  wine;  or, 
when,  in  addition  to  the  symptoms  of  disordered  stomach,  a  degree 
of 'fever  returns  every  second  day. 

Ipecacuanha,  When  a  rash  has  been  throwTn  out,  from  the 
effects  of  a  disordered  stomach,  attended  with  anxiety,  oppressed 
breathing,  and  sickness,  this  remedy  will,  in  most  cases,  effect  speedy 
relief; — but  should  the  difficulty  of  breathing,  or  a  degree  of  nausea, 
or  other  uneasiness  continue,  Bryonia  should  be  employed.  (Tar- 
tarus  emeticus  is  sometimes  more  efficacious  than  either  Ipecac,  or 
Bryonia,  when  there  is  great  drowsiness,  with  constant  nausea  and 
frequent  vomiting  :  relaxed,  brownish,  yellow  motions.) 

Bryonia.  In  addition  to  the  usefulness  of  this  remedy  in  the 
foregoing  instance,  it  is  also  very  serviceable  when  the  following 
symptoms  are  present:  bitter  eructations  \  fever,  alternately  with  cold- 
ness and  shivering ;  or  redness  of  the  face,  heat  in  the  head,  and  thirst 
with  coldness  and  shivering ;  also  where  diarrhoea  or  constipation  and 
peevishness,  or  excessive  irritability  are  present.  (In  derangement  of 
the  stomach,  arising  from  succulent  vegetables,  and  attended  with 
excessive  flatulence,  this  remedy  is  frequently  productive  of  speedy 
relief.) 

Arsenicum  is  appropriate  when  there  are  acrid  and  bitter  eruc- 
tations with  nausea  and  vomiting ;  also  dry  tongue,  excessive  thirst, 
salt  taste  in  the  mouth,  and  burning  or  violent  pressure  in  the  sto- 
mach, with  diarrhoea  or  cholic,  and  griping  in  the  hypogastrium,  and 
particularly  when  these  derangements  have  arisen  from  the  effects  of 
an  ice  which  had  been  partaken  of  when  warm,  or  from  fruit,  stale 
vegetables,  or  acids.  It  may,  in  many  cases,  be  advantageously  fol- 
lowed by  Carlo  vegetabilis,  which  see. 


DERANGEMENT  OF  THE  STOMACH,  ETC.  131 

Nux  vomica  is  indicated  by  offensive  or  acrid  eructations,  consti- 
pation, and  confused  headache,  particularly  when  arising  from  previous 
intoxication,  or  even  slight  over-indulgence  in  wine  or  other  stimulants  ; 
when  possible,  it  should  be  taken  the  same  night,  as  taken  in  the 
morning,  although  eventually  relieving,  it  frequently  causes  an  aggra- 
vation for  a  few  hours.  (In  derangement  of  the  stomach  with  heart- 
burn, flatulence,  more  or  less  nausea  and  headache,  &c,  in  conse- 
quence of  a  chill  or  of  indulging  in  mental  or  corporeal  exertion  im- 
mediately after  a  meal,  this  remedy  commonly  affords  speedy 
amelioration.) 

Arnica,  deranged  stomach,  accompanied  by  eructations  resembling 
rotten  eggs.# 

Pulsatilla  is,  next  to  Antimonium  crudum,  the  most  im- 
portant remedy  in  recent  cases  of  deranged  digestion,  with  eruc- 
tations of  ingesta,'  tongue  foul  and  covered  with  mucus  ;  chilliness 
and  lowness  of  spirits ;  and  also  when  a  rash  has  been  thrown  out 
in  consequence  of  the  derangement.  This  remedy  is,  moreover, 
almost  specific  when  the  disturbance  has  arisen  from  the  effects  of 
rich  food,  such  as  pork  or  pastry,  or  even  tainted  meat,  or  from  the 
effects  of  ices,  cold  fruits,  or  crude  vegetables,  acid  wine,  &c.  ^Arsenicum 
may  follow  Pulsatilla,  if  the  latter  do  not  effectually  relieve.) 

Aconite.  When  the  affection  owes  its  origin  to  partaking  of 
sour  beer,  vinegar,  or  other  acids>  particularly  when  we  find  oppressive 
pain  in  the  stomach,  great  heat  in  the  head,  nausea,  or  actual  vomit- 
ing of  mucus,  or  even  of  blood. 

He-far.  sulfhuris.  When  the  digestion  is  naturally  weak,  and 
sour  vomiting,  attended  with  burning  in  the  throat,  colic,  and 
diarrhoea,  is  liable  to  ensue  from  the  slightest  error  of  diet,  and 
particularly  when  anything  of  an  acid  quality  has  been  partaken  of. 
{Lachesisis  often  of  great  service  here  in  alternation  with  Hepar  sul- 
jphuris,  at  intervals  of  a  week  or  so.) 

When  a  fit  of  passion  has  produced  an  attack  of  indigestion, 
Chamomilla  rarely  fails  to  relieve.  Bryonia  is,  however,  to  be  preferred 
when  chilliness  and  shivering  accompany  the  symptoms  of  gastric 
derangement.  (See  Mental  Emotions.) 

Carbo  vegetabilis,  although  last  mentioned,  is  not  one  of  the 
least  valuable  remedies  in  this  affection,  and  is  often  found  par- 
ticularly useful  after  Pulsatilla,  Arsenicum,  or  Nux  vomica,  in  removing 
any  symptoms  that  may  remain ;  it  is,  moreover,  particularly  useful 

*  See  also  note,  page  132. 


132  DIGESTIVE  SYSTEM. 

where  great  susceptibility  to  the  influence  of  the  atmosphere,  par- 
ticularly to  cold,  exists  at  the  same  time ;  or  in  sufferings  arising 
from  abuse  of  wine,  ices,  or  salt;  further,  in  derangement  of  the 
stomach,  arising  from  having  partaken  of  game  or  fish  which  has 
been  too  long  kept,  or  meat  that  has  been  recooked  whilst  in  a  state 
of  fermentation,  which  is  liable  to  occur  in  warm  weather ;  in  the 
latter  instances  Carlo  v.  is  to  be  preferred  to  any  other  medicine,  and 
will  rarely  fail  to  afford  relief;  but  if  any  disagreeable  symptoms 
remain,  Cinchona  may  be  administered  in  a  little  water  ;  and  followed, 
if  required,  by  'Pulsatilla  in  the  same  manner.  Finally,  this  remedy 
{Carlo,  v.)  is  peculiarly  valuable  in  obstinate  and  chronic  cases  of 
deranged  digestion  when  annoyance  or  inconvenience  is  felt  after  every 
meal,  even  amounting  to  nausea  and  vomiting,  attended  with  excessive 
flatulency,  and  where  the  pit  of  the  stomach  is  tender  on  pressure,* 


FLATULENCY. 

Flatulentia.     Flatus.     Tympanitis  intestinalis. 


This  affection,  together  with  the  sufferings  it  entails,  is  generally 
found  in  individuals  of  weak  digestion,  and  many  also  suffer  from  it 
immediately  on  taking  cold  in  the  abdomen  or  feet ;  it  is  also,  as 
well  known,  a  common  result  of  errors  in  diet,  and  the  too  frequent 
indulgence  in  vegetables  and  fruits.  In  corpulent  individuals  the 
sufferings  arising  from  this  complaint,  such  as  difficulty  of  breathing, 
palpitation  of  the  heart,  trembling  of  the  limbs,  confusion  of  the 
head,  and  swelling  of  the  face,  especially  in  hypochondriacal  subjects 
are  most  distressing.  However,  with  proper  attention  to  regimen, 
and  suitable  medical  treatment,  it  is  rarely  very  difficult  to  remove. 

As  an  accompaniment  .of  deranged  digestion,  it  has  already  been 
noticed  under  Dyspepsia. 

The  most  useful  preservatives  against  the  complaint  are  avoiding 
cold,  exposure  in  cold  damp  weather,  very  cold  drinks,  or  distending 
the  stomach  with  a  large  quantity  of  warm  fluid,  particularly  strong 
tea  or  coffee ;  each  patient  should  also  study  his  own  digestion,  and 
carefully  refrain  from  partaking  of  any  species  of  aliment  which 
experience  has  proved  to  produce  flatulency.     Sedentary  habits  also 

*  A  small  quantity  of  finely-powdered  charcoal,  in  a  little  good  French  brandy,  will  be 
found  an  equally  efficacious  mode  of  administering  this  remedy  as  a  corrective  against  de- 
rangement of  the  stomach  produced  by  having  partaken  of  tainted  meat  or  fish. 


FLATULENCY.  133 

should  be  avoided,  and  a  proper   portion  of  the  day  devoted  to 
exercise  in  the  open  air. 

Therapeutics.  In  the  treatment  of  this  affection  the  following 
medicines  are  most  frequently  called  for :  Cinchona,  Arsenicum,  Nux 
vomica,  Pulsatilla,  Carlo  vegetalilis,  Colchicum,  Belladonna,'  Colocynth, 
and  Spirit  sulphuris.  Of  these  Nux  vomica  and  Pulsatilla  are  perhaps 
the  most  frequently  required. 

Cinchona.  When  the  affection  can  be  traced  to  the  effects  of 
habitual  indulgence  in  tea  or  warm  drinks,  an  hour  or  two  after  a 
hearty  meal,  by  which  the  process  of  digestion  has  been  interrupted ; 
or  to  debility,  loss  of  humours  from  venesection,  or  the  continued 
use  of  purgatives ;  or  to  deranged  digestion  arising  from  flatulent 
food,  with  painful  tension  and  distension  of  the  abdomen  ;  or  when,  on 
the  occasional  expulsion  of  flatus,  a  sensation  of  tension  is  felt  in 
the  umbilical  region ;  or,  finally,  where  coldness  or  shuddering  is 
experienced  after  drinking. 

Arsenicum,  where  the  last-mentioned  symptom  has  not  been 
relieved  by  the  foregoing  medicine. 

Nux  vomica.  In  cases  where  the  flatulence  is  attended  with 
sensation  of  pressure  at  the  pit  of  the  stomach,  causing  dyspnoea 
and  a  feeling  as  if  the  clothing  were  too  tight,  or  a  sensation  of 
pressure  as  from  a  stone,  and  particularly  when  the  affection  arises 
from  an  habitual  use  of  coffee,  or  from  sedentary  habits. 

Pulsatilla,  when  the  affection  has  arisen  from  having  eaten  of 
rich  or  greasy  food,  after  which  a  copious  draught  of  water  has  been 
partaken  of,  and  the  abdomen  is  tumid  and  accompanied  by  a  pain  as 
from  a  bruise,  with  borborygmus.  Carlo  vegetalilis  is  one  of  the 
most  important  remedies  after  the  foregoing,  in  chronic  cases, 
especially  when  the  inconvenience  arises  after  partaking  of  the  smallest 
morsel  of  food. 

Colchicum,  when  from  a  considerable  accumulation  of  flatus  the 
abdomen  is  extremely  distended,  or,  as  it  might  be  expressed,  inflated, 
and  sounds  like  a  drum  on  being  struck  with  the  hand  [Tympanitis 
intestinalis) — without  any  marked  pain,  but  with  heat  and  difficulty 
of  respiration.  This  remedy  is  generally  peculiarly  efficacious  when 
the  derangement  is  attributable  to  vegetable  food ;  or  to  the  effects 
of  exposure  to  a  cold,  damp  atmosphere. 

Belladonna.  In  cases  of  flatulent  obstruction,  in  which  the 
transverse  section  of  the  colon  is  the  particular  seat  of  the  accumulated 


134  DIGESTIVE  SYSTEM. 

flatus,  and  becomes  protruded  like  a  pad,  this  remedy  should  be 
employed ;  it  may  be  followed  by  Colocynth  when  the  relief  obtained 
is  only  temporary,  or  when,  from  the  manner,  in  which  the  patient 
traces  the  course  of  his  uncomfortable  feelings,  there  is  every  reason 
to  conclude  that  the  flatulent  distension  and  obstruction  occupy  the 
entire  extent  of  the  colon. 

When  the  flatulence  occurs  very  frequently,  in  fact,  where  a 
marked  predisposition  to  it  exists,  we  must  have  recourse  to  Spirit. 

SULPHURIS. 

Although  we  have  pointed  out  the  remedies  best  suited  to  the 
eases  of  this  affection  most  ordinarily  met  with,  and  have  also  treated 
of  the  same  subject  under  Dyspepsia  and  Colic,  to  which  the 
reader  is  referred,  we  still  think  it  advisable  to  add  a  few  medicines 
which  bear  particularly  upon  this  disorder,  and  are  deserving  of  atten- 
tion. They  are:  Lycopodium,  Cocculus,  Natrum,  Natnmi  muriaticuwi, 
Zincum  foliatum,  Magnetis  Polus  Arctus,  Agnus  castus,  Fermm,  Graphites. 


SPASM  OF  THE  STOMACH. 

Gast?:odynia,  Cardialgia,  Gastralgia. 

Diagnosis.  Contractive  and  spasmodic  or  gnawing  pains  at  the 
epigastrium,  extending  to  the  chest  and  back,  attended  with  anxiety, 
nausea,  eructation  or  vomiting,  with  faintness  and  coldness  of  the 
extremities:  the  patient  is  sometimes  relieved  by  emission  of 
ascending  flatus,  and  when  complicated  with  pyrosis,  by  a  discharge 
of  a  quantity  of  limpid  fluid ;  occasionally  headache  and  constipation 
are  present.  In  some  cases  the  pain  is  very  slight,  but  there  is 
always  more  or  less,  and  a  degree  of  anxiety,  with  nausea,  often  in- 
creased by  taking  food.  The  disease  originates  in  an  abnormal  state 
of  the  nerves  of  the  stomach,  and  is  frequently  accompanied  by  a 
disease  of  the  liver,  spleen,  or  pancreas,  or  even  by  scirrhus  of  the 
stomach  or  duodenum,  in  its  advanced  stages.  It  is  a  frequent 
attendant  on  gout ;  and  very  rarely  occurs  before  the  age  of  puberty. 
The  paroxysms  last  for  a  longer  or  shorter  time,  according  to  the 
violence  of  the  affection,  and  return  in  many  instances  periodically, 
and  may  be  brought  on  by  partaking  of  improper  articles  of  diet,  or 
in  severe  cases  by  any  solid  food  whatever. 

The  chief  articles  to  be  avoided  by  an  individual  suffering  from  this 


SPASM  OF  THE  STOMACH.  135 

malady  are — crude,  uncooked  vegetable  substances  (such  as  salads), 
also  cheese,  new  bread,  sweetmeats,  cherries,  nuts,  olives,  and  roasted 
chesnuts ;  and  stimulants  of  all  kinds,  whether  strong  tea,  coffee, 
alcoholic  or  fermented  drinks. 

The  exciting  causes  are  :  long  fasting  between  meals,  very  hot  or 
cold  drinks,  an  habitual  use  of  ardent  spirits,  or  of  indigestible  food, 
worms,  and  in  some  instances,  perhaps,  exposure  to  cold  or  damp 
weather. 

It  is  a  more  frequent  affection  in  the  female  than  the  male  sex, 
often  occurring  after  the  cessation  of  the  usual  monthly  discharge,  or 
from  any  interruption  of  its  usual  course ;  in  such  instances  it  is  fre- 
quently accompanied  with  hysteria,  syncope,  and  may  pass  on  to 
vomiting  of  blood. 

Notwithstanding  the  general  intractable  nature  of  this  affection,  it 
has  been  treated  with  marked  success  by  the  method  about  to  be 
pointed  out. 

Therapeutics.  Nux  vomica  is  one  of  the  principal,  and,  in  a 
large  number  of  cases,  the  most  appropriate  remedy  against  spasms  of 
the  stomach,  and  particularly  in  cases  where  this  affection  can  be 
attributed  to  the  long-continued  use  of  strong  coffee,  or  an  excessive 
indulgence  in  spirituous  liquors ;  it  is,  moreover,  of  essential  service 
in  many  cases  which  have  arisen  after  the  suppression  of  chronic  or 
hemorrhoidal  discharges,  or  when  the  party  affected  is  liable  to  fits  of 
hysteria  or  hypochondriasis ;  the  following  are  the  immediate  symp- 
toms which  call  for  the  administration  of  this  medicine :  Constipation, 
pressure,  squeezing,  or  spasm  in  the  stomach,  accompanied  with  a  sensa- 
tion as  if  the  clothes  were  too  tight  at  the  waist,  or  as  if  flatus  were  pent 
up  in  the  hypochondria.  This  sensation,  as  well  as  the  pains  before 
mentioned,  become  generally  increased  after  a  meal,  or  after  partaking 
of  coffee  ;  in  addition  to  which,  a  feeling  of  depression  or  constriction 
is  experienced  at  the  chest,  which,  in  many  cases,  extends  to  between 
the  shoulders  and  the  lower  part  of  the  back.  Frequently,  also,  we 
find  nausea,  accumulation  of  clear  water  in  the  mouth,  or  risings  of 
sour  bitter  fluids,  attended  with  a  sensation  of  burning  in  the  throat 
and  gullet  (pyrosis) ;  sour  or  putrid  taste  in  the  mouth,  vomiting  of 
ingesta,  flatulent  distension  of  the  bowels,  constipation,  aching  in  the* 
forehead,  palpitation  of  the  heart,  and  anxiety.  When  these  symp- 
toms are  liable  to  be  excited  by  a  fit  of  passion,  or  become  aggravated 
in  the  morning,  or  when  the  patient  is  occasionally  awakened  out  of 


136  DIGESTIVE  SYSTEM. 

his  sleep  by  the  spasmodic  attack,  this  remedy  is  still  more  certainly 
indicated. 

Should  Nux  vomica  merely  afford  temporary  benefit,  followed  by  re- 
newed aggravation,  and  in  cases  where  the  disorder  returns  again  after 
it  has  been  for  a  time  suppressed  by  Nux,  we  should  first  repeat  that 
remedy;  and  if  it  then  fail  to  afford  relief,  Carbo  vegetabilis  will 
generally  be  found  to  answer  our  purpose ;  if  not,  Spirit,  sulphuris 
may  then  be  had  recourse  to,  particularly  where  the  affection  is  trace- 
able to  the  suppression  of  some  chronic  eruption.  This  last-named 
medicine,  as  well  as  Pulsatilla  and  Sepia,  the  value  of  which  in  such  cases 
we  shall  notice  under  their  several  heads,  is  particularly  useful  in 
gastrodynia  in  females,  arising  from  derangements  of  the  menstrual 
functions. 

In  other  cases,  where  no  improvement  results  from  the  exhibition 
of  Nux  vomica,  the  following  should  be  consulted :  Chamomilla,  Bella- 
donna, Cocculus,  Ipecacuanha,  Pulsatilla,  Sepia,  Ignatia  amara,  Cinchona, 
Staphysagria,  Stannum,  Bryonia,  Platina,  Senega,  Batanhia,  and  Arnica 
montana.  Should  any  one  of  these  seem  strongly  indicated  from  the 
first,  we  must  not  hesitate  to  employ  it  in  preference  to  those  we 
have  already  noticed  above. 

Chamomilla.  For  the  employment  of  this  remedy  the  principal 
indications  are  :  pressure  as  if  from  a  stone  in  the  pit  of  the  stomach;  or 
painful  pressure  at  the  precordial  region,  as  if  the  heart  would  be 
crushed,  flatulent  distension  at  the  same  part,  as  also  of  the  hypochon- 
dria and  abdomen,  with  shortness  of  breath,  anxiety,  and  throbbing 
headache  ;  mitigation  of  the  above  symptoms  on  partaking  of  coffee, — a 
distinguishing  mark  between  the  indications  of  this  remedy  and  those 
of 'Nux  vomica ; — on  the  other  hand  (as  in  the  case  of  the  latter),  it  is 
also  indicated  when  the  symptoms,  as  described,  are  liable  to  be 
brought  on  by  a  fit  of  passion. 

Colocynth  is  sometimes  more  efficacious  than  Cham,  in  the 
latter  case,  and  especially  when  the  fit  of  passion  is  accompanied  by 
indignation. 

In  obstinate  cases,  where  Chamomilla  fails,  notwithstanding  the 
apparent  similarity  of  the  symptoms,  Belladonna  ought  to  be  sub- 
stituted for  it ;  also  when  we  meet  with  gnawing  pressure,  or  spas- 
modic tension  in  the  pit  of  the  stomach,  relieved  on  lending  backwards 
and  holding  in  the  breath ;  or,  further,  spasm  of  the  stomach,  which 
recurs  daily  during  dinner,  or  else  pain  of  so  violent  a  nature  as  to  de- 
prive the  patient  of  consciousness.     Carbo  v.  may,  however,  be  preferred 


SPASM  OF  THE  STOMACH.  137 

to  Belladonna,  when  the  most  prominent  symptom  remaining  consists 
of  a  sense  of  aching  and  pressure  at  the  pit  of  the  stomach  and  the 
praecordial  region,  causing  a  feeling  as  if  the  heart  were  about  to  be 
crushed.     (See  Chamomilla.) 

Cocculus,  in  many  cases  of  this  complaint,  is  particularly  indi- 
cated, when,  in  addition  to  the  usual  symptoms,  there  are  constipation 
and  constrictive  pains  over  the  entire  abdomen,  wdth  flatulency,  and 
accumulation  of  water  in  the  mouth,  and  alleviation  of  the  sufferings 
on  the  recurrence  of  the  latter  symptoms. 

Ipecacuanha  is  useful  m  cases  of  this  affection,  when  the  pa- 
roxysms are  accompanied  by  nausea,  vomiting,  dull  darting  pains  in 
the  pit  of  the  stomach,  and  sensation  of  excessive  uneasiness  in  the  same 
region. 

Pulsatilla.  In  cases  with  shooting  pains  in  the  stomach,  which 
are  aggravated  by  movement,  and  particularly  by  making  a  false  step. 
Pulsatilla  is  also  one  of  the  most  appropriate  remedies  when  the 
attacks  are  followed  by  vomiting,  or  accompanied  by  violent  tension 
and  squeezing,  or  throbbing  and  sensation  of  anxiety  about  the  pit 
of  the  stomach,  increase  of  pain  after  eating,  or  more  particularly  a 
feeling  of  pressure  and  pinching  after  dinner,  with  a  relaxed  state  of 
the  bowels,  or  a  disposition  thereto.  Tendency  to  hysteria  or  hypo- 
chondriasis. This  remedy,  as  wrell  as  Sulphur  and  Sepia,  is  called  for 
in  cases  of  this  affection,  arising  from  suppressed  menstruation.  When 
Pulsatilla  does  not  afford  much  relief,  the  desired  result  is  often  attain- 
able through  the  agency  oilgnatia. 

Sepia  is  an  efficacious  medicine  in  gastrodynia  arising  from  sup- 
pressed or  difficult  menstruation,  and  may  in  general  cases  advan- 
tageously follow  Pulsatilla ;  it  is  indicated  when,  as  in  the  cases  of 
Nux  v.  and  Pulsatilla,  most  of  the  sufferings  arise  after  a  meal,  when 
there  is  pressure  in  the  stomach  as  from  a  stone,  and  a  burning  pain  is 
experienced  in  the  epigastrium  and  scrobiculus.  By  restoring  singly, 
or  in  conjunction  wdth  Pulsatilla  and  Sulphur,  the  menstrual  flux,  it 
frequently  removes  the  cardialgia  and  hysteria  consequent  upon  this 
derangement,  or,  at  least,  places  the  affection  in  such  a  position  that 
it  is  easily  cured  by  some  other  medicine,  closely  corresponding  to 
the  remaining  symptoms. 

Ign atia  amara  i3  indicated  under  nearly  the  same  circumstances 
as  Pulsatilla,  with  the  exception  of  the  state  of  the  bowrels,  Ignatia 
being  more  appropriate  to  cases  attended  with  costiveness,  and 
where  the  inclination   to  vomit  is  absent,  or  when  the  affection  has 


138  DIGESTIVE  SYSTEM. 

been  caused  by  grief,  anxiety,  exhaustion  by  long  abstinence,  &c,  or 
occurs  in  very  hysterical  or  hypochondriacal  individuals.  (See  also 
the  remedies  mentioned  at  the  end  of  the  chapter.) 

Cinchona  is  of  great  service  in  most  cases  of  spasms  of  the 
stomach  with  general  weakness  arising  from  loss  of  humours,  the 
result  of  bloodletting,  or  repeated  hemorrhages,  abuse  of  emetics  or 
aperients,  too  long -continued  suckling,  &c. ;  and  is  further  indicated  by 
great  weakness  of  digestion,  distension  and  uncomfortable  weight, 
pressure,  or  pains  in  the  stomach  after  eating,  so  that  the  patient 
feels  much  easier  when  fasting ;  these  latter  symptoms  are  the  more 
immediate  indications  for  the  employment  of  this  medicine.  (Nux  v. 
and  Carlo  v.  may  follow  Cinchona,  should  the  latter  not  remove  all 
the  symptoms.) 

Staphysagria.  This  is  useful  in  some  cases  of  this  complaint, 
and  is  particularly  applicable  when  there  is  acute  pressive  tension 
and  squeezing  about  the  pit  of  the  stomach,  which  sometimes  ob- 
structs the  breathing,  but  which  is  relieved  by  bending  the  body  forward. 
When,  however,  the  pain  partakes  of  a  marked  tensive  character, 
and  extends  to  the  region  of  the  navel,  accompanied  by  sensibility  of 
the  region  of  the  stomach  on  external  pressure,  shortness  of  breath, 
anxiety,  and  nausea,  St  annum  will  be  found  more  appropriate. 

Bryonia.  This  medicine  is  more  particularly  adapted  to  the 
milder  cases  of  cardialgia,  with  painful  pressure,  or  a  feeling  of  dis- 
agreeable fulness  in  the  stomach  after  a  meal,  which  occasionally 
becomes  converted  into  a  feeling  of  constriction,,  cutting,  or  pinching, 
and  is  relieved  by  eructation  and  external  pressure.  This  remedy  is, 
moreover,  still  more  clearly  indicated  when  the  symptoms  are  gene- 
rally accompanied  by  severe  headache  or  painful  compression  in 
various  parts  of  the  head,  and  particularly  at  the  temples,  which  is 
liable  to  be  excited  whenever  any  article  of  diet  disagrees  in  the 
slightest  degree ;  increase  of  the  Sufferings  by  movement ;  habitual 
costiveness. 

PiiATiNA.  Spasms  of  the  stomach  in  females,  occurring  particularly 
at  the  monthly  period,  (Chamomilla,  Pulsatilla,  Nux  v.,  and  Cocculus  are 
equally  efficacious  at  such  periods  when  the  symptoms  are  as  indi- 
cated under  these  remedies,)  and  especially  when  the  menses  are,  at 
the  same  time,  generally  very  copious,  and  of  too  long  duration. 

Senega  will  be  found  efficacious  in  cases  characterized  by  painful 
pressure  and  burning  in  the  stomach,  especially  at  night. 

Ratanhia.     Spasm  of  the  stomach,  or  painful  constrictive  pain, 


SPASM  OF  THE  STOMACH.  139 

relieved  by  eructation,  with  loss  of  appetite,  hiccough,  distension  of 
the  abdomen,  costiveness,  and  frequent  micturition. 

Arnica  Montana,  in  spasm  or  pains  in  the  stomach,  which  have 
originated  in  the  effects  of  a  strain,  or  from  a  Mow,  etc.,  will  be  found 
specific.  It  is,  however,  also  an  excellent  remedy  when  there  is  a 
sense  of  pressure  as  from  a  stone,  or  of  fulness  in  the  stomach  and 
scrobiculus,  constrictive  pain  in  the  stomach  and  in  the  precordial 
region,  shooting  pain  in  the  pit  of  the  stomach,  with  painful  pressure 
or  aching,  extending  to  the  back,  and  tightness  of  the  chest,  increased 
by  eating,  drinking,  and  external  pressure.  Bismuth, — Cardialgia, 
with  tenderness  on  pressure  at  the  pit  of  the  stomach  in  hysterical 
females.  This  remedy  is,  further,  often  of  great  service  in  some  of 
the  most  obstinate  cases,  particularly  when  there  is  a  sensation  of 
great  weight  or  pressure,  with  indescribable  pain  and  uneasiness  in 
the  stomach. 

Arsenicum.  Periodic  pains  in  the  stomach,  chiefly  consisting  of 
a  burning  character,  and  attended  with  acrid,  sour  eructations, 
vomiting  of  ingesta,  or  of  mucus,  sometimes  even  of  blood ;  ano- 
rexia, extreme  debility,  emaciation. 

Lycopodium.  Squeezing  or  compressive  pains  proceeding  from 
each  extremity  of  the  stomach,  with  flatulent  distension;  want  of 
appetite,  pains  in  the  back  and  loins  (constipation) ;  exacerbation  of 
the  symptoms  in  the  open  air,  after  a  meal,  or  in  the  morning  ;  car- 
dialgia in  lymphatic  females,  with  too  copious  catamenia. 

Lachesis.  Spasms  of  the  stomach,  particularly  in  persons 
addicted  to  excessive  indulgence  in  wine  or  ardent  spirits,  relieved  by 
partaking  of  food ;  tongue  covered  with  a  dark  brown  fur,  or  glazed, 
red,  and  cracked,  or  swollen ;  flatulence,  constipation ;  tremulousness, 
numbness,  and  paralytic  weakness  of  the  extremities. 

Sulphur  is  frequently  an  indispensable  remedy  in  chronic  cases, 
attended  with  heartburn  ;  aggravation  of  the  pains  after  a  meal ; 
constipation,  hemorrhoids. 

Calcarea.  In  obstinate  cases,  occurring  in  individuals  who  are 
habitually  addicted  to  the  abuse  of  wine  or  ardent  spirits,  Calcarea  will 
generally  be  found  of  great  service,  especially  after  the  previous 
employment  of  Nux  v.,  Lachesis,  and  Sulphur,  It  is  further  a  valuable 
remedy  in  the  cases  of  plethoric  females  subject  to  nasal  hemorrhage, 
or  to  excessively  copious  menstruation ;  and  is  generally  indicated 
when  the  paroxysms  of  pain  come  on  usually  at  night,  or  after  a  meal; 
in  which  latter  instance,  vomiting  sometimes  results,  or  nausea  and 


140  DIGESTIVE  SYSTEM. 

acidity,  with  painful  sensibility  on  pressure  at  the  epigastric  region. 
Constipation,  hemorrhoids,  or  chronic  looseness  of  the  bowels,  are 
additional  general  indications  for  the  employment  of  this  remedy. 

These  are  the  principal  remedies  to  be  employed  in  ordinary  cases 
of  Cardialgia ;  but,  in  some  cases,  one  or  more  of  the  following  medi- 
cines may  be  called  for :  Sanguinaria  canadensis,  Bismuth,  Carlo  v., 
Graph.,  Gratiola,  Magn.,  Nitr.  spir.,  Sil.,  Stann.,  Staph.,  Stront.,  Am.  c, 
Cup.,  Daph.,  Kali,  Euphorb.,  Kreos.,  Natr.,  Natr.  m.,  Nux  m.,  Assqfcctida, 
Digitalis.  In  Cardialgia  occurring  in  hysterical  or  hypochondriacal 
subjects,  Ign.,  Nux  v.,  Calc,  Grat.,  Cocc,  Stann.,  Bism.,  Digitalis,  etc., 
form  the  more  important  medicaments. 

The  diet  ought  to  be  extremely  simple,  and  easy  of  digestion ;  and 
everything  which  is  known  by  experience  to  bring  an  attack  should 
be  eschewed.  Fat,  oil,  butter,  cheese,  etc.,  are  often  hurtful,  and 
should  therefore  be  avoided.  See  also  Dyspepsia,  of  which  this 
malady  is  but  a  modification. 


HEARTBURN. 

Black  water.    Water-brash.    Pyrosis. 

This  is  not  an  affection  of  that  organ  which  its  name  would  imply, 
but  a  painful  or  uneasy  sensation  of  heat  or  acrimony  about  the  pit  of 
the  stomach,  sometimes  extending  upwards.  It  is  frequently  accom- 
panied with  anxiety,  nausea,  and  vomiting ;  or  a  violent  gnawing 
spasmodic  pain  in  the  region  of  the  stomach,  from  which  the  patient 
experiences  no  relief,  until  he  succeeds  in  ejecting  a  quantity  of  limpid 
fluid.  The  remedies  required  for  the  treatment  of  the  disorder  are  the 
same  as  those  mentioned  under  Dyspepsia,  Flatulence,  and  Spasm  of 
the  Stomach,  according  to  the  symptoms  :  of  which  Nux  v.,  Puis., 
Sulphur,  Acid,  sulphuricum,  Carbo  v.,  Cinchona,  or  Calcarea,  will  be  found 
the  most  appropriate  in  ordinary  cases.  (See  the  aforesaid  derange- 
ments for  particular  indications.) 


VOMITING  OF  BLOOD. 

Hcematemesis. 

Diagnosis.     'Blood    evacuated    by    vomiting,    sometimes    pure 
(generally  venous),  of  a  dark  colour,  but  sometimes  of  a  bright  red ; 


VOMITING  OF  BLOOD.  141 

it  is  occasionally  mixed  with  bile,  food,  &c. ;  the  quantity  varies ; 
blood  is  also  not  unfrequently  discharged  in  coagula  by  stool. 

Premonitory  Symptoms.  Weight,  pressure,  fulness  or  tensive  pain  or 
spasm  in  the  hypogastric  or  hypochondriacal  regions  ;  griping  and 
colic ;  burning  heat  in  the  region  of  the  stomach ;  anxiety,  particu- 
larly on  partaking  of  food  or  drink,  or  on  pressure  at  the  stomach  . 
saltish  taste  in  the  mouth ;  impaired  appetite  and  nausea  ;  giddiness ; 
syncope,  cold  perspiration ;  sometimes  also  an  intermittent  pulsation 
is  perceptible  at  the  scrobiculus. 

Some  only  of  the  preceding  symptoms  may  be  present  previous  to 
the  attack,  and  others,  during  its  course  when  very  severe,  or  fre- 
quently renewed.  We  often  find  wild  delirium  or  wandering  accom- 
panied with  spasms,  and  a  gradually  increasing  weakness  and  remis- 
sion of  pulse  with  frequent  syncope. 

The  most  frequent  causes  of  this  affection  are  the  sudden  suppres- 
sion of  any  sanguineous  discharge,  and  the  consequent  determination 
of  blood  to  the  stomach ;  it  is,  therefore,  agt  to  declare  itself  after  a 
stoppage  of  the  hemorrhoidal  flux,  and  is  a  very  common  affection 
in  females,  from  the  suppression  or  cessation  of  the  catamenia;  in 
which  case  (as  before  remarked  under  that  affection),  it  is  frequently 
preceded  by  Cardialgia.  Other  causes  are  scirrhus  of  the  stomach, 
internal  lesions  or  injury  of  that  organ  from  swallowing  sharp  sub- 
stances, or  from  worms;  poisons,  drastic  purgatives,  or  emetic  drugs, 
external  contusion,  obstruction  of  important  viscera,'  or  a  change  in 
the  constituent  principles  of  the  blood  itself;  the  direct  cause  is  the 
bursting  of  some  of  the  vessels  of  the  stomach. 

The  dangers  arising  from  the  use  of  powerful  astringents  are,  inflam- 
mation or  subsequent  induration  of  the  stomach,  or  putrid  gastric 
fever. 

When  this  affection  occurs  in  females  from  non-appearance  or 
suppression  of  the  monthly  discharge,  or  from  its  final  cessation,  see 
articles  Chlorosis,  Amenorrhcea,  Cessatio  mensium  ;  when  it 
arises  from  worms,  see  Helminthiasis  ;  from  poisonous  substances, 
see  Poisons  ;  and  when  it  originates  in  diseases  of  the  spleen,  consult 
Splenitis. 

We  may  now  proceed  to  the  consideration  of  the  remedies  above 
alluded  to. 

Aconitum.  When  the  premonitory  symptoms  above  given,  declare 
themselves,  and  particularly  when  a  considerable  degree  of  fever  pre- 
cedes the  attack. 


142  DIGESTIVE  SYSTEM. 

Ncjx  vomica.  In  a  decidedly  plethoric  constitution  with  a  marked 
(venous)  stomachic  or  abdominal  congestion,  and  tendency  to  constipa- 
tion^ particularly  when  arising  from  suppression  of  hemorrhoids,  or 
of  the  menstrual  flux,  or  from  indulgence  in  vinous,  spirituous,  or 
fermented  liquors ;  this  remedy  is  still  further  indicated  by  irritability 
of  temper. 

Pulsatilla.  The  value  of  this  remedy  is  noticed  in  the  diseases 
of  females  above  mentioned;  it  is  also,  in  many  cases,  found  more 
suitable  than  Nux  vomica  for  males,  when  of  lymphatic  temperament 
and  mild  disposition.  Some  of  the  best  indications  for  this  medicine 
will  be  found  under  Dyspepsia,  Cardialgia,  and  Derangement 
of  the  Stomach. 

Cinchona.  When  a  quantity  of  blood  has  been  already  vomited, 
this  remedy,  from  its  power  of  restoring  the  energy  of  the  system  after 
debilitating  losses,  is  clearly  indicated ;  it  should  also  be  chosen  when 
the  patient  has  had  a  severe  attack  of  haematemesis,  which  has  ceased 
of  itself,  but  stil]  left  great  weakness. 

Arnica.  One  of  our  most  important  remedies  in  severe  cases, 
and  especially  when  occurring  in  individuals  of  a  robust  constitution, 
of  a  sanguine  temperament,  and  choleric  disposition.  It  is  further 
indicated,  when  the  patient  complains  of  pains  resembling  the  results 
of  a  contusion,  in  all  the  extremities. 

Spirit,  sulphuris  is  useful  in  strumous  habits,  or  when  the 
affection  has  arisen  from  suppressed  hemorrhoids ;  its  value  also  in 
cases  of  abnormal  menstruation  will  be  pointed  out  in  the  proper 
place. 

The  following  remedies  also  deserve  a  careful  study:  Phosphorus, 
Belladonna,  Arsenicum,  Lycopodium,  (which  may  be  ranked  next  to  Nux  v. 
in  cases  arising  from  abdominal  congestion^)  Hyoscyamtis,  (which,  with 
Belladonna,  is  particularly  useful  in  cases  attended  wTith  Spasmodic 
action,)  Lycopodium,  Arsenicum,  Phosphorus,  and  Secale  cornutum  (in 
Schirrus),  together  with  Carlo  vegetabilis,  Millefolium,  Cantharides,  Cal- 
carea  carbonica,  Natrum  muriaticum,  and  Zincum,  under  peculiar  circum- 
stances, and  as  tending  to  eradicate  the  predisposition  to  such 
affections. 

The  application  of  dry  cupping-glasses  to  the  abdomen  and  under 
the  ribs,  or  of  a  cloth  which  has  been  dipped  in  cold  water,  to  the 
lower  region  of  the  abdomen,  sometimes  forms  a  useful  auxiliary  in 
arresting  the  hemorrhage.  See  also  Hemorrhage  from  the  Lungs, 
under  Haemoptysis. 


CONSTIPATION.  143 

Diet.  The  rules  already  given  under  Cardialgia  should  be 
observed^  but  with  still  greater  strictness ;  no  solid  food  must  be  par- 
taken of;  all  drinks  should  be  cold  ;  animal  jellies^  preparations  of 
milk;  light  puddings,  and  broths,  merely  tepid,  may  be  allowed  in 
cases  where  the  patient  may  require  such  nourishment,  but  nothing 
more  must  be  taken  than  is  absolutely  necessary  for  that  purpose ; 
immediately  after  an  attack,  no  food  should  be  given  for  some  hours, 
and  then  very  cautiously,  and  in  small  quantity.  It  is  evident  that, 
in  such  cases,  absolute  rest,  both  mental  and  bodily,  is  essentially 
requisite. 


COSTIVENESS,  CONSTIPATION,  OBSTIPATION. 

Constipatio,  Obstipatio,  Obstructio  Alvi. 

We  have  now  to  treat  of  an  affection  which  so  frequently  baffles 
the  skill  of  the  practitioners  of  the  old  school ;  their  leading  cause  of 
failure  being  their  ignorance  of,  or  inattention  to,  the  great  curative 
principle,  and  consequent  proceeding  upon  a  system  opposed  to  the 
operations  of  Nature.  This  complaint  is  generally  sympathetic  with 
some  other  derangement  of  the  organism,  and,  consequently,  in  our 
treatment  of  different  diseases,  we  have  had  frequent  occasion  to 
allude  to  it.  One  of  the  leading  causes  of  aggravation  and  excessive 
obstinacy  in  the  Constipation,  most  closely  approaching  to  an  idio- 
pathic form,  is  the  practice  of  flying  to  aperient  medicines  on  the 
slightest  appearance  of  costiveness,  under  the  absurd  idea  that  keeping 
the  bowels  open  is  a  species  of  panacea  against  disease  of  every  descrip- 
tion. Many  mothers  are  so  possessed  with  this  idea,  that  they  con- 
tinually administer  physic  to  their  children,  without  the  slightest 
apparent  call  for  it,  and  thus  lay  the  foundation  of  dyspepsia  and  other 
visceral  derangements  in  after-life.  Many  a  slight  case  of  costiveness 
which,  if  left  to  nature,  would  have  disappeared  of  itself,  leaving  no 
ill  consequences,  has,  by  an  ill-judged  administration  of  aperients, 
been  converted  into  obstinate  and  habitual  constipation,  embittering 
existence,  and  predisposing  the  constitution  to  a  variety  of  diseases 
in  after-life.  To  prevent  misconception  upon  this  point,  it  should  be 
clearly  understood,  that  we  by  no  means  undervalue  a  regular  state  of 
the  bowels,  but,  that  when  costiveness  shows  itself,  we  happily  possess 
remedies  calculated  to  restore  the  general  balance  of  the  system;  and, 
in  obstinate  cases,  do  not  content  ourselves  with  simply  alleviating  the 


144  DIGESTIVE  SYSTEM. 

symptoms,  but  mainly  direct  our  attention  to  the  permanent  removal 
of  the  affection. 

Many  of  the  principal  causes  of  this  disorder,  besides  that  men- 
tioned, are  the  same  as  those  particularised  under  Indigestion  or 
Dyspepsia. 

Therapeutics.  In  trivial  cases  it  will  be  found  sufficient  to  pay 
proper  attention  to  diet,  to  avoid  too  dry  or  indigestible  food,  to 
masticate  properly,  to  partake  of  meat  only  once  a  day,  and  to  take 
sufficient  exercise  in  the  open  air.*  Should  this  course  not  have  the 
desired  effect,  we  must  choose  one  or  more  of  the  following  remedies: 
namely,  Opium,  Alumina,  Bryonia,  Nux  vomica,  Pulsatilla,  Platina,  Na- 
trnm  muriaticum,  Plumhim  metallieum,  et  carbonicum,  Sulphur,  Calcarea  c, 
Lachesis,  Veratrum,  Lycopodium,  Sepia,  Veratrum^  Silicea,  Zineum,  etc. 

Opium  is  chiefly  to  be  selected  in  recent  cases,  when  constipation 
is  not  habitual ;  but  is  also,  like  Nux  v.,  and  other  remedies,  service- 
able in  cases  of  a  more  chronic  character,  occurring  in  vigorous, 
plethoric,  well-nourished  subjects,  and  arising  from  inactivity  in  the 
intestinal  canal,  or  from  sedentary  habits.  In  old  people,  it  is  generally 
more  useful  than  Bryonia  and  Lachesis,  when  diarrhoea  alternates  with 
the  constipation,  although  these  and  other  remedies,  such  as  Antim., 
Phosph.,  and  Ruta,  must  be  borne  in  mind  and  administered  when 
called  for  by  the  nature  of  the  symptoms.  The  more  immediate  in- 
dications for  Opium  are ;  want  of  power  to  relieve  the  bowels,  with  a 
feeling  of  constriction  in  ano ;  pulsation  and  sense  of  weight  in  the 
abdomen,  dull,  heavy  pain  in  the  stomach,  parched  mouth,  and  want 
of  appetite,  determination  of  blood  to  the  head,  with  redness  of  the  face, 
and  headache.f 


*  See  also  the  concluding  remarks  of  this  chapter. 

f  Opium  is  strongly  recommended  by  Dr.  Perry,  as  the  best  palliative  remedy  in  consti- 
pation arising  from  pressure  on  the  rectum,  such  as  that  which  is  occasioned  by  the  gravid 
uterus,  abdominal  tumours,  swelling  of  the  ovarium,  fibrous  swelling  of  the  uterus,  and,  in 
consequence  of  which,  the  faecal  matter  frequently  accumulates  in  excessive  quantities  in 
the  rectum,  and  can  only  be  expelled  after  great  effort,  accompanied  by  severe  pain.  In 
weak,  nervous,  emaciated  females,  in  whom  the  monthly  discharge  is  always  too  copious, 
or  in  cases  where  the  constipation  has  arisen  from  affections  of  the  stomach  or  liver,  Opium 
is  contraindicated.  M.  Perry  recommends  the  administration  of  Opium  by  olfaction,  in  pre- 
ference to  the  ordinary  method,  and  that  as  follows.  At  the  period  of  the  day  at  which  the 
patient  used  formerly  to  have  the  bowels  relieved,  or,  otherwise,  as  soon  as  a  slight 
ineffectual  inclination  for  stool  is  experienced,  he  desires  the  patient  to  smell  a  solution  of 
Opium  (a  few  globules  dissolved  in  a  small  phial  containing  a  mixture  of  spiritus  and  aqu. 


CONSTIPATION.  145 

Alumina.  Constipation  from  an  apparent  absence  of  peristaltic 
motion ;  faeces  hard,  dry,  broken,  evacuated  with  considerable  exer- 
tion of  the  abdominal  muscles  and  forcing,  and  sometimes  streaked 
with  blood;  constipation  from  travelling, 

Bryonia  is  especially  useful  in  constipation  occurring  in  warm 
weather  >  and  in  persons  of  dark  complexion  and  an  irritable  or  obsti- 
nate disposition,  with  a  tendency  to  be  easily  chilled,  and  subject  to 
rheumatism;  it  is  further  indicated  when  constipation  arises  from 
disordered  stomachy  and  is  attended  with  determination  of  Hood  to  the 
head,  and  headache. 

Nux  vomica,  This  remedy  is  particularly  useful  when  constipa- 
tion results  from  too  heavy  a  meal,  indigestible  food,  and  stimulating 
liquids ;  or  when  the  confined  state  of  the  bowels  has  resulted  from 
prolonged  diarrhoea  or  frequent  purgings.  In  the  latter  instances 
Opium  may  often  be  advantageously  alternated  with  Nux  v.  In  chronic 
cases  arising  from  long-continued  indulgence  in  vinous,  fermented,  or 
spirituous  drinks,  or  coffee,  or  from  sedentary  habits  or  excessive  study, 
Nux  is  one  of  the  most  effectual  medicaments.  It  is  peculiarly  adapted 
to  persons  of  irascible  and  lively  temper,  with  determination  of  blood  to 
the  head,  and  headache*  unfitness  for  exercise,  disturbed  sleep,  and  a 
feeling  of  general  oppression  or  heaviness ;  frequent  and  ineffectual 
efforts  to  relieve  the  bowels,  attended  with  a  sensation  of  stricture, 
and  sometimes  frequent,  painful  and  difficult  emission  of  urine.  It 
is  further,  as  remarked  under  Dyspepsia,  particularly  indicated  for 
individuals  subject  to  hemorrhoids. 

Pulsatilla  has  nearly  the  same  indications  as  Nux  vomica,  with  the 
characteristic  distinction  of  temp  eram  en  t  before  notedunder  Dyspepsia. 
In  recent  cases,  it  is  particularly  indicated  when  the  obstruction  has 
arisen  from  indigestion  brought  about  by  rich  or  greasy  food,  and 
when  it  is  accompanied  by  moroseness  and  shivering. 

Platina  is  a  useful  remedy  when  constipation  has  been  brought 
about  by  travelling,  when  Opium  has  failed,  or  especially  w7hen  the  act 
of  expulsion  is  attended  with  great  straining. 

destill.)  several  times,  and  to  repeat  the  process  after  an  interval  of  half  an  hour,  and  again, 
as  before,  on  the  day  following,  if  no  satisfactory  action  result  from  the  first  trial.  He  fre- 
quently found,  that  on  the  first  occasion,  only  a  more  decided  inclination  to  go  to  stool  was 
the  sequel,  whereupon,  after  a  repetition  of  the  olfactus,  the  desired  effect  took  place.  In 
some  very  obstinate  cases,  he  ordered  a  simple  enema  to  be  employed,  after  several  pre- 
vious trials  of  Opium,  in  the  foregoing  method,  and  succeeded  in  this  manner  in  instances 
where  neither  Opium,  nor  the  enema  alone,  was  capable  of  affording  the  desired  relief. — 
Journal  de  la  Med.  Homceop.,  torn,  i,  chap.  1. 

10 


146  DIGESTIVE  SYSTEM. 

Plumbum  metallicum,  or  Carbonicum.  Obstinate  constipa- 
tion, with  ineffectual  efforts ;  painful  retraction  and  constipation  of 
the  anus ;  or  evacuation  of  tenacious,  hard,  bullet-shaped  faeces. 
(See  Obstipation.) 

Natrum  muriaticum.  This  remedy  will  sometimes  be  found 
efficacious  when  many  others  have  failed  to  relieve,  particularly  in 
chronic  and  extremely  obstinate  cases. 

Sulphur  is  one  of  the  best  remedies  in  the  relief  of  habitual  cos- 
tiveness,  constipation,  particularly  when  hemorrhoids  are  present,  or  a 
disposition  to  them  exists;  or  frequent  inclination  to  go  to  stool,  but 
without  the  desired  result. 

Veratrum.  Constipation,  chiefly  from  inactivity  of  the  rectum, 
with  heat  and  dryness  of  skin,  determination  of  blood  to  the  head 
and  lateral  headache.  (Alumina  is  also  of  great  efficacy  in  consti- 
pation from  torpidity  of  the  rectum — -see  Constipation  from  inertia 
recti.) 

Lachesis.  In  obstinate  constipation,  this  medicine  may  be  given 
with  effect  after  Nux  v.  to  those  wrho  habitually  take  wine  rather  freely, 
or  who  experience  flatulent  distension  after  meals  and  ineffectual  efforts 
to  eructate. 

Sepia  may  frequently  be  taken  with  advantage  in  chronic  constipa- 
tion after  Nux  and  Sulphur  ;  and  is,  moreover,  particularly  well  adapted 
for  females  in  whom  there  is  an  irregularity  or  obstruction  of  the 
menstrual  flux  ;  it  is  also  indicated  by  constipation  in  individuals  sub- 
ject to  rheumatism,  as  wTell  as  by  hard,  conglomerate  bullet-shaped 
faeces.     (See  Obstipation.) 

Silicea  is  often  useful  when  constipation  is  accompanied  with 
colic,  impaired  appetite  and  thirst;  the  stools  hard,  knotty,  and 
passed  with  great  difficulty;  and  the  patient  troubled  with  tenes- 
mus. (Conium  is  occasionally  useful  in  completing  the  cure  after 
Silicea.) 

Lycopodium .  Chronic  constipation  with  ebullition  and  determination 
of  blood  to  the  head:  colic,  flatulence,  sense  of  tveight  in  the  lower  part 
of  the  bowels. 

In  Obstipation  with  indurated  faeces,  formed  into  hard  balls  (scybald), 
Pkimb.,  Magn.  m.,  Sep.,  Ruta,  Verb.,  and  sometimes  Nux  v.,  Op.,  Veratr., 
Sulph.,  &c,  are  useful ;  but  in  obstinate  and  complicated  forms  of  this 
affection,  the  treatment  requires  considerable  experience,  in  addition 
to  a  thorough  knowledge  of  the  Materia  Meclica.  In  all  cases  of  con- 
stipation of  an  obstinate  or  chronic  nature,  recourse  may  occasionally 


CONSTIPATION.  147 

be  had  to  an  enema  of  tepid  water,  as  a  temporary  mode  of  relief, 
until  the  medicine  has  effected  the  desired  result.  The  drinking  of  a 
tumblerful  or  more  of  cold  water,  thrice  a  day,  fasting,  dashing  cold 
water  against  the  abdomen,  and  then  applying  brisk  friction  by  means 
of  a  coarse  towel,  combined  with  early  rising  and  daily  exercise,  (not 
violent  or  beyond  the  strength  of  the  patient,  so  as  to  cause  suffering, 
or  defeat  the  object  we  have  in  view,  by  exhausting  instead  of 
giving  tone  to  the  energies  of  the  patient,)  will  be  found  useful  auxi- 
liaries in  promoting  a  regular  action  of  the  bowels.  The  diet  ought 
to  be  regulated  according  to  the  state  of  the  primary  digestive  organs,* 
and  highly-seasoned  food,  or  that  which  contains  much  fibrous  or 
ligneous  matter,  such  as  radishes,  cabbages,  turnips,  green  fruits, 
&c,  avoided.  When  constipation  occurs  in  alternation  with  diarrhoea, 
Nux  v.,  Lachesis,  Rhus,  Antimonium,  Ruta,  Bryonia,  Opium,  and  Phos- 
phorus have  been  found  useful.  In .  constipation  from  inertia  recti, 
or  from  atony  of  the  intestinal  canal,  Sepia,  Veratrum,  Awrum  mu~ 
riaticum,  Alumina,  Natrum  m.,  and  Padus  avium  have  been  recom- 
mended as  the  best  general  remedies ;  but  when  the  indications  for 
the  selection  of  any  of  the  remedies  we  have  given  in  the  preceding 
part  of  this  article  manifest  themselves,  we  must  not  hesitate  to  pre- 
scribe accordingly. 

For  constipation  in  aged  persons,  the  following  medicaments 
are  generally  the  most  efficacious  :  Opium,  Aurum  m.,  Natrum  m.,  and 
Padus  avium,  {Padus  prudus,)  or  Veratrum,  Bryonia,  Lachesis,  Baryta  c, 
Ruta,  &c. 

In  that  which  is  prone  to  occur  when  travelling :  Platina,  Opium 
or  Alumina,  Calcarea,  Cocculus,  Conium,  Graphites,  Gratiola,  Arseni- 
cum, Kali,  Baryta  c,  Agaricus  m.,  or  Ammon.,  &c,  may  also  be  called 
for  in  particular  cases.  When  frequent  purgings  or  protracted  diar- 
rhoea have  given  rise  to  constipation,  Nux  v,  and  Opium  sometimes  in 
alternation,  or  China,  Aurum  m.,  Natr.  m.,  Pad.  prud>,  Lachesis,  Antim., 
Ruta,  usually  answer  best. 

Against  constipation  from  exposure  to  the  Vapoujr  of  Lead; 
Opium,  Alumina,  Platina,  are,  in  general  cases,  the  most  important  re- 
medies. 

That  from  Congestion  or  fulness  of  the  vessels  of  the  head;  Aconit., 
Belladonna,  and,  still  better,  Opium,  Ntix  v.,  Pulsatilla,  Sulphur,  Calcarea, 
Lycopodium,  &c.     (See  Determination  to  the  head.) 

*  See  Dyspepsia,  rules  for  diet  in. 


148  DIGESTIVE  SYSTEM. 

And  against  that  from  Duodenitis  {chronic) :  Nux  v.,  Pulsatilla,  Sul-> 
phur,  Lachesis,  Veratrum,  and,  sometimes,  Mercurius,  Digitalis,  Kali> 
Sepia,  Ars.,  Silicea,  Amnion,  c.  (See  also  Hepatitis,  Dyspepsia,  and 
Spasmodic  stricture  of  the  rectum.) 


PILES.     HEMORRHOIDS. 

Diagnosis.  Varices,  or  effusion  of  blood  in  the  cellular  tissue  of 
the  rectum,  either  within  or  without  the  anus,  (internal  or  external 
piles ;)  or  protrusion  and  filling  of  one  or  more  of  the  inner  folds  of  the 
same  intestine,  and  with  or  without  bleeding  (open  or  blind  piles), 
preceded  or  accompanied  by  pains  in  the  back,  sacrum,  and  abdomen ; 
sensation  of  itching,  pricking,  tickling,  burning,  or  pressing  at  the 
rectum,  sometimes  extending  to  the  adjacent  parts,  with,  in  general, 
constipation,  and  not  unfrequently  derangements  of  the  urinary 
functions. 

The  predisposing  cause  of  the  disease  is  a  constitutional  taint; 
whilst  among  the  exciting  causes  are  habitual  costiveness,  severe  ex- 
ertion on  horseback,  prolapsus,  use  of  drastic  medicines,  stimulating 
diet,  the  use  of  vinous,  alcoholic,  and  fermented  drinks,  or  coffee,  the 
suppression  of  long  continued  discharges,  sedentary  habits,  &c. 

During  the  treatment  of  this  affection  it  is  of  the  utmost  import- 
ance to  attend  strictly  to  the  homoeopathic  rules  for  diet.  Strong  or 
heating  drinks,  such  as  wines,  coffee,  strong  tea,  and  stimulating  ox  highly - 
seasoned  food  of  all  kinds  are  particularly  to  be  avoided.  Sedentary 
habits  and  the  use  of  soft  cushions  or  chairs  materially  tend  to  aggra- 
vate the  affection.  The  painful  practice  among  surgeons  of  removing 
the  hemorrhoidal  excrescences  by  means  of  the  knife  or  ligature  is 
much  to  be  deprecated ;  for,  independent  of  the  danger  not  unfre- 
quently attending  the  operation,  it  may  occasion  serious  consequences 
by  metastasis  of  the  congestion  to  some  of  the  noble  viscera ;  in  a 
great  number  of  cases,  moreover,  it  wholly  fails,  and  the  disease  re- 
turns, sometimes  even  in  an  aggravated  form. 

Therapeutics.     The  medicines  most  used  in  this  affection  are 

Aconitum,  Nux  vomica,  Sulphur,  Lycopodium,  Arsenicum,  Belladonna,  Hepar 
sulphuris,  Pulsatilla,  Platina,  Ignatia,  Antimonium  crudum,  Colocynth,  also 
Ipecacuanha,  Calcarea,  and  Cinchona. 

Aconite,  although  not  specific  in  its  curative  action,   is  useful  in 


HEMORRHOIDS.  149 

allaying  pain,  when  considerable  and  distressing  inflammation  exists, 
and  may  in  such  cases  precede  the  administration  of  each  of  the  fol- 
lowing medicines,  which  are  among  the  principal  remedial  agents  in 
this  disease. 

Nux  vomica,  as  wre  have  before  had  occasion  to  remark,  is  a  most 
valuable  remedy  in  this  affection,  and  is  equally  efficacious  against 
both  descriptions  of  piles,  particularly  for  individuals  who  lead  a 
sedentary  life,  or  who  indulge  in  the  use  of  coffee  or  stimulating 
liquids,  and  also  for  females  during  pregnancy ;  when  the  hemorrhoids 
are  attended  with  shooting,  burning  or  itching  pains  ;  colic  ;  shooting 
and  jerking  pain,  as  if  from  bruises  in  the  loins,  rendering  it  difficult 
to  rise  or  walk  in  an  erect  position ;  and  when  they  are  accompanied 
by  constipation  and  sometimes  painful  and  difficult  urination,  and  the 
other  symptoms  described  under  Indigestion  or  Dyspepsia. 

Sulphur  may  follow  the  administration  of  Nux  vomica ;  and  an 
alternation,  at  intervals  of  a  week  or  ten  days,  of  these  remedies  fre- 
quently effects  a  cure  in  cases  of  long  standing. 

Arsenicum.  Hemorrhoids  accompanied  by  burning  and  shooting 
pains,  heat,  and  agitation,  sometimes  with  prostration  of  strength. 

Belladonna,  moist  hemorrhoids,  with  an  insufferable  pain  in  the 
sacral  region,  as  if  the  back  would  break  or  be  rent  asunder ;  difficulty 
in  voiding  urine, 

Hepar  sulphuris  may  follow  Belladonna,  should  that  medicine 
fail  to,  or  only  partially,  i*elieve  these  symptoms. 

Rhus  toxicodendron,  when  the  violent  pain,  mentioned  under 
'Belladonna  still  continues  severe,  this  medicament  may  be  selected  in 
preference  to  Hepar,  particularly  if  the  pain  be  relieved  by  motion. 

Capsicum,  when  a  burning  sensation  exists,  attended  with  consi- 
derable itching  and  diarrhoea. 

Pulsatilla,  discharge  of  blood  and  mucus  during  stool,  some- 
times accompanied  by  painful  smarting,  and  sensation  of  excoriation 
in  the  hemorrhoids,  pains  in  the  back,  pallid  countenance,  and  dispo- 
sition to  fainting ;  difficulty  in  passing  water. 

Platina,  when  there  is  frequent  inclination  to  go  to  stool,  followed 
by  a  very  scanty  and  difficult  evacuation,  succeeded  by  general  shudder- 
ing and  a  feeling  of  weakness  in  the  abdomen  /  frequent  creeping,  itching, 
and  piercing  at  the  anus,  particularly  in  the  evening;  griping  in  the 
lower  intestine,  discharge  of  blood  during  stool,  and  at  other  times. 

Lycopodium  is  a  most  important  remedy  in  chronic  hemorrhoidal 
affections,  particularly  when  there  is  congestion  to  the  head,  with 


150  DIGESTIVE  SYSTEM. 

giddiness  and  headache,  flatulent  distension  of  the  abdomen,  constipa- 
tion, severe  burning,  itching,  and  pricking  pains  in  ano,  with  painful 
protrusion  of  the  hemorrhoids,  and  sometimes  prolapsus  ani  after  a 
motion ;  acrid  discharge  from  the  hemorrhoids ;  and  prurient  erup- 
tion round  the  anus. 

Ignatia,  is  indicated  by  itching  and  creeping,  and  also  sensation 
of  constriction  and  excoriation  in  the  anus,  and  pricking  or  darting 
pain  extending  deep  into  the  lower  intestine ;  discharge  of  blood  or 
of  bloody  mucus,  rumbling  noise  in  the  abdomen,  and  protrusion  of 
the  lower  intestine  accompanied  by  acute  pain. 

Antimonium  crudum,  discharge  of  mucus  and  of  blood  at  every 
stool,  followed  by  severe  coUcwxA  pain  in  the  hemorrhoids,  with  throbs 
bing,  itching,  and  burning  at  the  anus,  and  discharge  of  viscous  acrid 
moisture,  particularly  at  night ;  frequent  determination  of  blood  to  the 
head,  with  bleeding  at  the  nose;  stiffness  in  the  back,  shooting  pains 
in  the  loins,  burning  and  rheumatic  pains  in  the  limbs,  flatulence,  and 
constipation. 

Golocynth.  In  cases  of  hemorrhoids,  attended  with  excessive 
almost  insupportable  colic,  this  is  a  most  efficient  remedy. 

When  the  discharge  of  blood  from  piles  amounts  to  hemorrhage,  a 
dose  or  two  of  Aconitum  may  be  given  in  the  first  place,  followed  by 
Ipecacuanha,  if  improvement  do  not  speedily  follow ;  again,  if  Ipeca- 
cuanha does  not  arrest  or  diminish  the  discharge  in  a  few  minutes, 
Sulphur  should  be  prescribed,  and  followed  in  turn  by  Aconitum :  but 
if,  notwithstanding  the  employment  of  these  remedies,  the  hemor- 
rhage does  not  cease,  Belladonna  should  be  given,  and  then  Calcarea.* 

Cinchona  is  valuable  either  as  an  immediate  remedy  to  support 
the  patient,  when  there  has  been  much  loss  of  blood,  or  afterwards 
against  prolonged  debility. 

These  are  the  principal  medicaments  to  be  employed  in  the  treat- 
ment of  ordinary  cases  of  hemorrhoids ;  and  when  judiciously  selected, 
will  be  certain  to  afford  the  desired  relief,  provided  the  patient  is 
careful  to  adhere  strictly  to  the  rules  laid  down  in  the  introductory 
remarks  upon  this  affection.  In  severe  cases  of  long  standing, 
much  patience  and  perseverance  are  required  before  the  disease  can 
be  permanently  removed. 

Against  hemorrhoids  with  mucous  discharge  (blennorrhea  intesiini 
recti),  Mercurius,  Helleborus  niger,  Colchicum,  and- Spigelia are  valuable 
medicines. 

*  C.  Hering's  Hausartz. 


STRICTURE  OF  THE  RECTUM.  151 


STRICTURE  OF  THE  RECTUM. 


Stricture  of  the  rectum  is  divided,  by  some  authors,  into  two 
kinds,  viz.  the  spasmodic  and  permanent.  The  first  appellation 
being  given  to  that  form  of  the  complaint  which  sometimes  arises  in 
consequence  of  the  existence  of  hemorrhoids,  or  from  constipation, 
the  prolonged  use  of  drastic  purges,  etc.,  and  in  which  the  patient 
is  affected  with  the  following  symptoms :  costiveness,  with  consider- 
able pain  in  the  anus,  particularly  after  a  stool ;  the  faeces  are  small 
in  diameter,  and  present  a  twisted  appearance.  On  passing  the 
finger  into  the  rectum,  the  lower  sphincter  is  felt  spasmodically  con- 
stricted. The  disease  is,  moreover,  often  complicated  with  a  small 
but  painfully  sensitive  ulcer  of  the  mucous  membrane,  or  with  rha- 
gades,  or  irregular  fissures  or  cracks.  The  second  variety,  the  per- 
manent stricture,  or  stricture  proper,  consists  in  a  thickening  and 
induration  of  the  mucous  and  muscular  textures,  and  probably  also 
of  the  interposing  cellular  tissue.  In  this  form  of  the  disease,  the 
faeces  are  flattened  and  diminished  in  volume,  and  the  patient  en- 
counters much  difficulty  in  expelling  them  ;  the  pain  about  the  anus 
is  distressingly  severe,  and  does  not  remit,  as  in  spasmodic  stricture. 
When  the  finger  is  introduced  into  the  rectum,  the  gut  will,  in  most 
cases,  be  found  contracted  two  or  three  inches  from  the  anus  ;  but 
in  some  cases  the  seat  of  the  stricture  is  considerably  higher.  As 
permanent  stricture  of  the  anus  is  by  far  the  most  serious  and  ob- 
stinate form  of  the  complaint,  we  shall  offer  the  following  additional 
particulars  connected  with  it.  The  disease  comes  on  very  insi- 
diously, and  occurs  in  both  sexes  and  at  all  ages,  but  in  adults  more 
frequently  than  in  children.  The  patient,  at  the  commencement, 
meets  with  some  difficulty  in  evacuating  the  contents  of  the  rectum, 
and  is  under  the  necessity  of  exerting  considerable  expulsive  force. 
These  symptoms  gradually  increase  in  severity,  and  are  sometimes 
accompanied  by  others,  which  resemble  those  of  ileus  ;  the  pain 
becomes  extremely  violent,  and  the  faeces  are  not  only  accompanied 
by  a  discharge  of  mucus,  but  also  of  blood  and  purulent  matter, 
from  the  accession  of  inflammation  in  the  contracted  portion  of  the 
intestine.  If  the  disease  be  not  checked,  the  cellular  tissue  around 
the  rectum  becomes  implicated  in  the  inflammatory  process,  and 
putrid  abscesses  form  which  burst  in  various  spots  in  the  vicinity  of 


152  DIGESTIVE  SYSTEM. 

the  anus,  and  the  patient  sinks.  In  some  cases,  the  patient  is  carried 
off  with  symptoms  resembling  those  of  strangulated  hernia,  from 
the  blocking  up  of  the  stricture  by  indurated  faeces. 

In  the  advanced  stage  of  the  disease,  most  patients  become  hectic, 
but  frequently  linger  on  for  several  years. 

Therapeutics.  In  spasmodic  stricture,  or  preternatural  contrac- 
tion of  the  sphincter  ani,  the  homoeopathic  treatment  is,  in  recent 
cases,  at  once  gentle,  simple,  and  peculiarly  efficacious ;  and  even  in 
long-standing,  inveterate  cases,  their  employment  is  generally 
attended  with  successful  results,  when  the  patient  can  be  prevailed 
upon  to  pursue  the  treatment  long  enough. 

The  following  are  amongst  the  more  frequently  applicable  reme- 
dies in  ordinary  cases  of  the  disorder.  Nux  v.,  Opium,,  Lachesis, 
Plumb.  c,  Sepia,  Natrum  m.,  Mang.,  Mags.,  Staph.,  Calc,  Coloc,  Aug., 
Thuja.  Where  the  patient  is  habitually  of  a  costiv.e  habit,  or  the 
faeces  are  dry  and  hard,  as  is  commonly  the  case  in  this  affection, 
these  remedies  will  prove  equally  opportune.  And  where  hemor- 
rhoids appear  to  have  given  rise  to,  or  at  all  events  accompany  and 
aggravate  the  disorder,  the  same  medicines,  together  with  Sulphur, 
Colocynth,  Calcarea,  etc.,  form  the  principal  remedial  agents. 

In  hysterical  females,  Lgnatia,  Sepia,  Nux  v.,  Lachesis,  and  Natr.  m., 
Calc.,  Staph.,  N  moscL,  deserve  a  preference.  The  indications  which 
are  given  for  the  choosing  the  above-mentioned  remedies  under  the 
chapters  of  Constipation,  and  Hemorrhoids,  as  also  under  that  of 
Dyspepsia,  when  deranged  digestion  accompanies  the  complaint,  will 
assist  us  in  making  a  selection  of  the  remedy  or  remedies  best 
adapted  to  particular  cases.  Although  we  are  opposed  to  the  em- 
ployment of  a  bougie  for  the  purpose  of  dilating  the  anus  in  spas- 
modic stricture,  still  we  are  willing  to  allow  that  there  are  some  cases 
in  which  the  introduction  of  a  suppository  of  tallow,  at  night,  (a  por- 
tion of  a  mould  candle  for  instance,)  may  prove  serviceable.  Cases 
that  are  complicated  with  rhagades  require  the  employment  of  such 
remedies  as  Graphites,  Agnus,  Sulphur,  Calcarea,  Rhus,  or,  Hepar, 
Mezereon,  Alumina,  Merctirius,  Lycopodmm,  Sarsaparilla ;  but  one  or 
more  of  the  medicaments  enumerated,  at  the  commencement  of  this 
article,  will  commonly  be  called  for  in  the  course  of  treatment. 

When  the  complication  of  a  small,  and  excessively  painful  ulcer 
exists  :  Lachesis,  Arsenicum,  Lycopod.  And,  sometimes,  Sulphur,  Silicea, 
and   Calcarea  are   chiefly  requisite.     The  homoeopathic  treatment  of 


STRICTURE  OE  THE  RECTUM.  153 

permanent  stricture  likewise  possesses  many  advantages  over  that  of 
the  ordinary  method,  particularly  when,  in  the  latter,  the  employ- 
ment of  bougies  is  rendered  unsafe  or  inapplicable  by  the  distance  of 
the  obstruction  from  the  anus,  or  by  an  insuperable  degree  of  irri- 
tability of  the  bowel. 

At  the  commencement  of  the  disease,  when  the  patient  expe- 
riences much  difficulty  in  expelling  the  faeces,  and  almost  constantly 
complains  of  more  or  less  pain  about  the  anus,  the  same  remedies  are 
required  as  those  we  have  mentioned  as  appropriate  in  recent  cases 
of  spasmodic  stricture.  In  the  majority  of  instances,  and  especially 
in  the  male  subject,  Mix  v.  answers  best  to  begin  with,  the  more  so, 
if  the  patient  has  been  addicted  to  a  rather  free  mode  of  living,  or 
been  given  to  sedentary  habits  and  suffers  from  constipation, 
hemorrhoids,  &c.  in  consequence.  After  the  employment  of  Nux  v., 
we  shall  generally  find  it  requisite  to  have  recourse  to  Sepia,  Sulphur, 
and  Calcarea  at  proper  intervals.*  At  a  more  advanced  stage  of  the 
complaint,  where  inflammation  has  taken  place  in  the  constricted 
portion  of  the  bowel,  and  the  pain  has  become  intense,  and  is 
attended  with  a  discharge  of  blood  and  even  of  purulent-looking 
matter,  we  have  often  obtained  very  satisfactory  results  from  the  use 
of  a  dose  or  two  of  Aconitum  followed  by  Sulphur  in  repeated  doses. 
After  deriving  all  the  apparent  benefit  from  Sulph.  which  it  seemed 
capable  of  accomplishing,  we  have  prescribed  Nux  v.,  Ignatia,  or 
Xachesis,  according  to  circumstances,  with  decided  benefit ;  the  former 
was  selected  in  preference  where  the  indications  or  peculiarities  were 
present  which  we  have  already  given  above, — Ignatia  where  the 
patient  was  affected  with  shuddering  after  each  evacuation,  and  the 
last-named  remedy,  where  the  pain  in  the  anus  was  accompanied  by 
throbbing.  Pulsatilla  we  have  substituted  with  advantage  for  Nux  v., 
as  an  intermediate  remedy,  in  individuals  of  phlegmatic  tempera- 
ment ;  but  have  always  found  it  necessary  to  follow  up  the  adminis- 
tration of  this,  or  any  of  the  three  preceding  remedies,  with  Sep., 
Sulph.,  Calc,  Silex,  &c.  There  are  a  variety  of  other  medicines 
which  may  be  required  in  preference,  or  subsequent  to  any  of  the 
foregoing,  in  particular  cases,  and  in  different  stages  of  the  disease. 
Amongst  these,  we  may  quote  the  following,  as  deserving  of  especial 
attention :  Staphys.,  Graph.,  Zycop.,  Clem.,  Magn.  n.,  Natr.  m.,  Plumb,  c, 
Alum.,  Merc.,  Mez.,  Dulc,  Coloc,  Plat.,  Rhod.,  Hep.  s.,  Phosph.,  Thuj., 
etc.  In  cases  where  the  bougie  may  be  thought  necessary,  but 
*  See  rules  for  the  repetition  of  the  dose,  etc.,  in  the  Introduction. 


154  DIGESTIVE  SYSTEM. 

where  great  pain  is  produced  by  its  introduction,  the  alternate  use  of 
Aconitum  and  Arnica  may  remove  the  irritation.  When  the  faeces 
accumulate  above  the  obstruction  and  give  rise  to  additional  irritation 
by  over-distending  the  rectum,  Opium  should  be  prescribed,  and 
succeeded  by  Nux  v.,  if  no  effect  take  place  after  an  interval  of  a  few 
hours. *  But  when  symptoms  resembling  strangulated  hernia  have 
made  their  appearance,  in  consequence  of  a  blocking  up  of  the 
stricture  by  a  collection  of  hardened  faeces,  it  may  be  advisable  to 
attempt  to  introduce  an  elastic  gum  catheter  through  the  stricture, 
for  the  purpose  of  throwing  up  an  injection  of  tepid  soap  and  water, 
and  then  tepid  water  and  a  couple  or  so  of  tablespoonfuls  of  sweet  oil, 
previously  to  having  recourse  to  aforesaid  medicines ;  and  if  the 
enema  fail  to  empty  the  bowel  of  its  contents,  we  must  avail  our- 
selves of  the  remedies  mentioned,  or  any  of  the  others  for  which  we 
have  given  special  indications  in  the  article  on  Hernia. 

In  advanced  cases  of  stricture,  with  ulceration  of  the  mucous 
membrane,  and  the  formation  of  abscesses,  a  cure  may  yet  be  attain- 
able through  the  instrumentality  of  Silicea,  P7wsp/iorus,  Sulpk., 
Calc,  Lycop.)  Merc,  or  Hepar  s.,  etc. 

ABSCESSES  IN  ANO.     FISTULA  IN  ANO. 

The  formation  of  matter  in  the  vicinity  of  the  anus,  is  often  pre- 
ceded by  a  shivering  fit.  In  some  cases,  the  first  marked  symptom 
of  derangement  consists  in  a  swelling  of  a  part  of  the  buttocks  in  the 
vicinity  of  the  anus,  which  presents  a  somewhat  extensive  circum- 
scribed hardness,  and  soon  becomes  very  red  in  the  centre,  or  assumes 
the  form  of  phlegmonous  inflammation,  accompanied  by  a  quick,  full 
rpulse,  with  great  dryness  and  heat  of  skin.  In  other  instances,  the 
suppurative  process  is  ushered  in  by  ah  attack  of  widely  ramified  ery- 
sipelatous inflammation,  unattended  by  any  circumscribed  hardness, 
and  exhibiting  the  disease  in  a  more  superficial  character ;  the  quan- 
tity of  matter  secreted  being  at  the  same  time  small,  but  the  cellular 
tissue  sloughy  to  a  greater  or  less  degree.  On  some  occasions,  the 
affection  commences  somewhat  in  the  appearance  of  a  carbuncle ;  the 
skin  displays  a  livid  or  dusky  red  aspect,  the  matter  is  unhealthy  and 
small  in  quantity,  and  the  cellular  membrane  is  in  a  gangrenous  state. 
Finally,  it  may  be  observed,  that  the  abscess  sometimes  begins  as  a 
hardening  of  the  cutaneous  surface,  near  the  anus,  exempt  from  pain 

*  Plumbum  c.  may,  perhaps,  be  better  indicated  than  Nux  v.  in  certain  cases. 


ABSCESS  IN  ANO.  155 

and  discoloration;  the  induration  softening  and  suppurating  very 
gradually.  The  pulse  is,  incipiently,  full,  and  hard ;  but  as  the  dis- 
ease progresses,  it  speedily  becomes  low,  or  feeble,  unequal  and  irre- 
gular ;  the  strength  sinks  rapidly ;  and  the  spirits  are  excessively 
dejected. 

The  abscess  may  point  in  the  buttock,  either  remote  from  the  anus 
or  in  its  immediate  vicinity;  or  in  the  perineum.  The  matter  may 
make  its  exit  from  one  orifice  or  from  several.  Most  frequently  there 
is  either  only  an  external  opening,  or  both  an  external  and  an  internal 
one,  which  communicates  with  the  exterior  of  the  rectum;  but  in 
other  instances  there  is  merely  an  internal  aperture.  Hence,  abscess, 
or  rather  fistula  in  ano,  has  been  divided  into  three  kinds:  viz.  the 
blind  external;  the  complete;  and  the  blind  internal.  When  a  fistula 
in  ano,  or  sinus  by  the  side  of  the  rectum,  is  fairly  established,  the 
following  symptoms  present  themselves:  The  patient  experiences 
pain  in  expelling  the  faeces,  and  is  not  unfrequently  affected  with 
strangury,  prolapsus  ani,  tenesmus,  hemorrhoids,  diarrhoea,  or  obsti- 
nate costiveness;  there  is  a  discharge  of  thin  sanies  from  the  anus,  or 
from  a  small  fistulous  opening  in  its  immediate  vicinity,  according  to 
the  variety  of  the  fistula;  and  the  surrounding  integuments  are  gene- 
rally red  and  indurated. 

Therapeutics*  The  homoeopathic  treatment  of  fistula  in  ano 
is,  in  many  instances,  eminently  preferable  to  the  surgical.  It 
is  the  duty  of  a  surgeon,  however  expert  he  may  be  as  an  operator, 
to  spare  the  knife  on  every  occasion,  and  in  every  disease,  when  he 
can  do  so  without  detriment  to  the  case,  and  especially  when  there 
are  other,  and  equally  efficacious  means  either  of  terminating  or  of 
materially  alleviating  the  sufferings  of  his  patient.  The  disease  in 
question,  in  addition  to  being  frequently  capable  of  a  cure  through 
the  instrumentality  of  medicine,  is,  moreover,  in  some  cases,  so  com- 
plicated, that  the  performance  of  the  surgical  operation  for  laying 
open  the  fistula,  will  fail  in  effecting  a  cure,  or  if  it  succeed,  the  affec- 
tion will  either  return  again  at  some  future  period,  or  its  healing  up 
will  be  followed  by  a  more  rapid  advance  and  unequivocal  develop- 
ment of  the  existing  collateral  disease.  We  particularly  allude  to 
complications  with  disorders  of  the  liver,  lungs,  or  with  stricture  of 
the  rectum,  scirrhus,  &c,  or  to  cases  where  the  complaint  occurs  in 
persons  of  a  very  bad  habit  of  body,  and  whose  organism  is  in  a 
greater  or  less  degree  of  general  derangement. 


156  DIGESTIVE  SYSTEM. 

In  the  early  stage  of  abscess  about  the  anus/  if  the  patient  be  of  a 
full,  plethoric  habit,  the  pain  violent,  and  the  inflammation  of  a  phleg- 
monous character,  a  few  doses  of  Aconitum  are  requisite.  A  simple 
emollient  poultice  may  then  be  applied  to  the  part,  and  the  suppura- 
tive process  forwarded  by  repeated  doses  of  the  third  trituration  of 
Silicea,  or  of  Hepar  s.  and  Silicea  in  alternation.  Should  the  abscess 
not  burst,  during  the  employment  of  one  or  both  of  these  remedies, 
which  will  rarely  be  the  case,  however,  it  may  be  opened  mecha- 
nically, when  the  skin  has  become  much  attenuated.  When  the 
inflammation  is  erysipelatous,  and  spreads  extensively,  Bella,  and 
Rhus  may  be  prescribed  alternately  in  the  first  instance,  but  as  soon 
as  a  degree  of  fluctuation,  however  trivial,  can  be  felt,  or  when  shiv- 
ering sets  in, . Silicea,  which  is  one  of  the  most  important  remedies  in 
established  fistula  in  ario,  must  be  given  in  repeated  doses.  Should 
an  opening  not  form,  soon  after  the  exhibition  of  Silicea,  and  the  cel- 
lular membrane  be  found  in  a  sloughy  state,  an  aperture  should  be 
made  for  the  discharge  of  the  matter.  If  the  skin  presents  a  livid 
appearance,  and  the  fistula  commences  with  the  features  of  a  car- 
buncle, Lachesis  and  Silicea  must  be  exhibited  in  alternation  at  the 
commencement ;  but  if  a  healthy  action  do  not  early  display  itself,  a 
free  incision  may  be  made  in  the  part,  and  Arsenicum  and  Cinchona 
had  recourse  to,  in  alternation,  if  the  patient's  strength  and  spirits 
become  much  depressed.  A  little  wine  may  also  be  allowed,  where 
required,  as  is  sometimes  the  case,  even  under  the  invigorating  or 
tonic  action  of  the  homoeopathic  remedies,  and  that  particularly  in 
elderly  subjects,  or  in  those  who  have  been  long  habituated  to  the  use 
of  stimulants,  or  have  had  their  constitutions  impaired  by  intemper- 
ance. After  the  bursting  of  the  abscess  and  discharge  of  its  contents, 
the  approximation  and  union  of  the  sides  of  the  cavity  may  be  left  to 
Nature;  but  when  incarnation  appears  to  proceed  slowly  or  imper- 
fectly, her  efforts  must  be  assisted  by  the  internal  exhibition  of  Mer- 
curius,  Sulphury  and  Silex,  or  of  Merc,  Hepar,  and  Cole. 

When  the  rectum  has  become  involved  or  a  true  fistula  has 
resulted,  either  through  neglect  or  otherwise,  our  first  object  ought 
to  be  ta  attempt  to  heal  it  by  the  employment  of  medicine.  Even 
in  cases  of  long  standing,  and  particularly,  as  already  stated, 
where  any  other  disease  is  found  to  exist,  or  where  the  general 
health  is  in  a  much  impaired  state,  the  employment  of  appropriate 
homoeopathic  medicines  must  be  resorted  to  before  the  surgical 
operation  is  thought  of.     In  recent  cases  where  the  fistula  has  not 


PROCTALGIA.  157 

been  under  homoeopathic  treatment  from  the  beginning  of  the  attack, 
a  dose  or  two  of  Mercurms  may  be  given,  and  then  Silicea  and  Sulphur 
to  forward  granulation.     Should  these  not  be  sufficient  to  effect  a 
cure,  or  should  the  case  have  been  under  homoeopathic  treatment 
from  the  commencement,  and  Silicea  have  been  employed  to  promote 
the  ripening  and  bursting  of  the  abscess,  we  may  have  recourse  to 
Pulsatilla,  Sulphur,  and  Calcarea,  in  alternation,  if  the  employment  of 
only  one  of  these  be  found  inadequate  to  effect  a  cure  or  surmount 
the   complicated  features   of    the  case.      Hepar  may  sometimes  be 
required  after  Mercurius  where  the  fistula  is  extensive,  and  Phosphoms 
after  Silicea  where  there  is  considerable  constitutional  disturbance,  or 
where  there   is  complication  with  disease  of  the  lungs.     In  cases 
which  have  been  maltreated,  or  which  have  been  long  in  existence  and 
utterly  neglected,  the  medicines  with  which  the  cure  may  be  attempted 
are  the  same  as  we  have  already  mentioned ;  but  Silex,  Sulphur,  and 
Calcarea  may  be  named  as  those  on  which  we  may  chiefly  rely,  where 
any  chance  of  success  remains.     It  may  be  added  that,  when  the  liver 
is  implicated,  or  the  digestion  much  impaired,  either  through  habits 
of  intemperance  or  otherwise,  JVuw'v.,  Pulsatilla,  Mercurius,  and  Lachesis 
will  form  valuable   intermediate  remedies,  provided  Sulphur,  Silicea, 
and   Calcarea  prove  insufficient  to  overcome  that  additional  derange- 
ment. (See  Hepatitis  and  Dyspepsia.)     Where  hemorrhoids  exist, 
■Sulphur  is  almost  indispensable  (see  also  art.  Hemorrhoids);  and 
where  the  disease  is   associated  with  scirrhus  or  carcinoma,  Silicea, 
Sulphur,  or  Merc,  Lack.,  Con.,  Arsenicum,  and  Lycopoclium,  are  the  reme- 
dies that  are  most  likely  to  afford  any  chance  of  a  cure.       In  compli- 
cations with  stricture  Nux,  Sulph.,  Calc,  &c.,  claim  attention.     (See 
Stricture.) 


PROCTALGIA. 

Proctalgia,  or  severe  pain  in  the  anus,  is  liable  to  attack  certain 
individuals  after  every  exposure  to  cold ;  but  it  more  commonly 
occurs  as  symptomatic  of  some  other  affection,  such  as  piles,  prurigo, 
scirrhus,  or  the  existence  of  a  small  ulcer,  which  often  forms  on  the 
posterior  wall  of  the  rectum,  opposite  to  the  extremity  of  the  os 
coccygis.  The  suffering  in  the  latter,  or  symptomatic  forms  of  the 
complaint,  is  solely  experienced,  or  is  at  all  events  materially. aggra- 


158  DIGESTIVE  SYSTEM. 

vated  during  and   after  the   expulsion   of  faeces ;    and  the  act  of 
defecation  is  frequently  attended  with  copious  hemorrhage. 

Therapeutics.  When  the  disorder  takes  place  in  consequence 
of  exposure  to  cold,  or  occurs  apparently  as  a  purely  idiopathic 
affection,  it  will  often  yield  to  the  employment  of  Kali  c.  In  other 
cases,  especially  when  the  pain  is  excessively  acute,  a  dose  of  Aconitum 
will  be  found  useful,  followed,  if  required,  by  the  continuation  of  the 
pain  in  an  undiminished  ratio,  after  an  interval  of  a  few  hours,  by 
Nux  v.,  or  by  Ignatia  if  the  pain  is  increased  after  a  stool,  or 
is  attended  with  shivering  or  shuddering.  The  following  medica- 
ments may  be  named  as  likely  to  prove  efficacious  in  some  instances : 
Conium,  Natrum  m.,  Snlph.,  Sepia,  or  Carl.  v.,  &c.  In  the  symptomatic 
forms  of  the  disease,  the  remedies  must  be  selected  according  to  the 
nature  of  the  primary  complaint.  Thus,  in  the  case  of  hemorrhoids, 
Aconitum,  Belladonna,  Nux  v.,  Puis.,  Sulph.,  Sec,  are  principally  re- 
quired. (See  Hemorrhoids.)  In  that  of  prurigo,  Sulph.,  Sep.,  Ac.  nitr., 
Merc,  Thuja,  Calc.,  &c.  In  scirrhus  or  cancer,  Con.,  Arsenic.,  Lachesis, 
Merc,  Sulph.,  SiUcea.  And  in  that  arising  from  the  formation  of  a 
small,  excessively  sensitive,  ulcer  in  the  lower  and  posterior  part  of 
the  rectum,  Lachesis,  Lycopod.,  Sulphw,  especially  when  there  is 
obstinate  constipation ;  and  Arsenicum,  SiUcea,  or  Calcarea,  when 
the  bowels  are  in  a  normal  state,  or  the  former  remedies  are  insuf- 
ficient to  effect  a  cure. 

PROTRUSION  OF  THE  INTESTINE. 

Prolapsus  Ani. 

By  this  term  is  understood  the  protrusion  of  a  portion  of  the 
mucous  membrane  of  the  lower  intestine ;  it  is  of  much  more  fre- 
quent occurrence  in  children  than  adults,  and  takes  place  during 
straining  when  at  stool,  or  when  urinating.  The  reduction  of  the 
protruded  portion  of  intestine  is  easily  effected  by  gentle  pressure 
with  the  thumb,  or  thumb  and  fore-finger,  which  have  previously 
been  dipped  in  oil. 

Therapeutics.  The  principal  remedies  for  removing  the  ten- 
dency to  this  affection  are,  Ignatia,  Nux  vomica,  Mercnrius,  and 
Sulphur. 


colic.  159 

Ignatia  is  particularly  efficacious  when  the  disorder  occurs  in 
persons  of  mild  and  sensitive  temperament,  and  is  attended  with 
constipation. 

Nux  vomica  is  indicated  for  persons  of  irritable  or  lively  disposi- 
tion, and  addicted  to  high  and  stimulating  diet,  with  a  tendency  to 
hemorrhoids  and  constipation. 

Mercurius  is  particularly  suited  for  children,  in  whom  the 
disease  is  attended  with  hardness  and  swelling  of  the  abdomen,  and 
great  tenesmus. 

Sulphur  is  one  of  the  best  remedies  for  the  permanent  removal 
of  the  disease.  Calcarea,  Jjt/cqpoa%um  and  Sepia  may  be  found  neces- 
sary in  some  obstinate  cases,  after  SuVpli.  In  other  cases  :  Plumbum, 
Arsenicum,  Mezereum,  Natrum  m.,  Colchicum,  Ruta,  Tkericlion,  and  Mag- 
nes  artificialis  have  been  found  efficacious. 


COLIC. 

Enteralgia. 

Diagnosis.  Griping,  tearing,  gnawing,  or  shooting  pain  in  the 
bowels,  chiefly  confined  to  the  region  of  the  navel,  generally  attended 
with  painful  distension  of  the  abdomen,  spasmodic  contraction,  and 
sometimes  vomiting  and  costiveness,  or  diarrhoea. 

The  general  exciting  causes  of  this  complaint  are,  acid  fruits  and 
indigestible  substances;  cold  from  wet  feet,  drinking  cold  beverages 
when  heated,  constipation,  worms,  &c.  It  is  frequently  also  a  conco- 
mitant symptom  of  some  other  derangement,  but  occurs  equally  often 
as  a  primary  disease.  We  shall  here  content  ourselves  with  giving 
the  symptoms  under  the  medicines,  without  entering  upon  the  differ- 
ent varieties  of  this  affection.  One  of  the  ^distinctive  characteristics 
between  this  malady  and  internal  inflammation,  is  the  pain  being 
somewhat  relieved  by  pressure. 

Therapeutics.  In  general  cases  the  selection  of  the  remedy  is 
considerably  facilitated  by  directing  our  attention  to  the  cause  of  the 
affection.  Thus,  when  the  pain  is  evidently  induced  by  a  morbid 
accumulation  of  flatus  {flatulent  colic)  one  or  more  of  the  following 
remedies  will  be  required:  Nux  v.,  Puis. ,  CMn.,  Cocc,  Card,  v.,  Cham., 
Bella.,  Sulp/mr  ;  or,  Lycop.,  ColcL,  Natr.  m.,  Coloc*,  Grapk.,  Fer., 
Veratr.,  Acid,  nitr.,  Mags,  arct.,  N.  moscli.,  Agn.,  Pkbsph.,  Zincum.  When 


160  DIGESTIVE  SYSTEM. 

the  attack  proceeds  from  a  spasmodic  contraction  in  a  portion  of  the 
intestinal  tube  (Ileus) :  Opmm,  Plumbum  ;  or,  when  inflammation  has 
supervened,  or  given  rise  to  this  form  of  the  complaint :  Nux  v.j 
Bella.,  Lachesis,  Merc.  (See  Enteritis.) 

For  colic  resulting  from  hemorrhoids  {Hemorrhoidal  colic);  Nux  v.* 
Puis.,  Lack,,  Coloc,  Carl,  v.,  Sulphur.  (See  Hemorrhoids.) 

For  that  arising  from  the  presence  of  worms  in  the  alimentary 
canal:  Cina,  Cicuta,  Spigelia,  Merc;  or,  Per.,  Ruta,  Salad.,  Nux 
mosch,  etc.  (See  Invermination.) 

For  spasmodic  colic :  Bella.,  Hyosc,  Cham.,  Coloc,  Cocc,  Nux  v., 
Puis.,  Cupr.,  Laclu,  Sttlph.,  etc. 

For  that  wThich  has  been  occasioned  by  indigestible  food:  Puis., 
Antim.  c,  Nux  v.,  Bella.  :  or,  Bryon.,  Carlo  v.,  Arsenic,  China,  Coffea, 
Hepar,  Sulph. 

For  colic  which  has  been  excited  by  a  moral  cause,  such  as  a  fit' of 
passion,  or  indignation :  Chamomilla,  Colocynth,  and,  sometimes, 
Sulphur. 

When  external  violence,  such  as  a  blow,  strain  in  the  abdomen,  or 
in  the  loins,  has  given  rise  to  the  attack :  Rhus,  Bryonia,  Am.,  or, 
Carlo,  v.,  Cole,  Bach. 

Against  Lead  colic,  Devonshire  colic,  Pry  bellyache  (colica  pictonum), 
Opium,  Belladonna,  and,  secondly,  Alumina  or  Platina,  are  the  most 
efficacious  remedies.     (See  also  Lead  paralysis,  Art.  Palsy.) 

For  colic  arising  from  a  chill,  Nux  v.,  Cham.,  Merc,  Coloc,  China, 
are  the  most  serviceable. 

For  that  from  exposure  to  cold,  damp  weather,  Pulsatilla;  and 
that  from  a  thorough  wetting,  Rhus. 

In  hysterical  coUc :  Ignatia,  Cocculus,  Mosch.,  Magn.  m.yNux  v.,  Puis., 
Ipecac,  Bella.,  Bryon.,  Stramon.,  are  the  most  useful. 

And  in  that  which  occurs  in  females  during  the  catamenia,  (menstrual 
colic) :  Cocculus,  Nux  vomica,  Belladonna,  Pulsatilla,  Coffea  ;  and  Carlo,  v., 
Secale,  Sulphur,  Zincum,  etc.   (See  Dysmenorrhea.) 

Nux  vomica  is  especially  indicated,  either  in  flatulent  or  hemor- 
rhoidal colic,  or  colic  arising  from  a  chill,  when  there  is  a  sensation 
of  fulness  and  tightness  at  the  upper  part  of  the  abdomen;  deep- 
seated  or  cutting  pains  in  the  abdomen,  with  acute,  pressive,  and 
forcing-down  sensation,  compelling  the  sufferer  to  bend  double  ; 
violent  cutting  pains  in  the  hypogastrium ;  confused  headache,  with 
occasional  loss  of  consciousness ;  short  and  difficult  respiration  ; 
flatulence,  aggravation  of  the  pains  on  the  slightest  motion,  generally 


COLIC.  161 

disappearing  when  at  rest;  violent  pains  in  the  loins,  and  sensation 
of  internal  heat  and  obstruction ;  constipation,  coldness  and  numbness 
in  the  hands  and  feet  during  the  paroxysm.  It  is  a  very  useful 
remedy  at  the  monthly  period  in  females,  when  we  find  weight  or 
violent  deep-seated  aching  pain  in  the  abdomen,  and  aching  in  the 
sacral  region ;  dragging  pains  extending  to  the  thigh ;  aching  and 
creeping  sensation  in  the  same  part  when  sitting ;  painful  pressure 
towards  the  rectum. 

Pulsatilla  is  often  of  peculiar  efficacy  in  colic  occurring  in 
females,  either  during  the  catamenia  or  at  other  times,  when  coming 
on  periodically  in  the  evening  during  cold,  damp  weather,  and  accom- 
panied by  tightness  and  distension  of  the  abdomen  and  epigastrium; 
pulsation  in  the  pit  of  the  stomach,  aggravation  of  the  suffering  when  at 
rest  or  in  the  evening,  attended  with  shivering,  which  increases  with  the 
pains,  and  is  mitigated  by  motion ;  severe  bruising  pains  in  the 
loins,  especially  when  rising  up  ;  also  when  the  affection  has  arisen 
from  overloading  the  stomach,  or  from  rich  greasy  food,  with  incli- 
nation to  vomit,  flatulence,  diarrhoea,  paleness  of  the  face,  livid  circle 
round  the  eyes,  and  headache ;  or  in  hemorrhoidal  colic,  with  fulness 
of  the  veins  of  the  hands  and  forehead,  restlessness,  anxiety,  and 
sleeplessness. 

Chamomilla, — bilious  colic ;  colic  in  females  during  the  men- 
strual flux.  The  following  are  the  principal  indications :  sensation 
as  if  the  intestines  were  gathered  into  a  ball,  and  as  if  the  abdomen 
were  empty,  with  tearing  and  drawing  pains,  attended  with  excessive 
anxiety  and  restlessness;  distension  under  the  lower  ribs  and  in  the  pit 
of  the  stomach  ;  incarcerated  flatus,  sometimes  nausea,  or  vomiting  of 
a  bitter  or  bilious  fluid,  bitter  vomiting,  followed  by  desire  to  relieve 
the  bowels,  and  bilious  diarrhoea  ;  livid  circles  round  the  eyes,  alternate 
paleness  and  redness  of  the  face ;  the  pains  come  on  particularly  at 
night,  at  other  times  early  in  the  morning,  or  after  a  meal.  This 
remedy,  as  before  stated,  is  particularly  adapted  for  children  of 
irritable  temperaments,  and  is  extremely  serviceable  in  all  cases,  in 
which  a  fit  of  passion  has  been  the  exciting  cause  of  the  sufferings. 
It  is  also  useful  when  colic  has  arisen  from  cold  in  the  feet  or 
checked  perspiration.  Although  hr  instances  quoted,  Chamomilla  is 
of  itself,  generally  sufficient,  it  has  been  sometimes  found  useful  to 
precede  it  by  a  dose  oi  Aconite.  [Colocynth  is  often  useful  after  Cha- 
momilla, when  the  latter  has  produced  only  partial  relief.) 

Belladonna, — flatulent   colic,    when    there   is   distension  of  the 

11 


162  DIGESTIVE  SYSTEM. 

transverse  section  of  the  great  intestine,  attended  with  colic-like  pain 
which  is  relieved  by  pressure  on  the  part ;  also  severe  dragging  pains, 
from  above  downwards,  as  if  the  whole  of  the  intestines  would  be 
forced  downwards  from  their  containing  cavity  ;  menstrual  colic, 
with  spasmodic  constriction  in  the  abdomen,  and  a  burning  pain  lower 
down  or  in  the  small  of  the  back ;  violent  griping  in  the  hypogas- 
trium.  The  symptoms  are  frequently  attended  with  a  liquid  or 
puriform  species  of  diarrhoea,  and  swelling  of  the  veins  of  the  head ; 
and  the  pains  are  aggravated  by  movement,  or  are  sometimes  so 
violent  as  almost  to  deprive  the  patient  of  reason. 

Cocculus  is  indicated  (especially  in  menstrual  or  flatulent  colic) 
when  there  are  severe  constrictive  or  spasmodic  pains  in  the  lower 
part  of  the  abdomen  ;  great  flatulence,  fulness,  and  distension  of  the 
entire  abdomen,  with  nausea  and  difficulty  of  breathing ;  also  when 
there  are  a  sensation  of  emptiness,  tearing  and  burning  pains  in  the 
intestines,  sometimes  with  squeezing,  tearing  and  dragging  pains, 
excessive  anguish  and  nervous  excitement,  and  constipation. 

Colocynth.  In  the  majority  of  violent  and  obstinate  cases,  we 
find  this  a  valuable  remedy ;  it  is*  indicated  when  the  pains  are  exces- 
sively violent,  and  of  a  constrictive  or  spasmodic  character,  or  resemble 
stabbing  and  cutting,  as  if  from  knives  ;  sometimes  there  is  a  sensation 
of  clawing  and  pinching,  and  tenderness  of  the  abdomen,  with  a 
pain  as  from  a  blow ;  or  distension  of  the  abdomen  ;  at  other  times  a 
sense  of  emptiness  is  experienced,  with  cramps  and  shivering,  or 
tearing  pains  in  the  legs ;  during  the  continuance  of  the  attack,  we 
find  excessive  restlessness,  agitation,  and  tossing  about  from  the 
violence  of  the  pain  :  when  the  pains  come  on^  they  continue  with- 
out any  apparent  intermission ;  after  their  disappearance,  a  bruised 
sensation  remains,  and  the  sufferer  feels  as  if  the  intestines  were 
held  together  by  thin  threads,  likely  to  break  from  the  slightest 
motion.  Both  this  remedy  and  Chamomilla  are  particularly  effica- 
cious in  the  so-called  bilious  colic,  being  indicated  by  the  diarrhoea 
and  bilious  vomiting  attending  it,  and  also  in  cases  where  passion 
has  been  the  exciting  cause.  Colocynth  is  more  particularly  useful  in 
the  case  of  adults,  or  where  the  fit  of  anger  is  attended  with  indig- 
nation. 

Sulphur  may  follow  either  Chamomilla  or  Colocynth  in  cases  of 
bilious  colic,  where  only  partial  relief  has  been  obtained ;  or,  in 
flatulent  colic,  may  be  taken  after  Nux  v.,  Carbo  v.y  Cocculus,  or  Cha- 
momilla ;   and  in  hemorrhoidal  colic  after  Nux  v.*  or  Carbo  v. 


DETERMINATION  OE  BLOOD  TO  THE  ABDOMEN.  163 

Arsenicum  in  colic,  arising  from  disordered  stomach,  with  nau- 
sea, vomiting ;  diarrhoea,  with  green  or  yellow  evacuations,  violent 
gripings,  headache,  paleness  of  the  face,  and  blue  marks  round  the 
eyes ;  accession  of  the  pains  particularly  during  the  night,  or  after 
eating  or  drinking. 

Coffea  is  valuable  when  we  have  to  prescribe  for  colic  with 
excessive  pains,  attended  with  great  agitation^  anxiety,  and  tossing 
about,  grinding  of  the  teeth,  convulsions,  threatening  suffocation, 
oppressive  despair,  acidity,  and  coldness  of  the  body  and  extremities. 
It  is  also  useful  in  some  kinds  of  menstrual  colic,  denoted  by  a 
sensation  as  if  the  abdomen  were  being  rent  asunder ;  or  by  fulness 
and  pressure  in  the  abdomen,  and  violent  spasms,  which  extend  to 
the  chest.  It  is  also  indicated  by  cutting  pains  in  the  intestines  as 
if  divided  by  a  knife,  and  when  the  pains  are  so  violent  as  almost  to 
drive  the  patient  to  distraction,  causing  him  to  bend  double,  and 
draw  up  his  limbs. 

Bryonia,  colic  with  constipation,  tension  in  the  abdomen,  and 
flow  of  saliva  like  salivation.  In  cases  of  colic,  arising  suddenly 
from  indigestible  food,  a  cup  of  black  coffee,  without  milk  or  sugar, 
will  frequently  afford  relief,  by  causing  the  stomach  to  free  itself 
from  the  cause  of  annoyance ;  i.  e.  in  patients,  who  have  not  used 
that  article  as  an  ordinary  beverage.  When  the  complaint  arises 
from  Constipation,  Silicea  is  sometimes  called  for,  at  others 
Conmm.  See  Constipation.  (See  also  articles  Dyspepsia,  Gastro- 
dynia,  Flatulency,  Hepatitis,  JVep/iritis.) 


DETERMINATION  OF  BLOOD  TO  THE  ABDOMEN. 

Congestio  viscemm  abdominis.       Conc/estio  ad  abdomen. 

This  derangement  is  characterized  by  a  disagreeable  or  painful 
sensation  of  wTeight,  heat,  and  burning,  with  hardness  and  tension  in 
the  lower  portion  of  the  abdomen. 

Nux  vomica  is  one  of  the  most  frequent  sources  of  relief  in 
those  who  lead  a  sedentary  life,  or  are  much  addicted  to  over- 
indulgence in  the  pleasures  of  the  table,  and  particularly  when  the 
following  symptoms  are  complained  of:  hardness,  tension,  and  fixed 
pain  in  the  abdomen,  sense  of  great  weakness  or  prostration,  ren- 
dering it  difficult  or  almost  impossible  to'  walk  about ;  constipation, 
with  pain  in  the  loins,  spirits  oppressed  and  irritable. 


164  DIGESTIVE  SYSTEM. 

Sulphur  will  frequently  be  found  serviceable  in  completing  the 
cure  after  the  above,  or  it  may  be  selected  in  preference  in  cases  of 
long  standing,  when  we  meet  with  the  following  indications  :  dull 
pains,  and  disagreeable  sensation  of  distension  in  the  abdomen,  con- 
stipation, tendency  to  obstinate  hemorrhoidal  attacks,  extreme 
dejection. 

Carbo  vegetabilis,  may  be  selected  when  the  symptoms  are 
accompanied  with  excessive  flatulency,  and  will  frequently  be  found  of 
great  service  in  some  obstinate  cases  when  alternated  with  the  two 
preceding  remedies. 

Arsenicum  will  also  be  found  useful,  especially  when  there  is  a 
disposition  to  diarrhoea  with  extreme  weakness  :  or — 

Capsicum,  when  these  symptoms  occur  in  individuals  of  a  lymph- 
atic temperament. 

Sepia*  is  often  of  much  utility  in  the  case  of  females,  particularly 
when  the  symptoms  are  analogous  to  those  described  under  Sulphur. 

In  particular  cases  the  following  will  also  be  found  useful :  Pulsa- 
tilla, Belladonna,  Mercurius,  Bryonia,  Zycqpodium,  C/iamomilla,  Rims, 
Veratrum,  Toxicodendron.     (See  also  Dyspepsia  and  Hemorrhoids.) 

Daily  exercise  in  the  open  air,  together  with  a  careful  attention 
to  regimen,  must  be  observed  by  those  who  are  afflicted  with  this 
affection. 


LOOSENESS  OF  THE  BOWELS. 
Diarr/ioea. 

Diagnosis.  Fluid  discharge  from  the  intestines  in  increased 
quantity. 

This  affection  is  simply  an  increase  of  the  peristaltic  action  of  the 
intestinal  canal,  and  is  so  well  known  under  its  different  forms,  that 
I  shall  simply  allude  to  the  principal  exciting  causes,  and  then  pro- 
ceed to  the  treatment. 

The  exciting  causes  are  acid  indigestible  food,  a  check  of  perspira- 
tion, sudden  changes  of  temperature,  the  prolonged  use  of  powerful 
purgatives,  which,  although  still  more  frequently  the  cause  of  consti- 
pation, nevertheless,  by  producing  irritation  of  the  intestinal  canal, 
also  predispose  to  attacks  of  this  derangement,  worms,  &c. 

Sometimes  diarrhoea  is  a 'salutary  crisis,  as  remarked  under  Fevers ; 
here  again   the  homoeopathic  treatment  assists  Nature,  and,  while  it 


LOOSENESS  OF  THE  BOWELS.  165 

abridges  the  duration  of  the  affection, — and  thereby  obviates  future 
debility, — does  not  rashly  check  its  course. 

Therapeutics.  We  shall,  in  the  first  place,  give  a  synopsis  of 
the  medicaments,  and  the  different  forms  of  diarrhoea  in  which  they 
are  especially  applicable,  and  then  proceed  to  describe  the  leading 
indications  for  those  remedies  which  are  most  frequently  required  in 
general  cases.  In  Diarrhoea  biliosa, — Pulsatilla,  Nux  v.,  Bryon., 
Cham.,  Ipecac,  Antim.  c,  chiefly ;  or,  Arsenic,  Coloc,  China,  Veratr., 
Aeon.,  Bella.,  Digitalis,  Tarax.,  Asar.,  Colch^  Ign.9  Acid,  phosph.  In 
Diarrhoea  mucosa  s.  pituitosa  :  Puis.,  Coloc^  Merc,  chiefly;  and 
Petrol.,  Acid,  phosph.,  or  Phosph.  in  inveterate  cases.  Or  again,  Nuxv., 
Secale  c,  Dulc,  Ammon.  m.,  Ignat.,  Staph.,  Senega,  Bry., Rheum,  Cham.y 
Digit.,  Cina,  Bella.,  Acid,  sulph.,  Arsenic,  Sep.,  China,  Rhus,  Spig.,  Mez> 
In  Diarrhoea  stercoralis:  Puis.,  Ipecac,  Ant.  c,  Nux,  Bry., 
Cham.,  Tart.,  Arsenic,  Ac.  phosph.,  Sulph.,  chiefly ;  or  Coloc,  Coccul., 
China,  Merc,  Dig.,  Bella.,  Veratr.,  &c.  Diarrhoea  serosa  :  Arsenic, 
Cham.,  China,  Puis.,  Nux,  Rhus,  Lach.,  Calc,  Sec,  Per.,  Hyosc,  chiefly; 
or \  Phosph.,  Petr.,  Sulph.,  &c.  Lienteria  :  Cinchona,  Ferrum ;  or 
Arsenic,  Bry.,  Nux  v.,  Phosph.,  Acid,  phosph.,  Lach.,  &c. 

When  an  attack  of  diarrhoea  has  been  occasioned  by  a  Chill  : 
Cham.,  Dulc,  Bry.,  Bella.,  Merc,  Veratr.,  or  Nux  mosch.  j  in  some 
cases,  Puis.,  China,  Natr.,  Nux,  Sulph.,  are  the  most  appropriate 
remedies.  When  arising  from  a  chill,  during  spring,  summer,  or 
autumn :  Ars.,  Dulc,  Bry.,  ox  Merc  When  from  cold  drinks  :  Ars., 
Bry.,  Puis.,  Card,  v.,  Nux  mosch.  If  a  sudden  mental  emotion  has  given 
rise  to  the  attack, — Coffea,  Opium,  Veratr.,  Antim.,  Aeon.,  or  Puis.,  are 
the  most  useful  when  it  has  consisted  of  a  sudden  fright  or  an 
unexpected  joy, — Ignatia  or  Acid,  phosph.  when  of  a  depressing  cha- 
racter, such  as  grief;  and  Cham.,  Coloc,  or  Bry.,  when  a  fit  of  passion 
or  the  effects  of  contradiction  have  brought  on  the  complaint. 

For  diarrhoea  arising  from  excessive  indulgence  in  intoxi- 
cating liquors,  Nux  v.  and  Carlo  v.  are  commonly,  the  most  useful. 
That  which  is  liable  to  ensue  after  partaking  of  milk,  Bry.,  Sulph., 
Lycop.,  Sep.,  Natr.  And  that  which  takes  place  after  eating  fruit,  or 
after  the  use  of  acids,  Ars.,  Lach.,  or  Puis.,  chiefly. 

Against  the  diarrhoea  which  sometimes  occurs  as  a  sequela  of 
Measles,  Scarlatina,  Smallpox,  &c,  Arsenic,  Puis.,  Merc,  Ac 
phosph.,  or  Sulph.,  are  commonly  of  the  greatest  efficacy.  That  which 
is  encountered  in  strumous  habits,    Calc,  Sulph,,  Silic,  Lye,  Sep., 


166  DIGESTIVE  SYSTEM. 

Bulc ;  or  Arsenic,  China,  and  Baryta  c  That  in  Phthisical,  per- 
sons :  Fer.,  China,  Phosph.,  Calc  That  in  individuals  of  Debili^ 
tated  or  exhausted  constitutions :  Secale  c,  China,  Fer.,  Acid, 
phosph.,  Phosph.,  Nux  mosch.  And  that  in  the  aged,  Antim.,  Secale,  Bry., 
Phosph, 

When  diarrhoea  is  unattended  with  pain,  Ferrum  is  the  most 
useful  remedy  in  general  cases,  but  China  and  Secale  c.  are  often 
useful ;  the  latter  especially  when  the  tongue  is  coated  with  mucus, 
the  taste  clammy  or  pap-like,  and  there  is  much  borborygmus. 
When  accompanied  by  colic  (Diarrhoea  torminosa)  :  Cole,  Ars., 
Merc,  Cham.,  Puis.,  Bry.,  Rhus,  Rheum,  Sulph.,  Acid,  nitr.,  Hepar  s., 
&c.  When  attended  with  tenesmus,  Merc,  Bach.,  Hepar,  Rhus, 
Nux  v.  ;  or  Arsenic,  Rheum,  Caps.,  Sulph.,  Sec.  With  vomiting  :  Ars., 
Ipecac,  Veratr. ;  or  Cham.,  Coloc,  Dulc,  Fer.  (See  also  Cholera.) 

With  prostration  of  strength  {colliquative  diarrhoea)  :  Arsenic, 
Veratr.,  dn.,  Ipecac. ;  or  Secale  c,  Phosph.,  Acid,  phosph.,  Nux  v.,  Sep. 

In  chronic  or  inveterate  diarrhoea,  Phosph.,  Acid,  phosph.,  Petrol., 
Sulph.,  Calc,  China,  Fer.,  Acid,  nitr.,  Graph.,  Hepar,  Rhus,  Bach,,  Acid, 
sulph.,  are  the  most  important  medicaments.  And  in  cases  in  which 
there  is  constantly  a  relaxed  state  of  the  bowels  or  tendency  to 
have  several  stools  daily,  Phosph.,  Sulph.,  Calc,  Acid,  nitr.,  Sep.,  Kreos., 
Graph.,  or  Natr,  m. 

The  principal  remedies  in  ordinary  cases  are,  Bulcamara,  Bryonia, 
Cinchona,  Ferrum  aceticum,  Chamomilla,  Rheum,  Mercurius,  Pulsatilla, 
Nux  vomica,  Ipecacuanha,  Arsenicum,  Antimonium  crudum,  Rhus  toxico^ 
denckon,  Opium,  Sulphur,  Calcarea,  Acidum  phosphoricum,  Phosphorus,  &c. 

Dulcamara  is  often  the  most  appropriate  remedy  in  diarrhoea, 
occurring  in  summer  from  cold,  especially  from  wet  feet  or  exposure 
to  rain.  Particular  indications  for  its  exhibition  are  the  diarrhoea 
being  attended  with  colic,  or  cutting  pain,  chiefly  in  the  region  of  the 
navel;  the  evacuations  being  liquid,  slimy  and  yellow,  or  greenish, 
generally  coming  on  at  night,  and  sometimes  attended  with  nausea,  or 
even  vomiting;  want  of  appetite  and  great  thirst,  paleness  of  the 
countenance,  and  lassitude. 

Bryonia  should  be  given  in  cases  of  diarrhoea  arising  from  the 
before-mentioned  causes,  and  attended  with  many  of  the  symptoms 
noted  under  Bulcamara,  when  that  medicine  has  failed  to  afford  the 
required  relief  in  six  or  eight  hours,  particularly  if  the  looseness  is 
liable  to  be  aggravated  after  a  meal,  or  after  drinking,  and  the  stools 

*  Sec  Synopsis. 


LOOSENESS  OF  THE  BOWELS.  167 

are  passed  almost  involuntarily,  and  certain  portions  undigested ;  also 
when  looseness  is  experienced  after  partaking  of  milk?*  In  diarrhwa 
occurring  during  hot  iveatKer,  when  we  cannot  trace  the  causes  to  any 
errors  of  diet,  requiring  other  remedies,  this  medicine  is  further  indi- 
cated, and  particularly  so  in  the  following  instances  :  diarrhoea  from 
checked  perspiration,  or  being  overheated — cold  drinks — a  chill  from 
remaining  in  any  cold  exposed  situation,  or  in  draughts — or  from 
biting,  easterly  winds.  When  this  affection  has  been  produced  by 
passion,  particularly  in  individuals  of  a  bilious  temperament,  Bryonia 
is  again  a  most  useful  remedy.  (Chamomilla  is  equally  efficacious 
here,  and  deserves  a  preference  in  the  case  of  children.)  %  It  may  also 
be  remarked,  that  the  diarrhoea,  arising  from  drinking  impure  water 
when  heated,  has  frequently  found  relief  in  this  medicine.  When  the 
water  is  strongly  impregnated  with  vegetable  substances,  it  may  be 
advantageously  followed  by  Cinchona,  Pulsatilla,  or  by  Arsenicum, 
according  to  the  symptoms,  (see  these  remedies.)  (Antimonium  is 
sometimes  required  to  complete  the  cure  after  the  previous  employ- 
ment of  Bryonia.) 

Cinchona  : — Looseness,  in  consequence  of  indigestion,  particularly 
if  occasioned  by  partaking  of  fruit  or  flatulent  food,  such  as  vegetables; 
stools  very  profuse,  sometimes  attended  with  but  little  pain,  fre-^ 
quently  occurring  immediately  Sifter  partaking  of  food,  or  especially  dur- 
ing the  night,  watery,  and  brownish,  and  sometimes  containing  portions 
of  undigested  food.  Cinchona  is,  in  some  instances,  further  indicated 
when  considerable  spasmodic  or  griping  pain  is  present,  accompanied 
by  flatulence,  want  of  appetite,  thirst,  and  great  weakness  ;  and  is  also 
valuable  after  improper  treatment  or  protracted  cases  of  this  affection, 
when  considerable  debility  remains. 

Ferbum  aceticum  may  be  advantageously  given  in  alternation 
with  Cinchona  at  intervals  of  twelve  hours,  when  the  evacuations  are 
partly  composed  of  undigested  food*  and  pass  without  pain;  or  this 
remedy  may  be  administered  alone,  w7hen  the  diarrhoea  is  unattended 
with  pain,  and  there  are  paleness  of  the  face,  weakness  of  the  eyes, 
pains  in  the  back  and  anus,  with  great  weakness  of  digestion. 

Chamomilla  is  a  remedy,  as  already  stated  elsewhere,  particularly 
useful  in  children,  either  at  the  time  of  teething,  or  at  a  more 
advanced  period,  when  the  affection  has  been  excited  by  checked 
perspiration ;  it  is  further  particularly  indicated  when  the  evacuations 
are  watery,  biliots,  green,  yellow,  or  slimy,  or  of  a  fetor  resembling 
rotten  eggs,  and  accompanied  by  fulness  at  the  pit  of  the  stomach,  severe 
*  See  also  Arsen.^  Merc.f  Bryonia,  Phosph.,  Lachesis. 


168  DIGESTIVE  SYSTEM. 

colic  or  spasm,  pain  in  the  abdomen,  distension  arid  hardness  of  the 
abdomen,  bitter  taste  in  the  mouth,  foul  tongue,  thirst,  want  of  appe- 
tite, bilious  vomiting,  and  flatulence  (in  infants),  with  restlessness, 
screaming,  and  drawing  up  of  the  limbs  towards  the  stomach.  Sulphur 
is  frequently  useful  in  completing  the  cure  when  the  pains  have  been 
removed  by  Chamomilla. 

Rheum,  when  the  symptoms,  in  a  great  measure,  resemble  those  of 
Chamomilla,  but  the  pain  is  not  so  violent,  and  the  evacuations  have  a 
very  sour  smell;  paleness  of  the  face  is  also  an  indication  for  this 
medicine.     (See  Diarrhoea  in  Children.) 

Mercurius,  when  the  diarrhoea  arises  from  a  chill,  and  the  motions 
are  copious,  watery,  slimy,  frothy,  bilious,  or  greenish,  or  streaked  with 
blood,  and  cause  a  smarting  or  burning  sensation  on  being  evacuated ; 
also  when  there  is  painful  tenesmus  before,  during,  and  after  stool,  fre- 
quently followed  by  protrusion  of  the  lower  intestine  ;  severe  cutting 
pains;  moreover,  nausea  and  eructation,  cold  perspiration,  trembling  or 
shivering,  shuddering,  great  lassitude,  and  disposition  to  syncope ; 
sour  smelling  stools  ;  diarrhoea  with  ingesta. 

Pulsatilla,  is  one  of  the  best  remedies  in  simple  looseness,  or 
diarrhoea,  arising  from  errors  of  diet,  such  as  indulgence  in  acids, fruits, 
or  rich  indigestible  food,  attended  with  foul  tongue  and  other  dyspeptic 
symptoms.  (See  Indigestion.)  Another  remarkable  indication  for 
this  remedy  is  one  evacuation  differing  from  another  in  colour. 

Ipecacuanha: — Looseness  arising  from  indigestion,  particularly 
if  caused  b,y  imperfect  mastication,  attended  with  nausea  and  vomiting; 
paleness  of  the  face  (see  also  Arsen.),  weakness,  and  desire  to  retain  the 
recumbent  posture  (in  the  case  of  children).  When  Ipecacuanha  does 
not  appear  to  afford  much  relief,  Pulsatilla  ought  to  be  had  recourse 
to,  in  the  space  of  from  twelve  to  twenty-four  hours,  after  the  last 
dose  of  Ipecacuanha. 

Nux  vomica: — Scanty  stools,  consisting  of  slime  and  blood, 
attended  with  straining  and  great  weakness,  flatulency,  and  violent 
cutting  pains  in  the  region  of  the  navel.  For  some  of  the  occasional 
accompanying  symptoms  the  reader  is  referred  to  the  indications 
given  under  this  remedy,  in  Indigestion. 

Arsenicum  : — Autumnal  diarrhoea,  or  looseness  arising  from  errors 
in  diet,  acids,  fruits,  cold  drinks,  ices,  or  from  a  chill,  &c.  the  characte- 
ristic symptoms  for  its  employment  are,  watery,  slimy,  greenish,  or 
brownish,  corrosive,  burning  evacuations,  with  violent  colic,  excessive  thirst, 
emaciation,  and  great  weakness  ;  and  when  the  affection  is  more  liable 
to  come  on  at  night,  or  after  eating  or  drinking.— -{Vide  the  further  indi- 


LOOSENESS  OE  THE  BOWELS.  ]  69 

cations  for  this  important  remedy  in  Part  III,  under  Bowel  Com- 
plaints in  Children.)* 

Antimonium  crudum  is  a  good  remedy  in  cases  arising  from 
disordered  stomach,  with  white  tongue,  loss  of  appetite,  eructations  and 
nausea ;  also  when  the  symptoms  given  under  Bryonia  (which  see) 
continue  after  the  administration  of  that  medicine. 

Rhus  toxicodendron: — Lumpy  or  pap-like  diarrhoea,  coming 
on  only  at  night,  and  preceded  by  colic,  which  disappears  after  each 
evacuation. 

Opium  is  efficacious  in  diarrhoea  arising  from  fright,  or  from  cold, 
and  may  be  followed,  if  required,  by  Dulcamara  in  the  latter  case. 
For  other  indications,  vide  Mental  Emotions. 

Lachesis  : — Diarrhoea  from  acid  drinks,  or  sour  unripe  fruits,  with 
severe  griping ;  diarrhoea  with  ingesta ;  diarrhoea  during  damp  weather. 

Sulphur  is  a  most  valuable  remedy  in  diarrhoea,  particularly 
when  the  affection  is  worst  during  the  night,  or  when  it  occurs  in 
strumous  habits.  In  adults  predisposed  to  hemorrhoids,  or  in  chil- 
dren, when  the  diarrhoea  is  attended  with  excoriation  and  papular 
eruptions,  it  is  particularly  efficacious ;  also  in  very  obstinate  cases, 
and  where  the  slightest  cold  brings  on  a  relapse  or  an  attack ;  or  when 
milk  disagrees  and  causes  a  looseness. 

Calcarea  may  be  had  recourse  to  after  Sulphur. 

Acidum  phosphoricum  : — In  obstinate  cases,  with  portions  of 
undigested  food  in  the  evacuations;  or  occasional  involuntary 
evacuations. 

Phosphorus  : — In  chronic, painless  diarrhoea,  with  gradual  prostra- 
tion of  strenth ;  diarrhoea  with  ingesta. 

When  diarrhoea  occurs  only  or  chiefly  during  the  night,  Arsenicum, 
Cham.,  China,  Puis.,  Merc,  Rhus,  Sulph.,  Dulc,  or  Bryonia,  are  the  most 
appropriate  remedies  ;  and  when  it  occurs  alternately  with  constipa- 
tion, Nux  v.,  Bach.,  Antim.  c,  Rhus,  Ruta,  or  Tartarus. 

Lastly,  when  diarrhoea  has  been  produced  by  the  abuse  of  medi- 
cinal agents  in  allopathic  practice,  the  following  are  the  most  service- 
able :  Hepar  s.,  or  Acid,  nitr.,  China,  or  Carlo,  when  from  the  abuse  of 
Mercurial  preparations.  Puis.,  or  Rheum,  when  from  the 
employment  of  Magnesia.  And  Puis.,  Cham.,  Merc. ;  or  Coloc,  and 
'Nux  n.,  when  from  Rhus. 

*  When  Arsenicum  does  not  answer  our  expectations,  Veratrum  should  be  substituted ; 
the  latter  remedy  is,  moreover,  for  the  most  part  to  be  preferred,  when  the  disease  appears 
to  have  arisen  from  atmospheric  causes. 


170  DIGESTIVE  SYSTEM. 

Diet.  Acids  or  acidulous  wines/ beer,  coffee,  strong  tea,  and 
fruits,  whether  raw  or  cooked,  should  be  carefully  avoided.  Solid 
food  should  likewise  be  proscribed,  as  tending  to  keep  up  the  intes- 
tinal irritation ;  and  gruel,  fresh  milk,  broths,  and  light  mucilaginous 
food  substituted. 

In  protracted  cases,  attended  with  debility,  but  no  symptoms  of 
inflammation  or  ulceration,  generous,  easily  digestible  food,  and 
sometimes  a  little  wine,  or  wine  and  water,  must  not  be  withheld. 

DYSENTERY. 

Dgsenteria.     Fehris  Bgsenterica. 

Diagnosis.  Constant  urgency  to  evacuate  the  bowels,  tenesmus, 
violent  pains  in  the  abdomen,  a  greater  or  less  degree  of  fever,  parti- 
cularly towards  evening,  and  stools  of  mucus  or  blood,  or  both. 

It  may  appear  suddenly,  but  is  frequently  preceded  some  time  by 
loss  of  appetite,  costiveness,  flatulency,  nausea  or  slight  vomiting, 
with  chills  followed  by  heat  of  skin  and  accelerated  pulse,  then  dull 
abdominal  pains  and  increased  evacuations ;  after  a  time  no  faeces  are 
discharged,  but  white  mucus  {dgsenteria  alba)  which  may  after- 
wards change  to  blood  {dgsenteria  rubra) ;  stools,  particularly  when 
fever  is  present,  very  frequent  and  fetid.  If  not  checked  in  time,  the 
disease  may  terminate  in  ulceration  or  gangrene,  or  the  patient  may 
sink  from  exhaustion. 

The  prognosis  becomes  very  unfavorable  when  the  pains,  which 
have  previously  been  extremely  severe,  suddenly  cease,  the  extremities 
become  cold,  the  pulse  small  and  intermittent,  the  stools  putrid  and 
involuntary. 

This  affection  is  very  frequently  complicated  with  pains  resembling 
those  of  rheumatism  {Dgsenteria  r/ieumatieo-catarr/ialis),  which  will  be 
noticed  under  the  different  remedies,  as  an  additional  indication  for 
their  employment.  The  exciting  causes  are,  checked  perspiration, 
particularly  in  warm  weather,  or  an  exposure  to  the  cool  atmosphere 
of  an  autumnal  evening  after  the  pores  have  been  opened  by  active 
exercise,  or  exertion  during  the  day ;  low  or  marslf^  situations,  local 
irritations,  such  as  worms,  scybala,  &c,  and  suppression  of  hemor- 
rhoids, metastases,  and  sometimes,  in  infants,  difficult  dentition. 

Therapeutics.  The  principal  remedies  in  dysentery  are  Aconitum, 
Belladonna,  Chamomilla,  Pulsatilla,  Ipecacuanha,  Colocgntk,  Mercurius 
corrosivus,  Merc,  vivus,  Arsenicum  album,  Carbo  vegetabilis,  Nux  vomica, 


DYSENTERY.  171 

Capsicum,  Cinchona,  Kreos.,  Aloe.,  Rhus,  Sulphur,  Staph.,  Tart.,  Sep.,  &c. 
Of  these  Aeon.,  Bella.,  and  Nux  or  Merc,  are  the  most  appro- 
priate in  Dysenteria  inflammatoria.  Aeon.,  Cham.,  Rhus  or 
Puis,  in  Dysenteria  riieumatico-catarrhalis.  Aconitum,  Mere, 
corros.,  Colocynth,  Colch.,  Puis.,  or  Veratrum  in  Dysenteria  biliosa. 
Puis.,  Ipecac. 9  Merc,  Dulc,  but  more  especially  Colchicum  and  Merc. 
corros. ;  and,  in  some  cases,  Acid,  sulph.,  Hepar  s.,  Aloe.,  Canth.,  Caps., 
Carlo  v.,  Rhus,  Staphys.,  Acid,  nitr.,  Plumb.,  in  Dysenteria  pittji- 
tosa  s.  alba.  Arsenic.,  Nux,  Carlo  v.,  Petrol,,  Kreosot.,  Acid,  sulph. 
et  nitr.,  in  Dysenteria  putrida.  On  consulting  the  chapters  on 
Enteritis,  Febris  gastrica,  biliosa,  et  mucosa,  Diarrhoea,  Cholera,  and  Dys- 
pepsia, many  of  the  general  indications  for  the  most  of  these  remedies 
will  be  found  detailed,  and  considerable  assistance  in  the  selection  of 
the  remedies  thereby  afforded.  The  following  are,  however,  some  of 
the  characteristic  indications  for  so*ne  of  those  medicaments  which  are 
most  frequently  called  for  in  dysentery : 

Aconitum.  This  remedy  is  peculiarly  adapted  to  cases  attended 
with  synochal  fever,  and  in  young  and  plethoric  patients  is  generally 
required  at  the  commencement  or  in  the  course  of  the  disease.  It  is 
indicated  by  full  and  hard  pulse  ;  severe  pains,  generally  in  one  spot  5 
abdomen  tense  and  painful  when  touched,  denoting  the  commence- 
ment of  inflammation  [dysenteria  inflammatoria) ;  and  is  also  valuable 
when  we  find  pains  resembling  rheumatism  in  different  parts  of  the 
body,  with  shivering,  or  excessive  heat  and  thirst. 

Prescription  as  in  Inflammatory  Fever,  which  see. 

Chamomilla  should  be  prescribed  if,  after  the  administration  of 
Aconite,  we  still  find  violent  heat  and  thirst,  rheumatic  pains  in  the 
head,  and  constant  agitation  and  tossing.  This  remedy  is  also  useful 
when  the  disease  seems  to  have  taken  for  its  proximate  cause  the 
formation  of  gastric  impurities  in  the  primae  viae ;  or  when  it  has 
arisen  from  exposure  to  a  cool  atmosphere  when  in  a  state  of  perspira- 
tion. When  we  find  foul  tongue,  with  clammy,  bitter  taste  in  the 
mouth,  and  bilious  stools,  before  tenesmus  declare  itself.  This  remedy 
is  evidently  indicated  as  most  useful  in  the  first  or  diarrhoeal  stage  of 
the  complaint;  it  may  be  followed  by  Pulsatilla,  when  the  symptoms 
given  under  that  remedy  present  themselves. 

R  Tinct.  Cham.  vulg.  3,  gtt.  iij. 
Aq.  pur.  3  ij. 

M.  Dose.   Jss  every  six  hours,  until  improvement  takes  place,  or  indica- 
tions for  some  other  remedy  present  themselves. 


172  DIGESTIVE  SYSTEM. 

Pulsatilla,  when  the  gastric  symptoms  noted  under  Chamomilla 
are  present,  but  the  stools  consist  entirely  of  mums,  striated  with 
blood.    {Bysenteria  pituitosa.) 

R  Tinct.  Puis.  6,  gtt.  iij. 
Aq.  pur.  §ij. 

M.  Dose,     jss  every  six  hours.* 

The  three  remedies,  above-mentioned,  are  also  valuable  in  dysen- 
tery, arising  from  cold,  or  what  is  commonly  denominated  rheumatic 
catarrhal  dysentery. 

Ipecacuanha.  This  remedy  is  serviceable,  when  the  dysenteric 
affection  seems  fairly  established  5  when  the  stools  consist  of  slimy 
matter  containing  white  flocks,  followed  by  evacuations  of  sangui- 
iiolent  mucus. 

R  Ipecac.  3,  gtt.  iij. 
Aq.  pur.  3  ij. 

M.  Dose.    As  above. 

Colocynth.  In  cases  attended  with  violent  colic  and  excessive 
distension  of  the  abdomen ;  shivering  with  chills,  apparently  ex- 
tending from  the  abdomen  over  the  whole  body  ;  excessive  agitation 
and  restlessness ;  tongue  coated  white ;  slimy,  and  sometimes  bloody 
evacuations ;  it  is  sometimes  found  useful  after  Ipecacuanha  or  Mer~ 
curius. 

R  Tinct.  Coloc.  6,  gtt.  viij. 
Aq.  pur.  giv. 

M.  Dose.  3SS  every  hour,  or  every  three  to  six  hours,  according  to 
the  severity  of  the  symptoms,  until  amendment  supervenes,  when  the 
intervals  between  the  doses  may  be  lengthened. 

Mercurius  corrosivus,  may  be  considered  to  be  one  of  the 
most  important  of  all  the  homoeopathic  remedies  in  dysentery  ;  but 
it  is  more  especially  in  cases  with  the  following  train  of  symptoms 
that  it  is  characteristically  indicated  :  in  the  red  dysentery  or  bloody 
flux,  when  we  find  severe  tenesmtis  or  straining,  with  evacuation 
merely  of  a  little  mucus,  sometimes  succeeded  or  accompanied  by 
the  protrusion  of  a  portion  of  the  intestine,  and  increased  discharge 
of  pure  blood,  or  of  putrid,  corrosive,  greenish,  yellowish,  or  frothy 
mucus,  intermixed  with  blood,  and  sometimes  followed  by  the  evacua- 

*  See  "  Rules  for  the  repetition  of  the  dose." — Introduction. 


DYSENTERY,  173 

tion  of  small  hard  substances  (scybala)  after  much  straining ;  burn- 
ing in  ano;  severe  griping  and  lancinating  pain  before,  during,  and 
even  after  the  motions;  increased  desire  to  go  to  stool  after  each 
evacuation. 

R  Merc,  corros.  3,  gr.ij. 
Pulv.  sacch.  lact.  gr.  viij. 
Misce  intime,  et  in  chart,  sequales  viij  distribue,  quarum  sumat  imam 
tertiis  vel  quartis  horis,  p.  r.  n.* 

In  cases  with  the  above  symptoms,  Mereurius  corrosivus  may  be 
considered  a  specific :  it  will,  at  all  events,  prove  so  efficacious  a 
remedy,  that  any  remaining  symptoms  can,  in  general/ be  removed 
with  facility,  either  by  means  of  Colocynth,  Acidum  phosphoricum,  or 
Acidum  nitricum  (the  two  latter*  especially,  in  the  event  of  a  conti- 
nuance of  the  sanguineous  stools),  or  any  of  the  other  remedies, 
which  may  seem  more  appropriate,  according  to  the  indications  for 
their  employment,  as  given  in  this  chapter, 

(The  directions  for  the  dose  are  already  given  above.) 

Bryonia  is  frequently  called  for  in  those  cases  in  which  it  has 
been  found  necessary  to  administer  Aconite,  at  the  commencement  of 
the  disease ;  but  is  more  particularly  indicated,  when  the  attack  has 
occurred,  during  the  heat  of  summer,  from  the  effects  of  a  chill,  and 
is  attended  with  typhoid  fever  of  the  inflammatory  form  ;  with  loose 
evacuations  of  a  brownish  colour  and  putrid  odour,  occasionally 
containing  lumps  of  coagulated  mucus,  resembling  undigested  sub- 
stances, or  small  hard  lumps  or  balls  (scybalous  faecal  matter),  with 
griping  during,  and  burning  in  ano  after,  the  act  of  evacuating,  and 
aching  pains  in  the  limbs,  aggravated  by  movement.  When  the 
disease  has  attained  an  advanced  stage,  and  the  accompanying  fever 
is  of  a  low  typhoid  type,  the  patient  being  much  exhausted  and 
distressed  with  severe  rheumatic  or  aching  pains  in  the  loins  and 
extremities,  when  reclining  or  sitting  still,  and  the  stools  of  a  slimy, 
frothy,  white,  gelatinous,  or  sanguineous  nature,  passed  involuntarily 
at  night  in  bed,  Rhus  not  unfrequently  gives  a  favorable  turn  to 
the  disorder. 

Dose  of  Bryonia  or  Rhus.  Three  drops  of  the  third  dilution  to  two 
ounces  of  water,  a  dessert-spoonful  every  two  to  four  hours,  until  a 
favorable  alteration  is  effected. 

Arsenicum.— Dysentery  of  epidemic  or  contagious  origin,  wdth 
fever  of  a  typhoid  or  putrid  type    (Dysenteria  putrida)  ;    dysentery 

*  See  "  Rules  for  the  repetition  of  the  dose." — Introduction. 


174  DIGESTIVE  SYSTEM. 

arising    from  exposure  to    noxious    exhalations   in  marshy  situa- 
tions, &c. 

This  remedy  may,  however,  be  selected  in  all  cases,  from  whatever 
cause  arising,  when  great  weakness  and  even  prostration  exists  from  the 
commencement,  with  burning  pain  in  relieving  the  bowels,  thirst  and 
aggravations  of  the  sufferings  after  drinking,  or,  on  the  contrary,  adipsia ; 
— also  when  the  disease  threatens  to  assume  the  ulcerative  or  gan- 
grenous form — characterized  by  previous  severe  pains,  particularly 
burning,  which  suddenly  cease ;  hypocratic  expression  of  counte- 
nance; rapid  sinking  of  the  vital  energies;  pulse  small  and  inter- 
mittent ;  coldness  of  the  extremities ;  highly  offensive,  putrid,  and 
cadaverous-smelling  evacuations,  both  of  faeces  and  urine ;  uncon- 
scious passing  of  stools ;  offensive  breath,  and  petechia  in  different 
parts  of  the  body. 

Be  Tinct.  Arsen.  alb.  6,  gtt.  iv. 
Aq.  pur.  Jiij. 

Dose.  A  dessert-spoonful  every  two,  three,  or  six  hours,  according  to 
the  urgency  of  the  case,  carefully  watching  the  effects,  and  shortening  or 
lengthening  the  intervals  accordingly. 

Carbo  vegetabilis  is  a  most  useful  remedy  in  those  desperate 
cases,  where  the  breath  is  cold,  the  pulse  almost  imperceptible,  and  the 
patient  complains  of  severe  burning  pains.  Its  indications  closely 
resemble  those  of  Arsenicum,  with  the  exception  of  the  thirst,  and  the 
aggravation  caused  by  drinking.  It  may  be  given  with  benefit  when 
that  remedy  has  failed^,  or  only  partially  relieved,  and  in  this,  as  in 
other  affections,  many  instances  might  be  cited,  where  a  judicious 
alternation  of  these  two  remedies  has  effected  benefit — -neither  of 
them  having  been,  singly,  adequate  to  the  exigency  of  the  case. 

Form  of  prescription,  same  as  Arsenicum. 

Nux  vomica.  When  Arsenictim  has  diminished  the  severity  of 
the  symptoms  and  warded  off  the  impending  danger,  but  we  find 
that  the  faeces  still  retain  a  highly  putrid  odour;  also  at  any  period 
during  the  course  of  the  disease,  when  the  following  symptoms  are 
present : — Frequent  and  scanty  evacuations  of  mucus  or  sanguineous 
mucus,  and  occasionally  small,  compact,  hard  faeces  (scybala), 
attended  with  violent  cutting  or  griping  pains  in  the  region  of  the 
navels  borborygmus,  pains  in  the  loins,  tenesmus,  burning  or  sensa- 


DYSENTERY.  175 

tion  of  excoriation  in  the  anus,  and  sometimes  protrusion  of  the 
intestine  ;  great  heat  and  excessive  thirst. , 

Cinchona  is  a  good  medicine  when  the  disease  has  an  endemic 
character,  occurring  in  marshy  countries,  and  in  many  cases  where 
a  state  of  putridity  remains  in  the  faeces,  after  the  administration  of 
the  remedies  above  mentioned. 

Form  of  prescription  for  Nux  and  China,  same  as  that  given  for 
Pulsatilla. 

Cantharides  :  Sanguineous  stools,  mixed  with  whitish  mucus  or 
solid  substances  like  false  membranes  ;  strangury.* 

R  Tinct.  Canth.  6.  gtt.  iv. 
Aq.  pur.  ^iij. 
M.  Dose.    Jss  every  four  or  six  hours. 

Sulphur  : — When  the  more  marked  symptoms  are  ameliorated 
by  the  use  of  the  foregoing  remedies,  but  the  dysentery  still  con- 
tinues obstinate,  and  especially  when  the  disease  occurs  in  subjects, 
who  have  previously  been  long  affected  with  hemorrhoids ;  or  when 
it  has  from  time  to  time  been  subdued,  and  afterwards  returned  with 
greater  or  less  violence ;  or  even  when  the  apparently  best  selected 
remedial  agents  have  failed  to  check  its  course.  It  will  frequently 
be  found  most  efficacious  in  all  these  cases,  since,  whenever  they 
occur,  we  may  suspect  some  latent  constitutional  cause  is  baffling 
our  efforts.  In  the  first  instance,  denoted  by  the  removal  of  the 
more  prominent  symptoms,  the  affection  is  terminated  ;  in  the  second^ 
the  predisposition  to  a  return  of  the  attack  is  obviated ;  and  in  the 
third,  the  constitutional  taint  alluded  to  being  controlled,  the  organ- 
ism becomes  susceptible  to  the  specific  action  of  the  other  medi- 
caments. 

R  Tinct.  Suiph.  6,  gtt.  iij. 
Aq.  pur.  Jij. 

M.    Dose.    2SS   at  first   every  twelve   hours,   until  an   effect    is 
produced,  then  discontinued  for  a  time  and  allowed  to  act. 

In  conclusion,  we  must  not  omit  to  add  that,  when  the  disease  is 
of  long  standing,  and  has  become  (so  to  speak)  habitual,  a  cure  is 
often  effected  by  means  of  Phosphorus. 

*  ColcMcum  autumnale  is  preferable  to  Cantharides  when  the  symptoms  are  as  described, 
but  more  particularly  when  the  stools  consist  almost  exclusively  of  mucus,  unmixed  with 
blood  (dysenteria  alba,pituitosa),  and  when  pain  is  experienced  in  the  sigmoid  flexure  of 
the  colon,  and  the  disorder  rages  as  an  epidemy  during  the  autumnal  season. 


176  DIGESTIVE  SYSTEM. 

Rules  of  Conduct  and  Diet.  In  this  affection,  it  is  of  great  import- 
ance to  keep  up  a  moderate  degree  of  warmth  around  the  abdomen, 
which  is  best  obtained  by  flannel,  worn  outside  the  linen. 

During  the  course  of  treatment  barely  sufficient  nutriment  to  keep 
up  the  strength  of  the  patient  should  be  allowed ;  and  the  more 
severe  the  inflammatory  symptoms,  the  more  strict  must  be  the 
abstinence.  No  solids  should  on  any  account  be  given  ;  but  the  diet 
should  consist  principally  of  mucilaginous  or  demulcent  fluids,  such 
as  thin  barley-water,  and  gruel ;  in  comparatively  mild  cases,  white 
of  egg  in  sugar  and  water,  weak  chicken-broth  or  beef-tea,  may  be 
allowed.  Even  after  convalescence,  this  course  of  diet  should  be  for 
a  short  time  observed,  fruit  and  vegetables  eschewed  (especially  when 
the  disease  is  raging  in  an  epidemic  form),  and  a  return  to  the  usual 
diet  gradually  brought  about.  Wine  and  alcohol  are  absolute  poisons 
in  this  affection. 

Having  thus  given  the  general  mode  of  treatment  for  this  disease, 
which  is  ordinarily  so  fatal,  we  may  remark  that,  in  a  great  majority 
of  cases,  the  homoeopathic  method  checks  it  at  its  commencement, 
without  allowing  it  to  assume  the  more  serious  forms  portrayed  in 
the  instructions  for  its  treatment,  but,  on  the  contrary,  causing  it  to 
pass  off,  leaving  the  patient  in  sound  health ;  whilst  in  the  most 
violent  cases,  where  it  has  already  made  head,  and  seems  approaching 
a  fatal  termination,  this  may  almost  be  said  to  be  the  only  system 
which  offers  a  chance  of  salvation  to  the  sufferer ;  and  in  strumous 
constitutions,  (where,  under  the  old  mode  of  procedure,  the  results 
were  commonly  so  unfortunate,)  it  gently  mitigates  the  violence  of  the 
symptoms,  and  safely  conducts  the  patient  through  his  perils. 

Suppressed  Dysentery.  When  the  dysenteric  evacuations  have  been 
suddenly  checked  by  allopathic  means,  and  a  violent  inflammatory 
or  spasmodic  action  declares  itself,  distinguished  by  severe  pains, 
anxiety,  dyspnoea,  nausea,  and  empty  retchings,  or  distension  and 
tenderness  of  the  abdomen ;  suppression  both  of  faeces  and  urine ; 
coldness  of  the  face,  tongue,  and  extremities ;  breath  also  cold ;  with 
spasms,  of  various  kinds  in  different  parts  of  the  body,  which  are 
renewed  by  any  exertion,  either  of  speech  or  movement, — the  follow- 
ing remedies  will  be  found  useful. 

AcoNiTUM.  Against  a,ny  inflammatory  symptoms  that  may  pre- 
sent themselves. 

Cuprum  aceticum,  when  spasms  or  cold  sweats  predominate. 


CHOLERA.  177 

Belladonna,  against  inflammatory  colic,  or  if  symptoms  of 
abdominal  inflammation  set  in,  (see  article  Enteritis,  and  also 
Colic,)  aqd  administer  accordingly. 

Colocynth,  violent  colic  and  distension  of  the  abdomen,  (see 
Colic.) 

Veratrum  album,  coldness  of  the  body  and  extremities,  and 
retelling. 

Carbo  vegetabilis,  in  extreme  cases,  with  scarcely  perceptible 
pulse,  and  cold  breath. 

The  use  of  clysters  of  warm  water  has,  in  many  instances,  been 
found  serviceable,  in  promoting  an  evacuation  of  the  bowTels,  and 
bringing  back  the  suppressed  discharge. 

When  the  patient  has  escaped  the  serious  consequences  above 
noticed,  chronic  complaints  are  often  the  result  of  Suppressed  Dysen- 
tery :  the  most  frequent  being  Dropsy,  Paralysis,  and  Rheumatism. 


cholera. 

By  the  term  Cholera  Morbus  was  formerly  understood  a  disease 
attended  with  nausea,  griping,  purging,  and  vomiting,  generally  pre- 
valent towards  our  summer  months,  and  at  the  season  when  fruit 
abounds.  But  it  has  now  become  a  generic  term,  under  which  are 
included  two  varieties — the  Cholera  Morbus,  properly  so  called,  and 
the  Asiatic  Cholera. 

Diagnosis.  The  first-named,  sometimes  called  the  Sporadic 
Cholera,  generally  commences  with  a  sudden  feeling  of  nausea  and 
griping,  followed  by  purging  and  vomiting ;  in  severe  cases,  accom- 
panied with  coldness  of  the  body,  particularly  the  extremities,  anxious 
and  hurried  breathings,  excessive  thirst,  a  feeling  of  cramp  in  the 
legs,  sometimes  in  the  arms,  with  spasmodic  contractions  of  the  abdo- 
minal muscles,  shrinking  of  the  features,  and  a  hollow  expression 
about  the  eyes ;  pulse  weak,  sometimes  scarcely  perceptible ;  thin, 
watery,  and  fetid,  or  bilious  evacuations,  sometimes  with  dark  bilious 
vomiting,  anxiety,  and  tenesmus. 

Causes.  The  most  frequent  are  worms,  gall-stones,  unwholesome 
indigestible  food ;  fruits,  or  crude  vegetables,  alterations  in  tempera- 
ture, moist  or  marshy  situations,  damp  weather,  wet  feet,  suppressed 
perspiration  from  sudden  exposure  to  cold,  cold  drinks  when  over- 
heated, dentition,  or  parturition. 

12 


178  DIGESTIVE  SYSTEM, 

Therapeutics.  In  the  treatment  of  Cholera,  in  its  sporadic 
form,  (i.  e.  when  the  disease  arises  from  occasional  causes,  such  as 
cold,  fatigue,  &c.)  the  following  remedies  will  be  found  the  most 
efficacious  :  Chamomilla,  Ipecacuanha,  Veratmm  album,  Arsenicum  album, 
Cinchona,  and  Pulsatilla. 

Chamomilla  is  almost  specific  in  the  premonitory  stage,  particu- 
larly when  the  complaint  has  been  excited  by  a  chill,  or  a  fit  of  passion, 
or  great  dread  of  being  attacked  during  the  prevalence  of  the 
disease. 

The  following  are  the  symptoms  which  particularly  indicate  its 
employment :  acute  colic-like  pains,  or  heavy  pressure  in  the  region  of 
the  navel,  sometimes  extending  to  the  heart,  with  excessive  anguish ; 
bilious  diarrhoea,  cramps  in  the  calves  of  the  legs;  yellow  furred  tongue, 
and  sometimes  vomiting  of  acid  matter.  {Pulsatilla  is  preferable  to 
Chamomilla,  when  the  attack  has  been  brought  on  by  partaking  of 
rich,  indigestible  food,  and  when  the  stools  are  more  of  a  mucous 
character.  Colocynth,  again,  is  more  appropriate  in  some  cases  arising 
from  a  moral  cause,  more  especially  a  fit  of  anger  or  mortification, 
attended  with  indignation.)  Chamomilla,  etc.,  may  be  prescribed  as 
follows : 

R    Tinct.  Cham.  vulg.  3,  gtt.  iij. 
Aq.  pur.  Jij. 
M.     Dosis.  Coch.  maj.  j,  tertia  vel  sexta  quaq.  hor.  pro  re  nata.  * 

Ipecacuanha  may  be  administered  after  the  above,  should  the 
attacks  of  vomiting  become  more  prominent ;  or  it  may  be  selected 
from  the  commencement,  should  vomiting  predominate,  or  at  least  assume 
as  marked  a  character  in  the  complaint  as  the  diarrhoea.  Other  indi- 
cations are — sensation  of  weakness,  or  softness  (flaccidity)  in  the 
epigastrium,  coldness  in  the  face  and  limbs,  sense  of  shivering  in  the 
abdomen;  slight  cramps  in  the  calves  of  the  legs,  and  in  the  fingers 
and  toes.  {JSux  v.  has  been  found  of  great  value  after  Ipecac,  when 
the  vomiting  yielded  to  the  employment  of  that  remedy,  but  symp- 
toms of  Cardialgia  remained,  such  as  wTeight  in  the  epigastric  region, 
anxiety,  pain  in  the  abdominal  viscera,  frequent  small  evacuations, 
and  tenesmus,  frontal  headaches,  horripilation  with  predominating 
internal  chills.) 

Form  of  prescription,  same  as  Chamomilla. 

*  Vide  Rules  for  the  repetition  of  the  dose,  in  the  Introduction. 


CHOLERA.  179 

Veratrum  album,  should  the  disease  increase  notwithstanding 
the  employment  of  the  preceding  remedy,  and  assume  the  following 
characteristics  :  violent  vomiting  with  severe  diarrhoea,  excessive  weakness?, 
and  cramps  in  the  calves  of  the  legs  ;  eyes  hollow  or  sunken,  countenance 
pale,  and  expressive  of  acute  suffering  and  intense  anguish  ;  coldness  of 
the  breath  and  tongue  ;  excruciating  pain  in  the  region  of  the  navel,  ten- 
derness of  the  abdomen  when  touched;  dragging  pains  and  cramps 
in  the  fingers,  shrivelled  appearance  of  the  skin  on  the  palms  of  the 
hands.  (This  is  one  of  the  best  remedies  in  both  varieties  of  this 
disease.) 

R    Tinct.  Veratr.  6,  gtt.  iij. 
Aq.  pur.  Jiij. 

Dosis.      Coch.  medioc.  j.  omni  bihorio,   omni   hor.,  omn.  quadr.  hor., 
vel  ssepius  p.  r.  n.* 

Arsenicum  is  useful,  when  this  malady  assumes  a  severe  cha- 
racter from  the  beginning,  but  is  more  particularly  indicated  when 
the  disease  is  attended  with  rapid  prostration  of  strength,  insatiable 
thirst,  excessive  anxiety,  loss  of  articulation,  with  fear  of  approaching 
death,  burning  sensation  in  the  region  of  the  stomach,  almost  constant 
discharge  from  the  bowels,  or  renewal  of  the  discharge,  as  often  as 
the  desire  for  drink  is  gratified  ;  suppression  of  urine  or  scanty 
micturition,  followed  by  a  burning  sensation;  violent  and  painful 
vomiting,  tongue  and  lips  dry,  cracked,  blueish  or  black;  hollow  cheeks, 
pointed  nose ;  pulse  almost  imperceptible,  or  small,  weak,  intermittent, 
and  trembling ;  severe  spasms  in  the  fingers  and  toes;  clammy  per- 
spiration. 

Form  of  prescription  the  same  as  that  given  for  Veratr.  The  dose 
to  be  repeated  every  half  hour,  every  hour  or  every  two  hours,  ac- 
cording to  the  severity  of  the  symptoms;  the  intervals  to  be 
lengthened  as  soon  as  signs  of  amendment  set  in. 

Cinchona  is  chiefly  most  useful  against  the  weakness  which 
remains  after  cholera,  but  is  also  serviceable,  occasionally,  during  the 
course  of  the  disease,  particularly  when  there  are  vomiting  of  ingesta, 
and  frequent  watery  and  brownish  evacuations,  containing  particles 
of  undigested  food ;  also  when  there  is  oppression  at  the  chest,  with 
eructations,  which  afford  temporary  relief;  severe  pressure  in  the 
abdomen,  especially  after  partaking  of  the  smallest  portion  of  food ; 

*  See  Rules  for  the  repetition  of  the  dose,  in  the  Introduction. 


180  DIGESTIVE  SYSTEM. 

great  exhaustion  sometimes  amounting  to  fainting.  This  remedy  is, 
moreover,  indicated  when  the  disease  has  been  excited  by  indigestible 
substances,  such  as  unripe  fruit,  &c,  or  by  inhabiting  a  marshy 
situation : 

R  Tinct.  Cinch.  3,  gtt.  §iij. 
Aq.  pur.  §ij. 
M.      Dose,  ^ss  every  six  or  twelve  hours,  according  to  circumstances, 
until  amelioration  results.* 

Pulsatilla,  in  mild  cases,  with  mucous  diarrhoea  and  dyspeptic 
symptoms.  It  is  also  useful  when  the  disease  has  been  excited  by 
the  use  of  indigestible  articles  of  diet.  (Vide  Diarrhcea  and  Indi- 
gestion.) 

R  Tinct  Puis.  6,  gtt.ij. 
Aq.  pur.  gij- 
M.     Dose.     A  dessert-spoonful  every  six  or  eight  hours,  until  amend- 
ment takes  place. 

Asiatic  Cholera.  Malignant  Cholera.  {Cholera  asiatica, 
epidemica,  spasmodical)  This  disease  generally  commences  with  vertigo, 
headache  and  singing  in  the  ears,  a  sensation  of  flatulence  in  the 
stomach,  or  griping  pains,  and  a  feeling  of  weight  and  oppression  in 
the  region  of  the  heart. 

In  some  though  not  all  cases  of  Asiatic  Cholera,  we  find  the  lips, 
nails,  and  sometimes  the  whole  skin,  of  a  blue  colour,  but,  in  almost 
every  instance,  the  frame  loses  its  power  of  generating  heat,  the  pulse 
and  pulsation  of  the  heart  are  almost  unfelt,  and  the  circulation  of 
the  blood  becomes  stagnant. 

Patients,  who  have  escaped  through  the  second  stage,  are  fre- 
quently carried  off  by  a  typhoid  fever  in  the  third. 

We  quote  the  following  accounts  of  malignant  cholera,  as  it  has 
appeared  in  India,  in  the  north  of  Europe,*  and  in  this  country,t 
as  giving  a  sufficiently  full  and  vivid  description  of  the  symptoms  of 
the  malady  in  its  different  stages. 

"The  attack  of  the  disease  in  extreme  cases  is  so  sudden,  that, 
from  a  state  of  apparent  good  health,  or  with  the  feeling  only  of 
trifling  ailment,  an.  individual  sustains  as  rapid  a  loss  of  bodily 
power  as  if  he  were  suddenly  struck  down,  or  placed  under  the 
immediate  effects  of  some  poison;'* the  countenance  assuming  a 
death-like  appearance,  the   skin  becoming  cold,  and  giving  to  the 

*  Hoopers  Med.  Diet.,  page  380. 

f  Mackintosh's  Practice  of  Physic,  p.  337. 


CHOLERA.  181 

hand  (as  expressed  by  some  observers)  the  sensation  of  coldness  and 
moisture  which  is  perceived  on  touching  a  frog ;  by  others  repre- 
sented as  the  coldness  of  the  skin  of  a  person  already  dead.  The 
pulse  is  either  feeble,  intermitting,  fluttering,  or  lost;  a  livid  circle 
is  observed  round  the  eyelids  ;  the  eyes  are  sunk  in  their  sockets ; . 
the  tongue  is  cold,  and  either  clean  or  covered  with  a  slight  white 
fur ;  and,  in  many  instances,  even  the  breath  is  cold.  In  cases  of 
this  severity,  the  vomiting  and  purging  characteristic  of  the  disease 
do  not  commonly  take  place  so  early  as  in  milder  attacks,  but  seem 
to  be  delayed  until  the  almost  overpowered  functions  of  the  body 
make  a  slight  effort  at  reaction.  It  is  worthy  of  remark,  that,  unless 
death  takes  place  in  these  extreme  cases  within  a  few  hours,  some 
effort  of  the  animal  power  is  made  to  rally  the  constitution ;  and 
this  point  is  insisted  upon  here,  because  it  will  direct  the  mind  of 
practitioners  to  the  particular  moment  when  bleeding,  and  certain 
other  parts  of  practice,  recommended  in  the  Indian  Reports,  can  be 
enforced  in  this  country  with  probable  success.  Vomiting  soon 
succeeds;  first  of  some  of  the  usual  contents  of  the  stomach,  next 
of  a  turbid  fluid,  like  whey,  white  of  egg,  water-gruel,  or  rice-water ; 
described,  perhaps,  more  accurately  as  a  serous  fluid,  containing 
flocculi  of  coagulated  albumen.  The  lower  bowels  seem  to  let  go 
their  contents;  what  happens  to  be  lodged  in  the  rectum  is  passed 
more  or  less  in  its  natural  state  ;  the  next  discharges  are  similar  to 
those  thrown  up  from  the  stomach,  and  are  passed  with  violence,  as 
if  squirted  with  a  syringe.  The  same  similitude  may  be  applied  to 
the  vomiting.  Spasms,  beginning  at  the  toes  and  fingers,  soon 
follow,  and  extend,  by  degrees,  to  the  larger  muscles  of  the  legs  and 
arms,  and  to  those  of  the  abdomen.  These  vary  in  intensity,  but 
are  sometimes  so  violent  as  to  put  on  the  appearance  of  tetanus. 

ci  In  some  severe  cases  the  vomiting  is  slight,  in  others  consider- 
able; and  the  purging  and  vomiting  precede  each  other  without  any 
known  rule ;  but  whichever  may  be  the  precursor,  a  severe  burning 
heat  is  early  felt  at  the  praecordia ;  there  is  an  invincible  desire  A)r 
cold  liquids,  particularly  water ;  and,  although  the  skin  and  tongue 
are  cold  to  the  touch,  and  the  pulse  nearly  lost,  or  altogether  imper- 
ceptible, the  patient  complains  of  intense  heat,  and  has  an  almost 
insuperable  aversion  to  any  application  of  it  to  the  skin.  The  spasms 
increase,  sometimes  spreading  gradually,  sometimes  suddenly,  to  the 
abdomen,  as  high  as  the  scrobiculus  cordis.  The  next  severe  symp- 
toms are,  an  intolerable   sense  of  weight  and  constriction  felt  upon 


182  DIGESTIVE  SYSTEM. 

the  chest,  accompanied  with  anxious  breathing,  the  spasms  con- 
tinuing at  the  same  time;  a  leaden  or  blueish  appearance  of  the  coun- 
tenance, the  tongue,  fingers,  and  toes  assuming  the  same  colour ; 
the  palms  of  the  hands  and  soles  of  the  feet  becoming  shrivelled ; 
the  fingers  and  toes  giving  the  appearance  of  having  been  corrugated 
by  long  immersion  in  hot  water.  There  is,  throughout,  a  suppression 
of  the  secretion  of  urine,  of  the  secretions  of  the  mouth  and  nose: 
no  bile  is  seen  in  the  evacuations ;  and  it  may  be  generally  observed, 
that  all  the  functions  employed  in  carrying  on  life  are  suspended,  or 
alarmingly  weakened,  except  that  of  the  brain,— which  appears,  in 
these  extreme  cases,  to  suffer  little,  the  intellectual  powers  usually 
remaining  perfect  to  the  last  moment  of  existence.  At  length  a  calm 
succeeds, — and  death.  The  last  period  is  commonly  marked  by  a 
subsidence  of  the  severe  symptoms,  without  improvement  of  the 
pulse  or  return  of  natural  heat ;  but,  occasionally,  it  terminates  in 
convulsive  spasm.  Within  an  hour  or  two  from  the  commencement 
of  such  a  seizure,  and  sometimes  sooner,  the  pulse  may  be  imper- 
ceptible at  the  wrist,  or  in  the  temporal  arteries.  If  it  be  discover- 
able, it  will  usually  be  found  beating  from  eighty  to  a  hundred 
strokes  in  a  minute ;  this,  however,  is  not  invariable,  the  pulse  being 
not  unfrequently  quicker.  The  powTers  of  the  constitution  often 
yield  to  such  an  attack  at  the  end  of  four  hours ;  and  seldom  sustain 
it  longer  than  eight. 

"  In  the  less  rapid  and  more  ordinary  form,  sickness  at  the  sto- 
mach, slight  vomiting,  or  perhaps  two  or  three  loose  evacuations  of 
,  the  bowels,  which  do  not  attract  much  attention,  mark  the  commence- 
ment of  the  attack ;  a  sense  of  burning  heat  soon  felt  at  the  praecordia 
excites  suspicion  of  the  disease  ;  an  increased  purging  and  vomiting 
of  the  peculiar  liquid  gives  certain  indication  of  its  presence  if  this 
has  not  been  previously  declared  by  the  prostration  of  strength, 
and  an  expression  of  the  countenance  not  often  exhibited,  except 
when  death  is  to  be  expected  within  a  few  hours.  The  symptoms 
before  described  follow  each  other  in  similar  but  slower  succession  ; 
the  spasms  of  the  extremities  increase  with  the  vomiting  and  purg- 
ing, and  particularly  in  proportion  to  the  constriction  of  the  thorax ; 
and  this  form  of  the  disease,  which  creeps  on  at  first  insidiously, 
and  is  in  its  progress  more  slow,  by  giving  a  greater  opportunity  for 
assistance,  is,  if  treated  early,  more  tractable;  but  if  neglected, 
equally  fatal  with  the  more  sudden  seizures.  Such  cases  last  from 
twelve  to  thirty-six  hours. 


CHOLERA.  183 

"  The  principal  difference  consists  in  the  diffusion  of  the  symptoms 
through  a  greater  space  of  time  ;  a  misfortune,  it  is  true,  to  the 
patient,  if  the  disease  prove  ultimately  fatal,  but  advantageous,  by 
affording  an  interval  for  the  natural  powers  of  the  constitution  to 
rally  themselves,  and  for  the  employment  of  the  resources  of  medical 
art.  But  there  is  another  remarkable  distinction  well  worthy  of 
attention.  It  has  been  observed  before,  that  in  the  more  rapid  cases> 
the  intellectual  faculties  suffer  but  little  ;  and  it  may  be  added  here, 
that  the  disturbance  of  them  is  not  delirium,  but  rather  a  confusion 
and  hesitation  of  mind  resembling  slight  intoxication.  In  those  of 
longer  duration,  if  the  individuals,  either  by  the  natural  vigour  of 
their  constitution  or  medical  assistance,  sustain  the  shock  beyond 
the  period  of  twenty-four  hours,  suffusion  of  the  tunica  conjunctiva 
often  takes  place,  not  unfrequently  delirium,  and  even  coma. 

"  It  is  remarked,  that  those  who  survive  seventy-two  hours,  gene- 
rally recover — but  there  are  exceptions  to  this ;  for  although,  accord- 
ing to  the  Reports  of  the  Medical  Practitioners  in  the  Presidencies 
of  Bombay  and  Madras,  the  recovery  from  this  seizure  commonly 
terminates  the  disease  ;  or,  as  is  stated  in  the  latter,  the  sequelae  are 
those  dependent  upon  some  previous  ailment  of  the  individual ;  yet 
the  Bengal  Report  details  a  series  of  subsequent  symptoms  resem- 
bling those  of  low  nervous  fever,  which,  w*hen  they  proved  fatal, 
usually  terminated  within  eleven  days  from  the  commencement  of 
the  seizure  called  Cholera.  To  complete  the  outline,  an  account  of 
these  symptoms,  extracted  from  the  Bengal  Report,  will  be  presently 
given ;  and  we  may  observe,  that  they  correspond  accurately  with 
the  description  given  by  Dr.  Keir  of  the  second  stage  of  the  disease, 
as  it  appeared  at  Moscow  from  the  beginning  of  the  month  of 
October  to  the  earlier  part  of  the  month  of  March.  But  we  wall 
previously  point  out  the  manner  in  which  the  recovery  from  this 
seizure  commoniy  takes  place.  The  first  symptoms  are,  the  abate- 
ment of  the  spasms  and  difficulty  of  breathing,  a  return  of  heat  to 
the  surface  of  the  body,  and  a  restoration  of  the  pulse ;  these^  how- 
ever, are  equivocal,  from  being  often  only  temporary ;  and  the  prog- 
nostic from  them  is  very  uncertain  unless  they  follow  a  progressive 
march  of  amendment :  sleep  and  warm  perspiration  attending  it  are 
of  more  importance  and  more  certain  signs  of  recovery.  The  return 
of  the  secretion  and  evacuation  of  urine  is  reckoned  one  of  the  most 
favorable  signs ;  the  next  is,  the  passage  of  bile  by  the  bowels  ;  and 
if  this  be  freely  established,  and  accompanied  with  an  improvement 


184  DIGESTIVE  SYSTEM. 

of  the  pulse  and  of  the  temperature  of  the  skin,  the  patient  is  soon 
placed  in  a  state  of  security  from  the  attack :  but  it  will  appear,  from 
the  following  extract  from  the  Bengal  Report,  that  upon  this  recovery 
he  has  often  a  serious  stage  of  disease  to  encounter ;  the  description 
of  which  is  given  in  the  words  of  the  author.  Before,  however,  we 
proceed  to  this,  we  must  remark,  that  the  seizure,  when  not  fatal,  has 
three  modes  of  termination :  one  in  immediate  convalescence,  accom- 
panied only  with  great  weakness  ; — a  second,  in  which  large  evacua- 
tions of  vitiated  bile  are  passed  for  several  days,  sometimes  attended 
with  blood,  and  with  peculiar  pains  in  the,  bowels,  particularly  in  the 
rectum.  The  third  is  of  a  febrile  nature,  of  which  the  following 
account  is  supplied  from  the  information  given  in  the  Bengal  Re- 
port, viz, : — 

"  c  The  fever,  which  almost  invariably  attended  this  second  stage 
of  the  disease,  .  .  .  partook  much  of  the  nature  of  the  common 
bilious  attacks  of  these  latitudes.  There  was  a  hot,  dry  skin,  a  foul, 
deeply-furred  tongue,  parched  mouth,  thirst,  sick  stomach,  restless- 
ness, watchfulness,  and  quick  variable  pulse,  sometimes  with  delirium 
and  stupor,  and  other  marked  affections  of  the  brain.  Generally, 
when  the  disorder  proved  fatal  in  this  stage,  the  tongue,  from  being 
cream-coloured,  became  brown,  and  sometimes  black,  hard,  and  more 
deeply  furred ;  the  teeth  and  lips  were  covered  with  sordes,  the  state 
of  the  skin  varied,  chills  alternating  with  heats,  the  pulse  became 
extremely  quick,  weak,  and  tremulous,  hiccough,  catching  of  the 
breath,  great  restlessness  and  deep  moaning  succeeded,  and  the 
patient  soon  sunk  incoherent  and  insensible  under  the  debilitating 
effects  of  low  nervous  fever,  and  frequent  dark,  tarry  alvine  dis- 
charges/ It  is  to  be  observed,  that  the  able  author  of  the  Bengal 
Report  doubts  whether  these  symptoms  can  be  considered  as  e  form- 
ing any  integrant  or  necessary  part  of  the  disorder  itself/  or  whether 
they  belonged  to  the  bilious  seizures  of  the  climate.  Subsequent 
experience  of  the  disease  has  removed  this  doubt  by  showing  that 
the  febrile  stage  of  cholera  has  been  much  more  frequent  in  other 
climates  than  in  India. 

"The  cholera  morbus  of  the  north  of  Europe,  to  which  the 
Russian  peasants  have  given  the  name  of  6  chornaia  bolezn/  or  black 
illness,  like  most  other  diseases,  is  accompanied  by  a  set  of  symptoms 
which  maybe  termed  preliminary;  by  another  set  which  strongly 
mark  the  disease  in  its  first,  cold,  or  collapsed  stage ;  and  by  a  third  set, 
which  characterize  the  second  stage,  that  of  reaction,  heat,  and  fever. 


CHOLERA.  185 

"  Preliminary  Symptoms. — We  have  had  but  few  opportunities  of 
witnessing  the  presence  of  all  these  symptoms,  some  of  which  pre- 
cede the  complete  seizure  by  so  short  an  interval,  that  the  utmost 
diligence  is  scarcely  sufficient  to  bring  the  patient  and  the  physician 
together,  after  their  occurrence,  before  the  disease  is  fully  formed. 
Diarrhoea,  at  first  feculent,  with  slight  cramps  in  the  legs,  nausea, 
pain  or  heat  about  the  pit  of  the  stomach,  malaise,  give  the  longest 
warning.  Indeed,  purging,  or  ordinary  diarrhoea,  has  been  frequently 
known  to  continue  for  one,  two,  or  more  days,  unaccompanied  by 
any  other  remarkable  symptom,  until  the  patient  is  suddenly  struck 
blue,  and  nearly  lifeless.  Often  the  symptoms  just  mentioned  are 
arrested  by  timely  judicious  treatment,  and  the  disease  completely 
averted.  When  violent  vertigo,  sick  stomach,  nervous  agitation, 
intermittent,  slow,  or  small  pulse,  cramps  beginning  at  the  tips  of 
the  fingers  and  toes,  and  rapidly  approaching  the  trunk,  give  the 
first  warning,  then  there  is  scarcely  an  interval. 

"  First  stage. — Vomiting  or  purging,  or  both  these  evacuations,  of 
a  liquid  like  rice-water,  or  whey,  or  barley-water,  come  on  ;  the  fea- 
tures become  sharp  and  contracted;  the  eye  sinks;  the  look  is 
expressive  of  terror,  wildness,  and,  as  it  were,  a  consciousness  on 
the  part  of  the  sufferer,  that  the  hand  of  death  is  upon  him.  The 
lips,  the  face,  the  neck,  the  hands,  feet,  and  even  the  thighs,  arms, 
and  whole  surface  assume  a  leaden,  blue,  purple,  black,  or  deep 
brown  tint,  according  to  the  complexion  of  the  individual,  varying 
in  shade  with  the  intensity  of  the  attack.  The  fingers  and  toes  are 
reduced  at  least  a  third  in  thickness;  the  skin  and  soft  parts  covering 
them  are  wrinkled,  shrivelled,  and  folded ;  the  nails  put  on  a  blueish 
pearl  wThite.  The  larger  superficial  veins  are  marked  by  flat  lines  of 
a  deeper  black ;  the  pulse  is  either  small  as  a  thread,  and  scarcely 
vibrating,  or  else  totally  extinct.  The  skin  is  deadly  cold,  and  often 
damp,  the  tongue  always  moist,  often  white  and  loaded,  but  flabby 
and  chilled  like  a  bit  of  dead  flesh.  The  voice  is  gone  ;  the  respira- 
tion quick,  irregular,  and  imperfectly  performed.  Inspiration 
appears  to  be  effected  by  an  immense  effort  of  the  chest,  whilst  the 
aim  nasi  (in  the  most  hopeless  cases  and  towards  the  close),  instead  of 
expanding,  collapse,  and  stop  the  ingress  of  the  air.  Expiration  is 
quick  and  convulsive.  The  patient  asks  only  for  water,  speaks  in  a 
plaintive  whisper  (the  'vox  cholerica/)  and  only  by  a  word  at  a  time^ 
from  not  being  able  to  retain  air  enough  in  his  lungs  for  a  sentence. 
He  tosses  incessantly  from  side  to  side,  and  complains  of  intolerable 


186  DIGESTIVE  SYSTEM. 

weight  and  anguish  around  his  heart.  He  struggles  for  breath  ;  and 
often  lays  his  hand  on  his  stomach  and  chesty  to  point  out  the  seat 
of  his  agony.  The  integuments  of  the  belly  are  sometimes  raised 
into  high  irregular  folds,  whilst  the  belly  itself  is  violently  drawn  in, 
the  diaphragm  upwards,  and  inwards  towards  the  chest.  Sometimes 
there  are  tetanic  spasms  of  the  legs,  thighs,  and  loins ;  but  we  have 
not  seen  general  tetanus,  nor  even  trismus.  There  is  occasionally  a 
low  suffering  whine.  The  secretion  of  urine  is  always  totally  sus- 
pended ;  nor  have  we  observed  tears  shed  under  these  circumstances. 
Vomiting  and  purging,  which  are  far  from  being  the  most  important 
or  dangerous  symptoms,  and  which  in  a  very  great  number  of  cases 
of  the  present  epidemic  have  not  been  profuse,  generally  cease,  or 
are  arrested  by  medicine  early  in  the  attack.  Frictions  remove  the 
blue  colour  for  a  time  from  the  part  rubbed,  but  in  other  parts,  par- 
ticularly the  face,  the  livor  becomes  every  moment  more  intense  and 
more  general.  The  lips  and  cheeks  sometimes  puff  out  and  flap  in 
expiration,  with  white  froth  between  them,  as  in  apoplexy.  If  blood 
be  obtained  in  this  state,  it  is  black,  flows  by  drops,  is  thick,  and 
feels  to  the  finger  colder  than  natural.  Towards  the  close  of  this 
scene  the  respiration  becomes  very  slow ;  there  is  a  quivering  among 
the  tendons  of  the  wrist.  The  mind  remains  entire.  The  patient 
is  first  unable  to  swallow,  then  becomes  insensible ;  there  never  is, 
however,  any  rattle  in  the  throat,  and  he  dies  quietly,  after  a  long 
convulsive  sob  or  two. 

"The  above  is  a  faint  description  of  the  very  worst  kind  of  case 
dying  in  the  cold  stage,  in  from  six  to  twenty-four  hours  after  the 
setting  in  of  the  bad  symptoms.  We  have  seen  many  such  cases 
just  carried  to  the  hospital  from  their  homes  or  their  barracks.  In 
by  far  the  greater  number  vomiting  had  ceased ;  in  some,  however, 
it  was  still  going,  and  invariably  of  the  true,  serous  kind.  Many  con- 
fessed that  they  had  concealed  a  diarrhoea  for  a  day  or  two.  Others 
had  been  suddenly  seized,  generally  very  early  in  the  morning. 

"From  the  aggravated  state  which  we  have  just  described,  but 
very  few  indeed  recover ;  particularly  if  that  state  have  been  present 
even  for  four  hours  before  treatment  has  commenced.  A  thread  of 
pulse,  however  small,  is  almost  always  felt  at  the  wrist,  where 
recovery  from  the  blue  or  cold  stage  is  to  be  expected.  Singular 
enough  to  say,  hiccough,  coming  on  in  the  intermediate  moments  be- 
tween the  threatening  of  death  and  the  beginning  of  reaction,  is  a 
favorable  sign ;  and  generally  announces  the  return  of  the  circulation. 


CHOLERA.  187 

"  In  less  severe  cases,  the  pulse  is  not  wholly  extinguished,  though 
much  reduced  in  volume;  the  respiration  is  less  embarrassed;  the 
oppression  and  anguish  at  the  chest  are  not  so  overwhelming, 
although  the  vomiting,  the  purging,  and  the  cramps,  may  have  been 
more  intense.  The  coldness  and  change  of  colour  of  the  surface ; 
the  peculiar  alteration  of  the  voice ;  a  greater  or  less  degree  of  cold- 
ness of  the  tongue ;  the  character  of  the  liquids  evacuated,  have 
been  invariably  well  marked  in  all  the  degrees  of  violence  of  attack 
which  wTe  have  hitherto  witnessed,  in  this  epidemic.  In  no  case  or 
stage  of  this  disease  have  we  observed  shivering,  nor  have  we  heard, 
after  inquiry,  of  more  than  one  case  in  which  this  febrile  symptom 
took  place. 

"  Fever y  or  hot  stage. — After  the  blue,  cold  period  has  lasted  from 
twelve  to  twenty-four,  seldom  to  forty-eight  hours  or  upwards,  the 
pulse  and  external  heat  begin  gradually  to  return  ;  headache  is  com- 
plained of,  with  noise  in  the  ears ;  the  tongue  becomes  more  loaded, 
redder  at  the  top  and  edges,  and  also  dryer.  High-coloured  urine  is 
passed  with  pain,  and  in  small  quantities  ;  the  pupil  is  often  dilated ; 
soreness  is  felt  on  pressure  over  the  liver,  stomach,  and  belly  ;  bleed- 
ing by  the  lancet  or  leeches  is  required ;  ice  to  the  head  gives  great 
relief.  In  short,  the  patient  is  now  labouring  under  a  continued 
fever,  not  to  be  distinguished  from  ordinary  fever.  A  profuse,  criti- 
cal perspiration  may  come  on,  from  the  second  or  third  day,  and 
leave  the  sufferer  convalescent,  but  much  more  frequently  the  quick- 
ness of  pulse  and  heat  of  skin  continue  ;  the  tongue  becomes  brown 
and  parched  ;  the  eyes  are  suffused  and  drowsy  ;  there  is  a  dull  flush, 
with  stupor  and  heaviness,  about  the  countenance  much  resembling 
typhus ;  dark  sordes  collect  about  the  lips  and  teeth ;  sometimes  the 
patient  is  pale,  squalid,  and  low,  with  the  pulse  and  heat  below 
natural :  but  with  the  typhous  stupor,  delirium  supervenes ;  and  death 
takes  place  from  the  fourth  to  the  eighth  day,  or  even  later,  in  the 
very  individual,  too,  whom  the  most  assiduous  attention  had  barely 
saved  in  the  first  or  cold  stage.  To  give  a  notion  of  the  importance 
and  danger  of  the  cholera  fever,  a  most  intelligent  physician,  Dr. 
Reimer,  of  the  Merchant's  Hospital,  informs  us,  that  of  twenty  cases 
treated  under  his  own  eye,  who  fell  victims  to  the  disease,  seven  died 
in  the  cold  stage,  and  thirteen  in  the  consecutive  fever. 

"  This  singular  malady  is  only  cognizable,  with  certainty,  during  its 
blue  or  cold  period.  After  reaction  has  been  established,  it  cannot 
be   distinguished  from  an  ordinary  continued  fever,  except  by  the 


188  DIGESTIVE  SYSTEM. 

shortness  and  fatality  of  its  course.  The  greenish,  or  dark,  and 
highly  bilious  discharges,  produced  in  the  hot  stage,  by  calomel,  are 
not  sufficiently  diagnostic ;  and  it  is  curious,  that  the  persons  em- 
ployed about  these  typhoid  cases,  when  they  are  attacked,  are  never 
seized  with  ordinary  fever,  but  with  the  genuine,  cold,  blue,  cholera. 
Nothing  therefore,  is  more  certain,  than  that  persons  may  come  to 
the  coast  of  England,  apparently  labouring  under  common,  feverish 
indisposition,  who  really  and  truly  are  cases  of  cholera  in  the  second 
stage." 

"  Phenomena  of  Asiatic  Cholera  as  it  appeared  in  this  country. 

" The  disease  consists  of  three  stages.  The  first  stage  may  be  called 
premonitory;  the  second,  the  stage  of  collapse;  the  third,  that  of  consecutive 
fever. 

"  The  jkst  stage  is  characterized  by  symptoms  of  indigestion,  flatu- 
lent disturbance  in  the  abdomen,  precordial  weight  or  oppression, 
slight  nausea,  acidity,  griping  pains,  diarrhoea,  vertigo,  some  degree 
of  headache,  or  tinnitus.  These  symptoms,  even  when  accompanied 
by  spasms,  are  too  often  either  disregarded  or  concealed,  till  the 
second  stage  is  far  advanced.  It  is  most  unfortunate,  that  this  reluc- 
tance to  confess  the  early  part  of  the  indisposition  should  so  fre- 
quently exist  in  all  classes  of  society,  but  particularly  among  the  poor, 
because  few  of  the  more  severe  maladies  to  which  flesh  is  heir  are  so 
remediable  as  cholera  in  the  first  stage,  and  not  one  more  hopeless 
after  the  lapse  of  a  few  short  hours. 

"  It  is  stated  by  the  Russian  physicians,  that  at  Orenberg,  Moscow, 
and  other  places,  scarcely  a  person  escaped,  during  the  season  when 
cholera  prevailed,  without  some  disorder  of  the  stomach  and  bowels, — 
indicated  by  nausea,  vomiting,  .and  oppression  at  prsecordia,  indigestion, 
pain  in  the  belly,  and  looseness  of  bowels.  Many  instances  of  dis- 
order of  the  stomach  and  bowels  prevailed  during  the  epidemic 
season,  and  for  some  weeks  before  there  was  a  well -marked  case  of 
cholera  in  Edinburgh. 

"  Second  stage. — The  duration  of  the  premonitory  or  first  stage  is 
various ;  sometimes  the  unpleasant  symptoms  suddenly  cease,  and 
the  patients  recover  quickly ;  but  this  happy  issue  is  comparatively 
rare,  when  proper  remedies  are  not  used ;  and  in  some  few  cases, 
from  the  peculiarity  of  constitution  of  the  patient,  remedies  seem 
to  have  little  effect  in  arresting  the  progress  of  the  disease,  even 


CHOLERA.  189 

when  applied  in  this  early  stage.  The  stools,  which  were  at  first 
feculent  and  bilious,  now  become  characteristic  of  the  true  Asiatic 
cholera.  They  have  the  appearance  of  very  thin  gruel,  or  rice- 
water  ;  sometimes  they  are  watery,  limpid,  with  small  flakes  of  curdy- 
looking  matter  intermixed ;  at  other  times,  they  present  an  appearance 
of  water  in  which  fresh  beef  had  been  macerated.  The  usual  feculent 
smell  has  vanished,  instead  of  which  the  stools  have  a  peculiar  odour, 
which  struck  me  to  resemble  that  produced  by  macerating  fish  in 
water ;  a  similar  odour  is  generally  observed  from  the  surface  of  the 
body.  More  rarely,  the  stools  look  like  the  lees  of  port  wine ;  and  it 
was  remarked,  that  almost  none  recovered  who  passed  cc  port-wine 
stools ;"  I  recollect  at  present  one  recovery  only  in  which  there 
was  this  appearance.  The  desire  to  go  to  stool  is  irresistible 
and  instantaneous ;  tenesmus  is  great  in  some  cases,  sometimes  pre- 
ceded or  accompanied  by  a  sense  of  heat  or  griping.  The  stools  are 
generally  very  copious, — sometimes,  however,  scanty ;  often  accom- 
panied by  loud  discharges  of  flatus  from  the  bowels.  Along  with  the 
bowel- complaint,  there  are  burning  heat  in  the  region  of  the  stomach, 
and  vomiting  of  large  quantities  of  a  similar  fluid  from  the  stomach.  The 
abdomen  feels  doughy.  The  thirst  is  intense,  and  there  exists  an  urgent 
desire  to  drink  cold  water.  The  mind,  for  the  most  part,  remains 
comparatively  entire,  but  the  vertigo  and  tinnitus  increase.  Cramps 
are  general  attendants, — sometimes  confined  to  the  fingers  and  toes ;  at 
other  times  they  affect  the  muscles  of  the  extremities,  and  often  those 
of  the  trunk  of  the  body,  more  particularly  of  the  abdomen.  The 
urine  is  generally  suppressed  early  in  the  disease.  The  voice  is  whis- 
pering, the  person  being  unable  to  speak  in  any  other  tone.  The 
respiration,  although  weak,  is  often  nearly  natural  in  other  respects, 
even  at  times  when  the  pulse  is  scarcely  perceptible  at  the  wrist; 
occasionally,  however,  the  breathing  is  hurried  and  oppressed,  some- 
times laborious.  The  pulse  becomes  weak  and  rapid  early  in  the 
disease,  even  when  the  action  of  the  heart  is  comparatively  strong  and 
tumultuous;  but  frequently  both  the  pulse  and  action  of  the  heart 
are  feeble.  As  the  disease  goes  on,  both  become  more  and  more 
wreak ;  the  pulse  is  only  now  and  then  felt  like  a  '  flutter/  and  often 
ceases  to  be  perceptible  at  the  wrist  for  some  hours  before  death. 
The  tongue  is  cold  and  shrunk.  It  is  quite  painful  to  a  bystander  to 
watch  the  restlessness  and  impatience  of  the  sufferers,  who  are  con- 
stantly in  a  state  of  jactitation,  more  particularly  when  restrained,  arid 
when  heat  is  applied.      Tndeed,  they  seem  to  have   a  horror  at,  and 


190  DIGESTIVE  SYSTEM. 

to  suffer  pain  from,  warm  applications.  The  temperature  of  the  body, 
but  more  particularly  of  the  extremities,  diminishes  early  in  the  disease, 
and  goes  on  sinking.  It  is  often  impossible  to  raise  the  temperature 
of  the  body  during  life,  but  the  moment  death  takes  place,  and  for  two 
or  three  hours  afterwards,  the  body  becomes  warm, — even  the  icy 
coldness  of  the  extremities  gives  place  to  a  genial  warmth.  The 
colour  of  the  hands  and  feet  become  changed,  more  particularly  the 
nails  assume  a  blue  appearance  ;  the  face  often  is  similarly  affected  ; 
occasionally  the  whole  surface  presents  a  blue  colour,  and,  conse- 
quently, the  second  stage  has  sometimes  been  termed  '  the  blue 
stage  ;9  but  it  is  an  error  to  suppose  that  the  blueness  is  invariable, 
or  that  it  is  an  attendant  only  on  the  worst  forms  of  the  complaint, — 
the  patient  who  had  this  appearance  more  strongly  marked  than  any 
other,  was  the  one  who  made  the  most  rapid  and  the  most  complete 
recovery.  Blood,  drawn  from  an  artery  or  vein  during  this  stage, 
flows  with  difficulty,  is  of  a  dark  colour,  does  not  coagulate,  or  sepa- 
rate any  serum.  It  remains  in  a  semi-fluid  state,  and  has  the 
appearance  which  the  ancients  called  'dissolved  Mood,9  The  surface 
of  the  body  is  covered,  for  the  most  part,  with  a  cold  exudation,  the 
features  and  eyeballs  shrink,  and  death  closes  the  scene, — sometimes 
very  unexpectedly,  at  others  the  body  seems  to  be  long  dead,  while 
the  functions  of  the  brain  are  still  going  on  and  comparatively 
entire. 

"  Sometimes  the  prostration  of  strength  is  extreme ;  but  it  is  my 
belief,  that  muscular  debility  is  no  part  of  the  disease,  till  far  advanced 
in  the  second,  or  collapsed  stage.  I  have  been  surprised  at  the  efforts 
made  by  patients  when  they  were  thought  to  be  near  death.  .  .  . 
The  appearance  of  muscular  debility  is  occasioned  by  the  vertigo, 
wrhich  renders  the  gait  unsteady  and  tottering,  as  well  as  by  the  dread 
of  motion  producing  cramps. 

"  Many  exceptions  might  be  made  to  this  account  of  the  symptoms 
in  these  two  stages.  Sometimes  no  premonitory  symptoms  can  be 
traced.  I  know  of  one  case  where  the  person  appeared  to  have  died 
under  the  effects  of  the  first  attack  of  cramps ;  he  was  known  to  have 
laboured  under  slight  bowel  complaint  for  several  days,  but  he  did 
not  confine  himself,  and  was  lying  without  any  complaint  on  a  sofa ; 
he  was  dressed,  and  engaged  reading.  A  noise  was  heard,  and  he  was 
soon  after  found  on  the  floor  on  his  face,  dead,  with  the  book  clenched 
in  his  hand,  and  his  muscles  rigid.  I  have  seen  several  cases  where 
the  urine  was  not  entirely  suppressed,  and  others  in  which  the  stools 


CHOLERA.  191 

were  feculent  and  bilious  up  to  the  moment  of  death.  But  those  cases 
are  to  be  regarded  as  exceptions  to  the  rule,  which  they  do  not  con- 
travene. The  symptoms  in  this  disease,  as  in  all  others,  must  suffer 
modifications  from  peculiarity  of  constitution,  previous  condition  of 
health,  and  habits  of  the  patient  affected. 

"The  symptoms  which  present  the  most  unerring  characteristics 
of  Asiatic  cholera  are  diarrhoea,  and  other  symptoms  of  disordered 
stomach  and  bowels,  in  the  first  or  premonitory  stage.  I  believe  pre- 
vious diarrhoea  may  be  discovered  in  at  least  four  out  of  six  cases, 
and  probably  exists  in  all,  if  the  history  of  each  were  perfect.  Thus, 
in  the  city  of  Albany,  U.S.,  diarrhoea  occurred  in  282  out  of  '336 
cases  ;  in  the  remaining  54,  it  could  not  be  ascertained  whether  this 
symptom  had  or  had  not  existed.  In  the  stage  of  collapse,  there  are 
the  whispering  voice,  great  restlessness,  characteristic  discharge 
upwards  and  downwards,  cramps,  suppression  of  urine,  excessive 
thirst,  weak  faltering  pulse,  weak  respiration,  coldness  of  extremities, 
shrivelled  hands  and  feet,  bedewed  with  a  cold  exudation.  The  general 
blueness,  when  it  exists,  is  also  quite  peculiar  to  cholera.  It  is  re- 
markable how  quickly  an  extremely  collapsed  state  of  the  features 
takes  place.  The  patients  appear  to  dread  hot  applications.  The 
blood-vessels,  on  such  parts  of  the  body  as  the  temples,  where 
they  are  comparatively  superficial  and  easily  seen,  are  observed  to  be 
full  of  blood  of  a  very  dark  colour  ,•  even  the  serpentine  branches  of 
the  temporal  artery  can  be  traced  in  this  manner,  and  the  motion  of 
the  blood  is  very  slow. 

"  Third  stage, — A  large  proportion  of  patients  died  in  the  second 
stage;  there  were  few  immediate  recoveries  from  collapse,  without 
undergoing  the  danger  and  miseries  of  a  consecutive  fever,  which  is 
now  to  be  described.  I  shall  never  forget  the  joy  expressed  by  all' 
who  were  watching  the  first  case  of  cholera  in  which  death  did  not 
take  place  in  the  stage  of  collapse.  This  feeling  was  increased  as  the 
watery  diarrhoea,  vomiting,  and  cramps  diminished,  and  at  last 
ceased,  and  as  reaction  became  more  evident  and  permanent.  Nor 
shall  I  attempt  to  describe  the  subsequent  disappointment,  as  bad. 
symptoms  arose  one  after  another,  to  convince  us  that  the  patient, 
although  he  had  made  an  escape  from  one  set  of  dangers,  was  still 
surrounded  by  another,  which  experience  speedily  proved  to  us  were 
extremely  formidable. 

"The  symptoms  that  denoted  an  escape  from  the  horrors  of  the 
second  stage,  were,  diminution  in  the  number  and  quantity  of  the 


192  DIGESTIVE  SYSTEM. 

evacuations,  both  from  the  bowels  and  stomach ;  cessation  of  restless- 
ness, thirst,  and  cramps ;  increase  of  the  temperature  of  the  body,  and 
strength  of  the  pulse ;  an  expression  of  animation  in  the  countenance  ; 
and  a  disposition  to  sleep.  Sometimes  the  stools'  speedily  lost  the 
characteristic  watery  appearance,  and  became  feculent;  but  this 
change  was  generally  gradual.  Sometimes  the  secretion  of  urine  took 
place  early  after  the  reaction  was  established,  but  this  favorable 
circumstance  rarely  occurred  so  soon.  In  some  cases,  after  every- 
thing appeared  to  be  going  on  well,  the  vomiting  and  purging 
suddenly  returned,  the  pulse  became  weak  and  quick,  and  the  patient 
rapidly  died. 

"  The  phenomena  of  the  third  stage  presented  every  appearance  of 
fever ;  sometimes  of  that  form  denominated  in  this  country  ( Typhus,5 
and  in  several  cases  a  similitude  was  easily  traced  to  the  last  stage  of 
Yellow  Fever.  In  fact,  the  general  opinion  that  was,  and  still  is 
maintained,  that  cholera  is  nothing  but  a  fever,  with  violent  irrita- 
bility of  stomach  and  bowels,  suppression  of  the  secretions  of  bile  and 
urine,  with  a  cold  stage,  appeared  to  derive  support  from  the  resem- 
blance to  the  phenomena  of  intermittent  fever.  But  it  will  soon  be  in 
my  power  to  show  how  erroneous  this  opinion  really  is,  when  the 
pathology  of  cholera  falls  to  be  considered, 

"  After  the  complete  development  of  reaction,  patients  for  a  time 
appear  to  be  doing  very  well,  not  teased  with  violent  tenesmus  and 
vomiting,  nor  disturbed  with  intense  thirst  and  violent  cramps.  The 
restlessness  has  ceased,  and  they  seem  to  be  enjoying  tranquillity. 
But  this  state  is  generally  to  be  regarded  as  a  calm  which  is  too  soon 
to  be  followed  by  a  storm.  The  subequent  symptoms  vary  much  in 
different  cases,  depending  on  the  previous  state  of  health  and  habits 
of  the  patient,  and  his  peculiarities  of  constitution,  as  well  as  on  the 
phenomena  of  the  previous  stage,  and  the  treatment  pursued. 

cc  These  symptoms  were,  lethargy  or  coma,  which  were  frequent ; 
delirium ;  convulsions ;  paralysis ;  rigidity  of  the  flexor  muscles  of 
the  extremities;  distressing  nausea;  bilious  vomiting,  and  thirst; 
dyspnoea,  or  hurried  respiration ;  cough,  expectoration ;  palpitation 
and  irregular  action  of  the  heart,  and  more  or  less  heat  of  skin ; 
bilious  diarrhoea;  port-wine  stools;  tenesmus;  and  pain  or  tender- 
ness, increased  on  pressure,  in  some  part  of  the  abdomen.  Of  all 
these  symptoms,  convulsions  were  the  most  rare.  The  others  existed 
variously  combined  and  modified. 

"Cames  of  Cholera, — The  undivided  opinion  of  medical  men  who  saw 


CHOLERA.  193 

the  disease  in  India  is,  that  in  the  East  it  is  not  contagious.  After  the 
appearance  of  cholera  in  Russia  and  Poland,  however,  a  belief  became 
prevalent  that  the  disease  had  been  modified  by  climate,  and  the 
habits  of  the  people  in  Europe;  that  it  had  more  resemblance  to  a 
fever,  and  was  highly  contagious.  There  were  few  medical  men  who 
were  not  influenced  by  this  specious  statement ;  and  I  confess  that 
my  mind  was  at  one  time  so  strongly  impressed  with  the  belief  in  the 
contagious  nature  of  the  disease,  that  for  the  first  five  or  six  wreeks 
after  its  appearance  in  Edinburgh,  when  I  retired  to  bed  at  night  I 
scarcely  expected  to  find  myself  alive  in  the  morning.  But  my  fears 
were  at  last  dispelled,  and  my  opinion  is,  that  if  it  be  contagious,  it  is 
not  so  in  any  very  great  degree.  The  following  are  the  grounds  on 
which  this  opinion  is  formed.  It  was  intimated  to  me,  by  authority* 
that  as  the  disease  was  so  contagious,  every  possible  precaution  must 
be  taken  to  prevent  its  extension,  and  that  few  bodies  could  be  allowed  to 
be  opened^  as  the  contagion  was  more  virulent  and  searching  after  than 
before  death.  But  from  the  moment  my  mind  was  made  up  to  accept 
the  appointment,  I  resolved  that  fear  should  not  be  allowed  either  to 
interfere  with  my  attendance  on  the  sick,  or  to  hinder  my  investiga- 
tions after  death.  Accordingly,  in  attending  the  first  case  of  cholera 
in  the  hospital,  I  remained  in  the  ward  all  night,  and  became  so  much 
exhausted,  that  I  fell  fast  asleep  in  the  bed  next  the  dying  person,  and 
slept  for  above  an  hour,  at  a  time  when  my  animal  spirits  were  low, 
and  my  physical  strength  diminished  by  the  fatigues  of  the  previous  day. 
Subsequently,  I  have  more  than  once  accidentally  fallen  asleep  on  abed 
on  which  some  unfortunate  had  died,  and  in  a  ward  in  which  there 
were  several  dying  persons  at  the^time.  None  of  the  house  surgeons, 
the  number  being  between  20  and  30,  who  were  seldom  out  of  the 
wards,  had  the  disease,  although  their  bodies  must  have  been  ready  to 
receive  the  contagion,  if  fatigue  of  body,  anxiety  of  mind,  and  want  of 
sleep  ever  predisposed  any  person  to  take  a  disease.  Two  male  nurses 
had  cholera.  One  was  a  sober  man,  and  although  he  had  the  warning 
diarrhoea,  he  neglected  himself,  but  had  the  disease  slightly.  The 
other  was  a  complete  tippler ;  he  had  a  slight  bowel  complaint,  which 
he  concealed,  and  by  way  of  curing,  obtained  leave  to  go  home  to  see 
his  family ;  he  got  drunk,  and  was  brought  to  the  hospital  with  cholera, 
but  never  became  collapsed.  Several  female  nurses  were  also 
attacked ;  but  that  is  no  wonder,  for,  independent  of  the  fatigue  they 
underwent,  they  were  drunkards,  and  bad  characters  in  other  respects  . 
and  were  actually  in  the  habit  of  drinking  the  spirits  and  wine  served 

13 


194  DIGESTIVE  SYSTEM. 

out  to  their  patients.  Two  of  these  characters,  after  much  fatigue  and  a 
hard  course  of  drinking,  went  to  bed  one  night  quite  drunk;  they 
were  both  speedily  seized  with  cholera — one  died.  But  there  is  no 
proof  of  the  influence  of  contagion  in  these  cases.  In  truth,  no  case 
has  ever  been  advanced  in  proof  of  the  contagious  nature  of  cholera, 
that  cannot  be  explained  on  other  and  more  satisfactory  principles. 
Is  it  because  four  children,  with  father  and  mother,  in  one  family, 
have  had  cholera,  and  because  communication  can  be  proved  between 
them  and  an  infected  house,  by  means  of  a  bundle  of  dirty  clothes,  or 
a  web  of  linen,  or  actual  personal  contact,  that  we  are  rashly  to  attri- 
bute the  whole  to  contagion  ?  The  same  story  may  perhaps  be  told 
in  a  different  way.  The  father  is  a  dissipated  good-for-nothing  man, 
who  spends  almost  all  his  wages  on  whiskey ;  he  deprives  his  family  of 
the  means  of  procuring  suitable  nourishment ;  the  poor  mother  has 
pawned  her  last  blanket,  to  purchase  a  few  potatoes  for  her  starving 
children,  who  have  all  had  loose  bowels  for  several  days  or  weeks. 
The  explanation  is  easy  to  show  the  strong  predisposing  cause — in- 
sufficient clothing,  deficiency  of  food,  &c.  What  answer  can  be  made 
to  this  fact,  that  I  have  seen  several  mothers  suckle  their  children 
when  they  themselves  were  dying  of  cholera,  and  in  one  instance  I 
found  an  infant  sucking  its  dead  mother's  breast,- — and  yet  not  one 
of  them  had  a  symptom  of  cholera,  at  least  for  months  afterwards  ?  . 
♦  .  •  From  the  economical  arrangements  of  the  Board  of  Health,  and 
the  difficulty  of  procuring  a  proper  apartment,  the  dead-room,  where 
these  examinations  were  conducted,  wTas  a  miserable  place  about  eight 
feet  square ;  generally  six  or  eight  persons  were  present,  sometimes 
more ;  and  in  an  inner  apartment,  about  ten  feet  square,  there  some- 
times lay  six  dead  bodies.  Not  one  of  those  who  frequented  this  den 
of  death,  and  w7ho  had  their  hands  imbrued  in  the  secretions  of  the 
dead  for  six  hours  out  of  the  twenty-four,  were  affected  with  cholera, 
although  their  hands  were  irritated  and  punctured  daily  ! 

"  It  cannot  be  denied  that  some  mysterious  influence  was  operating 
at  the  period  cholera  prevailed,  by  whatever  name  it  may  be  called, — 
that  it  selected  its  own  victims — exercised  its  poisonous  qualities  in 
one  district,  town,  or  hamlet,  more  than  in  another— changed  the 
scene  of  its  ravages  suddenly  and  capriciously,  and  made  its  progress 
from  place  to  place,  by  strange  detours,  avoiding  many  populous 
situations,  in  the  direct  tract  of  human  intercourse.  .... 

"Were  any  persons  more  prone  to  contract  cholera  than  others? 
This  is  an  important  question,  and  it  is  rare  that  a  point  in  medical 


CHOLERA.  195 

investigation  can  be  so  satisfactorily  answered.  All  who  had  any  im- 
portant visceral  disease,  or  tendency  to  bowrel  complaint  from  slight 
causes,  and  drunkards,  were  the  persons  generally  attacked.  It  is  no 
doubt  certain,  that  in  each  locality  where  cholera  prevailed,  some 
instances  may  be  quoted  to  the  contrary ;  but  these  are  very  few 
indeed,  and  are  to  be  regarded  as  exceptions  to  the  general  rule. 
Nothing  could  be  more  unsatisfactory  than  the  accounts  we  received 
of  the  previous  health  and  habits  of  patients;  very  frequently  wTe 
found  them  to  be  quite  the  opposite  of  what  had  been  stated ;  but 
when  we  opened  the  bodies,  in  the  careful  and  minute  manner  in 
which  the  dissections  were  conducted,  we  had  the  best  evidence  that 
few  subjects  were  even  tolerably  sound. 

€C  Persons  advanced  in  age  had,  in  the  epidemic  that  I  saw,  a  bad 
chance  of  recovery.  Females  seemed  to  be  more  liable  to  the  disease 
than  males.  Almost  every  woman  we  opened,  under  a  certain  age, 
had  the  catamenia;  and  we  found  a  great  number  of  diseases,  of 
various  kinds,  of  the  uterus,  ovaries,  tubes,  and  broad  ligaments." 

Therapeutics.  We  now  proceed  to  mention  theremedies,  which 
have  been  successfully  prescribed  by  those  homceopathists  Vho  have 
treated  the  disease  in  all  its  forms. 

When  the  premonitory  symptoms  of  this  disease,  as  above  noted, 
exhibit  themselves,  its  complete  development  is  frequently  prevented, 
by  the  administration  of  the  saturated  solution  of  camphor. 

Dose.  One  or  two  drops  of  the  above,  every  five  minutes,  in  a 
teaspoonful  of  cold  water,  until  a  cessation  or  amelioration  of  the 
symptoms  takes  place,  when  the  intervals  between  the  doses  may  be 
lengthened  at  first  to  every  two,  and  then  to  every  four  or  six  hours. 

In  many  cases  also,  we  may  succeed  in  checking  the  disease  at 
its  commencement,  by  the  remedies  already  mentioned  under  Spo- 
radic Cholera.  But  when  Cholera  sets  in  in  all  its  frightful  forms, 
we  should  have  immediate  recourse  to  Veratrum,  a  remedy  which 
all  who  have  had  an  opportunity  of  trying  have  eulogized. 

R  Tinct.  Veratr.  3,  gtt.  viij. 
Aq.  pur.  3  iv. 
Dose,  A  dessert-spoonful  every  hour,  every  half  hour,  or  even  every 
quarter  of  an  hour,  according  to  the  severity  of  the  symptoms. 

But  should  no  improvement  set  in  after  several  doses,  and  the  cramps 
change  to  spasms  and  convulsions,  with  spasmodic  constriction  of  the 
chest,  which  obstructs  respiration, — Cuprum  (third  trituration,  or 


196  DIGESTIVE  SYSTEM. 

sixth  dilution)  must  be  had  recourse  to,  in  the  manner  as  prescribed 
for  Veratrum :  and  if  Cuprum  be  productive  of  only  partial  melioration, 
Veratrum  may  be  administered  in  alternation  with  it.  When  symp- 
toms of  trismus  and  tetanus  supervene,  Camphora  has  been  recom- 
mended as  preferable  to  Cuprum.  Arsenicum  should  be  selected 
in  preference  to,  or  given  alternately  with,  Veratrum,  when  an  intense 
burning  sensation  is  experienced  in  the  stomach  and  bowels,  with 
extreme  prostration  of  strength,  great  thirst,  &c.  (Vide  the  indica- 
tions for  both  these  remedies,  page  179.) 

Carbo  vegetabilis  (sixth  dilution),  may  often  be  given  with 
advantage  when  the  patient  is  reduced  to  a  state  of  almost  complete 
asphyxia,  with  scarcely  perceptible  pulse ;  or  when,  on  the  cessation  of 
vomiting,  diarrhoea,  and  cramps  or  convulsions,  congestion  to  the 
head  and  chest  ensues,  with  oppressed  breathing,  coldness  of  the 
breath,  redness  or  lividity  of  the  face  (which  is  covered  with  clammy 
sweat),  and .  lethargy.  It  has  been  found  useful  in  some  instances 
to  exhibit  a  dose  or  two  of  Acid,  hi/drocyanicum,  about  an  hour  before 
the  employment  of  Carlo  v.  Should  the  pulse  become  stronger 
under  the  action  of  Carbo  v.,  but  the  pain,  vomiting,  cramps,  &c, 
return,  Veratrum  must  again  be  had  recourse  to.  [Carbo  v.,  like  Cicuta, 
and  perhaps  Stramon.,  is,  properly  speaking,  not  so  appropriate 
during  the  disease  itself,  as  against  the  sequelae,  especially  those  of 
a  nervous  type.) 

Ipecacuanha  and  Nux  v.  have  been  found  efficacious  before  or 
after  Veratrum,  or  any  of  the  other  medicaments,  when  the  symp- 
toms assumed  the  character  mentioned  at  page  178.  (The  Russian 
homoeopathic  practitioners  found  Ipecac,  of  peculiar  efficacy.) 

Phosphorus  (followed  by  Acid um  phosphoricum,  should  great 
clamminess  of  the  tongue  supervene)  is  particularly  useful  in  cases  of 
diarrhoea,  which  are  so  liable  to  occur  during  the  prevalence  of  cholera, 
and  which,  if  neglected,  are  but  too  prone  to  pass  on  rapidly  to  con- 
firmed cholera.  [Camphora,  Secale  com.,  and  Mercurius  may  also  be 
required  in  cholerine.  The  Russian  practitioners  found  Mercurius 
often  useful  in  cholera  proper.  See  also  art.  Diarrhcea,  as  any  of 
the  remedies  mentioned  there  may  be  resorted  to  in  preference  to  the 
medicaments  just  named,  if  better  indicated.) 

Dosis.     Tinct.  Phosph.  3  gtt.  j,  quarta  vel  sexta  quaque  hora.* 

Phosphorus  is  also  useful  in  the  event  of  congestion  in  the  chest 

*  Vide  Rules  for  the  repetition  of  the  dose  in  the  Introduction. 


€H0LE11A. 


197 


during  the  course  of  the  disease;  and  is,  moreover,  one  of  the  most 
serviceable  remedies  against  the  obstinate  diarrhoea,  which  sometimes 
remains  after  an  attack. 

Tartarus  emeticus.  Amongst  the  physiological  effects  of  this 
medicament  we  find,  those  spasmodic  movements,  or  jerking  and 
twitching  of  the  muscles ;  the  trembling  of  the  limbs,  prostration  of 
strength,  or  weakness  to  fainting  ;  tremulous  or  imperceptible  pulse  ; 
peculiar  paleness  of  the  face ;  hoarseness ;  cramps  in  the  calves  of 
the  legs ;  and  especially  the  symptoms  of  gastric  derangement  that 
are  so  frequently  met  with  in  some  forms  of  the  disease.  When  the 
stools  still  consist  of  feculent  matter,  as  is  the  case  in  cholera  biliosa, 
or  at  the  commencement  of  cholera  indica,  or  also  at  the  termination 
of  the  same,  where  the  functions  of  the  abdominal  viscera  are  not  yet 
restored  to  a  normal  state,  Tartarus  is,  at  all  events,  well  deserving  of 
attention.* 

Cicuta  virosa  is  considered  an  appropriate  remedy,  when  there 
are  spasms  in  the  pectoral  muscles,  continuous  vomiting,  and  little 
diarrhoea;  when  the  eyes  are  turned  upwards,  and  the  patient  is  in 
a  soporific  state.  It  is  particularly  in  neglected  cases,  and  conse- 
quently more  in  the  sequelae  of  cholera,  than  in  the  disease  itself, 
that  this  remedy  is  more  generally  indicated.  Stramonium  may  like- 
wise be  useful  in  similar  cases. 

In  conclusion  it  may  be  added,  that  a  few  doses  of  Cantharis 
will  be  found  useful,  when  there  is  great  irritation  and  pain  in  the 
bladder ;  Rhus,  Bryonia,  Acid,  phosphor.,  Bella.,  Hyoscy.,  Stram.,  Carl,  v., 
Op.,  Sec,  when  Typhus  Fever  results  (vide  Typhus)  ;  Belladonna 
(followed,  if  required,  by  Opium  and  Lachesis),  wThen  there  is  Con- 
gestion  of  the  Brain  ;  Aconite,  Phosphorus,  Bryonia,  Belladonna,  Sec, 
in  addition  to  Phosphorus,  should  Congestion  in  the  Chest  super- 
vene ;  and  Aconite,  followed  by  Nux  v.,  Bryonia,  or  Mercnrius,  Sec,  when 
the  stomach  and  intestines  become  the  seat  of  congestion.  (Vide  Con- 
gestion to  the  Abdomen.)  Secale  cornutum  is  very  useful  in 
cases  of  colourless  diarrhoea,  with  pains  in  the  extremities  remaining 
on  the  cessation  of  the  vomiting,  but  is  also  valuable  after  Veratrum 
and  Cuprum,  when  the  cramps  or  convulsions  do  not  yield  to  these 
remedies.  Cinchona  is  useful  against  the  general  debility,  and  Sulphur 
and  Phosphorus  are  two  of  the  most  important  remedies  against  irri- 
tation or  weakness  in  the  alimentary  canal,  characterized  by  frequent 
attacks  of  or  nearly  continual  looseness  occurring  after  cholera.  The 
*  Hartmann's  Therapie,  3te  Auflage,  p.  188. 


198  DIGESTIVE   SYSTEM. 

foregoing,  then,  are  the  principal  remedies  employed  by  homoeo- 
pathists  in  cholera,  and  when  the  treatment  is  had  recourse  to  from 
the  commencement,  the  disease  generally  yields  without  difficulty, 
rarely  passing  even  into  the  second  stage,  and  scarcely  ever  into  the 
third.  When  patients  affected  with  cholera  sought  the  aid  of  a  homoeo- 
pathic practitioner,  after  having  been  previously  treated  allopathically, 
it  was  found  essential  to  give  Camphora  in  repeated  doses,  in  the 
first  place,  partly  for  the  purpose  of  rousing  the  reactive  power,  and 
partly  to  neutralize  the  effects  of  the  allopathic  medicines. 

The  best  preservatives  against  infection  are  Veratrum,  Ctcprum,  and 
Camphor ;  an  occasional  dose  of  the  preparation  mentioned  under  the 
latter  medicine,  at  page  195,  has  frequently  been  found  sufficient  to 
ward  off  an  attack :  it  is,  however,  more  particularly  during  the  first 
stage  of  the  disease  itself,  under  whatever  form  it  sets  in,  that  the 
greatest  reliance  is  to  be  placed  on  this  remedy.  Veratrum  and  Cu- 
prum are  the  prophylaxes  which  have  been  employed  with  the  greatest 
success.  Many  homoeopathic  practitioners  recommend  Veratrum  alone, 
but  the  alternate  prescription  has  perhaps  been  more  generally  pre- 
ferred.    They  may  be  prescribed  as  follows  : 

R  Veratr.  alb.  30,  glob.  xxiv.  (red.  in  pulv.) 
Pulv.  sacch.  lact.  q.  s, 
Misce  intime,  et  divide  in  partes  sequales  quatuor.     Sign  1,  3,  5,  7. 

R  Cupr.  30,  glob.  xxiv.  (red.  in  pulv.) 
Pulv.  sacch.  lact.  q.s. 
Misce  intime  et  divide  ut  supra.     Sign  2,  4,  6,  8. 
N.B. — A  powder  to  be  taken  in  numerical  order,  every  fourth  day. 

Some  practitioners,  again,  would  prefer  prescribing  as  follows : 

R  Veratr.- alb.  6,  gtt.  iij. 
Spirit,  vin.  rectif.  3j. 
Aq.  distil.  Jiij. 

R  Cupr.  6,  gtt.  iij. 
Spirit,  v.  rectif.  3j- 
Aq.  destil.  Jiij. 
N.B. — The  mixtures  to  be  taken  alternately;  the  dose  to  consist  of  a 
table-spoonful  night  and  morning,  every  third  day.    Or  thus : 

R  Veratr.  alb.  3,  gtt.  j. 
Pulv.  sacch.  lact.  q.s. 
F.  pulv.  tales  sex.    Sign  1,  3,  5,  7. 
R   Cupr.  3,  gr.  vj. 
Divide  in  chart,  aequales  sex.     Sign  2,  4,  6,  8. 
N.B. — A  powder  to  be  taken  in  the  order  numbered  every  third  day. 


CHOLERA.  199 

The  same  rules  should  be  observed,  whilst  these  preservatives  are 
being  taken,  as  those  we  have  notified  in  the  article  on  Scarlatina- 
The  patient  at  the  same  time  avoiding  excesses  of  all  kinds,  late 
hours,  exposure  to  night  air,  melancholy  thoughts,  or  fear,  which  are 
all  strongly  predisposing  causes  to  attacks  of  this  malady.  When 
the  disease  happens  to  break  out,  notwithstanding  these  precautions, 
it  is  almost  invariably  in  a  mild  form. 

During  the  prevalence  of  cholera  the  clothing  should  be  sufficient 
to  preserve  the  body  at  an  equable  temperature,  and  care  should  be 
taken  to  avoid  chills  or  checked  perspiration,  or  cold  and  wet  feet  : 
those  who  have  habitually  considerable  perspiration  in  the  feet,  should 
change  their  stockings  at  least  once  daily ;  a  flannel  bandage  worn 
round  the  abdomen,  is  also  a  useful  precaution,  and  should  not  be 
hastily  laid  aside,  even  when  the  danger  seems  to  have  passed  away ; 
constant  exercise  should  likewise  be  taken,  during  the  day,  in  the 
open  air.  Adherence  to  the  homoeopathic  rules  is  a  sufficient  dietetic 
guide,  but  too  sudden  a  change  of  diet  is  not  advisable ;  raw  vege- 
tables and  cold  fruits,  for  example  melons,  should  be  carefully  ab- 
stained from,  and  even  the  more  wholesome  varieties  and  all  cooked 
vegetables,  should  be  used  in  extreme  moderation ;  pure  beer  and 
non-acid  wines  are  unobjectionable  for  individuals  not  attacked,  and 
accustomed  to  their  daily  use,  with  the  same  limitation.  It  may  appear 
almost  supererogatory  to  observe  that  purity  of  air  and  thorough 
ventilation  are  highly  necessary. 

Accessory  Treatment.  The  patient  should  be  kept  in  a  room 
of  a  warm  temperature,  the  bed  should  be  heated  by  artificial  means, 
and  bottles  of  hot  water  applied  to  the  feet,  if  necessary.  The  ob- 
servance of  this  rule  greatly  facilitates  the  action  of  the  medicine 
employed:  anything  which  might  disturb  the  equanimity  of  the 
sufferer,  such  as  noise  or  contradiction,  should  be  carefully  avoided, 
and  his  spirits  should  be  sustained  as  much  as  possible.  Cold  water 
is  the-  best  drink,  but  the  patient  should  not  be  allowed  to  take  too 
much  at  a  time ;  the  occasional  administration  of  a  small  piece  of 
ice,  if  possible,  or  of  iced  water  in  teaspoonfuls,  is  often  attended 
with  benefit ;  and  injections  of  iced  water  are  sometimes  serviceable 
in  relieving  the  colic  and  cramps  in  the  intestimes.  During  the 
convalescence  following  this  disease,  we  must  be  careful  not  to  in- 
dulge the  patient  to  the  full  extent  of  his  appetite.  But  if  the  appe- 
tite remain  for   a  long  time  afterwards,  in   an  impaired  state,  the 


1200  DIGESTIVE  SYSTEM. 

employment  of  such  remedies  as  Arsenic,  Nux  v.,  Puis.,  Rfais,  Veratr., 
Cyclamen,  or  Acid,  nitr.,  will,  according  to  the  peculiarities  of  the 
individual  cases,  prove  of  considerable  service. 

Remarks.  When  this  disease  is  raging  as  an  epidemy,  we  not 
un frequently  find  individuals  suffering  under  many  symptoms  bearing 
a  marked  resemblance  to  those  of  cholera,  but  with  constipation 
instead  of  diarrhoea,  and  retching  in  place  of  vomiting ;  this  affection 
being  closely  analogous  to  Suppressed  Dysentery,  the  reader  will  find 
its  appropriate  treatment  under  that  head,  article  Dysentery. 


CHOLERINE. 

This  affection  being  merely  diarrhoea,  occurring  during  the  preva- 
lence of  Cholera,  without  any  of  the  more  severe  symptoms  of  that 
disease,  the  reader  is  referred  to  that  article  for  its  treatment. 


LIVER  COMPLAINT. 

This  disease  is  divided  into  the  Acute  and  Chronic :  the  latter 
generally  goes  by  the  name  of  Liver  Complaint,  although  a  careful 
diagnosis  will  often  discover,  that  the  real  disease  is  in  the  stomach 
and  intestines ;  however,  in  many  cases  the  liver  itself  becomes 
materially  implicated,  and  in  itself  deserves  considerable  attention. 

When  the  disease  has  been  for  a  long  time  unchecked,  and  the 
inflammation  becomes  deeply  seated  in  the  substance  of  the  liver,  an 
abscess  frequently  forms,  bursting  either  externally  or  internally; 
in  the  latter  case  often  proving  critical,  or  bringing  on  hectic 
fever. 


ACUTE  INFLAMMATION  OF  THE  LIVER. 
Hepatitis. 

This  disease  is  much  more  common  in  tropical  climes  than  with 
us.  There,  a  high  mode  of  living,  exposure  to  heavy  dews  or  damps 
in  the  evening,  and  the  powerful  rays  of  the  sun  by  day,  are  among 
its  principal  exciting  causes;  but  it  may  also  arise  from  violent 
mental  emotions,  the  use  of  stimulating  or  alpoholic  drinks,  suddenly 


HEPATITIS.  201 

suppressed  evacuations,  strong  emetics  or  purgatives,  the  abuse  of 
mercury,  gall-stones,  external  lesions,  or  injury  of  the  brain. 

Diagnosis.  This  differs  according  to  the  seat  of  the  inflamma- 
tion. When  it  occurs  on  the  outer  surface  or  convex  side,  the 
symptoms  closely  resemble  those  of  pleuritis ;  there  is  generally  a 
violent  pain  in  the  right  hypochondrium,  sometimes  resembling 
stitches,  at  others  burning — shooting  to  the  sternum,  the  right 
scapula  and  point  of  the  shoulder,  and  even  affecting  the  right  foot, 
— sensation  of  numbness  or  tingling  in  the  arm  of  the  same  side, 
the  pain  increased  by  inspiration ;  a  short  dry  cough,  and  the  symp- 
toms of  inflammatory  fever  •  bowels  irregular,  generally  constipated, 
and  stools,  in  the  majority  of  cases,  of  an  unnatural  colour. 

In  this  form  the  patient  can  only  lie  on  the  left  side. 

When  the  seat  of  inflammation  is  on  the  inner  or  concave  side  of 
the  liver,  the  pain  is  much  less,  and  the  patient  complains  rather  of 
a  sensation  of  pressure  than  actual  pain,  but  the  whole  biliary  sys- 
tem is  much  more  affected.  The  eyes  and  countenance  become 
yellow,  and  sometimes  complete  jaundice  declares  itself;  the  urine  is 
orange  coloured,  the  evacuations  mostly  hard,  and  generally  of  a 
whitish  or  gray  colour.  We  also  find  bitter  taste  in  the  mouth, 
vomiting,  and  considerable  distress.  The  patient  can  only  lie  on  the 
right  side.     Inflammatory  fever  is  met  with  in  this  variety  likewise. 

In  both  forms,  the  right  hypochondrium,  on  examination,  will 
usually  be  found  hot,  tumefied,  and  painful  on  pressure. 

Inflammation  of  the  liver,  unless  properly  treated,  is  apt  to  assume 
the  chronic  form ;  it  may  also  end  in  suppuration  externally,  or 
internally  by  a  communication  either  with  the  lungs  or  intestinal 
canal,  or  by  a  vomica  in  the  substance  of  the  organ  itself,  or  it  may 
terminate  in  indurations  or  other  alterations  of  structure,  in  gan- 
grene, or  in  the  formation  of  adhesions. 

The  disease  may  terminate  by  resolution,  critical  metastases, 
hemorrhoids,  diarrhoea,  epistaxis,  or  cutaneous,  particularly  erysipe- 
latous, eruptions. 

Therapeutics.  The  following  remedies  are  those  which  are 
most  frequently  required  in  the  generality  of  cases: — 

Aconitum,  Belladonna,  Mercurius,  Lachesis,  Bryonia  alba,  Chamomilla, 
Nux  vomica,  Pulsatilla,  and  Sulphur. 

Aconite  is  especially  indicated  in  the  commencement  of  the 
attack,  and  may  always  precede  the  other  remedies,  when  there  is 


202  DIGESTIVE  SYSTEM. 

violent  inflammatory  fever,  attended  with  insupportable  shooting  pains 
in  the  region  of  the  liver,  with  tossing,  restlessness,  and  great  anxiety 
and  anguish. 

Belladonna*  may  be  advantageously  employed  after  Aconite  has 
subdued  the  preceding  symptoms,  or  from  the  commencement,  when 
the  following  indications  present  themselves :  oppressive  pains  in  the 
region  of  the  liver,  which  extend  to  the  chest  and  shoulders,  dis- 
tension of  the  pit  of  the  stomach,  sometimes  extending  across  the 
epigastrium,  producing  a  sensation  of  tension,  with  difficult  and 
anxious  respiration;  determination  of  blood  to  the  head,  with  cloudi- 
ness and  giddiness,  sometimes  causing  faintness ;  great  thirst,  tossing 
about  at  night  and  sleeplessness.  (Temperament,  sanguine  lymph- 
atic.) 

When  Belladonna  fails  to  remove  the  whole  of  these  symptoms, 
we  frequently  find  that  Mercurius  will  have  the  desired  effect; 
this  medicament  is  too  well  known  as  an  allopathic  remedy  in  the 
cure  of  this  disease,  and  the  consequences  produced  by  its  abuse  are 
frequently  so  great,  as  to  render  the  disease  almost  incurable.  It  is 
generally  administered  by  allopathic  practitioners,  even  when  not 
indicated,  until  its  marked  pathogenetic  symptoms  declare  them- 
selves, and  consequently  the  patient,  in  addition  to  the  original 
malady,  has  frequently  to  contend  with  a  medicinal  disease.  The 
following  are  some  of  the  principal  indications  for  ifes  employment . 

Considerable  fulness  or  tumefaction  in  the  region  of  the  liver, 
with,  pricking,  burning,  or  oppressive  pains,  not  allowing  the  patient  to 
lie  long  on  the  right  side,  and  sometimes  augmented  by  movement  of 
the  body  or  part  affected ;  pains  in  the  shoulders  ;  bitter  taste  in  the 
mouth,  want  of  appetite,  thirst,  and  protracted  shivering,  sometimes 
followed  by  sweating,  but  without  relief,  with  pale  yellow  colour  of 
the  skin  and  eyes ;  also  in  more  advanced  stages  of  the  complaint 
when  there  is  induration  of  the  liver,  or  when  we  have  reason  to 
suspect  the  formation  of  matter.  (Arsenicum,  Hepar  s.,  or  Silicea,  are 
equally,  if  not  more,  deserving  of  attention  in  the  latter  case.)     If 

*  Dr.  Bosch  found  the  alternate  employment  of  Belladonna  and  Bryonia  very  efficacious  in 
acute  inflammation  of  the  liver  ;  when  the  liver  remained  tumid  and  painful  after  the  removal 
of  the  fever,  Phosphorus  and  Bryonia;  and  when  fulness,  weight,  dull  pain,  with  dyspepsia 
and  icterus,  Carlo  v.  and  Bryon. ;  or,  when  the  said  fulness  and  weight  were  unaccompanied 
by  pain,  but  the  patient  complained  of  a  feeling  of  weight  in  the  scrobiculus,  with  frequent 
eructation,  constipation,  clayey  stools,  extreme  languor,  and  jaundice,  Carbo  v.  and  Nux  in 
alternation.— Hygea,  XX  Bd,  5  Heft. 


HEPATITIS.  203 

the  patient  is  of  a  lymphatic  temperament,  or  is  distinguished  by 
softness  of  the  muscular  system,  there  will  be  additional  reason  for 
selecting  Mercurius. 

Lachesis.  In  subacute  cases,  or  in  those  in  which  Belladonna  or 
Mercurius  have  merely  afforded  partial  relief,  Lachesis  is  often  of  great 
service.  It  may  also  be  administered  with  advantage,  alternately 
with  the  said  remedies,  in  obstinate  cases  occurring  in  drunkards. 

Bryonia,  when  the  pains  in  the  region  of  the  liver  are  mostly 
shooting,  or  consist  of  an  obtuse  pressure,  with  tension  and  burning, 
increased  by  touch,  coughing,  or  respiration,  and  especially  during 
inspiration ;  or  much  exacerbated  by  movement ;  also  when  the 
symptoms  are  attended  with  violent  spasmodic  oppression  of  the 
chest;  rapid  and  anxious  respiration;  bitter  taste  in  the  mouth, 
tongue  coated  yellow  ;  and  constipation.  Bryonia,  like  Chamomilla,  is 
particularly  useful  in  cases  which  have  been  excited  by  mental 
emotion,  such  as  a  violent  paroxysm  of  anger,  and  is  well  adapted  to 
persons  of  nervous  or  bilious  temperament,  and  of  choleric  dis- 
position, 

Chamomilla,  in  slight  cases,  or  simple  irritability  of  the  liver 
with  pressive,  aching  pains,  pressure  in  the  stomach,  oppression  of 
the  chest,  and  a  Sensation  of  tightness  under  the  ribs  ;  yellow  colour 
of  the  shiny  pains  not  aggravated  by  motion,  &c. ;  tongue  foul  and 
yellowr,  bitter  taste  in  the  mouth  ;  paroxysms  of  great  anxiety*  Chamo- 
milla is  almost  a  specific,  when  the  above  symptoms  have  been 
brought  on  by  a  fit.  of  passion. 

Nux  vomica  is  particularly  indicated,  when  the  pains  are  shoot- 
ing and  pulsative,  and  attended  with  excessive  tenderness,  at  the 
region  of  the  liver,  to  the  touch,  pressure  in  the  epigastrium  and 
under  the  ribs,  with  shortness  of  breath,  and  constipation  :  also  when 
enlargement  and  induration  occur ;  and,  in  the  chronic  form,  when 
there  are  marked  symptoms  of  gastric  derangement.  (Temperament 
sanguine  or  bilious ;  disposition  choleric.)  (Vide  Nux  vomica,  art. 
Indigestion.) 

Arsenicum  : — Distension  of  the  right  hypochondrium,  with 
severe  burning  pains  and  sensibility  to  the  touch,  burning  heat  of 
skin,  accelerated  pulse,  intense  thirst,  anxiety,  vomiting  of  a  dark- 
coloured,  grumous  fluid. 

Pulsatilla.  Sensation  of  tension  in  the  region  of  the  liver, 
and  pressure  or  dull  pain  in  the  epigastric  region  ;  oppression  at  the 
chest,  bitter  taste,  yellow  tongue,  nausea  ;  loose,  greenish,  and  slimy 


204  DIGESTIVE  SYSTEM. 

stools;  excessive  anxiety,  especially  towards  evening  or  during  the 
night.     (Temperament  lymphatic ;  disposition  mild.) 

Sulphur  is  valuable  to  follow Nux  v.  or  Pulsatilla  when  either  the 
one  or  the  other,  although  apparently  indicated,  does  not  speedily 
declare  a  decided  action,  or  when  the  disease  continues,  although  in 
a  diminished  degree  ;  it  is  particularly  efficacious  after  Nux  vomica,  to 
combat  the  sequelae  of  the  disease.  Rhus,  Lycopodium,  and  Kali  c. 
may  be  required  in  some  forms  of  Hepatitis.  The  two  latter  have, 
together  with  Sulphur,  Silicea,  and  Hepar,  been  especially  recom- 
mended in  abscess  of  the  liver. 

Diet.  The  same  as  under  Fevers,  modified  according  to  the 
violence  of  the  disease. 


LIVER  COMPLAINT,  or  CHRONIC  INFLAMMATION  OF  THE  LIVER. 

Hepatitis  Chronica. 

In  this  form  of  the  disease  we  find  many  of  the  symptoms  which 
attend  the  acute  variety,  but  in  a  modified  degree  ;  and  in  addition, 
a  continued  pain  or  uneasiness  in  the  right  side  seldom  leaves  the 
patient,  who  gradually  falls  off  in  flesh,  and  loses  strength ;  and 
there  is,  not  unfrequently,  an  occasional  cough  with  expectoration ; 
sometimes  considerable  perceptible  enlargement  of  the  liver,  either 
continuous  or  returning  periodically,  with  a  number  of  dyspeptic 
symptoms ;  high-coloured  or  red  urine,  yellow  tinge  of  the  skin  and 
eyes,  occasional  febrile  symptoms ;  the  pulse,  except  during  these 
attacks,  generally  quick  but  regular. 

Nux  vomica,  Bryonia,  Arsenicum,  and  Sulphur  are  reme- 
dies of  great  value  in  this  as  well  as  the  acute  form  of  liver  com- 
plaint. It  frequently,  however,  requires  a  careful  discriminative 
treatment,  and  all  the  acumen  of  the  experienced  practitioner  to 
conduct  the  affection  to  a  happy  issue. 

For  the  indications  for  the  above  medicaments,  see  Acute  inflam- 
mation  OF   THE    LIVER. 

Carduus  marianus.  This  remedy  is  indicated  by  most  of  the- 
symptoms  which  have  been  described  under  Bryonia  and  Nux  v.  in 
the  preceding  chapter,  but  it  is  more  particularly  called  for,  when 
there  is  bitter  taste,  wdth  dull  pain  or  occasional  shooting  or  pricking 
in  the  right  hypochondrium,  increased  by  inspiration ;  yellow  hue  of 


ICTERUS.  205 

the  skin;  short  dry  cough,  or  cough  with  expectoration  of  mucus 
streaked  with  blood ;  and  slight  feverishness. 

Aurum,  Hepar  s.,  Lycopodium,  Magn.  m.,  Natrum,  Silex,  Cinchona, 
Alumina,  Calcarea,  Digitalis,  Laurocerasus,  Berheris  vulgaris,  Sepia, 
Carlo  v.,  Natrum  m.,  Kali  <?.,  Plumbum  c,  Acid,  nitr.,  Magnesia,  Cuprum  m,, 
etc.,  have  also  been  found  useful  in  chronic  disease  of  the  liver. 


JAUNDICE. 

Icterus. 

Diagnosis.  Yellow  colour,  varying  in  shade  from  a  pale  saffron 
to  a  dark  brown  yellow,  appearing  first  in  the  eyes,  then  extending 
over  the  surface  of  the  whole  body ;  hard  whitish  faeces ;  orange- 
coloured  urine ;  symptoms  of  deranged  digestion,  and  sometimes, 
tensive  pain  or  pressure  in  the  region  of  the  liver. 

In  severe  cases,  even  the  perspiration  will  impart  a  yellow  hue  to 
the  patient's  linen. 

The  disease  frequently  declares  itself  without  being  plainly  refer- 
able to  any  exciting  cause ;  the  principal  causes,  however,  are  affec- 
tions of  the  liver,  indigestion,  poisonous  substances,  taking  cold, 
powerful  mental  emotions,  emetics,  or  drastic  purgatives,  or  internal 
obstructions,  such  as  gall-stones,  or  even  worms  obstructing  the 
biliary  duct. 

Among  the  predisposing  causes  may  be  enumerated  a  too  seden- 
tary or  irregular  mode  of  life,  indulgence  in  spirituous  liquors,  and 
the  frequent  use  of  aperients. 

It  may  be  remarked  that  the  malady  frequently  assumes  the  inter- 
mittent type. 

Jaundice  is  not,  of  itself,  to  be  considered  as  a  dangerous  disorder, 
but  rather  as  an  indication  of  some  internal  derangement,  which,  if 
neglected,  may  entail  serious  consequences,  for  example,  dropsy, 
hectic  fever,  or  general  atrophy. 

Therapeutics.  Mercurius  and  Cinchona  are  two  of  the 
best  remedies  in  the  treatment  of  the  disorder,  particularly  the  former ; 
but,  in  cases  where  the  patient  has  suffered  from  the  abuse  of  that 
mineral,  a  preference  may,  in  most  cases,  be  given  to  Cinchona,  espe- 
cially when  the  disease  appears  to  have  arisen  from  partaking  of 
indigestible  substances,  or  where  it  assumes  an  intermittent  form. 


206  DIGESTIVE  SYSTEM. 

In  cases  which  have  been  excited  by  a  fit  of  passion, — as  we  have 
before  noted,  no  unfrequent  cause — we  should  have  recourse  to  Cha- 
momilla;  but  Nux  vomica  is  to  be  preferred,  w7hen,  in  addition 
to  this,  the  bowels  are  confined,  or  alternately  confined  and  relaxed. 
Nux  vomica  is  also  indicated,  when  sedentary  habits,  over-study,  or 
indulgence  in  spirituous  liquors,  appear  to  be  the  predisposing,  or 
partly  the  exciting  causes. 

Pulsatilla  :  Lassitude,  great  weakness  and  anxiety,  especially 
towards  evening ;  obtuse  pressure,  but  sometimes  also  pricking  or 
shooting  pain,  in  the  region  of  the  liver,  extending  occasionally 
upwards,  towards  the  right  shoulder ;  whitish  stools. 

Digitalis,  is  a  most  important  remedy  in  many  cases  of  this 
disease ;  the  following  are  the  principal  indications  for  its  employ- 
ment :  nausea,  retching,  or  vomiting,  tongue  clean  or  coated  white  ; 
pressure  at  the  pit  of  the  stomach  and  region  of  the  liver  ;  sluggish  state 
of  the  bowels,  with  white,  gray,  or  clay-coloured  evacuations ;  alternate 
heats  and  chills.     (Icterus  Spasmod.  s.  Spast.) 

Aurum  is  frequently  an  excellent  remedy  in  obstinate  cases,  after 
Pulsatilla,  when  the  disorder  occurs  in  young  females. 

Should  the  Jaundice  be  accompanied  with  symptoms  of  inflamma- 
tion, and  pain  and  pressure  in  the  hepatic  region,  see  Acute 
inflammation  of  the  liver  ;  it  may,  however,  be  again  ob- 
served in  this  place,  that  in  the  majority  of  such  cases,  Aconite,  fol- 
lowed if  needful,  by  Belladonna,  Mercurius,  or  Chamomilla,  as  best 
indicated,  will  be  found  of  essential  service. 

In  inveterate  icterus,  the  alternation  of  Sulphur,  Ilepar  sulphuris, 
Lachesis,  and  Acid,  nitricum  has  been  found  successful ;  but  as  these 
cases  frequently  arise  from  obstructions,  atony,  or  a  spasmodic  or 
irritable  state  of  the  liver  and  duodenum,  they  require  considerable 
skill  and  discrimination  in  their  treatment. 

The  diet  should  be  light  and  unstimulating ;  veal  or  chicken  broth, 
with  bread  (unfermented) ;  roast  apples,  also  mild  vegetables,  such 
as  vegetable  marrow,  stewed  lettuce,  and  French  beans.  Bacons 
butter,  eggs,  milk,  wine,  spirits,  and  malt  liquors  in  general  must  be 
strictly  avoided.     The  drink  should  chiefly  be  confined  to  water. 


INFLAMMATION  OF  THE   SPLEEN. 


207 


INFLAMMATION  OF  THE  SPLEEN. 
Splenitis. 

Diagnosis.  Sharp  pressing  or  shooting  pains  in  the  region  of 
the  spleen,  with,  in  most  cases,  a  high  degree  of  fever,  general 
derangement,  and  sometimes  enlargement  and  tumefaction;  and, 
when  very  severe,  hematemesis. 

It  is  a  rare  disease  in  this  country,  but  sometimes  declaims  itself 
in  hot  seasons,  when  it  is  not  unfrequently  mistaken  for  other 
affections.  It  may,  however,  arise  in  individuals  of  delicate  con- 
stitutions, or  in  children,  when  exposed  to  the  influence  of  marsh 
miasms,  particularly  when  to  that  cause  has  been  added  insufficient 
clothing,  want  of  exercise  or  proper  nutriment,  and  long-continued 
mental  disquietude. 

The  value  of  Cinchona  in  this  malady,  and  the  power  it  displays  of 
developing  an  affection  closely  similar  to  it  affords  one  of  many 
exemplifications  of  the  truth  of  the  homoeopathic  law. 

From  our  very  imperfect  knowledge  of  the  physiology  of  this 
viscus  and  its  relation  to  the  other  organs,  this  disease,  except  when 
it  presents  itself  in  the  tangible  form  above  mentioned,  is  extremely 
difficult  to  diagnose.  Its  best  characteristics  are  tenderness  or 
sensibility  on  pressure  in  the  splenic  region,  with  general  debility, 
paleness  of  the  complexion,  bloodless  appearance  of  the  conjunctiva, 
languid  circulation,  and  tendency  of  the  extremities  to  become  cold. 

Therapeutics.  The  chief  remedies  in  this  affection  are  Cinchona 
and  Arsenicum,  which  are  useful  not  only  in  its  treatment,  but  against 
the  tendency  to  dropsy,  which  not  unfrequently  develops  itself  in 
connexion  with  this  complaint ;  an  aggravation,  however,  which  can 
but  rarely  occur,  where  the  proceedings  of  the  practitioner  are  guided 
by  the  homoeopathic  law,  inasmuch  as  the  very  remedies  employed  to 
combat  the  disease  itself  are  the  surest  preventives  against  such  a  result. 

The  other  medicines  most  frequently  required  are  Aconitum,  Arnica 
Montana,  Nux  vomica,  and  Bryonia  alba. 

Aconitum.  Against  the  fever  generally  present,  if  the  disease  be 
severe. 

Cinchona,  when  the  inflammatory  symptoms  have  abated,  or  if 
no  fever  of  any  moment  exists  at  the  commencement,  particularly  if 
the  disease  owes  its  origin  to  marsh  miasm,  or  if  the  accompanying 
fever  presents  an  intermittent  type,  in  which  case  it  should  be  ad- 


208  DIGESTIVE  SYSTEM. 

ministered  during  the  Apyrexia;  moreover,  if  impaired  appetite  and 
general  derangement  be  present; — see  this  medicine  under  Apepsia. 
Also,  if  the  patient  have  been  weakened  by  hematemesis  or  diarrhoea  ; — 
see  these  articles.  When  the  abuse  of  this  medicine  has  given  rise  to 
disease  of  the  spleen,  benefit  will  often  be  derived  from  the  employ- 
ment of  Arsenic.,  Carlo  v.,  Puis.,  Veratr.,  and  Stdjph. 

Arsenicum  is  useful  where  the  disease  resembles  or  is  complicated 
with  ague  (see  Cinchona  and  this  remedy  under  art.  Intermittent 
Fever)  ;  and  further,  when  the  patient  complains  of  a  violent  burning 
pain  in  the  region  of  the  spleen,  and  a  constant  pulsation  at  the 
scrobiculus,  attended  with  great  anxiety;  also  vomiting  of  a  dark 
grumous,  fluid,  watery,  or  sanguineous  diarrhoea,  and  burning  at  the 
anus;  excessive  weakness,  and  oedema  of  the  feet.  In  some  cases  it 
has  been  found  advantageous  to  alternate  these  two  remedies,  by 
giving  a  dose  of  Cinchona  morning  and  evening,  allowing  an  action 
of  one,  two,  or  three  days, ,  according  to  circumstances,  and  then 
exhibiting  the  other  in  the  same  manner. 

Arnica  is  indicated  by  pressive  pain  in  the  left  hypochondrium, 
causing  dyspnoea,  and  when  the  vomiting  of  blood  is  excessive. 
(When  external  violence  has  given  rise  to  the  disorder,  Arnica  is 
especially  called  for.  Rhus  may  also  be  useful  under  similar  circum- 
stances, particularly  when  severe  corporal  exertion  has  produced  the 
disease.) 

Nux  vomica  is  chiefly  indicated  by  the  symptoms  of  deranged 
digestion,  constipation,  &c,  which  remain  after  the  more  threatening 
symptoms  are  removed. 

Bryonia  is  found  useful  in  milder  cases,  where  an  aching,  shoot- 
ing pain  is  felt  in  the  region  of  the  spleen,  which  is  much  aggravated 
by  the  slightest  movement;  or  when  the  patient  complains  of  a 
constant  stitch  in  the  side,  or  the  left  hypochondriac  region,  and 
general  gastric  derangement,  with  constipation. 

The  preceding  are  the  remedies,  which  have  been  found  most 
useful  in  the  treatment  of  the  disease,  in  the  acute  form.  Chronic 
enlargement  and  indurations  of  the  spleen  require  a  long  and  judicious 
course  of  treatment  for  removal,  or  even  amelioration.  We  shall, 
therefore,  simply  direct  the  attention  of  the  reader  to  those  remedies, 
which  have  proved  most  successful  in  these  instances — namely, 
Sulphur,  Calcarea  carbonica,  and  Baryta  carbonica  (particularly  when 
the  mesenteric  glands  have  become  affected),  and  further,  Lycopodium, 
Carlo  vegetalilis,  Plumbum,  Ferrmn,  Mezereum,  Platina,  and  Stannum. 


INFLAMMATION  OF  THE  STOMACH.  209 


INFLAMMATION  OF  THE  STOMACH. 

Gastritis. 

As  some  difference  of  opinion  exists  among  medical  authors,  as  to 
the  application  of  this  term,  it  may  be  as  well  to  state  clearly  the 
disease  intended  to  be  treated  of  in  this  place. 

By  gastritis  is  here  meant,  inflammation  of  the  mucous  membrane 
of  the  stomach/ which  frequently  involves  the  submucous  tissue,  and 
sometimes  the  muscular  coat. 

Diagnosis.  Burning,  pricking,  or  shooting  pain  in  the  gastric 
region,  increased  by  pressure,  inspiration,  or  the  passage  of  food ; 
swelling,  considerable  heat,  and  tension  over  the  whole  stomachic 
region,  sometimes  with  pulsation ;  great  thirst,  nausea,  and  vomiting, 
increased  or  brought  on  by  the  smallest  quantity  of  food  or  drink ; 
sometimes  with  hydrophobic  symptoms  {Jvyd/rophobia  symptomatica) ; 
soreness  of  the  throat,  with  inflammation  of  the  fauces ;  hiccough, 
sobbing,  great  restlessness,  anxiety,  and  prostration  of  strength; 
coldness  of  the  extremities;  tongue  generally  red  at  the  tip  and  round 
the  edges,  foul,  rough  at  the  centre  and  round  the  root ;  frequently 
also  syncope,  violent  spasms,  convulsions,  even  tetanus ;  small,  some- 
times scarcely  perceptible,  and  remittent  pulse;  sunken  features, 
with  expression  of  anxiety;  and,  generally,  constipation,  but  fre- 
quently diarrhoea,  or  alternations  of  these  two  states. 

Death  may  ensue — either  from  gangrene,  in  which  case  the  pains 
suddenly  cease,  the  coldness  of  the  extremities  increases,  and  the 
pulse  becomes  scarcely  perceptible,  and  remittent ;  or  from  paralysis 
of  the  nervous  system,  during  the  attacks  of  the  spasms  or  syncope. 
When  this  disease  has  been  neglected  or  improperly  treated,  and  the 
patient  has  the  good  fortune  to  escape  with  life,  it  may  pass  into 
chronic  inflammation,  scirrhus,  or  ulceration  of  the  stomach. 

Causes.  The  most  frequent  are  partaking  of  cold  drinks  or  iced 
water  when  heated  or  during  hot  weather ;  the  admission  of  acid  or 
poisonous  substances  into  the  stomach ;  lesion  from  having  swallowed 
any  rough-pointed  body,  external  mjury,  ardent  spirits,  suddenly 
checked  secretions  or  evacuations,  abuse  of  emetics,  and,  finally, 
metastases. 

14 


210  DIGESTIVE  SYSTEM. 

Therapeutics.  The  remedies  which  have  been  found  the  most 
useful  in  the  homoeopathic  treatment  of  Gastritis,  are  Aconitum  napel- 
lus,  Belladonna,  Ipecacuanha,  Nux  vomica,  Antimonium  crudum,  Pulsatilla, 
Bryonia,  Ranunculus  bulbosus,  JEuphorbium,  Cantharis,  Hyoscyamus, 
Arsenicum. 

Aconite  is  requisite  in  those  cases,  in  which  synochal  fever  is 
developed, — and  must  be  repeated  until  relief  is  obtained,  or  an 
alteration  in  the  symptoms  calls  for  the  selection  of  another  remedy. 

Belladonna  may  follow  Aconite,  if  the  active  febrile  symptoms 
become  relieved,  but  do  not  wholly  subside  under  the  employment 
of  Aconite,  and  when  there  is  vivid  redness  of  the  tongue  at  the  tip 
and  margins,  inflammation  of  the  fauces,  and  hydrophobia  symp- 
tomatica. 

Ipecacuanha  is  useful,  when  the  vomiting  is  excessive,  the 
epigastric  region  considerably  distended,  and  the  patient  affected 
with  great  anxiety,  restlessness,  and  difficulty  of  breathing.  Anti- 
monium crudum  may  follow7  this  remedy,  or  be  given  in  preference 
thereto,  if  the  tongue  be  much  loaded.  Bryonia  may  be  adminis- 
tered after  any  of  the  foregoing  remedies,  should  they  have  afforded 
only  partial  relief,  and  particularly,  if  the  disorder  has  been  excited 
by  a  chill  from  having  partaken  of  cold  drinks  when  overheated. 

Nux  vomica  is  one  of  the  most  important  remedies  in  the  gastritis 
mucosa  of  drunkards,  with  low  fever,  nausea,  and  vomiting,  in  the 
morning  or  after  the  simplest  food ;  weight,  fulness,  and  pain  in  the 
epigastric  region,  and  tremulousness  of  the  hands.  It  is,  moreover, 
one  of  the  most  useful  medicaments,  when  this  disease  occurs,  as  a 
metastasis  from  suppressed  hemorrhoids,  and  has  also  been  found 
efficacious  after  the  previous  administration  pf  Aconitum^  Bryonia,  Ipe- 
cacuanha, and  Arsenicum,  when  the  disorder  has  been  caused  by  a  chill 
from  drinking  iced  water  when  overheated.  Lachesis  and  Arsenicum 
may,  in  some  instances,  be  advantageously  administered  in  alternation 
with  Nux  v.,  in  the  idiopathic  gastritis  mucosa  of  drunkards.* 

Pulsatilla  has  been  recommended  in  the  subacute  form  of 
gastritis,  arising  from  the  sudden  suppression  of  some  secretion,  such 
as  the  menstrual  flux,  &c. ;  and  also  in  cases  proceeding  from  a  chill 
in  the  stomach  from  ice,  particularly  after  the  previous  employment 
of  Ipecacuanha  or  Arsenicum.  Banunculus  bulbosus,  Euphorbium,  and 
Cantharis  have  been  recommended  in  the  more  violent  forms  of  the 
disease,  especially  when  the  burning  pain,  so  commonly  attendant  on 

*  Opium  may  also  be  included  with  advantage  here. 


INFLAMMATION  OF  THE  STOMACH.  211 

this  disease,  is  well  marked.  When,  however,  in  addition  to  the  last- 
mentioned  symptom,  there  is  excessive  prostration  of  strength ;  thirst, 
with  violent  vomiting  immediately  after  drinking ;  small,  quick,  and 
occasionally  intermittent  pulse ;  anxiety,  restlessness,  and  apparent 
sinking  of  the  vital  energies — Arsenicum  must  at  once  be  had 
recourse  to,  whether  the  disease  has  arisen  from  a  chill  in  the  stomach 
or  any  other  cause,— excepting,  of  course,  poisoning  by  that  mineral, 
in  which  case  the  treatment  to  be  followed  will  be  found  under  the 
head  of  Poisons.  The  alternate  administration  of  Aconitum  with 
Arsenicum  has  been  found  useful  in  some  cases, — in  others,  Veratrum 
and  Arsenicum :  the  former,  at  an  earlier  stage  of  the  disorder,  with 
accompanying  inflammatory  fever  ;  and  the  latter,  where  the  extremi- 
ties have  become  cold,  the  puTse  small,  features  sunk  and  expressive  of 
great  anxiety ;  with  hiccough,  thirst,  vomiting  on  partaking  of  the 
smallest  morsel  of  food,  solid  or  liquid,  extreme  debility,  and  other 
symptoms  mentioned  in  the  diagnosis.  When  the  pain  suddenly 
ceases,  or  when  the  burning  pain  continues,  and  the  tongue  becomes 
covered  with  a  thick  yellow  coating,  the  pulse  weak,  irregular,  or 
intermitting,  and  purulent  matter  is  occasionally  ejected, — Arsenicum 
is  again  one  of  the  few- remedies  by  means  of  which  we  may  yet  hope 
to  arrest  the  progress  of  the  disease.  Sulphur,  Cocculus,  and  Card.  v. 
have  also  been  recommended  in  the  last  stage  of  gastritis.  In  certain 
cases  the  attention  of  the  practitioner  may  be  directed  to  the  follow- 
ing remedies.  Hyoscyamus, — Stupor,  or  confusion  of  ideas  with 
incoherent  speech ;  convulsions,  hydrophobia  symptomatica.  Lachesis, 
Stramonium,  and  Cantharis  may  likewise  prove  useful  in  cases  in  which 
the  latter  symptom  is  present, — see  Hydrophobia.  Finally,  Colo- 
cynth,  Mercurius  vivus,  Sulphur,  and  Chamomilla  may  be  mentioned,  as 
likely  to  prove  serviceable  auxiliary  remedies  in  some  instances;  and 
Arnica  should  be  resorted  to,  if  the  attack  can  be  traced  to  lesion  of 
the  stomach  from  any  rough  or  pointed  substance  having  been  swal- 
lowed, or  if  it  has  arisen  from  external  injury. 

When  the  disease  has  passed  into  the  chronic  form,  Natrum  m., 
Lachesis,  and  Nux  v.  may  be  administered  in  alternation  wTith  great 
advantage ;  and  followed,  if  required,  by  Lycopodium,  Colchicum,  Sul- 
phur, and  Phosphoms,  &c.  Arsenic,  Sep.,  Plumb.,  Platina,  Kali  c, 
Natrum  m.,  Calc.  c,  Magn.  c,  and  Rhus  may  also  be  named  as  likely 
to  be  required  in  some  old  standing  cases.*  Vide  also  Cardialgia 
(which  chronic  gastritis  nearly  resembles),  and  Dyspepsia. 

*  The  alternate  employment  of  Sulphur  and  Carbo  v.  has  been  recommended  in  chronic 
inflammation  of  the  stomach  with  the  following  symptoms:  Burning  constrictive  pains,  with 


212  DIGESTIVE  ST  STEM. 

INFLAMMATION  OF  THE  BOWELS. 

Enteritis. 

Diagnosis.  This  disease  is  comparatively  of  rare  occurrence  in 
the  idiopathic  form,  and  appears  much  more  frequently  as  a  symp- 
tomatic affection,  particularly  in  the  course  of  certain  fevers — such 
as  low  Nervous  or  Typhoid  Fever,  Scarlet  Fever,  Measles,  &c. ;  and  also  in 
all  diseases  attended  with  hectic  fever. 

It  much  more  frequently  occurs  in  the  subacute  or  chronic,  than 
in  the  acute  form.  In  the  acute  form  of  the  disease,  involving  the  sub- 
mucous tissue  and  peritoneal  coat,  as  well  as  the  mucous  membrane, 
the  symptoms  are  usually  as  follows :  intense  burning  or  pungent 
pain,  generally  in  one  spot  of  the  abdomen,  especially  in  the  region 
of  the  navel,  increased  by  the  slightest  pressure  and  by  movement, 
with  tightness,  heat,  and  tympanitic  distension  of  the  abdomen  ; 
sobbing,  anxiety,  and  violent  thirst,  with  aggravation  of  suffering 
from  cold  drinks ;  obstinate  constipation ;  violent  vomiting,  first  of 
slime  and  bile,  and  sometimes  even  of  excrements  {Ileus  miserere) ; 
small  and  contracted  pulse,  inflammatory  fever,  flatulence,  and  fre- 
quently obstruction  of  urine. 

In  the  subacute  form  of  the  disease,  or  in  simple  enteritis  mucosa, 
the  pain  is  often  very  slightly  felt,  in  comparison  with  that  which 
accompanies  inflammation  of  the  peritoneal  coat,  and  generally  con- 
sists of  a  diffused  soreness  over  the  abdomen,  which  is  commonly, 
though  not  always,  increased  on  pressure ;  but  indigestible  food  or 
cold  drinks  almost  invariably  cause  an  aggravation  of  pain.  The 
tongue  is  often  very  red,  smooth,  and  glossy  ;  and,  generally  speak- 
ing, there  is  more  or  less  redness  at  the  tip  and  margins,  however 
foul  the  centre  may  be.  We  also  find  loss  of  appetite,  and  indigestion 
with  nausea  and  vomiting,  more  or  less  prominent,  according  to  the 
portion  of  the  intestinal  tube  affected ;  being  greater  the  nearer  the 
seat  of  the  inflammation  is  to  the*stomach.  When  the  inferior  parts 
are  implicated  (indicated  by  pain  or  soreness  in  the  iliac  regions  and 

sensibility  to  the  touch,  fulness  and  tension  of  the  epigastric  region,  acidity,  and  frequent 
vomiting  of  watery  fluid,  or  even  of  ingesta,  great  debility  and  sensation  of  paralysis  in  the 
extremities  ;  should  indurations  (not  scirrhous)  have  formed,  (symptoms — periodic,  pressive 
aching  pains,  extending  from  the  stomach  to  the  spine,  commonly  increased  after  partaking 
of  the  most  simple  food,  and  accompanied  by  anxiety,  oppressed  breathing  and  obstinate 
constipation,  and  sometimes  vomiting  of  mucus),  which  are  often  to  be  felt  at  the  region 
of  the  pylorus,  Sepia  and  Aurum  should  be  given  in  alternation. — Hygea,  Zeitschrift 
besonders  fiir  rationell-specifische  Heilkunst,  XX  Band,  1  Heft. 


INFLAMMATION  OF  THE  BOWELS.  213 

in  the  course  of  the  colon);  there  is  usually  diarrhoea,  the  stools  being 
frequently  slimy  and  mixed  with  blood,  in  severe  cases  consisting  of 
pure  blood,  particularly  when  the  rectum  is  involved,  in  which  case 
there  is,  moreover,  considerable  straining.  The  pulse  is  quick,  the 
thirst  sometimes  excessive,  with  a  greater  or  less  degree  of  fever  and 
extreme  languor. 

Unless  resolution  take  place,  it  may  terminate  in  induration  of  the 
intestines — laying  the  foundation  of  chronic  constipation,  hydrops, 
suppuration,  or  gangrene. 

The  signs  of  approaching  gangrene,  or  of  its  having  set  in,  are  the 
same  as  in  gastritis,  with  the  difference  of  situation. 

Among  its  exciting  causes  are,  cold  in  the  feet  and  abdomen,  sup- 
pressed discharges,  cathartics,  worms,  metastases,  parturition,  indi- 
gestible or  highly  stimulating  food,  prolonged  use  of  acids,  sour  wine, 
or  beer,  &c.  The  state  of  the  atmosphere  appears  to  have  some  share 
in  producing  it,  from  the  circumstance  that  the  disorder  sometimes 
prevails  almost  as  an  epidemy. 

Therapeutics.  Arsenicum  and,  where  required,  Veratrum  are 
the  principal  remedies  in  the  first-described  variety  of  this  disease, 
as  well  as  in  the  severest  forms  of  gastritis,  to  which,  indeed,  it  bears  a 
strong  resemblance;  but  the  treatment  must  necessarily  be  com- 
menced with  Aconite  when  the  accompanying  fever  is  intense,  and 
the  skin  hot  and  parched.  For  the  selection  and  administration  of 
the  two  former  remedies,  see  Gastritis.  Opium  and  Plumbum 
are  the  principle  remedies  against  Ileus  miserere,  when  that  derange- 
ment arises  from  spasmodic  congestion  or  strangulation  of  the  intes- 
tines; but  when  it  is  connected  with  inflammatory  action,  or  has 
resulted  therefrom,  Aconitmn  and  Sulphur  are  more  appropriate. 
Lachesis,  Mere,  Bella.,  Sec,  may,  however,  be  better  indicated,  by  the 
existing  symptoms,  in  some  cases.  (See  also  Hernia.) 

In  the  subacute  form  of  the  complaint,  a  few  doses  of  Aconite  are 
often  serviceable ; — but  as  soon  as  the  marked  inflammatory  symp- 
toms have  been  subdued,  one  or  more  of  the  following  remedies  must 
be  selected  to  complete  the  cure  :  Belladonna,  Mercurius,  Acid,  nitricum, 
Bryonia,  Colocynth,  Cliamomilla,  Nux  v.,  Pulsatilla,  China,  Opium,  Can- 
tharis,  Colchicum,  Rhus,  Phosphorus,  Stilph.,  Silex. 

Belladonna  : — Tongue  red  and  smooth,  or  coated  while,  or  yellowish 
brown  in  the  centre  with  intense  redness  of  the  Up  and  margins,  and 
inflammatory  redness  of  the  papillae  ;  skin  hot  and  dry,  intense  thirst, 
hot,  flushed  face,  giddiness  with   occasional  delirium,  especially  at 


214  DIGESTIVE  SYSTEM. 

night ;  sensation  of  soreness  or  of  excoriation  either  in  the  umbilical  and 
ccecal  regions  or  over  the  entire  abdomen ,  with  tenderness  on  pressure,  and 
sometimes  considerable  distension,  particularly  in  the  region  of  the 
arch  or  transverse  section  of  the  colon.  {Lachesis  is  sometimes  of 
great  service  after  Belladonna.) 

Lachesis  is  a  most  important  remedy  in  enteritis,  with  burnings 
aching,  cutting  pain,  oppressed  respiration,  tense,  distended  abdomen, 
with  sensibility  on  pressure  over  the  affected  part,  and  obstinate 
constipation.  [Belladonna  may  sometimes  be  returned  to  with  ad- 
vantage after  Lachesis ;  but  if  any  of  the  other  remedies,  such  as 
Bryonia,  Nttx,  or  Sulphur,  &c,  seem  better  indicated,  they  should 
unhesitatingly  be  had  recourse  to.) 

Nux  vomica  : — Redness  of  the  margins  of  the  tongue,  with  yellow 
or  whitish  coating  in  the  centre ;  sensation  of  soreness,  with  burning 
heat  in  the  abdomen ;  loss  of  appetite ;  indigestion,  with  vomiting 
after  partaking  of  food,  and  aggravation  of  the  abdominal  pain  after 
drinking ;  flatulence,  constipation,  or  constipation  and  looseness 
alternately  ;  scanty  watery  stools,  or  stools  consisting  of  a  small 
quantity  of  mucus,  sometimes  tinged  with  blood,  and  attended  with 
straining.  This  remedy  is  especially  useful  when  the  above  symp- 
toms have  been  caused  by  the  sudden  suppression  of  a  hemorrhoidal 
flux,  or  from  indigestible  food,  &c.  Sulphur  is  frequently  of  great 
service  after  the  previous  employment  of  Nux. 

Mercurius  is  a  most  important  remedy  in  this  disease,  even  in 
the  most  serious  cases,  and  especially  after  Aconite,  and  Belladonna, 
or  even  Arsenicum,  should  that  remedy  have  been  called  for.  The 
following  are  its  principal  indications  :  tongue  very  foul,  coated  white 
or  dark  brown,  sometimes  dry,  but  more  frequently  covered  with 
thick  mucus;  excessive  thirst;  abdomen  hard,  tense,  distended,  and 
very  tender  to  the  touch ;  copious,  watery,  bilious,  and  highly  offensive 
stools,  but  more  frequently  there  is  constant  urging  to  stool,  followed, 
after  severe  straining,  by  the  evacuation  of  a  small  quantity  of  mucus 
tinged  with  blood ;  or  at  other  times,  of  pure  blood  in  considerable 
quantity;  extreme  prostration  of strength,  chilliness  and  shivering,  with 
tendency  to  sweating  at  night,  which,  however,  brings  little  or  no 
relief,  {Mercurius  may  sometimes  be  beneficially  alternated  with 
Belladonna,  or  with  Lachesis  in  more  advanced  cases.) 

Acidum  nitricum.  The  indications  for  this  remedy  are  much 
the  same  as  those  described  under  the  foregoing;  it  is,  therefore, 
sometimes  of  great  service  in  completing  the  cure,  when  Mercurius 
has  effected  considerable  improvement,  but  seems  inadequate  to  give 


INFLAMMATION  OF  THE  BOWELS.  215 

further  relief.  It  is  an  invaluable  medicine,  in  chronic  cases,  attended 
with  abdominal  tenderness  and  tenesmus,  and  especially  when  the 
disorder  occurs  in  individuals  who  have  been  previously  subjected  to 
an  abuse  of  Mercury  under  allopathic  treatment. 

Bryonia.  After  the  previous  employment  of  Aconite,  Bryonia  is 
occasionally  a  very  useful  remedy  here,  particularly  when  the  patient 
complains  of  severe  headache,  with  constipation,  and  acute  pain  in 
the  abdomen,  aggravated  by  movement,  and  after  meals ;  it  is  also 
indicated  when,  after  Aconite,  there  remain  dark  redness  of  the  tongue, 
or  whitish  or  yellow  coated  tongue,  with  parched  mouth,  and  con- 
siderable thirst;  loose,  offensive  evacuations,  particularly  after  par- 
taking of  food  or  drink  ;  nausea  and  vomiting  after  eating. 

Pulsatilla  : — When  the  acute  inflammatory  symptoms  of  ente- 
ritis, arising  from  the  sudden  suppression  of  some  habitual  discharge, 
such  as  the  catamenia,  or  the  hemorrhoidal  flux,  or  occurring  as  a 
sequela  of  measles,  have  been  subdued  by  Aconite,  and  the  following 
symptoms  remain :  tongue  loaded  with  a  thick  white,  grayish,  or 
yellow  coating ;  adipsia,  or,  on  the  contrary^  excessive  thirst,  deranged 
digestion,  loss  of  appetite,  with  nausea  and  vomiting  after  partaking 
of  a  little  nutriment ;  sensibility  of  the  abdomen  on  pressure,  or  on 
every  movement ;  flatulence. 

Colocynth  : — In  cases  where  the  large  intestines  are  the  seat  of 
inflammation,  attended  with  tympanitic  distension  of  the  abdomen,  and 
soreness  and  sensibility  to  the  touch ;  tormina  and  diarrhoea,  with 
increase  of  pain,  followed  by  urgent  desire  to  go  to  stool,  after  eating 
or  drinking ;  nausea,  or  vomiting  of  bilious  matter ;  frequent  dis- 
charge of  flatus. 

Chamomill a  is  peculiarly  well  adapted  to  the  treatment  of  the 
disorder  in  the  form  it  is  sometimes  met  with  in  children,  or  in  highly 
nervous  and  excitable  females,  who  are  extremely  sensitive  to  pain 
and  complain  loudly  from  trivial  suffering ;  it  is  indicated,  moreover, 
by  a  sensation  of  soreness  in  the  abdomen,  as  if  arising  from  internal 
excoriation  or  ulceration,  accompanied  with  painful  tenderness  on 
slight  pressure,  and  slimy,  whitish,  watery,  or  greenish,  or  yellowish 
diarrhoea^  of  an  offensive  odour. 

Cinchona  is  frequently  useful  after  Aconite  or  any  of  the  foregoing 
remedies,  when  there  is  a  tympanitic  distension  of  the  abdomen ; 
diarrhoea,  aggravated  after  a  meal,  with  portions  of  undigested  food 
in  the  evacuations ;  thirst,  extreme  weakness  of  digestion,  and  great 
debility. 

Cantharis: — In  very  serious  cases,  with  discharge  of  pure  blood 


216  DIGESTIVE  SYSTEM. 

at  stool,  and  strangury ;  or  in  an  advanced  stage  of  the  disorder,  with 
evacuations  of  mucus  and  solid  substances,  like  shreds  of  membrane, 
this  remedy  will  frequently  be  found  of  considerable  service. 

Colchicum  will  also  be  found  useful,  occasionally,  in  advanced 
stages  of  the  disorder,  with  tympanitic  distension  of  the  abdomen,  diar- 
rhoea, the  stools  consisting  of  white  or  transparent  gelatinous  mucus, 
or  of  blood  mixed  with  substances  resembling  false  membrane. 

Rhus  : — When  eruptions  break  out  about  the  mouth,  and  there 
is  redness  of  the  tongue,  with  pain  as  if  from  soreness  or  ulceration 
in  the  abdomen,  and  tenderness  on  pressure ;  watery,  slimy,  frothy, 
or  sanguineous  stools ;  low  fever,  with  nocturnal  delirium.  Rhus  is 
chiefly  useful  in  symptomatic  enteritis,  such  as  frequently  occurs  in 
low  Nervous  Fever,  which  see.  When  ulceration,  with  purulent  evacua- 
tions and  nocturnal  sweats,  sets  in,  Arsenicum,  Nux  v.,  Sulph.,  PhospL, 
Acid,  nitr.,  or  Card,  v.,  rarely  fail  to  relieve,  and  may  even  effect  a 
cure  when  the  mischief  is  not  too  extensive. 

The  chronic  stage  of  the  complaint,  which  is  chiefly  characterized 
by  fixed  pain,  fulness,  or  uneasines  and  oppression  in  the  lower  part 
of  the  abdomen,  increased  after  meals  or  after  cold  drinks;  appetite 
impaired  or  capricious;  thirst,  particularly  after  dinner  or  at  night; 
bowels  constantly  relaxed,  or  affected  by  constipation  alternately  with 
diarrhoea ;  fetid  and  discoloured  evacuations ;  skin  hot,  harsh,  and  of 
an  unhealthy  hue ;  pulse  rather  quick  ;  tongue  loaded,  but  red  at 
the  tip  and  margins, — or  redness  of  the  entire  tongue,  with  large  and 
elevated  papillae,  especially  at  the  root ;  emaciation,  weakness,  and 
languor.  Here  the  foregoing  remedies  required  the  acute  and  sub- 
acute varieties,  but  more  particularly  Belladonna,  Nux  v.,  Bryonia,  and 
Rhus,  together  with  Acidttm  nitricum,  Phosphorus,  Sulphur,  SiUcea, 
Arsenicum,  &c,  will  in  most  instances  be  found  the  most  serviceable. 

Acidum  nitricum  is  particularly  indicated  when  there  is  thirst, 
attended  with  pains  in  the  bowels  or  other  uneasiness  after  drinking ; 
impaired  appetite,  tenderness  of  the  abdomen,  fetid  diarrhoea  and  tenesmus; 
greenish  stools,  with  ingesta,  skin  dry  and  harsh  during  the  day, 
sometimes  with  nocturnal  sweats. 

Phosphorus: — Soreness  in  the  abdomen,  with  tenderness  on 
pressure,  and  distressing  distension  after  meals ;  obstinate  diarrhoea, 
or  constipation  and  diarrhoea  alternately ;  stools  containing  ingesta ; 
pulse  rather  quick  and  hard  ;  weakness  and  emaciation. 

Sulphur.  This  remedy  is  one  of  the  most  useful  in  enteritis, 
arising  from  the  suppression  of  some  accustomed  discharge,  such  as 
the  hemorrhoidal,  &c. ;    as  also  in  cases   arising  from  the  driving 


INFLAMMATION  OF  THE  BOWELS.  fe]7 

inward  of  a  tetter,  or  sudden  healing  up  of  an  ulcer.  It  is  also 
indicated  when  we  find  the  tongue  red  or  loaded ;  thirst ;  pain,  as 
from  excoriation,  in  the  abdomen,  with  tenderness  on  pressure ;  or 
fulness  and  uneasiness  in  the  abdomen,  increased  by  cold  drinks  or 
after  meals  ;  diminished  or  fastidious  appetite,  with  aversion  to  meat ; 
fetid  diarrhoea,  frequently  containing  ingesta ;  constipation,  or  con- 
stipation alternately  with  diarrhoea,  flatulence ;  skin  yellow,  or  other- 
wise unhealthy  looking,  or  dry  and  peeling,  but  often  covered  with 
perspiration  at  night,  or  towards  morning ;  pulse  quick  and  hard ; 
emaciation,  with  considerable  debility. 

Silicea.  When  the  disorder  has  been  excited  by  the  sudden 
suppression  of  the  perspiration  of  the  feet,  or  the  sudden  healing  up 
of  a  chronic  ulcer,  Silicea  is  one  of  the  most  important  remedies. 
The  following  symptoms  are  some  of  the  more  immediate  indications 
for  its  selection  :  dryness  of  the  mouth,  loaded  tongue,  great  thirst, 
with  diminished  appetite,  and  sometimes  disgust  at  meat,  or  cooked 
and  hot  food,  with  desire  for  cold  food  and  drinks ;  abdomen  hard, 
hot  and  tense,  and  painful  to  the  touch ;  constipation,  or  extremely 
fetid  watery  stools  ;  borborygmus,  especially  on  movement ;  skin  dry 
and  parched  during  the  day,  and  covered  with  sweat  towards  morn- 
ing ;  pulse  quick  and  hard. 

Arsenicum,  has  already  been  noticed  as  the  principal  remedy  in 
acute  cases  of  a  violent  character ;  it  is,  moreover,  a  remedy  of  con- 
siderable service  in  some  of  the  chronic  varieties  of  enteritis,  charac- 
terized by  a  feeling  of  soreness  or  of  burning  heat  in  the  abdomen, 
attended  with  nausea,  want  of  appetite,  and  great  thirst ;  increase  of 
pain  after  cold  drink;  borborygmus;  diarrhoea^  sometimes  with 
ingesta ;  fetid,  discoloured  stools ;  skin  parched,  hard,  and  of  a 
yellowish,  unhealthy-looking  hue ;  emaciation,  with  extreme  debility. 

Lachesis,  Lycopodinm,  Kali  nitricum,  Natrum  mtoriaticum,  Secale  cornu- 
tum,  Hepar  sulphuris,  Sepia,  Calcarea,  Graphites,  arid  Carbo  vegetabilis, 
may  also  be  of  considerable  service  in  some  cases.  When  we  have 
reason  to  suspect  worms  as  the  cause  of  this  affection,  the  patient 
must  be  treated  accordingly.     See  Invermination. 

Diet.  In  acute  cases  of  inflammation,  either  of  the  stomach  or 
bowels,  the  regimen  must  be  placed  under  the  same  restrictions  as 
described  at  page  7  {Fever)  ;  and  in  subacute  and  chronic  cases  the 
food  should  be  very  light,  and  given  in  small  quantities  ;  raw  fruit, 
green  vegetables,  and  sometimes  potatoes,  must  be  strictly  prohi- 
bited ;  and  the  drink  should  consist  solely  of  toast-water,  barley- 
water,  or  the  like. 


218  DIGESTIVE  SYSTEM. 

INFLAMMATION  OF  THE  PERITONEUM. 

Peritonitis. 

Diagnosis.  Painful  tension  and  tumefaction  of  the  abdomen, 
with  a  sensibility  to  the  touch  even  more  acute  than  in  Enteritis,  so 
much  so,  that  the  patient  cannot  bear  the  pressure  even  of  a  sheet 
upon  the  abdomen ;  frequently  constipation  or  ischuria,  and  the 
symptoms  of  enteritis. 

Causes.  General  causes  of  inflammation,  and,  moreover,  external 
injury,  parturition,  chill  of  the  abdomen,  and  metastases. 

Therapeutics.  In  the  first  place  it  will  generally  be  found  bene- 
ficial to  administer  three  or  four  doses  of  A^onitum,  exhibited  at 
intervals  of  time  varying  according  to  the  exigency  of  the  case,  until 
the  fever  and  inflammation  lower :  this  remedy  has  been  found,  in 
many  cases,  sufficient  of  itself  to  remove  the  affection,  and  in  all  it 
materially  modifies  its  violence. 

When  the  cause  is  external  lesion,  we  should  prescribe  Arnica, 
and  at  the  same  time  apply  bandages  wetted  with  a  diluted  tincture 
of  the  medicine,  as  recommended  under  External  injuries  in 
cases  of  contusion.  {Aeon,  followed,  if  requisite,  by  Belladonna,  is, 
nevertheless,  indispensable,  as  soon  as  inflammatory  fever,  with  ex- 
cessive local  tenderness,  supervenes.) 

Sometimes  vomiting  and  other  symptoms,  closely  resembling  those 
of 'enteritis,  are  present ;  at  other  times,  merely  the  marked  sensi- 
bility of  the  abdomen  and  tumefaction  with  gastric  derangement ; 
but  as,  physiologically  considered,  these  symptoms  arise  from  the 
intensity  and  extent  of  the  inflammation,  and  the  sympathy  of  the 
other  organs,  our  chief  care  must  be  to  lower  the  inflammation, 
which  having  been  in  a  great  measure  effected  by  the  first-mentioned 
remedy,  we  shall  find  considerable  benefit  from  the  employment  of 
Nux  vomica  and  Mercurins  in  combating  any  remaining  symptoms  : — 

Nux  vomica,  where  there  is  painful  sensibility,  and  distension  of 
the  abdomen,  with  a  tendency  to  the  predominance  of  gastric  symp- 
toms and  ischuria. 

Mercurius  is  more  particularly  suited  to  the  advanced  stages 
of  the  disease,  with  weak,  quick  pulse,  nocturnal  sweats,  and  great 
weakness. 

When  the  inflammation  extends  to  the  pleura,  and  the  breathing 


IN  VERMIN  ATION.  219 

becomes  affected,  with  acute  shooting  pain,  we  should  have  recourse 
to  Bryonia,  in  the  same  manner  as  directed  for  Aconite.  (See  also 
Pleuritis.) 

When  the  peritoneal  coat  of  the  upper  portion  of  the  alimentary 
tube  or  of  the  stomach  itself  becomes  affected,  evinced  by  an 
increase  in  the  intensity  of  the  disease,  the  pain  extending  higher — 
vomiting,  generally  a  rare  symptom,  becoming  severe  and  continual 
—collapse  of  the  features,  small  pulse,  and  a  rapid  sinking  of  the 
vital  energies,  we  should  have  recourse  to  Arsenicum. 

In  cases  where  there  are  evidences  of  the  brain  being  affected, 
Belladonna  may  be  had  recourse  to.  (See  Phrenitis.)  in  other 
instances  Cantharides,  ZacL,  Chamomilla,  Bryonia,  Rhus,  Lycopodium, 
Colocynth,  etc.  may  be  found  necessary.*  (See  also  Gastritis  and 
Enteritis,  as  the  indications  for  many  of  the  remedies  mentioned 
under  that  head  will,  in  many  instances,  prove  useful  in  the  selection 
of  the  appropriate  medicament  in  inflammation  of  the  peritoneal 
coat.) 

INVERMINATION.    WORMS, 
Helminthiasis.     Fehris  helminthiaca* 

The  existence  of  worms  in  the  intestinal  canal,  in  the  majority  of 
cases,  evidently  arises  from  a  peculiar  constitutional  taint,  inducing  a 
certain  diseased  statcof  the  mucous  or  lining  membrane,  and  thereby 
giving  rise  to  the  formation  of  these  parasites ;  and,  although  no 
period  of  life  is  wholly  exempt  from  their  presence,  infants  and  chil- 
dren appear  to  be  much  more  subject  to  the  affection  than  adults, 
on  account  of  the  predominance  of  nutrition  in  early  youth.  Weak- 
ness of  the  digestive  functions,  accumulation  of  mucus  in  the  intes- 
tines, an  ill-regulated  diet,  and  a  degree  of  moisture  in  the  atmos- 
phere, favour  their  generation. 

The  three  species  most  generally  met  with  in  the  human  subject 
are,  the  thread-,  or  maw-worm  {Ascaris  vermicularis,  Oxynris),  the  long 
round  worm  {Lumbricus,  Ascaris  lumbicoides) ,  and  the  taenia  or  tape- 
worm ;  of  the  latter  there  are  two  varieties, — -the  solitary  tape-worm 
(Tmnia  solium,  Tama  osculis  marginalihus),  composed  of  long  and  slen- 
der articulations,  which  has  been  known  to  exceed  the  length  of  thirty 

*  In  Peritonitis  puerperalis:  Aconitum,  Ipecacuanha,  Bryonia,  Arsenicum,  Veratrum, 
Chamomilla,  and  Pulsatilla  are  the  remedies  which  have  chiefly  been  used  ;  but  some  of  the 
others  which  have  been  mentioned  in  the  treatment  of  Enteritis  may  be  found  serviceable 
in  particular  cases. 


220  DIGESTIVE  SYSTEM. 

feet;  and  the  broad  tape-worm  (Taenia  osculis  stiperftcialiStis,  Bothrio- 
cephalus  latus),  which  varies  from  three  to  ten  feet,  seldom  comes 
away  entire,  but  in  joints,  which  are  considerably  broader  and  thicker 
than  those  of  the  variety  first  mentioned. 

The  presence  of  worms,  unless  when  passed,  is  not  always  easy  of 
detection,  since  subacute  inflammation  of  the  mucous  membrane 
from  other  causes  wrill  frequently  present  nearly  the  same  range  of 
symptoms ;  but  here  (as  in  the  treatment  of  most  diseases)  Homoe- 
opathy presents  two  manifest  advantages  over  the  old  system.  In 
the  first  place,  if  acting  upon  the  certainty  of  the  existence  of  worms, 
we  administer  a  remedy  specific  to  the  affection ;  in  the  next,  when 
wre  are  uncertain  as  to  the  true  character  of  the  complaint,  and  select 
a  medicament  distinctly  indicated  by  the  united  symptoms,  this  medica- 
ment will  be  found  applicable  to  the  affection,  from  whatever  cause 
it  arises;  whilst  a  careful  observance  of  the  known  pathogenetic 
powers  of  the  remedies  selected,  will  materially  assist  us  in  tracing 
the  disease  to  its  proper  source. 

Diagnosis.  Worms,  and  especially  ascarides,  frequently  exist  in 
the  intestines  without  occasioning  any  disturbance,  and  their  pre- 
sence is  only  known  by  their  being  observed  in  the  evacuated  faeces ; 
but  when  the  alimentary  tube  becomes  irritated  by  them,  a  number 
of  symptoms  are  developed,  of  which  the  following  are  the  principal  ; 
Pallor  and  sickly  appearance  of  the  countenance,  and  sometimes 
flushing;  livid  circles  round  the  eyes,  dilated  pupils;  headache  or 
vertigo  ;  irregularity  of  appetite,  or  great  voracity  ;  fetidity  of  breath ; 
acrid  eructations ;  occasional  nausea  and  vomiting ;  foul  tongue ; 
tensive  fulness  of  abdomen,  with  a  sensation  of  gnawing  and  burning 
at  particular  parts  of -the  intestines;  hard  and  tumid  belly;  great 
thirst ;  discharge  of  mucus  from  the  rectum,  bladder,  (and-  vagina)  ; 
heat  and  itching  at  the  anus ;  slight  febrile  symptoms,  or  remittent 
fever,  and  nocturnal  wakefulness,  with  low  spirits  or  irritability  of 
temper,  and  gradual  emaciation ;  we  also  usually  notice  an  inflamma- 
tory redness  of  the  nostrils,  with  great  disposition  to  picking  or 
boring  at  the  nose,  especially  in  children,  with  sudden  screaming 
when  waking,  and  grinding  of  teeth.  In  addition  to  the  above  gene- 
ral symptoms  of  this  affection,  we  frequently  meet  with  severe  colic- 
like pains,  with  tenesmus  and  slimy  and  bloody  evacuations ;  clysury ; 
strangury ;  involuntary  flow  of  saliva,  especially  when  asleep  ;  con- 
vulsions in  children,   and  epileptic  attacks,  combined  with  cerebral 


INVERMINAT10N.  221 

affections,  in  adults;  inflammation  of  the  bowels.  The  pain  is 
periodic,  and  occurs  particularly  in  the  morning,  and  whilst  fasting ; 
melioration  generally  after  eating.  The  quality  of  the  food  exercises 
considerable  influence  over  the  pains ;  milk,  sugar,  and  other  sweets, 
pungent,  salted  food,  ham,  cheese,  raw  fruit,  etc.,  often  produce 
aggravation. 

In  tania,  in  addition  to  the  above,  we  find  a  crawling,  scraping  or 
groping,  and  twisting  sensation,  extending  from  the  left  side  of  the 
abdomen  towards  the  epigastrium,  and  even  as  far  up  as  the  oeso- 
phagus ;  or  a  sensation  as  of  something  rising  into  the  left  side  of 
the  throat,  and  then  falling  back ;  the  feeling  of  a  cold  ball  on  either 
side,  with  an  undulatory  motion ;  a  sense  of  sugillation  in  the  abdo- 
men ;  creeping  torpor  and  numbness  in  the  fingers  and  toes. 

The  principal  exciting  causes  of  worms  are,  insufficient  and 
unwholesome  food,  (excess  of  vegetable,  and  deficiency  of  animal 
diet,)  uncleanliness,  impure  air,  with  residence  in  a  damp,  dark,  ill- 
ventilated  dwelling. 

The  leu  co-phlegmatic  habit  appears  to  engender  a  predisposition 
to  their  formation ;  and  females  are  oftener  affected  than  males. 

As  already  observed,  the  alimentary  tube  may  be  infested  with 
worms,  without  any  other  indication  of  their  existence  being  developed 
beyond. 

But  the  reverse  is  more  frequently  the  case,  and  in  addition  to  the 
anxiety  and  alarm  which  are  so  often  created  in  the  minds  of  parents 
by  the  distressing  nature  of  many  of  the  symptoms,  in  severe  cases 
a  further  and  more  serious  cause  for  apprehension  is  given  rise  to,  when 
other  diseases  above  noticed,  such  as  chronic  inflammation  of  the 
mucous  membrane  (sometimes  followed  by  perforation),  mucous  fever, 
epilepsy,  or  hectic  fever,  become  associated  with  invermination. 

The  progress  of  the  disease  is  generally  slow,  and  there  is  a  constant 
proneness  to  relapses.  The  prognosis  is  generally  favorable,  par- 
ticularly in  the  case  of  ascarides.  It  is  less  so  in  that  of  tape-worm, 
chiefly  on  account  of  the  greater  duration  of  the  disease,  and  its  more 
uncertain  cure.  When  the  colon  and  rectum  are  the  seat  of  the 
disorder,  the  cure  is  more  easily  accomplished  than  when  the  stomach 
and  small  intestines  are  affected.  When  the  nervous  symptoms  so- 
called,  such  as  sopor,  spasms,  dilated  pupils,  vomiting,  are  present^ 
the  case  is  liable  to  be  confounded  with  hydrocephalus  ;  but  in  the 
latter  the  abdomen  is  flat  or  retracted,  whereas  in  helminthiasis  it  is 


222  DIGESTIVE  SYSTEM. 

soft  and  distended;  the  head  in  hydrocephalus  is  hot,  and  the  symp- 
toms succeed  each  other  in  a  regular  course,  whereas  here  they  are 
very  changeable,  periodic,  and  inconstant.* 

Therapeutics.  Aconitum,  Ignatia  amara,  Sulphur,  Calcarea  carbonic  a, 
China,  Ferrum  metallicum,  Ma/rum  ver.,  Cina,  Nux  vomica,  Merctirius, 
Valeriana,  Spigelia,  Belladonna,  Sabadilla,  Silicea,  Cicuta  virosa,  Filix 
mas,  &e.  Of  these,  Aconitum,  Ferrum,  Ignatia,  Merc,  Nux  v.,  Valer., 
Marum  ver.,  Cina,  and  Sulph.  Unci.,  are  generally  the  most  appropriate 
against  Ascarides.  Cina,  Nux  v.,  China,  Bella,,  Merc,  Spigelia,  &c, 
against  LumbricL  And  Graph.,  Calc,  Sabad.,  and  Fragaria  vesca, 
(Dr.  Gross);  or  Sulph.,  Merc,  and  Calc,  (Dr.  C.  Hering) ;  as  also 
Carbo  a.  et  v.,  Kali  c,  Magn.  m.,  Natr.,  Phosph.,  Petrol.,  Plat.,  Tereb., 
Filix  mas,  Punica  granat.,  Stannum,  against  tape-worm. 

Aconitum  : — When  considerable  febrile  irritation  exists,  with  rest- 
lessness at  night,  fever  and  irritability  of  temper,  continual  itching  and 
burning  at  the  anus,  and  at  times  a  sense  of  crawling  in  the  throat. 

In  many  cases  Ignatia  amaba  will  be  found  the  most  appro- 
priate medicine  after  Aconite,  particularly  if  spasmodic  twitchings 
take  place  in  one  of  the  extremities  or  in  individual  muscles,  in- 
tolerable itching,  and  pain  as  from  excoriation  in  the  anus  and 
rectum.     (See  Cina.) 

Valeriana  maybe  substituted  when  the  insupportable  nocturnal 
itching  causes  spasmodic  muscular  twitching,  and  sleeplessness. 

Ferrum  metallicum  is  of  much  service  when  there  is  frequent 
vomiting  and  accumulation  of  watery  fluid  in  the  mouth. 

Mercurius  : — When,  in  addition  to  many  of  the  ordinary  symp- 
toms of  worms,  there  is  especially  a  constant  inclination  to  go  to 
stool,  and  diarrhoea  with  tenesmus ;  distension  and  hardness  of  the 
abdomen  (umbilical  region) ;  increased  secretion  of  saliva. 

Sulphur,  in  case  the  annoyance  still  continues  after  the  lapse  of 
two  or  three  days.  This  remedy  is,  however,  sometimes  indicated 
from  the  commencement,  and  is  in  some  cases  alone  sufficient  to  effect 
a  radical  cure.  It  is  especially  called  for  in  lymphatic,  leuco-phleg- 
matic  habits,  with  tendency  to  frequent  attacks  of  coryza  and  other 
mucous  discharges;  bitter,  slimy  taste,  aversion  to  meat ;  irresistible 
longing  for  sugar ;  alternations  of  loss  of  appetite  and  voracity ; 
frequent  regurgitation  of  ingesta,  together  with  pyrosis,  hiccough, 

*  Hartmann's  Therapie,  p.  163. 


INVERMlNATION.  223 

retching,  vomiting,  and  borborygmus ;  also  when  the  before-men- 
tioned itching  and  feeling  of  soreness  in  the  anus  and  rectum  are 
extremely  distressing. 

Calcarea  is,  if  anything,  still  better  calculated  than  Sulphur  to 
eradicate  the  tendency  to  worms*  It  is  peculiarly  well  adapted  to 
children  of  lymphatic  constitution,  with  disposition  to  blenorrhoea ; 
cold  in  the  head  and  diarrhoea;  feeble  debilitated  frame ;  defective 
nutrition  ;  face  pale  and  hollow,  or  puny,  and  of  diminished  tempera- 
ture ;  weakness  of  the  ankles ;  complications  with  scrofula  and  rickets ; 
chronic  derangement  of  the  digestive  functions. 

Silicea  is  often  of  essential  service  after  Sulphur  or  Calcarea,  when 
the  symptoms  are  generally  much  exacerbated  at  the  first  quarter, 
or  at  the  period  of  full  moon,  as  is  very  frequently  the  case  in 
helminthiasis.  Some  of  the  other  medicaments,  such  as  Mercurius, 
Nux  v.,  or  Pulsatilla,  Ipecacuanha,  Antimonium,  may  be  required  after 
a  few  doses  of  Sulphur  or  Calcarea,  when  indicated  by  the  turn  the 
symptoms  may  take;  moreover  the  beneficial  action  of  Sulphur  or 
Calcarea,  is  often  materially  assisted  by  the  intermediate  use  of  one 
or  more  of  the  aforesaid  remedies.  An  interval  of  from  six  to  ten 
days  and  sometimes  upwards,  must  generally  be  allowed  to  elapse 
between  the  different  remedies,  in  chronic  cases. 

This  course  of  treatment,  persevered  in  for  a  short  time,  has  often 
proved  successful  in  most  obstinate  cases,  by  purifying  the  consti- 
tution, and  restoring  the  mucous  membrane  to  a  healthy  state. 
When  excessive  irritation  is  present,  and  does  not  appear  to  diminish 
readily  under  the  action  of  the  preceding  remedies,  we  may  give  a 
drop  of  the  tincture  of  Urtica  urens,  in  a  little  water,  or  on  a  piece  of 
loaf  sugar,  every  night  or  morning  for  several  successive  days,  and 
should  this  not  relieve  the  annoyance,  we  may  administer  an  enema 
of  a  dessert-spoonful  of  salt  to  a  pint  of  water,  of  which  from  two  to 
six  fluid  ounces,  according  to  age,  may  be  injected ;  if  this  produces 
a  relaxed  state  of  the  bowels  a  mixture  of  vinegar  and  water,  in  the 
proportion  of  one  fourth  part  of  the  former,  may  be  used.*  After 
this  palliative  course  of  treatment,  the  course  above  mentioned  may 
again  be  adopted,  should  it  appear  necessary. 

Cina.  This  is  an  eminently  useful  medicine  in  the  case  of  worms, 
and  is  generally  indicated  where  the  following  symptoms  are  met 
with:  frequent  boring  at  the  nose,  obstruction  of  the  nose,  great 
perverseness  of  temper,  bashfulness,  heat   and  irritation,  constant 

*  Hering's  Hausartz. 


224  DIGESTIVE  SYSTEM. 

inquietude  and  restlessness,  -with,  in  children,  a  desire  for  things 
which  are  rejected  when  offered ;  fits  of  crying  when  touched,  pale- 
ness of  face,  with  livid  circle  round  the  eyes ;  constant  craving  for 
food,  even  after  a  meal ;  griping,  distension,  heat,  and  hardness  in  the 
abdomen,  with  discharge  of  thread-  and  round-worms,  costiveness, 
constipation,  or  loose  evacuations  ;  fever  chills  towards  evening,  hard, 
quick  pulse ;  little  sleep,  or  restlessness,  tossing  about,  startings, 
talking  or  calling  out  suddenly  during  sleep ;  transitory  paroxysms 
of  delirium;  heaviness  of  the  limbs;  changing  of  colour,  the 
face  being  at  one  time  pale  and  cold,  at  another  red  and  hot; 
pupils  dilated,  tongue  covered  with  tenacious  mucus  ;  disagreeable 
eructations,  vomiting;  itching  in  the  anus,  and  crawling  out  of 
thread- worms,  involuntary  micturition,  and  white,  turbid  urine  ;  occa- 
sional convulsive  movements  in  the  limbs  ;  weakness  and  lassi- 
tude. This  medicine  is  particularly  indicated  in  Colic  produced  by 
worms. 

Nux  vomica  is  a  valuable  adjunct  in  cases  of  worms,  with  con- 
siderable derangement  of  the  digestive  functions,  irritability  of  temper, 
and  constipation ;  or  excessive  distension  and  sensibility  of  the  abdomen 
and  epigastric  region ;  feeling  of  heat  in  the  abdomen ;  inclination 
to  vomit ;  exacerbation  of  symptoms  early  in  the  morning.  (See  also 
Dyspepsia,  Gastric  or  Mucous  Fever.) 

Mercurius.  When  we  find  diarrhoea,  distension  of  the  abdomen, 
and  hardness  in  the  umbilical  region,  with  increased  secretion  of  saliva. 

China  is  appropriate  when  the  symptoms  are  generally  exacerbated 
at  night,  particularly  the  abdominal  sufferings;  or,  when  pressive 
aching  pains  are  experienced  below  the  umbilical  region  after  every 
meal,  and  are  attended  with  distension  of  the  abdomen,  pyrosis,  pains 
in  the  epigastrium,  and  retching ;  also,  when  in  addition  to  the  fore- 
going, there  is  an  over-excitability  of  the  nervous  system,  with 
spasmodic  twitchings  of  the  muscles  in  various  parts,  tremulousness 
and  debility.  {Valeriana  and  Veratmm  are  also  deserving  of  attention 
here.) 

Spigelia  in  cases,  with  colic,  voracity,  diarrhoea,  and  chilliness; 
or  nausea  in  the  morning,  accompanied  by  a  sensation  as  if  some- 
thing were  ascending  from  the  stomach  into  the  throat;  smarting  in 
the  nostrils,  paleness  of  face,  palpitation  and  anxiety ;  exacerbation 
of  symptoms  particularly  after  dinner. 

Belladonna  is  best  adapted  to  cases  with  cerebral  disturbance, 
great  nervous  excitement;  nocturnal  delirium,  with  startings  during 


INVERMINATION.  235 

sleep ;  tendency  to  be  startled  or  frightened  by  the  most  trivial  cause ; 
also  colic,  headache,  thirst,  quick  pulse,  hot,  dry  skin.  Should  these 
symptoms  not  yield  to  Belladonna,  recourse  must  be  had  to  Lachesis, 
or  to  Silicea,  if  the  febrile  symptoms  continue,  and  the  patient  be  of 
a  scrofulous  diathesis. 

Cicuta  virosa.  Severe  worm-colic  with  febrile  irritation  and 
convulsions.  (Bella.,  Ignatia,  Hyoscyamus,  are  also  valuable  in  the 
event  of  convulsions.     See  that  article.) 

The  treatment  of  taenia,  although  similar  to  the  above,  has  some 
modifications.  In  most  cases  Aconitum  may  be  prescribed,  followed 
by  Cina,  after  which  considerable  relief  is  often  experienced ;  subse- 
quently Filix  mas,  a  drop  of  the  concentrated  tincture,  night  and 
morning  for  four  or  five  days.* 

Punica  granatum  has  been  employed  with  much  success  by 
Drs.  Lobethal  and  T.  O.  Miiller.  The  latter  gives  the  following 
symptoms  as  the  principal  indications  for  this  remedy :  convulsive 
movements,  catalepsy  and  epilepsy,  syncope,  emaciation  with  vora- 
cious appetite,  sudden  starting  from  sleep,  hallucinations,  hypo- 
chondriasis, vertigo,  confusion  in  the  head,  dilated  pupils,  yellow 
colour  of  the  face,  grinding  of  the  teeth,  accumulation  of  water  in 
the  mouth,  capricious  appetite,  eructations  of  watery  fluid,  vomiting, 
sensation  as  if  something  were  rising  up  in  the  stomach,  distended 
abdomen,  colic,  palpitation  of  the  heart,  &c.  (Hyg.,  Bd.  x,  pp.  137-93.) 

In  chronic  cases,  the  following  treatment  has  proved  successful : 
Nux  vomica,  Mercurius,  Sulphur,  and  Calcarea.  Dose,  four  globules  of 
each  remedy  in  rotation  in  two  doses,  two  globules  at  night  and 
two  in  the  morning, — an  interval  of  from  six  to  ten  days  to  be 
observed  between  the  different  remedies.  When  any  improvement 
takes  place  after  the  administration  of  any  one  of  these  remedies  in 
particular,  it  will  be  well  to  repeat  that  medicine  at  the  stated  intervals, 
as"  long  as  it  appears  to  do  good,  instead  of  going  on  to  the  next 
remedy  in  rotation*     In  addition  to  these  medicines,  the  following, 


*  Dr.  Wahle,  of  Rome,  considers  the  Filix  mas  a  specific  remedy  in  tcenia,  when  anything 
sweet  invariably  disagrees  with  the  patient,  or  rather  with  the  worm.  He  has  repeatedly 
found  only  a  few  doses  of  this  medicine  sufficient  to  remove  all  the  symptoms  and  sufferings 
arising  from  tape-worm,  when  the  aforesaid  peculiarity  formed  a  marked  symptom;  and 
that  every  trace  of  the  worm  disappeared  after  the  employment  of  the  remedy,  if  the  patient 
paid  strict  attention  to  diet— carefully  avoiding  indigestible  food  for  the  space  of  a  few 
months.     (Neues  Arch.,  Dritter  Band,  Erstes  Heft,  p.  3.) 

15 


226  DIGESTIVE  SYSTEM. 

as  already  observed,  are  more  or  less  useful  in  taenia :  Carlo  a*  et  v., 
Kali,  Magnes.  m,.,  Petrol.,  Plat.,  Tereb.,.  Natrum  muriaticum,  Lycopoclium, 
Sabadilla,  Fragaria,  Graphites,  Baryta,  Stanmcm,  Phosphorus,  as  the  one 
or  the  other  may  appear  the  best  suited  to  the  case. 

In  the  selection  of  these  or  other  remedies,  we  must  be  guided  by 
the  entire  group  of  symptoms.  In  many  cases  of  tape-worm,  a  cure 
has  been  performed,  and  the  parasite  discharged,  when  the  slightest 
suspicion  had  not  been  entertained  that  the  sufferings  of  the  patient 
arose  from  such  a  source, — by  administering  a  remedy  in  strict 
accordance  with  the  symptoms  complained  of  by  the  patient.  When 
the  symptoms  are  few,  or  not  well  marked,  we  may  derive  con- 
siderable assistance  by  paying  attention  to  such  particulars  as — the 
disposition  and  temperament  of  the  patient;  the  periods  of  the  day 
when  the  sufferings  make  their  appearance  or  become  exacerbated ; 
the  part  of  the  body  affected  (right  or  left  side) ;  the  partialities,  or 
peculiar  dislikes  of  the  patient;  the  agreeing  pr  disagreeing  of 
different  kinds  of  food  or  drinks,  &c. 

Regimen.  The  food  ought  to  be  wholesome  and  nutritious  ;  and 
consist  chiefly  of  meat,  such  as  roast  or  boiled  beef,  or  mutton,  some- 
times chicken,  and  occasionally  a  light  pudding ;  fruits  or  vegetables 
must  be  prohibited,  as  also  milk,  pastry,  and  sweetmeats :  and  the 
utmost  care  should  be  taken  to  prevent  children  from  eating  raw 
herbs,  roots,  &c.,  which  they  are  so  prone  to  pick  up  in  their  rambles, 
when  not  looked  after.  Plenty  of  exercise  in  the  open  air  is  of 
essential  service,  and  must  on  no  account  be  neglected. 


BLENORRHCEA. 

This  epithet  i$  given  to  an  increased  secretion  or  discharge  from 
any  of  the  mucous  surfaces.  We  purpose  to  restrict  ourselves  here 
to  the  consideration  of  the  affection  as  it  occurs  in  the  stomach  and 
bowels. 

Blenorrhoea  ventriculi.  This  form  of  the  complaint  is  chiefly  cha- 
racterised by  loss  of  appetite,  insipid,  clammy,  nauseating,  sweetish 
taste  in  the~mouth,  furred,  or  white  and  thickly- coated  tongue  and 
fauces,  flatulence,  absence  of  thirst,  constipation,  or  slimy  stools, 
pale,  cloudy  and  slimy  urine.  In  addition  to  these  symptoms,  a  sen- 
sation of  coldness,  with  pressure  and  aching,  or  gnawing,  throbbing, 
and  spasmodic  tension  is  experienced  in  the  epigastrium,  frequently 


BLENORRHCEA.  227 

attended  with  an  oppressive  feeling  of  sinking  and  emptiness  in  the 
stomach  while  fasting,  and  distressing  fulness  or  weight  after  meals, 
the  sleep  is  restless  or  disturbed  by  frightful  dreams,  or  nig^t-mare ; 
the  natural  temperature  of  the  body  diminished,  the  countenance  pale, 
and  the  physical  powers  much  depressed.  Accumulation  of  fluid  in 
the  mouth,  nausea,  and  vomiting  frequently  take  place  early  in  the 
morning  or  after  dinner,  and  occasionally  at  other  times.  Sometimes 
there  is  merely  an  adhesive,  tasteless,  rarely  acidulous,  inodorous  mu- 
cus ejected  by  the  act  of  vomiting.  The  prolonged  use  of  imperfectly 
azotized  and  indigestible  food,  sedentary  habits,  the  presence  of  worms 
in  the  alimentary  canal,  damp,  ill-ventilated  dwellings,  or  other  debili- 
tating influences — such  as  excessive  evacuations  of  blood,  immoderate 
excess  in  the  use  of  ardent  liquors,  depressing  passions,  and  a  lymph- 
atic temperament  are  the  general  predisposing  or  exciting  causes  of 
blenorrhcea  in  general.  A  moist,  relaxing,  and  changeable  state  of 
the  atmosphere,  errors  in  diet,  mental  emotions  of  all  kinds,  mate- 
rially aggravate  the  symptoms,  and  are  readily  productive  of  pituitous 
fever  (fehis j?ituitosa,feh?is  mucosa). 

Therapeutics.  Ipecacuanha  is  one  of  the-  most  important 
remedies  in  the  early  stage  of  the  disorder,  and  is  in  most  instances 
the  best  with  which  to  commence  the  treatment.  It  must  be  given 
in  repeated  doses,  until  it  has  produced  all  the  amendment  that  it 
seems  capable  of  producing,  after  which  another  remedy  must  be 
selected  in  accordance  with  the  remaining  symptoms.  Against  these, 
we  shall  generally  find  either  Nux  vomica,  Arsenicum  alburn^  Pulsatilla, 
Veratrum  album,  Tartarus  emeticus,  or  BJieum  patmalmm,  etc.,  the  most 
appropriate. 

Nux  v.  is  particularly  indicated  when  spasmodic  sufferings  in  the 
stomach  with  accumulation  of  watery  fluid  in  the  mouth,  acid  taste, 
vomiting  of  sour-smelling  and  tasting  mucus,  and  constipation, 
sometimes  in  alternation  with  slimy  stools,  form  the  most  prominent 
features  of  the  case ;  and  especially  when  these  symptoms  occur  in 
individuals  given  to  sedentary  habits,  or  to  habitual  over-indulgence 
in  spirituous,  vinous,  or  malt  liquors.  Arsenicum  may  be  frequently 
prescribed  with  advantage  after,  or  alternately  with,  Nux  v.  where 
there  is  an  extreme  degree  of  debility,  and  burning  heat  in  the 
throat,  or  stomach,  etc.  When  the  last-named  symptoms  occur 
in  lymphatic  subjects,  and  especially  females,  Capsicum  may  be  pre- 
ferred to  Arsenicum. 


228  DIGESTIVE  SYSTEM. 

Pulsatilla  is  productive  of  considerable  alleviation  where  the  pitui- 
tous  state  is  accompanied  by  continued  shivering,  frequent  slimy  eva- 
cuations, and  vomiting  of  mucus,  and  occurs  in  debilitated,  irritable, 
and  relaxed  constitutions,  but  more  particularly  in  chlorotic  females. 
Sulphur  may  follow  Pulsatilla  with  advantage  when  the  latter  is 
insufficient  to  remedy  the  state  of  matters.     (See  Chlqrosis.) 

In  cases  of  an  inveterate  character,  attended  with  repeated  and 
painful  attacks  of  vomiting  not  only  of  mucus,  but  also  of  bile,  from 
the  violence  of  the  act  of  vomiting,  Veratrum  rarely  fails  to  afford 
prompt  relief. 

Tartarus  emeticus  is  sometimes  useful  after,  or  alternately  with 
Ipecacuanha,  when  in  addition  to  the  frequent  recurrences  of  vomiting, 
there  is  also  a  constant  tendency  to  slimy  diarrhoea.  Rheum  may  be 
given  with  advantage  where  there  is  much  abdominal  flatulence,  ten- 
sion at  the  pit  of  the  stomach  and  epigastrium,  insipid,  slimy  taste, 
disposition  to  diarrhoea ;  with  brown-coloured  stools  mixed  with 
mucus. 

Gratiola  has  been  chiefly  recommended  as  being  of  considerable 
efficacy  in  rebellious  or  chronic  cases  where  the  foregoing  remedies 
have  only  effected  a  degree  of  melioration.  Along  with  Gratiola,  the 
following  may  be  mentioned  as  being  useful  in  the  treatment  of 
inveterate  cases  :  Sulphur,  Carlo  vegetabilis,  Veratrum  album,  Calcarea 
mrbonica,  Hepar  sulphuris,  Lachesis,  Lycopodium,  Natrum  muriaticum, 
Stannum,  Acidum  nitricum,  Plumbum,  Magnes,,  Assafoetida,  Bovista,  and 
occasionally  Squilla,  Cinchona,  Ferrum,  etc.  When  the  affection 
arises  from  worms,  Cina,  Spigelia,  Ferrum,  Valerian,  and  Mercurius,  etc. 
are  the  principal  remedies.     (See  Invermination.) 

Blenorrhoea  intestinorum,  is  chiefly  characterised  by  a  distressing 
tension  and  constrictive  sensations  in  the  abdomen,  accompanied 
with  flatulent  distension,  spasms,  and  obtuse  griping  pains.  Some- 
times the  bowels  are  sluggish,  or  there  is  obstinate  constipation  com- 
plained of ;  and  the  motions  that  are  passed  are  either  intermixed 
with  more  or  less  mucus,  or  are  formed  exclusively  of  masses  of 
thick,  tenacious  mucus.  At  other  times  the  bowels  are  relaxed,  the 
evacuations  consisting  of  large  quantities  of  watery  or  bilious-look- 
ing mucus,  passed  in  rapid  succession,  and  preceded  by  griping 
pains.  The  remedies  required  here  are  nearly  the  same  as  those  given 
in  the  foregoing  variety  of  the  disorder.  When  diarrhoea  is  present, 
Pulsatilla,    Rheum,   Arse?iicmm,    Phosphorus,    Mercurius,    Cinchona,   or 


BLENORRHCEA.  229 

Ferrum  will  commonly  be  found  the  most  appropriate,  the  latter  two 
particularly  when  the  prolonged  use  of  laxatives,  or  other  debilitating 
losses  have  been  the  predisposing  cause  of  the  malady.  When  the 
bowels  are  inactive,  but  the  motions  coated  or  mixed  with  consider- 
able quantities  of  mucus^  or  consist  entirely  of  slimy  substances,— 
Nux  vomica,  Sulphur,  Sepia,  Stannum,  Alumina,  Lachesis,  etc  ,  are  usually 
the  most  suitable. 

Blenorrhoza  recti.  (Hcemorrhoides  mucosa.)  This  variety  of  the  dis- 
order is  most  frequently  met  with  in  the  male  subject,  and  particularly 
in  those  of  a  debilitated  habit.  It  may  occur  in  the  idiopathic  form, 
but  is  often  purely  hemorrhoidal,  and  in  such  cases  partakes  wholly 
of  the  characteristic  features  of  hemorrhoids.  On  other  occasions  the 
complaint  appears  in  connexion  with  blind  piles.  Frequently  again 
it  either  immediately  precedes  a  fit  of  bleeding  piles,  or  exhibits  itself 
in  alternation  therewith.  The  mucous  discharge  takes  place  for  the 
most  part  periodically,  generally  subsequent  or  anterior  to  an  evacua^ 
tion,  but  occasionally  at  other  times,  and  involuntarily.  It  is  usually 
attended  with  more  or  less  tenesmus,  spasmodic  and  burning  pains 
in  the  rectum.  The  discharge  for  several  days  is  either  watery  or 
viscid,  sometimes  streaked  or  mixed  wTith  blood,  an d,  though  small  in 
quantity,  commonly  continues  for  several  days. 

This  form  of  blenorrhoea  is  not  unfrequently  preceded  by  indiges- 
tion, flatulence,  colic,  spasms  in  the  stomach,  bowels,  and  abdominal 
muscles,  local  intestinal  constrictions,  pains  in  the  hips  and  sacrum, 
spasm  of  the  bladder,  scanty  urine,  itching  in  the  glans.  These 
symptoms  increase  in  intensity  as  the  period  for  the  flow  of  mucus 
approaches,  -but  as  soon  as  it  makes  its  appearance  they  commence 
to  subside  in  a  similar  ratio. 

The  exciting  causes  of  blenorrhoea  recti,  as  well  as  blenorrhoea 
intestinorum,  of  which  the  former  is  but  a  variety,  are  nearly  the 
same  as  those  we  have  given  under  Blenorrhoea  Ventriculi,  to  which 
may  be  added  the  debilitating  effects  or  the  transposition  (Blenor-: 
rheea  metastatica)  of  catarrhal,  venereal,  or  rheumatic,  gouty  and  other 
more  purely  dyscratic  diseases. 

Therapeutics.  Hellehorus  niger,  Colchicum  autumnale,  Mercurius, 
Spigelia,  Capsicum,  'Pulsatilla,  Nux  vomica,  Carlo  vegetabilis,  and  Sulphur, 
will  in  the  majority  of  cases  prove  of  the  greatest  efficacy. 

Helleborus  is  extremely  serviceable  when  the  stools  consist  of 
mucus,  generally  in  solid  pieces,  and  without  any  admixture  of  proper 


230  DIGESTIVE  SYSTEM. 

fecal  matter.  ColchicumIs  equally  serviceable  under  such  circum- 
stances ;  but  particularly  when  the  motions  are  preceded  by  severe 
griping,  in  which  event  it  maybe  exhibited  in  preference  to  Hellebore. 

Where  the  presence  of  worms  in  the  alimentary  canal,  or  the 
existence  of  hemorrhoids  form  the  exciting  cause  of  the  malady,  Mer- 
curius  is  one  of  the  most  important  medicaments,  especially  when 
at  the  same  time  the  evacuations  consist  of  mucus  intermingled  with 
degenerate  fecal  matter,  during  the  expulsion  of  which,  violent  colic 
and  tenesmus  are  experienced.  Spigelia  is  useful  under  nearly  similar 
conditions;  it  may  consequently  be  had  recourse  to  with  advantage 
in  many  instances  where  Mercurws  affords  only  partial  relief.  Cap- 
sicum is  an  excellent  remedy  when  the  disorder  occurs  in  lymphatic 
subjects,  and  is  connected  or  not  with  hemorrhoidal  disease ;  the 
motions  copious,  somewhat  frequent,  and  accompanied  with  distress- 
ing burning  pain  in  the  rectum  and  anus.  Pulsatilla  may  follow, 
or  be  given  in  alternation  with  Capsicum,  when  the  pains  are  in  a  great 
measure  removed,  but  the  stools  unaltered  in  character.  Nux  v.  will 
be  found  of  essential  service  in  meagre,  debilitated  subjects,  of  san- 
guine or  bilious  temperament,  addicted  to  sedentary  or  intemperate 
habits.  Carbo  v.  may  be  prescribed  with  benefit  after  Nux  when 
there  is  excessive  flatulence,  or  burning  pains  in  the  lower  intestine, 
especially  after  stool. 

When  we  have  obtained  from  the  action  of  Nux  v.  and  Carb.  v.,  all 
the  improvement  that  they  are  evidently  capable  of  effecting,  we 
may  follow  up  the  treatment  by  the  administration  of  Sulphur,  by 
means  of  which  a  cure  will  often  be  obtained  in  cases  of  the  most 
obstinate  character.  Lachesis,  Rhus  toxicodendron,  Ignatia,  Antimo- 
nium  crudum,  and  Borax,  etc.  have  also  been  recommended  as  being 
capable  of  affording  considerable  assistance  in  the  treatment  of  this 
variety  of  blenorrhoea. 


DISEASES  OF  THE  ORGANS  CONNECTED  WITH  THE 
RESPIRATORY  SYSTEM. 


CATARRH,  or  COMMON  COLD.     CATARRHAL  FEVER. 

This  term  is  given  to  an  affection,  which  consists  of  a  mild  degree 
of  inflammation  of  the  lining  membrane  of  the  nostrils,  and  windpipe, 
and  occasionally  also  of  the  ramifications  of  the  latter,  induced  by 
exposure  to  sudden  changes  of  temperature,  or  to  a  damp  or  chilly 
atmosphere,  with  insufficient  clothing,  particularly  as  regards  children. 
This  complaint  is  characterized  by  slight  fever,  impaired  appetite, 
obstruction  of  the  nose,  sneezing,  unusual  languor,  pains  in  the  head 
or  in  the  back  and  extremities,  and  subsequently  hoarseness  or  cough, 
generally  preceded  by  transitory  chills  or  shiverings  ;  there  is  also  a 
slight  degree  of  wheezing  and  difficulty  of  breathing.  When  the 
disease  is  confined  to  the  nose  and  sinuses  it  is  termed  a  cold  in 
the  head  ;  of  which  latter  affection,  as  well  as  hoarseness  and 
cough,  we  shall  treat  separately. 

Therapeutics.  In  many  instances  catarrh  is  carried  off,  or  runs 
to  a  salutary  termination  in  a  day  or  two.  This  desirable  result  is 
frequently  obtained  by  having  timely  recourse  to  the  simple  proceeding 
of  remaining  a  little  longer  in  bed,  and  encouraging  a  gentle  sweat 
by  drinking  a  warm  demulcent  fluid,  such  as  gruel ;  bathing  the  feet 
and  legs  in  warm  water,  at  the  temperature  of  about  98-100  degrees 
of  Fahrenheit,  is  also  a  useful  auxiliary  mode  of  restoring  perspiration, 
but  the  patient  should  go  to  bed  immediately  afterwards.  Very 
robust  persons,  who  are  accustomed  to  be  in  the  open  air  in  all 
weathers,  but  who  have  caught  cold  after  having  overheated  them- 
selves, will  frequently  prevent  any  bad  effects  by  drinking  one  or 
two  glasses  of  cold  water  on  going  to  bed ;  when,  however,  they  have 
learned  by  experience  that  little  benefit  is  to  be  derived  therefrom, 


232  RESPIRATORY  SYSTEM. 

a  few  globules  of  Carl.  v.  or  Silicea  should  be  taken  instead.  A 
moderate  degree  of  abstinence  should,  at  the  same  time,  be  observed ; 
veal  or  chicken  broth,  bread,  sago,  or  semolina  pudding,  being  sub- 
stituted for  the  ordinary  diet.  The  drink  may  consist  of  water-gruel, 
barley-water  or  toast-water,  All  strong  liquors  must  be  abstained 
from. 

The  following  are  the  principal  medicines  to  be  employed  in  the 
majority  of  cases,  when  called  for:— 

Aconitum,  Bryonia,  Camphora,  Nux  vomica,  Chamomilla,  Coffea  cruda, 
Belladonna,  China,  Dulcamara,  Arnica  montana,  Mercurius,  Acidum 
phosphoricum,  Sulphur,  Calcarea,  Ipecacuanha,  Arsenicum,  Silicea. 

Nux  vomica,  when  the  symptoms  of  common  cold  declare  them- 
selves, will  often  check  the  attack.  It  is  especially  indicated  by  the 
following  symptoms :  Tickling  or  scratching  irritation  in  the  larynx, 
dry  cough,  particularly  in  the  morning,  and  sometimes  during  the 
day,  rarely  during  the  night;  occasionally  a  small  quantity  of 
adhesive  mucus  is  with  difficulty  expectorated  after  a  fit  of  coughing ; 
and  the  paroxysms  are  frequently  attended  with  a  painful  sensation 
in  the  umbilical  region,  as  if  arising  from  the  effects  of  a  bruise  or 
blow.  This  remedy  is  further  of  great  utility  in  catarrhal  fever  with 
disposition  to  chilliness,  or  wandering  fever  chills,  worse  during 
movement,  coming  on,  and  gradually  increasing,  in  the  after  part  of 
the  day,  and  alternating  with  flushes  of  heat.  Warmth  and  absolute 
rest  mitigates  these  symptoms.  When  convenient,  it  is  preferable 
that  this  remedy  should  be  taken  towards  evening. 

Chamomilla: — In  the  treatment  of  children  this  medicine  is 
generally  more  efficacious  than  Nux  vomica  in  arresting  the  attack. 
It  is  (like  Belladonna,  Bryonia,  China,  Dulcamara,  Sulphur,  and  Silicea) 
extremely  valuable  in  restoring  the  suppressed  perspiration,  and 
removing  the  following  symptoms :  colic,  with  pains  in  the  head, 
ears,  and  teeth,  thirst,  ill  humour,  and  impatience ;  or  dry  heat  of 
skin  with  chilliness  (in  any  part  of  the  body,  which  may  happen  to 
be  uncovered  for  a  short  time),  or  on  lifting  up  the  bedclothes; 
burning  heat  in  one  part  (as  for  instance  one  cheek)  and  chilliness 
in  another ;  severe,  dry  cough,  especially  at  night,  excited  by  tickling 
in  the  larynx, 

Coffea  cruda.  This  remedy  is  indicated  where  there  is  excessive 
sensibility,  fretfulness,  and  sleeplessness,  with  general  pains,  especially 
in  young  persons. 

Belladonna,  when  there   is   a   throbbing,  bursting  headache, 


COMMON  COLD.  233 

attended  with  determination  of  blood  to  the  head,  and  increase  of 
the  pain  from  movement  or  exposure  to  cold  air. 

Cinchona  : — Aching  pains  in  the  shoulder-blades,  and  in  the 
extremities,  increased  by  the  slightest  pressure  on  the  affected  parts, 
with  great  restlessness,  and  constant  desire  to  change  the  position 
of  the  limbs. 

Dulcamara,  when  the  pain  is  more  of  a  passive  or  dull,  aching 
description,  and  felt  only  in  particular  parts  of  the  head,  with  hum- 
ming in  the  ears,  and  obtuseness  of  hearing;  catarrhal  fever  with 
hoarseness,  dry,  rough  cough,  or  cough  with  copious  mucous  ex- 
pectoration, severe  coryza,  great  heat,  dryness,  and  burning  of  the 
skin ;  pains  in  the  limbs,  increased  when  at  rest,  and  attended  with 
a  feeling  of  coldness,  stiffness,  and  numbness ;  or  when  an  offensive 
perspiration  breaks  out  after  an  attack  of  cold ;  and  wrhen  the  affec- 
tion has  been  brought  on  by  suppressed  perspiration,  from  exposure 
to  a  cold  and  humid  atmosphere. 

Drosera  : — Painful  or  bruised-like  pains,  and  paralytic  weakness 
in  the  extremities;  frequent  rigors,  with  coldness  of  the  hands  and 
heat  in  the  face;  hoarseness,  and  cough  excited  by  roughness  and 
scraping  in  the  throat,  aggravated  by  talking. 

Arnica  Montana,  when  aching  pains,  or  pains  as  if  arising  from 
a  bruise,  are  felt  in  the  limbs  after  exposure  to  cold,  causing  excessive 
restlessness  and  a  constant  disposition  to  change  the  position  of  the 
affected  parts,  and  increase  of  pain  from  the  slightest  touch  or 
movement. 

Mercurius,  when  the  lining  membrane  of  the  eyelids,  nostrils 
and  bronchi,  is  highly  irritated,  and  gives  rise  to  copious  lachrymation; 
coryza  and  cough  with  profuse  expectoration ;  headache,  or  feeling 
of  tightness,  and  fulness  in  the  head,  with  pulsation  extending  to  the 
nose  ;  general  heats  predominate  over  the  chills.  Conium  macu- 
latum  is  of  great  service  in  catarrhal  fever  with  internal  heat,  much 
thirst,  and  great  debility,  scraping  or  scratching,  itching  and  creeping 
sensations  in  the  throat,  which  produce  a  dry,  almost  incessant  cough. 
The  patient  dreads  the  slightest  noise  or  whisper ;  passes  a  restless 
night,  the  sleep  being  unrefreshing,  and  disturbed  by  anxious  dreams ; 
urine  cloudy  and  whitish.  When  the  pains  in  the  limbs  and  joints 
are  accompanied  with  profuse  sweating,  which  affords  no  relief;  this 
remedy  may  be  followed  by  Dulcamara  should  the  sweat  continue, 
and  be  of  an  offensive  odour,  or  by : Euphrasia,  if  the  lachrymation 
and  coryza  remain  unmitigated. 


234  RESPIRATORY  SYSTEM. 

Acidum  phosphoricum,  aching  pains,  relieved  by  movement. 

Silicea,  pains  in  the  limbs,  colic  and  general  derangement  arising 
from  suppressed  perspiration,  particularly  in  those  who  are  subject 
to  sweating  at  the  feet. 

Sulphur,  in  cases  of  swelling  of  the  knee,  or  of  the  joints  of  the 
hand  and  fingers,  from  taking  cold.  It  may,  in  many  such  cases, 
be  followed  by  Calcarea  carbonica  in  a  week  or  ten  days. 

Mezereum  : — Alternate  heats  and  chills  (the  febrile  heat  occur- 
ring chiefly  in  bed,  and  the  chills  when  out  of  bed) ;  extreme  sensi- 
bility to  cold  air,  acrid  coryza,  burning  irritation  in  the  larynx  and 
trachea,  which  provokes  cough,  attended  with  difficult  mucous 
expectoration. 

Lycopodium  : — Inveterate  catarrh,  with  lemon-coloured,  often 
bitter-tasting,  mucous  sputa;  tearing,  throbbing,  frontal  headache, 
aggravated  in  the  afternoon  or  evening.  (Goullon,  Arch.  XX,  3-54.) 

Ipecacuanha: — Nausea  and  inclination  to  vomit,  or  Dyspnoea, 
almost  amounting  to  suffocation,  arising  from  having  taken  cold, 
followed  by — 

Arsenicum,  should  no  amelioration  declare  itself  in  six  or  eight 
hours.  (See  also  the  indications  for  this  remedy  in  the  article  on 
Cough  and  Influenza.) 

Hepar  s.  is  indicated  by  many  of  the  symptoms  which  call  for 
Merc,  JEupAr.,  and  Nux.  It  is  moreover  of  service,  where  the  respi- 
ratory organs  are  solely  or  particularly  affected,  the  cough  loose  and 
attended  with  mucous  rattling  in  the  chest ;  pain  in  the  larynx  while 
coughing,  and  a  feeling  of  weakness  of  chest  which  renders  talking 
oppressive. 

Pulsatilla  : — Useful  in  cold  in  the  head,  with  loss  of  the  senses 
of  taste  and  of  smelling  in  consequence  of  a  chill, — followed  or  pre- 
ceded by  Belladonna,  should  there  be  an  uncomfortable  sensation  of 
heat  in  the  eyes  and  head,  and  heat  and  smarting  in  the  nose  :  or 
by  Nux  v.,  should  there  be  complete  stuffing  or  dryness  of  the  nose. 
(See  Coryza  and  Cough.) 

Rhus  toxicodendron: — General  indisposition  from  exposure 
to  a  thorough  wetting,  when  in  a  state  of  perspiration :  followed  by 
Bryonia  in  a  few  hours,  if  no  improvement  is  experienced. 

Sepia.  Catarrhal  fever,  with  shivering  chills  on  every  movement 
in  a  warm  room,  rarely  alternating  with  heat ;  nocturnal  spasmodic 
cough,  with  shortness  of  breath  and  inclination  to  vomit,  coryza, 
occipital  headache. 


COMMON  COLD.  235 

Aconitum  is  one  of  the  principal  remedies  in  febrile  attacks, 
provoked  by  cold,  and  particularly  from  exposure  to  a  dry,  cold 
wind,  or  to  a  draught,  with  hot,  dry  skin,  or  general  shivering  chills, 
alternating  with  burning  heat  of  the  -  surface,  great  thirst,  especially 
towards  evening,  sensation  of  dryness,  and  roughness  or  scraping, 
slight  burning,  and  excoriation  in  the  region  of  the  larynx,  or  even 
throughout  the  whole  of  the  chest,  which  gives  rise  to  an  incessant, 
short,  dry,  hollow  cough  (more  of  a  hoarse  or  rough  description  at 
night) ;  restless  sleep,  disturbed  by  confusing  dreams,  or  crowding 
of  fantastic  ideas,  when  not  by  the  cough. 

Bryonia,  may  follow  Aconitum,  or  it  may  be  selected  in  preference 
at  the  commencement  of  the  attack,  when  there  is  an  excessively 
dry,  hollow  cough,  accompanied  by  tenderness  of  the  larynx  on 
pressure,  inclination  to  vomit,  and  pain  in  the  chest,  as  if  it  would  be 
torn  asunder,  severe  headache,  aching  pains  in  the  limbs,  increased 
by  the  slightest  movement,  violent  coryza,  thirst  and  coldness  of  the 
right  half  of  the  body. 

Camphora.  Incipient  catarrh,  coming  on  after  getting  the  feet 
wet,  is  frequently  cut  short  by  smelling  spirits  of  camphor.  When 
there  is  usually  weariness,  heaviness,  and  general  uneasiness,  attended 
with  shivering,  and  dryness  or  coldness  of  the  skin,  and  symptoms  of 
approaching  fever,  one  to  twro  drops,  every  ten  minutes,  for  two  or 
three  times,  will  generally  succeed  in  preventing  the  development  of 
an  attack,  either  of  common  catarrhal  fever,  or  of  influenza. 

The  remedies  for  any  other  effects,  arising  from  cold,  will  be  found 
under  the  different  heads,  such  as  Sore  Throat,  Diarrhoea, 
Cough,  Hoarseness,  &c. 

Some  individuals,  particularly  among  those  of  the  fair  sex,  are 
tormented  with  an  extreme  degree  of  susceptibility  to  cold ;  the  best 
corrective  of  which  is,  to  rub  the  throat,  chest,  and  indeed  the  whole 
body  every  morning  with  a  wet  towrel,  until  a  glow  of  heat  is  pro- 
duced,— drying  one  part  before  another  is  commenced, — also  to 
acquire  a  habit  of  going  out  every  day,  provided  there  is  no  inherent 
predisposition  to  pulmonary  consumption ;  all  extremes,  either  of  heat 
or  cold,  should  at  the  same  time  be  avoided,  and  care  taken,  when 
the  body  is  heated,  to  let  it  cool  gradually.  When  these  means  are 
not  sufficient  to  remove  the  tendency  to  suffer  from  the  slightest 
exposure  to  cold,  the  practitioner  will  find  Silicea,  Carb.  v.,  and 
Calcarea,  administered  at  intervals  of  from  two  to  three  weeks,  of 
considerable   power   in   removing  this  constitutional  delicacy.      In 


236  RESPIRATORY  SYSTEM. 

other  cases,  one  or  more  of  the  following  remedies  must  be  had 
recourse  to : — Bryonia,  Belladonna,  Dulcamara,  Nux  v.,  China,  Mercurius, 
Rhus,  Chamomilla,  Arsenicum,  Lachesis,  Rhododendron,  according  to  the 
character  of  the  sufferings,  which  are  experienced  after  each  exposure 
to  the  influence  of  the  atmosphere. 


INFLAMMATION  OF  THE  LARYNX. 

Laryngitis. 

This  disease  consists  in  a  suppurative  inflammation,  having  its  seat 
in  the  lining  membrane  of  the  larynx,  or  the  connecting  cellular  tissue 
between  it  and  the  subjacent  parts.  The  disease  bears  a  considerable 
resemblance  to  croup,  of  which  it  very  generally  forms  a  part;  but  occa- 
sionally the  inflammation  is  exclusively  restricted  to  the  larynx  ;  and 
it  is  a  frequent  cause  of  a  fatal  termination  in  scarlet  fever  and  small- 
pox. ,  It  is  distinguished  from  croup  by  a  constant  hawking  (which 
the  patient  voluntarily  exercises  in  order  to  clear  the  air-passages) 
rather  than  a  violent  and  involuntary  cough, — and  by  the  character 
of  the  sputa,  which  consists  of  a  thick  tenacious  mucus  rather  than 
a  coagulable  and  membranaceous-looking  exudation.  The  invasion 
of  the  disorder  is  announced  by  the  usual  signs  of  inflammatory 
fever ;  the  voice  soon  becomes  hoarse  and  inarticulate,  whilst  a  pain- 
ful sense  of  constriction  is  experienced  in  the  throat ;  the  breathing 
is  laborious  and  shrill  during  inspiration;  the  larynx  extremely 
sensitive  to  the  touch,  so  that  the  slightest  pressure  against  it,  either 
externally  by  the  hand,  or  internally  from  the  performance  of  the 
act  of  deglutition,  is  productive  of  'the  most  distressing  spasms,  and 
threaten  death  from  suffocation.  The  heat  of  skin  is  great,  the 
pulse  rapid  and  hard,  the  thirst  considerable,  but  incapable  of  being 
.  satisfied  from  the  suffering  that  is  occasioned  by  the  attempt.  On 
examining  the  throat,  the  fauces  are  often  found  to  present  a  red, 
inflamed,  and  turgid  appearance ;  in  some  cases  the  epiglottis  is 
involved,  and  the  motions  of  the  tongue  thereby  rendered  painful 
and  difficult.  As  the  disease  gains  ground,  the  face  becomes  swollen 
and  sometimes  livid  ;  the  eyes  protruded  as  in  threatened  strangula- 
tion, and  life  is  speedily  cut  short  by  asphyxia.  The  disease  -if  not 
arrested,  occasionally  runs  its  course  in  a  few  hours  to  a  day  or  two 
at  the  farthest. 


LARYNGITIS.  237 

^Therapeutics.  We  have  stated  that  the  symptoms  of  laryngitis 
bear  a  close  analogy  to  those  of  croup;  and  experience  has  proved 
that  the  same  remedies,  which  are  so  eminently  successful  in  the 
treatment  of  that  affection,  are  equally  efficacious  here.  ,  The  prin- 
cipal of  these  are  :  Aconitum,  Spongia,  Hepar  sulphuris,  Lachesis, 
Belladonna,  Phosphorus.  In  some  cases  of  a  less  formidable  nature, 
Chamomilla,  Mercurius,  or  JDrosera  rotundifolia  may  prove  serviceable. 

Aconitum  must  be  immediately  exhibited  when  the  signs  of 
inflammatory  fever  declare  themselves,  and  continued  until  it  gives 
evidence  of  having  effected  an  abatement  of  the  febrile  movement ; 
on  the  consummation  of  which,  or  as  soon  as  the  breathing  becomes 
shrill,  and  the  pain  and  sensibility  of  the  larynx  more  decided,  with 
increase  of  hoarseness  and  difficulty  of  articulation, — Spongia  must 
be  administered,  and  will,  for  the  most  part,  be  found  of  great  efficacy 
in  forwarding  the  curative  process.  When  we  have  satisfied  our- 
selves that,  we  have  obtained  from  the  action  of  Spongia  all  the 
benefit  which  it  is  capable  of  effecting,  we  may  then  prescribe 
Hepar  s.,  which  will  generally  be  found  sufficient  to  complete  the 
cure,  or  at  all  events  to  place  the  patient  out  of  danger,  and  thereby 
enable  us  to  make  a  careful  selection  of  the  remedy  required  to 
combat  the  remaining  symptoms.  {Hepar  may  be  selected  in  prefer- 
ence to  Spongia,  if  the  fever  and  burning  heat  of  skin  continue,  not- 
withstanding the  previous  employment  of  a  dose  or  two  of  Aconite.) 
In  some  instances  it  will  be  found  necessary  to  return  to  Aconite 
again,  or  to  exhibit  Aconite,  Hepar  s>,  and  Spongia  in  alternation,  but  the 
remedy  from  which  we  have  derived  the  most  marked  benefit,  when 
the  more  prominent  features  of  the  malady  did  not  yield  to,  or  were 
only  palliated  by,  the  use  of  Aconite,  Spongia,  or  Hepar,  is  Lachesis, 
the  pathogenetic  properties  of  which  correspond  very  accurately 
to  the  symptoms  of  the  malady,  particularly  the  extreme  sensibility  of 
the  larynx,  and  the  pain  and  difficulty  experienced  in  performing  the 
act  of  deglutition.  From  Belladonna  we  have  likewise  derived  very 
appreciable  service,  especially  when  there  was  considerable  heat  of 
skin,  much  thirst,  but  complete  inability  to  satisfy  its  cravings  from, 
the  spasms  which  the  attempt  occasioned :  further,  when,  on  looking 
into  the  throat,  it  is  found  to  present  an  inflamed  and  swollen  appear- 
ance. Should  Belladonna  have  previously  been  employed,  as  would 
naturally  be  the  case  if  the  disease  made  its  access  during,  or  im- 
mediately after,  an  attack  of  Scarlatina  pura,  the  substitution  of 
Hyoscyamus  for  Belladonna  may  be  found  advantageous. 


238  RESPIRATORY  SYSTEM. 

Phosphorus  may  prove  useful  against  remaining  hoarseness  with 
more  or  less  pain  and  frequent  expectoration  of  viscid  mucus.  Or 
Carlo  v.  when  the  hoarseness  is  accompanied  by  a  burning  and  scrap- 
ing sensation  in  the  larynx,  and  some  degree  of  cough  or  hawking 
up  of  phlegm  of  a  less  viscid  nature  than  in  the  preceding  instance. 
(See  also  the  articles  on  Hoarseness,  Chronic  Laryngitis,  and 
Croup.) 

hoarseness. 

Haucitas. 

Hoarseness,  or  roughness  of  the  voice,  arises  from  some  abnormal 
condition  of  the  larynx  or  trachea.  In  the  majority  of  cases  the  seat 
of  the  affection  is  in  the  mucous  lining  of  the  larynx,  which  is 
extremely  liable  to  be  affected  by  the  common  causes  of  catarrh ; 
hence  it  is  a  frequent  accompaniment  of  the  latter  disorder. 

The  remedies,  mentioned  under  Catarrh  and  Cough,  are  gene- 
rally found  the  most  useful  in  this  complaint.  Amongst  these,  in 
cases  of  recent  origin,  the  following  deserve  particular  notice  : 
namely,  Pulsatilla,  Mercurius,  Nux  vomica,  Capsicum,  Rfais  toxicodendron, 
Sambucus  nigra,  Chamomilla,  Carlo  vegetabilis,  Drosera,  Sulphur,  and 
Hepar  sulp/mris. 

The  indications  for  the  employment  of  these  medicines  are  as 
follow  : 

Pulsatilla  : — Almost  complete  aphonia,  particularly  when 
accompanied  with  loose  cough,  or  thick  yellow  coryza. 

Mercurius.  This  remedy  will  often  be  found  useful  in  removing 
any  symptoms  remaining  after  the  above,  but  is  to  be  preferred 
should  the  hoarseness,  from  the  commencement,  be  attended  with 
thin  coryza,  *  and  when  a  sensation  of  burning  or  tickling  is  com- 
plained of,  in  the  larynx,  with  the  characteristic  indication  of  Mer- 
curius, namely,  a  disposition  to  profuse  sweating,  especially  at  night. 

Nux  vomica  :— Hoarseness,  accompanied  by  a  dry  fatiguing 
cough,  worse  in  the  early  hours  of  the  morning,  with  dry  obstruc- 
tion of  the  nose. 

Capsicum  : — Hoarseness,  and  dry  obstruction  in  the  nose,  at- 
tended with  an  unpleasant  sensation  of  crawling  and  tickling  in  the 

*  Sulph.,  Calcarea,  and  Silicea  are  of  great  service  in  obstinate  hoarseness  attended 
with  coryza. 


HOARSENESS.  239 

nose ;  a  severe  cough,  worse  towards  evening :  and  pains  in  other 
parts  of  the  body,  such  as  the  head  and  abdomen.  It  is  better 
suited  than  Nux  vomica  for  individuals  of  a  lymphatic  temperament. 

Rhus  toxicodendron  : — Hoarseness,  accompanied  by  sensation 
of  excoriation  in  the  chest ;  oppressed  breathing,  with  frequent  and 
violent  sneezing,  unaccompanied  by  coryza,  but  occasionally  by  a 
great  discharge  of  mucus  from  the  nose,  during  the  attacks  of  ster- 
nutation. 

Sambucus  nigra: — Hoarseness,  with  deep,  hollow  cough  ;  op- 
pression at  the  chest ;  frequent  yawning ;  restlessness,  and  thirst. 

Chamomilla  : — Hoarseness,  with  accumulation  of  mucus,  in  the 
throat ;  cough  worse  at  night,  continuing  even  during  sleep,  and 
frequently  with  a  degree  of  fever  towards  evening,  and  great  irrita- 
bility of  temper.  This  remedy  is  frequently  specific  in  cases  of 
children. 

Drosera  : — Hoarseness,  with  very  low,  or  deep  and  hollow  voice. 

Carbo  vegetabilis  : — Chronic  hoarseness,  worse  in  the  morning 
and  towards  evening,  with  aggravation  after  talking. 

Sulphur  : — Hoarseness,  attended  with  roughness  and  scraping  in 
the  throat  ;  and  of  great  value  in  obstinate  cases,  where  the  voice  is 
low,  and  nearly  extinct,  particularly  in  cold  damp  weather.  {Sulphur 
is  especially  useful  after  Puis.) 

Hepar  sulphuri s  is  a  most  useful  remedy  in  chronic  hoarseness, 
particularly  in  individuals  who  have  taken  large  quantities  of  mercu- 
rial preparations ;  otherwise  Ammonium  carhonicum  is  of  equal  efficacy. 
(See  Coryza,  Catarrh,  and  Cough.) 

When  we  find  individuals  in  whom  this  affection  occurs  frequently 
at  different  seasons,  or  on  the  slightest  exposure  to  cold  or  damp,  we 
may  naturally  infer  that  there  is  a  constitutional  predisposition  to 
chronic  laryngitis,  a  malady  requiring  the  most  careful  and  judicious 
treatment,  as,  if  neglected,  it  may  eventually  end  in 

Chronic  laryngitis.  (Phthisis  laryngeal)  This  is  a  com- 
paratively rare  disease,  and,  when  present,  is  generally  attended  with 
a  degree  of  ulceration.  The  following  are  its  principal  symptoms  : 
pain  in  the  larynx,  and  round  the  glottis ;  pain  and  difficulty  in 
swallowing;  hoarseness,  and  difficulty  of  respiration  ;  frequent 
attacks  of  severe  cough,  with  scanty,  and  occasionally  sanious  ex- 
pectoration; it  sometimes  ends  in  hectic  fever,  which  carries  the 
patient  off. 


240  RESPIRATORY  SYSTEM. 

The  medicines,  to  which  we  would  particularly  direct  the  atten- 
tion of  the  practitioner  in  the  treatment  of  this  malady,  are  Hepar 
sulphuris,  Lachesis,  Phosphorus,  Garbo  vegetabilis,  Acidum  nitrieum,  Cal~ 
carea  carhonica,  Arsenicum,  Spongia,  Sanguinaria  canadensis — (this  re- 
medy proved  of  singular  efficacy,  after  the  previous  employment  of 
Sulphur,  in  chronic  laryngitis  with  the  following  symptoms :  sensa- 
tion of  swelling,  and  pain  as  if  arising  from  excoriation,  in  the 
larynx,  during  empty  deglutition ;  expectoration  of  whitish,  saline- 
tasting  mucus ;  hectic  fever) #—  and  Argentum  fol.  (The  latter  has 
been  found  very  efficacious  in  affections  of  the  larynx  occurring  in 
public  speakers,  with  a  sensation  at  a  small  spot  in  the  fore  part  of 
the  larynx,  as  if  a  foreign  substance  were  sticking  there,  and  giving 
rise  to  a  feeling  of  coldness  and  some  degree  of  pressure,  writh  fre- 
quent inclination  to  cough,  but  no  abatement  of  the  irritation  in  the 
larynx  after  coughing.)  f 

The  patient  should  adhere  rigidly  to  dietetic  rules,  avoid  unneces- 
sary exposure,  and  enter  as  little  as  possible  into  conversation. 

Tracheitis.     For  the  treatment  of  this  disorder,  see  Croup. 


COLD  IN  THE  HEAD. 

Coryza. 

This  affection  is  a  very  general  attendant  upon  common  catarrh. 

Therapeutics.  When  it  is  the  leading  symptom,  or  exists  inde- 
pendently of  those  already  mentioned,  the  best  medicines  for  expe- 
diting its  removal  are :  Nux  vomica,  Euphrasia,  Pulsatilla,  Chamomilla, 
Mercurius,  Hepar  sulphuris,  Belladonna,  Ammonium,  Natrum,  and 
Arsenicum,  Lachesis,  Silicea,  &c. 

Nux  vomica: — Dry  obstruction,  especially  during  the  night  only, 
with  pressive  heaviness  in  the  forehead,  and  confusion  in  the  head ; 
heat  in  the  face,  increasing  towards  evening.  If  these  sensations 
occur  in  combination  with  other  catarrhal  symptoms,  see  the  indica- 
tions already  given  for  the  exhibition  of  this  remedy  under  the 
several  heads  of  Catarrh,  Hoarseness,  and  Cough.  This  direc- 
tion equally  applies  to  the  other  medicaments  here  quoted. 

*  Neues  Archiv.     Zweiter  Band,  Zweites  Heft,  p.  148. 
f  Neues  Archiv.  Ill  Band,  1  Heft,  p.  99. 


COLD  IN  THE  HEAD.  241 

Lycopodium,  will  often  be  found  efficacious  after  Nux  v.,  in  obsti- 
nate cases  of  stuffing  of  the  nose,  particularly  at  night,  rendering  it 
necessary  to  sleep  with  the  mouth  open,  which  causes  a  disagreeable 
dryness  without  much  thirst,  attended  with  confusion  in  the  head, 
and  burning  pain  in  the  forehead.  This  remedy  is  frequently  more 
or  less  useful  in  colds  in  the  head  of  all  hinds. 

Pulsatilla  : — The  discharge  thick,  fetid,  greenish  yellow,  or 
mixed  with  clots  of  blood ;  loss  of  taste  and  smell,  headaches,  sneez- 
ing, chill,  especially  towards  evening ;  disposition  to  weep,  lowness 
of  spirits,  heaviness  or  confusion  of  the  head  in  a  warm  room. 

Chamomilla  :— When  the  affection  has  arisen  from  checked  per- 
spiration, and  there  is  an  acrid  discharge  from  the  nose,  causing 
redness  of  the  nostrils,  and  excoriation  or  soreness  under  the  nose ; 
chapped  lips  ;   shivering ',  with  thirst. 

Mercurius  : — Dryness  of  the  nose,  with  obstruction;  profuse 
discharge,  producing  excoriation,  swelling,  or  redness  of  the  nose, 
pains  in  the  head  and  face.  This  is  a  valuable  remedy  in  the  gene- 
rality of  ordinary  cases  of  cold  in  the  head,  particularly  when  the 
complaint  is,  as  it  were,  epidemic* 

Hepar  sulphuris  : — Chiefly  when  only  one  nostril  is  affected,  or 
when  there  is  headache  which  is  aggravated  by  the  slightest  move- 
ment ;  or  when  the  complaint  is  renewed  on  each  exposure  to  cold 
air ;  further,  in  most  cases  in  which  Mercurius,  though  apparently 
indicated,  has  produced  little  or  no  improvement. 

Belladonna  may  follow  the  above,  after  an  interval  of  a  few 
hours,  if  the  headache  continues  unabated.  When  the  sense  of 
smelling  is  variously  affected,  being  at  one  time  too  acute,  and  an- 
other too  dull,  there  will  be  additional  reason  for  resorting  to  this 
remedy. 

Ammonium  : — Stuffed  nose,  especially  at  night ;  swelling  and  pain- 
ful sensibility  of  the  nostrils  ;  dryness  of  the  nose. 

Natrum: — Cold  in  the  head,  renewed  by  the  slightest  chill,  or 
exposure  to  a  current  of  air ;  obstruction  of  the  nose  every  second 
day. 

Lachesis  : — Swelling  and  soreness  of  the  nose  and  nostrils,  with  copious 
watery  secretion. 

Arsenicum  : — Obstruction  of  the  nose,  with,  at  the  same  time,  dis- 

*  When  the  secretion  from  the  nose  is  excessive,  and  there  is,  at  the  same  time,  con- 
fusion in  the  head,  with  redness  and  soreness  of  the  eyes  and  eyelids,  and  copious  acrid  or 
scalding  lachrymation,  Euphrasia  should  be  prescribed. 

16 


242  RESPIRATORY  SYSTEM. 

charge  of  thin,  acrid,  excoriating  mucus,  and  burning  heat  in  the 
nostrils,  &c.  buffering  relieved  by  heat ;  pain  in  the  back,  feeling  of 
general  debility,  or  prostration  of  strength.  Dulcamara  is  useful 
when  fresh  obstructions  arise  from  every  trivial  exposure  to  the  air. 
Ipecacuanha  may  be  had  recourse  to  after  Arsenicum,  if  the  latter  has 
only  partially  relieved. 

Ammon.  cars.: — Cold  in  the  head  with  copious  discharge,  parti- 
cularly of  an  acrimonious,  burning,  watery  fluid ;  hoarseness,  tick- 
ling, suffocating  cough,  with  alternate  heats  and  chills. 

Graphites,  and  also  Silicea,  are  useful  in  all  cases  which  are 
of  frequent  recurrence,  and  always  of  a  most  obstinate  character. 

Camphor  : — In  the  premonitory  stage  of  the  complaint,  with  shi- 
vering and  headache,  the  attack  may  frequently  be  checked  by  a  drop 
or  two  of  spirits  of  weak  camphor  administered,  &c. 

Sulphur,  Calcarea,  Silicea,  Natrum,  and  Pulsatilla  are  the  best  reme- 
dies for  removing  extreme  susceptibility  to  colds  in  the  head.* 
Against  the  effects  of  a  suddenly  suppressed  catarrh,  the  following 
are  the  most  important  remedies:  Aconite  against  headache,  followed 
by  Pulsatilla,  and  then  Cinchona,  if  the  secretion  does  not  return ; 
difficulty  of  breathing, — Ipecacuanha,  followed,  if  required,  by  Bryonia 
and  Sulphur.  In  other  cases  Nux  v.,  Arsenicum,  or  Cina,  may  be  re- 
quired to  remove  the  sequelae  resulting  from  the  suppression.  (See 
also  Hoarseness,  Cough,  and  other  affections  of  the  organs  of 
respiration.) 

COUGH. 

Tussis. 

Diagnosis.  Forced  and  audible  expiration  without  fever;  or  a 
symptom  in  acute  diseases,— such  as  fever,  pneumonia,  or  phthisis  ; 
either  dry  or  accompanied  with  expectoration. 

Cough,  although  not  dangerous  of  itself,  may  become  so,  or  form 

*  In  other  cases,  this  desirahle  result  may  be  attained  by  the  administration  of  Mercu- 
riusyUepar  s.,  and  Belladonna,  on  each  successive  attack  (when  the  symptoms  resemble 
those  which  have  been  described  under  these  remedies)— and  failing  these;  Silicea,  Sulphur 
and  Calcarea:  the  other  remedies  also,  mentioned  above  as  useful  in  removing  this  suscep- 
tibility, must  sometimes  be  had  recourse  to.  The  state  of  the  digestive  functions  ought,  at 
the  same  time,  to  be  attended  to ;  and  if  found  to  be  in  a  disordered  state,  such  remedies  as 
NuXrV.,  Pulsatilla,  Bryonia,  &c,  must,  in  addition  to  Sulph.,  Silic,  Calc,  be  had  recourse 
to.     (See  Dyspepsia.) 


cough.  243 

an  important  feature  of  other  diseases.     As  a  precursor  of  phthisis 
it  is  too  often  neglected. 

It  may  arise  from  an  irritation  of  the  air-passages  or  lungs,  from 
disease  of  these  organs,  or  from  cold  or  other  causes ;  or  be  merely 
sympathetic  or  the  consequence  of  derangements  of  other  important 
viscera.  We  purpose  here  to  treat  more1  particularly  of  idiopathic, 
mucous  or  moist  and  dry  cough. 

Therapeutics.  The  following  are  the  medicines  most  useful  in 
this  affection  :  Aconitum,  Dulcamara,  Belladonna,  Hyoscyamus,  Nux  vo- 
mica, Pulsatilla,  Ammonium  carhonicum,  Ammonium  muriaticum,  Chamo- 
milla,  Hepar  sulphuris,  Ignatia,  Ipecactianha,  Mercurius,  Carlo  vegetabilis, 
Capsicum,  Bryonia,  Rhus  toxicodendron,  Arsenicum  album,  Drosera, 
Silicea,  LacJiesis,  Caustieum,  Sulphur,  Calcarea  carbonica,  Euphrasia,  Sepia, 
Stannum,  Verbascum,  Arnica  montana,  Squilla,  &c. 

Aconitum  : — Violent  short  cough,  with  quick  hard  pulse and  feverish 
heat;  pricking  in  the  chest  when  coughing,  or  during  inspiration. 
(See  Acute  Bronchitis.) 

Dulcamara.  The  following  are  indications  for  the  selection  of 
this  remedy  :  moist  or  loose  cough,  with  copious  expectoration  after 
exposure  to  wet ;  or  cough  with  hoarseness  and  copious  secretion  of 
mucus  in  the  bronchial  tubes,  sometimes  accompanied  by  expecto- 
ration of  bright-coloured  blood  during  the  night ;  barking,  shaking- 
cough,  increased  or  excited  by  taking  a  deep  breath.  (Compare  with 
Rhus.) 

Belladonna  :— Short,  dry,  barking  {spasmodic,  catarrhal,  or  nervous) 
cough  at  night  in  bed,  and  also  during  sleep,  renevjed  by  the  slightest 
movement ;  dry  cough  day  and  night,  with  irritation  or  tickling  in 
the  pit  of  the  throat,  or  sensation  as  if  a  foreign  body  were  in  the 
larynx,  or  as  if  dust  had  been  inhaled  ;  spasmodic  cough,  which 
scarcely  allows  time  for  respiration.  This  medicine  is  also  sometimes 
useful  in  cough  with  rattling  of  mucus  in  the  chest,  pricking  in  the 
sternum  or  in  the  hypochondria^  and  expectoration  of  thick  white 
mucus,  coming  on  especially  after  meals;  lancinating  pains  in  the 
abdomen;  hoarseness,  redness  of  the  face,  headache,  sneezing  after 
coughing,  and  pain  in  the  nape  of  the  neck.* 

*  Hyoscyamus  frequently  answers  when  Belladonna  has  only  afforded  partial  relief,  and 
may  be  preferred  to  that  remedy,  when  the  dry,  tickling,  nocturnal  cough  is  mitigated  for 
the  time  by  sitting  up  in  bed ;  also,  when  there  is  mucus  rattling  in  the  throat.  In  dry, 
spasmodic  cough,  increased  at  night,  Conium  is  a  valuable  remedy. 


244  RESPIRATORY  SYSTEM. 

Nux  vomica.  This  is  a  valuable  remedy  in  many  cases  either  of 
a  catarrhal  or  nervous  character,  and  is  particularly  efficacious  where 
there  is  a  dry  hoarse,  fatiguing,  and  sometimes  spasmodic  cough, 
which  occurs  in  an  aggravated  form  in  the  morning,  and  occasionally 
also  towards  evening,  and  attacks  more  or  less  during  the  day,  but 
relaxes  again  at  night  when,  however,  it  is  occasionally  supplanted 
by  oppression  at  the  chest,  on  lying  down  or  on  awaking  during  the 
night,  accompanied  with  a  feeling  of  heat,  and  dryness  in  the  mouth ; 
if  there  be  any  expectoration,  it  consists  merely  of  a  little  mums, 
which  is  detached  with  great  difficulty.  The  cough  is  generally  excited 
by  a  disagreeable  Holding  or  scraping,  with  a  feeling  of  roughness  and 
rawness  in  the  throat,  sometimes  attended  with  Hoarseness  and 
feeling  of  roughness  in  the  chest,  but  more  frequently  with  severe 
Jieadache,  or  pain  as  if  from  a  How  or  bruise  in  the  epigastrium  and 
hypochondria ;  it  is  frequently  aggravated  after  meals,  or  by  move- 
ment, not  unfrequently  also  by  reading  or  meditation,  and  is  occa- 
sionally followed  by  vomiting. 

Pulsatilla  : — Severe  shaking,  catarrhal  or  nervous  spasmodic 
cough,  worse  towards  evening  and  at  night,  frequently  followed  by 
vomiting ;  sensation  of  suffocation,  as  if  from  the  vapour  of  sulphur ; 
increase  of  cough  when  in  the  recumbent  posture ;  cough  which  is 
at  first  dry,  then  followed  by  copious  expectoration  of  yellowish  or 
whitish  mucus,  sometimes  of  a  salt  or  bitter  taste ;  or  expectoration 
of  mucus  streaked  with  blood;  wheezing,  or  rattling  of  mucus  in 
the  chest ;  the  paroxysms  of  coughing  are  frequently  accompanied 
wdth  soreness  in  the  abdomen,  as  if  from  a  bruise  or  blow,  or  painful 
shocks  in  the  arms,  shoulders,  or  back,  and  sometimes  followed  by  a 
sensation  as  if  the  stomach  became  inverted  from  the  violence  of  the 
cough  ;.  involuntary  emission  of  urine  when  coughing ;  loose  cough^ 
with  aching  in  the  chest,  hoarseness,  cold  in  the  head ;  excited  by 
a  sensation  of   scraping  or  of  erosion  in  the  throat ;  shivering. 

Chamomilla  : — Dry  cough,  excited  by  continued  tickling  or 
irritation  in  the  larynx  and  chest,  and  increased  by  talking;  the 
cough  is  most  troublesome  during  the  night,  but  also  occurs  during 
the  day,  particularly  in  the  morning  and  towards  evening ;  accumu- 
lation of  tenacious  mucus  in  the  throat ;  wheezing  in  the  chest ; 
cough  during  sleep,  sometimes  accompanied  with  paroxysms,  as  of 
threatening  suffocation  ;  cough  with  scanty  expectoration  of  tena- 
cious bitter  mucus.  This  medicine  is  well  adapted  to  the  treatment 
of  coughs  in  children,  accompanied  with  more  or  less  of  the  gymp- 


cough,  245 

toms  above  described,  or  with  hoarseness,  cold  in  the  head,  dryness 
in  the  throat  and  thirst ;  great  fretfulness ;  fever  towards  evening ; 
paroxysms  of  coughing  after  crying,  or  after  a  fit  of  passion. 

Bryonia  : — Catarrhal  cough  occurring  in  winter  during  the  preva- 
lence of  frost  and  cold  easterly  winds,  with  aggravation  of  the  fits  of 
coughing  on  coming  from  the  open  air  into  a  warm  room.  The  fol- 
lowing are  the  general  indications  for  its  employment :  Dry  cough, 
excited  by  constant  irritation  in  the  throat,  or  as  if  caused  by  vapour  in 
the  larynx  and  windpipe,  with  greatly  accelerated  respiration,  as  if  it 
were  impossible  to  obtain  sufficient  air;  spasmodic,  suffocating  cough, 
after  partaking  of  food  or  drinks,  and  also  after  midnight ;  cough  with 
prickings  in  tlie  chest,  and  violent  bursting  headache,  especially  at  the 
temples,  also  with  prickings  in  the  pit  of  the  stomach,  or  in  the  side ; 
further,  in  loose  cough  with  yellowish  expectoration  or  slight  spitting  of 
blood,  this  remedy  wTill  frequently  be  found  of  great  service;  and 
likewise  in  dry  nervous  cough. 

Rhus  toxicodendron  : — Short,  dry  cough,  worse  towards  evening, 
and  before  midnight,  excited  by  tickling  in  tlie  chest,  attended  writh 
hoarseness,  or  a  feeling  of  roughness  or  rawness  in  the  throat,  con- 
gestion in  the  chest,  a  sensation  of  suffocating  constriction,  anxiety 
and  shortness  of  breath  ;  cough  on  waking  in  the  morning,  or  short 
cough  with  litter  taste  in  the  motith,  on  lying  down  at  night  and  on 
waking  in  the  morning,  with  expectoration  of  viscid  mucus,  some- 
times followed  by  vomiting.  Cough  with  expectoration  of  bright 
blood,  with  sensation  of  insipidity  or  exhaustion  in  the  chest,  or 
shooting  pains  in  the  chest  and  sides. 

Ipecacuanha  :  —  Catarrhal,  nervous,  or  spasmodic  cough,  parti- 
cularly at  night,  attended  with  painful  shocks  in  the  head  and  sto- 
mach, and  followed  by  nausea,  retching,  and  vomiting ;  or  dry  cough, 
arising  from  tickling  in  the  throat;  or  severe,  shaking,  spasmodic  cough, 
with  oppressed  breathing,  almost  amounting  to  suffocation.  In  the 
case  of  children,  this  remedy  is  frequently  valuable,  when  they  ap- 
pear to  be  threatened  with  suffocation  from  the  accumulatian  of  mucus, 
or  where  the  paroxysm  is  so  severe  as  scarcely  to  afford  time  for 
respiration,  causing  the  face  to  assume  a  livid  hue,  and  the  frame  to 
become  quite  rigid.     (Calo.  is  often  useful  after  Ipec.) 

Mercurius  : — Catarrhal  cough,  with  hoarseness,  or  watery  coryza,  or 
accompanied  by  diarrhaa ;  or  dry  cough,  excited  by  irritation  in  the 
throat,  or  the  upper  part  of  the  chest,  which  becomes  particularly 
troublesome  towards  evening,  and  at  night ;  sometimes  with  slight 


246  RESPIRATORY  SYSTEM. 

prickings  in  the  chest  when  coughing  'or  sneezing;  excited  or  in- 
creased by  talking ;  cough  in  children  with  discharge  of  blood  from 
the  nose,  which  coagulates  as  it  flows,  vomiturition,  and  headache ; 
dry  spasmodic  cough,  with  retching  after  the  paroxysms,  and  ex- 
pectoration of  blood. 

Carbo  vegetabilis: — Hollow  cough  excited  by  irritation,  or  a 
troublesome  sensation  of  crawling  in  the  throat  and  attended  with 
burning  pain  and  sensation  as  if  from  excoriation  in  the  chest ; 
catarrhal  or  nervous  spasmodic  cough,  frequently  followed  by  inclina- 
tion to  vomit  or  vomiting,  occurring  in  paroxysms  throughout  the 
day;  cough  with  hoarseness,  especially  towards  evening,  or  morning 
and  evening,  increased  by  speaking.  Chronic  cough  with  expectora- 
tion of  greenish  mucus,  or  even  of  yellowish  pus— or  with  expectora- 
tion of  blood  and  burning  sensations  in  the  chest  (a  characteristic 
indication  for  this  remedy  as  well  as  Arsenicum.) 

Capsicum  : — This  remedy  is  frequently  very  efficacious  in  cases  of 
cough  occurring  in  individuals  of  the  lymphatic  temperament.  It  is  par- 
ticularly indicated  when  the  paroxysms  are  more  severe  towards 
evening  and  at  night,  frequently  attended  with  unsettled  pains  in 
various  parts  of  the  body,  and  bursting  headache;  also  painful 
pressure  and  aching  in  the  throat  and  ears  ;  cough  with  offensive  breath, 
and  disagreeable  taste  in  the  mouth. 

Hepar  sulphuris  : — Obstinate  cases  of  violent  dry,  hoarse  cough, 
sometimes  attended  with  a  dread  of  suffocation,  and  ending  in  lachry- 
mation.  The  attacks  are  frequently  excited  or  aggravated  on  any 
part  of  the  body  being  exposed  or  becoming  cold  from  the  bedclothes 
slipping  off,  and  are  generally  worse  at  night ; — also  dry  deep  cough 
excited  by  a  feeling  of  tightness  in  the  chest,  or  by  talking,  stooping, 
or  ascending  stairs;  hoarseness. 

Ignatia  : — Shaking  spasmodic  cough,  or  short  hacking  cough,  as 
if  arising  from  the  presence  of  dust  or  feather-down  in  the  throat, 
which  becomes  aggravated  the  longer  the  paroxysm  of  coughing  con- 
tinues; dry  tickling  cough  with  coryza,  occurring  both  day  and 
night.  This  remedy  is,  further,  particularly  efficacious,  when  the 
attacks  of  coughing  become  aggravated  after  eating,  or  on  lying  down 
at  night,  or  on  rising  in  the  morning,  and  when  the  patient  is  of  a 
mild  and  placid  temper,  or  subject  to  alternations  of  high  and  low 
spirits. 

Arsenicum  : — Cough  with  oppression  at  the  chest,  and  tenacious 
mucus  in   the   larynx  and  chest ;  cough  excited   by  a  sensation  of 


cough.  247 

dryness  and  burning  in  the  larynx.  Dry  cough  chiefly  in  the  evening 
after  lying  down,  often  with  difficult  respiration  and  fear  of  soffocation  {suf- 
focative catarrh,  catarrahal  asthma),  as  if  arising  from  inhaling  the  vapour 
of  sulphur  ;  dry  cough,  excited  by  eating  or  drinking,  or  by  ascending 
stairs,  or  cough  which  arises  as  soon  as  the  open  air  is  encountered ;  thin 
acrid  coryzaj  sneezing ;  periodic  dry  cough — nocturnal  cough  with  general 
burning  heat;  cough  with  expectoration  of  sanguineous  mucus; 
pulmonary  catarrh  in  old  people,  attended  with  tenacious  mucous 
sputa,  which  is  extremely  difficult  to  eject,  and  causes  rattling  in  the 
chest,  oppressed  respiration,  and  frequently  symptoms  of  impending 
suffocation,  or  paralysis  of  the  lungs.  (Ipecac,  Tartarus  emet.,  and 
Baryta  c,  are  sometimes  required  after,  or  in  alternation  with, 
Arsenicum.) 

Ammonium  carbonicum  : — Dry,  tickling,  suffocating  cough,  espe- 
cially in  the  morning,  sometimes  with  fever,  occurring  during  the 
prevalence  of  a  cold,  stormy,  bleak,  state  of  the  atmosphere,  and 
attended  with  a  sensation  of  heat  or  burning  behind  the  stermim,  resem- 
bling that  which  is  occasioned  by  drinking  spirits  ;  hoarseness ;  cold 
in  the  head  with  copious  discharge  of  acrid  watery  fluid* 

Ammonium  muriaticum  : — This  remedy  is  sometimes  serviceable 
after  the  former,  when  the  cough  sounds  looser,  yet  is  unattended 
with  expectoration. 

Drosera  : — In  many  cases  of  chronic  cough  with  hoarseness;  or 
deep  hollow  cough,  with  pain  in  the  chest  and  under  the  ribs,  alleviated 
by  pressing  the  hand  on  the  side,  excited  or  aggravated  by  laughing ; 
cough  on  lying  down  in  the  evening  and  during  the  night.  Matutinal 
cough,  with  bitter  and  nauseotcs  expectoration ;  dry,  spasmodic  cough, 
aggravated  at  night,  or  towards  evening,  and  frequently  followed  by 
vomiting  of  ihgesta,  or  bleeding  from  the  nose  and  mouth. 

Silicea  : — Cough  with  oppressed  breathing  on  lying  on  the  back, 
or  cough  attended  with  tightness  and  oppression  at  the  chest,  as  if 
something  stopped  the  respiration  while  speaking,  or  coughing* 
Fatiguing,  or  deep  hollow  cough,  day  and  night,  aggravated  by  move- 
ment or  speaking,  and  sometimes  attended  with  aching  and  pain,  as 
if  from  a  bruise,  in  the  chest ;  cough  with  copious  expectoration  of  trans- 
parent mucus,  or  pus,  sometimes  streaked  with  blood ;  cough  with 
asthmatic  breathing  and  emaciation,  with  dread  of  suffocation  at 
night ;  cough  irritated  or  excited  by  a  sensation  as  if  a  hair  were  on 
the  tongue. 

Lachesis: — Fatiguing   cough,   excited   by  dryness   or   continual 


248  RESPIRATORY   SYSTEM. 

tickling  in  the  lazynx  or  chest ;  or  by  pain  or  tickling  in  the  pit  of 
the  stomach  or  the  epigastrium ;  also  by  the  slightest  pressure  on 
the  exterior  of  the  throat ;  cough  excited  by  talking,  laughing,  or 
reading  aloud,  or  anything  which  may  tend  to  increase  the  dryness 
or  irritation  in  the  throat ;  short,  dry,  suffocating  cough,  as  if  caused 
by  the  presence  of  a  crumb  of  bread  sticking  in  the  throat,  with 
ineffectual  efforts  to  expectorate.  Cough  on  rising  from  the  re- 
cumbent posture,  or  attacks  of  cough  always  after  sleeping,  or  on 
lying  down  to  sleep ;  or  cough  during  the  day,  and  at  night  during 
the  sleep,  so  that  the  patient  is  unconscious  of  it;  continual  hoarse- 
ness, with  a  sensation  as  if  something  were  in  the  throat  which  could 
not  be  detached. 

Sulphur: — In  some  cases  of  chronic  cough,  and  particularly  in 
cfoy  cough,  which  disturbs  the  patient  at  night  as  well  as  during  the 
day;  the  cough  is  frequently  excited  after  partaking  of  food,  or 
during  deep  inspiration,  and  is  generally  attended  with  a  sensation 
of  spasmodic  constriction  in  the  chest,  sometimes  followed  by  incli- 
nation to  vomit,  or  the  involuntary  escape  of  urine,  or  pain  as  if 
from  excoriation,  or  pricking  pains  in  the  chest;  headache,  pains  in 
the  chest,  abdomen,  loins,  and  hips ;  also  cough,  with  expectoration 
of  thick,  whitish  or  yellowish  mucus,  or  of  a  greenish  yellow,  fetid 
mucus,  or  pits,  of  a  saltish  or  sweetish  taste ;  feverish  cough  with 
spitting  of  blood. 

Calcarea  carbonic  a: — Dry  cough,  aggravated  towards  evening, 
or  at  night,  excited  by  tickling  in  the  throat,  or  by  a  sensation  as  if 
there  were  a  feather  down  in  the  throat  j  also  loose  cough,  with  rattling 
of  mucus  in  the  chest,  and  expectoration  of  offensive  thick,  yellow 
mucus;  anxiety. 

Euphrasia  :— Cough,  with  violent  coryza  and  tachrymaiion ; 
diurnal  cough,  with  difficult  expectoration  of  mucus ;  or  matutinal 
cough,  with  copious  expectoration,  and  oppressed  breathing. 

Sepia  :— Cough,  with  copious  expectoration  of  mucus  of  a  saltish 
taste,  of  a  yellow  or  greenish  colour ;  also  dry  spasmodic  cough,  par- 
ticularly at  night,  or  on  first  lying  down,' attended,  in  children,  with 
crying,  fits  of  threatening  suffocation,  nausea,  retching,  and  bilious 
vomiting.  This  remedy  is  especially  adapted  to  individuals  having 
a  constitutional  taint,  such  as  the  scrofulous,  scorbutic,  &c. ;  and  in 
chronic  coughs,  with  thick,  yellowish,  greenish,  or  even  puriform 
expectoration,  with  a  putrid  taste,  it  is  also  a  valuable  remedy. 

Stannum: — Cough,  with   copious   greenish   yellow  sputa,  of  a 


cough.  249 

sweetish  ox  saltish  taste,  attended  with  great  weakness  and  disposition 
to  sweats ;  soreness  at  the  chest  as  from  internal  excoriation ;  feeling 
of  weakness  or  sinking  in  the  chest,  as  if  it  were  empty,  parti- 
cularly after  expectorating,  or  even  after  speaking ;  or  dry  shaking 
cough,  worse  at  night  or  towards  morning,  excited  or  aggravated 
by  speaking  or  laughing,  and  occasionally  followed  by  vomiting  of 
ingesta. 

Lycopodium  is  very  efficacious  in  obstinate  coughs  which  are 
worst  at  night,  and  are  attended  with  expectoration  of  tenacious 
mucus,  and  sometimes  vomiting ;  paleness  of  the  face,  emaciation, 
precordial  pains  and  oppression,  flatulence,  ill-humour. 

Cinchona  : — Paroxysms  of  cough  as  if  excited  by  the  vapour  of 
sulphur,  with  whistling  or  rattling  in  the  throat  from  mucus ;  ex- 
pectoration difficult,  consisting  of  clear  tenacious  mucus,  sometimes 
streaked  with  blood;  pains  in  the  shoulders,  or  prickings  in  the 
chest  and  windpipe ;  cough,  sometimes  with  bilious  vomitings ;  cough 
after  hemoptysis. 

Verbascum  : — This  remedy  is  frequently  of  great  service  in 
children,  though  less  frequently  so  than  Chamomilla.  Indications: 
dry,  hoarse  cough,  worse  towards  evening  and  at  night,  occurring 
during  sleep. 

Iodium  : — Cough  in  plethoric  children,  with  copious  accumulation 
of  mucus  in  the  bronchi,  and  ineffectual  efforts  to  expectorate. 

Phosphorus  : — Dry  cough  excited  by  tickling  irritation  in  the 
throat  or  chest,  or  by  laughing,  talking,  or  drinking,  or  by  cold 
air,  and  accompanied  writh  pricking  in  the  larynx ;  hoarseness,  or 
pains  in  the  chest  as  if  from  excoriation;  cough  with  hoarseness, 
fever,  and  depression  of  spirits,  sometimes  with  apprehensions  of 
death ;  dry  sounding  cough,  followed  by  expectoration  of  viscous 
or  sanguineous  mucus. 

Arnica,  is  of  great  value  in  coughs  attended  with  bleeding  from 
the  nose  and  mouth ;  headache,  pricking  in  the  chest  (pleurodynia), 
rheumatic  pains  in  the  loins  and  extremities,  and  soreness  or  pain, 
as  from  a  bruise  in  the  chest  and  abdomen. 

Staphysagria  : — Cough  attended  with  pain  under  the  sternum 
as  if  arising  from  excoriation  or  ulceration ;  expectoration  of  yellow, 
purulent-looking  mucus;  sometimes  spitting  of  blood,  and  invo- 
luntary discharge  of  urine ;  exacerbations  at  night. 

ArgentuM  foliatum: — Cough  excited  by  laughing;  or  cough 
attended  wdth  a  feeling  of  rawness  or  soreness  in  the  throat,  and 


250  UESPIRATORY  SYSTEM. 

sometimes  with  accumulations  of  viscid  mucus  on  the  palate,  which 
causes  a  disagreeable  scratching  or  scraping  sensation. 

Squilla  : — In  shorty  dry  cough,  excited  by  a  full  inspiration,  or 
chronic  cough,  or  catarrh  with  copious  secretion  of  whitish,  viscous 
mucus,  which  is  alternately  expectorated  with  ease  and  difficulty, 
this  remedy  is  useful, 

Spongia  : — In  acute  inflammation  of  the  bronchial  membrane, 
this  remedy  is  often  of  essential  service  (see  Bronchitis), — but  it  is  of 
equal  utility  in  the  chronic  variety  when  the  following  symptoms 
prevail :  cough  with  expectoration  of  muco-purulent  sputa,  emaciation, 
redness  and  deformity  of  points  of  the  fingers,  lividity  and  incurvation 
of  the  nails,  hectic  fever. 

These  are  the  principal  remedies  to  be  had  recourse  to  in  this 
disorder ;  but  in  complicated  cases,  we  may  have  to  call  in  the  aid 
of  other  medicaments.  When  the  symptoms  take  on  an  inflammatory 
character,  the  treatment  recommended  in  acute  bronchitis  will  generally 
be  found  applicable.  In  obstinate  nervotts  or  stomach  or  duodenal 
coughs,  w7hich  frequently  occur  in  highly  irritable,  nervous,  and 
hysterical  habits,  or  in  women  during  the  last  months  of  pregnancy, 
and  which  are  generally  dry,  or  attended  with  scanty  and  difficult 
expectoration,  consisting  of  a  little  clear  •  mucus,  are  to  be  relieved 
by  the  remedies  mentioned  under  Dyspepsia.  Change  of  air  is 
often  beneficial  in  such  cases.  For  cough  arising  from  Worms, 
see  the  remedies  mentioned  under  that  head ;  or  from  teething, 
see  Dentition. 

Finally,  the  following  summary  of  a  few  characteristic  indications 
may  prove  useful  in  selecting  the  appropriate  remedy.  Cough,  increased 
or  excited  by  cold  air :  Bachesis,  Arsenicum,  Phosphorus,  Cough,  excited 
by  a  feeling  of  dryness  in  the  chest:  Bachesis,  Pulsatilla,  Mercurius. 
Cough  provoked  by  a  tickling  sensation  in  the  throat:  JSTuxv.,  Merc, 
Cham.,  Arnica,  Bryonia,  Phosph.y  Bep.y  Sulph.,  Bycop.,  Kali,  Bros.,  Puis., 
&c.  (see  also  the  other  indications,  given  above  for  most  of  these 
medicines.)  From  tickling  in  the  pit  of  the  throat:  Cham.,  Bella.* 
Silicea.  Cough  from  a  sensation  of  down  in  the  throat :  Calcarea, 
Ignatia,  Amm.  c.  From  a  sensation  as  if  from  dust  in  the  throat : 
Bella.,  Teuc,  Ferr.  mag.  Cough  from  a  sensation  of  scraping,  or  a 
feeling  of  roughness  or  rawness  in  the  throat:  Nux  v.,  Puis.  Cough 
from  a  feeling  of  dryness  in  the  throat :  Puis.,  Bach.,  Carlo  a.,  Mang., 
Petr.  Cough  excited  by  a  tickling  in  the  chest :  Veratrum,  Phosphorus, 
Cham.,  Bach.,  Puis.,  Ammon.  c,  Sep.,  Stann.,  8tc.  From  a  burning 
sensation  in  the  chest :  Phosph.,  Buphorb.,  &c.     From  accumulation 


COUGH.  251 

of  mucus  in  the  chest :  Stannum,  Arsenicum,  Ipecac,  Tart.,  Kreos.,  &c. 
From  roughness  or  scraping  in  the  chest :  Puis.,  Acid,  phosph,  Grat. 
nitr.  Cough,  particularly  when  in  the  recumbent  posture  :  Arsenicum, 
Lachesis,  Hyoscyamus,  Puis.,  Sidph,  Nix  v.,  Merc,  Hepar,  Con.  Cough 
when  lying  on  the  back :  Phosph,  Nux,  &c.  When  on  the  right  side  : 
Am.  m.,  Stann.  On  the  left :  Ipecac,  Par.,  &c.  Cough  which  comes 
on  chiefly  after  eating :  Nux  v.,  Bryon.,  Tartarus,  Cham.,  Bella.,  Sulph., 
Amm.  m.,  China,  Digit.,  Per.,  Sec.  Cough  after  drinking :  Arsen.,  Bach., 
Bryon.,  Aeon.,  Bros.,  Hepar,  Bye,  Phosph.  After  eating  and  drinking : 
Bryon.  Cough  on  exerting  the  intellectual  faculties :  Nux  v.,Mgs., 
&c.  Cough,  especially  in  the  morning:  Puis.,  Nux,  Baches.,  Calc, 
Etcphr.,  Sep.,  Stann.,  Sulph,  Rhus,  &c.  Cough,  chiefly  at  night:  Bella., 
Puis.,  Nux,  Ars.,  Bach.,  Merc,  Sulph,  Tart.,  Veratr.,  Verb.,  Cham., 
Hyosc,  Phosjph.,  Con.,  Sep'.,  Silic,  Rhus,  Staph.,  Sec.  Midnight  (towards) : 
Bella.,  Mgs.  arct.  During  the  day,  exclusively  or  principally :  Calc, 
Baches.,  Nux,  Phosph.,  Stann.,  Am.  c,  Alum.,  Euphr.^  Nitr.,  Rhus,  Sec. 
Day  and  night :  Bella.,  Nux,  Puis.,  Bulc,  Stann.,  Sulph.,  Silic,  Bycop., 
Natr.  m.,  Ignatia,  Buphorb.,  Bismuth,  Spong.,  Sec.  Cough  excited  or 
aggravated  by  laughing :  Phosph.,  Stann.,  China,  Argent.,  Bros.  Cough 
during  sleep :  Bach.,  Cham.,  Verb.,  Bella.,  Calc,  Am.,  Merc,  Sec. 
Cough  excited  by  speaking :  Merc,  Phosph.,  Cham.,  Bach.,  China,  Silic, 
Stann.,  Sulph.,  Caust.,  Anac,  Sec.  Cough  which  comes  on  periodically 
(every  second  or  third  day) :  Nux  v.,  Ars.,  Bach.  Cough  when  reading 
aloud:  Phosph.,  Magn.,  Staph.,  Sec.  When  singing:  Stann.,  Bros.,  Sec. 
Cough  exacerbated  or  excited  by  movement :  Nux  v.,  Bachesis,  Arseni- 
cum, Bella.,  China,  Ferr.,  Silic  Cough  on  entering  a  heated  room  : 
Bryon.,  Natr.,  Veratr.  Cough  on  touching  the  larynx:  Bachesis, 
Spongia,  Hepar.  On  pressing  against  the  pit  of  the  stomach:  Calad. 
Dry  cough ;  Aeon.,  Nux,  Bella.,  Cham.,  Bryon.,  Baches.,  Merc,  Bye, 
Phosph.,  Hepar,  Ign.,  Sulph.,  Spongia,  Natr.  m.,  Sec.  Sec.  Cough  with 
expectoration :  Bide,  Pids.,  Stann.,  Tart.,  Sepia,  Sidph.,  Calc,  Kali,  Euph, 
Caustic,  Merc,— Bryon.,  Carb.  v.,  Bye,  Phosph.,  Bella.,  Squill,  Staph^ 
Natr.  m.,  Acid,  nitr.,  Sec.  Sec.  Cough  with  difficult  expectoration : 
Bachesis,  Aur.,  Staph,  Sulph.,  Sep.,  Kali,  Zinc,  Euph.,  Am.,  Canst.  Cough 
with  easy  expectoration  :  Bulc,  Stann.,  Alum.,  Veratr.,  Kreos.  Cough 
with  offensive  expectoration :  Sanguinaria  canad.,  Kreosotum,  Carb.  v., 
Sulph.,  Calc,—Guai.,  Sed.,  Natr.,  Arsen.,  Stann.  With  expectoration 
of  mucus  :  Bella.,  Bulc,  Puis.,  Bryonia,  Am.  c,  Bachesis,  Sqtdlla, 
Hepar,  Carb.  v.,  Phosph.,  Merc,  Stann.,  Sep.,  Sulph.,  Tart.,  Sil.,  Thuja, 
Sec.  With  purulent  expectoration  :  Sulph.,  Sil.,  Staph.,  Calc,  Phosph., 
Acid,  phosph,  Gtiaiac,  ylcid.  nitr.,  Kali,  Bycop.,  Carb.  v.  et  a  >  Plumbs 


252  UESPI&ATOUY  SYSTEM. 

Stann.,  Bros.,  China,  Sep,,  &c.  With  expectoration  of  a  bitter  taste : 
Puis., — Ars.,  Cham.,  Bros.  With  expectoration  of  a  putrid  taste: 
Carb.  v.,  Kreos.,  Sep.,  Stann.,  Con.,  Ptils,  Ferr.,  Cupr.  With  expectora- 
tion of  a  saline  taste :  Bycopod.,  Natr.,  Sep., — Phosph.,  Stann.,  Sulph., 
— Ambra.,  Magn.,  Samb.  Of  a  sour  taste  :  Bachesis.  Of  a  sweetish 
taste  :  Stann.,  Phosph.,  Sulph.,  Calc.,  Kreos.,  Samb.  Cough  with  greenish 
sputa ;  Stann.,  Sulph.,  Thuja,  Cann.,  Bye,  Sep.,  Phosph.,  Carb.  v.  et  a.,  &c. 
With  grayish  sputa :  Bycopod.,  Bros.,  Thuja.  With  frothy  sputa : 
Bach.,  Ars.,  Baph.,  Op.,  Sec.  Gough  with  thick  sputa:  Puis.,  Sulph., 
Stann.,  Calc,  Phosph.,  Am.  m.,  Argent.,  Bella.,  Kreos.,  Ruta,  Op.  Cough 
with  transparent  sputa :  Ars.,  Silk.,  Per.,  Sen.,  Nux.  With  viscid, 
tenacious  sputa :  Phosph.,  Senega,  Baches.,  Nux,  Puis.,  Stann.,  Staph., 
Cann.,  Par., — Spong.,  Arsen.,  Cham.,  China,  Per.  With  serous  or 
watery  sputa :  Arg.,  Magn.,  Stann.,  Baph.  Cough  with  whitish  sputa  : 
Sulph.,  Puis.,  Am.  m.,  Arg.,  Ambr.,  Aeon.,  China,  Cupr.  Ac.  phosph., 
.Kreos.  Cough  with  yellowish  sputa:  Sulph.,  Calc,  Puis.,  Staph., 
Thuja,  Con., — By  cop.,  Stan.,  Sep.,  Acid,  nit.,  Acid,  phosph.,  Carbo  v., 
Kreos.,  Baph.,  Spong.,  Bros.,  Aug.,  Bug.,  Magn.,  Mang.,  Carbo  v.,  Arsen., 
Bryon.,  Ruta,  &c.  Cough  with  expectoration  of  mucus  mixed  or 
streaked  with  blood :  Aeon.,  Phosph.,  Bryon.,  Am.,  Bach.,  China,  Per., 
Natr.  m.,  Sab.,  Silic,  Baph.,  Bug.,  Btcph.,  Later.,  Iod.,  Op.,  Zinc,  &c. 
Deep  cough  :  Hepar,  Veratr.,  Verb., — Arsen.,  Bach.,  Aug.,  Sil.,  Samb. 
Hollow  cough :  Veratr.,  Spong.,  Verb.,  Carbo  v.,  Tart., — Phosph.,  Sil., 
Kreos.,  Caust.,  Buph.,  Sed.,  Merc,  Op.,  Samb.,  Staph.,  Spig.  Hoarse 
cough :  Hep.,  Merc,  Verb., — Carb.  v.,  Cham.,  Kreos.,  Nux,  Natr.,  Natr. 
m.,  Verat.,  Cina.  Shaking  cough :  Ipecac,  Bella.,  Ilyoscy.,  Puis., 
Sulph.,  Anac,  Bachesis,  Ars.,  Ign.,  Bycop.,  Merc,  Sed.,  Caust.,  Ac  nitr., 
Rhus,  Sil.,  China,  Ant.,  Sen.,  Mgs.  arct.  Spasmodic  cough  :  Bella., 
Hyos.,  Ipec,  Cupr.,  Brosera,  Veratr.,  Nix,  Puis.,  Sulph.,  Hepar,  Cina, 
Merc,  Carbo  v.,  Bryon. — Aeon.,  Ambra,  Calc,  China,  Con.,  Big.,  Per., 
Ign.,  Iod.,  Kali,  Kreos.,  Bact.,  Sed.,  Magn.,  Magn.  m.,  Natr.  m.,  Nitr.  ac, 
JPkcmb.,  Sil.,  Mags.,  Mags.  arc.  Short  cough:  Bella.,  Coff.,  Bach., 
Baur.,  Natr.  m.,  Nux  v.,  Squilla, — Aeon.,  Alum,,  Anac,  Arg.,  Asa.,  Ign., 
Nitr.  ac,  Cham.,  Petr.,  Plat.,  Rhus,  Sabad.,  Stdph.  ac  Suffocating 
cough  :  Ipecac,  Arsenic,  Tart.,  Samb.,  Hep.,  Lach.,  Bros.,  Cham.,  Bryon., 
China,  Spigel.,  Sulph., — Con.,  Ind.,  Bed.,  Op.,  Natrum  m.,  Petr.,  Phell., 
Tab.,  Mags,  arc  Cough  attended  with  pain  in  the  abdomen  during 
the  paroxysms :  Ars.,  Bella.,  Coloc,  Con.,  Nux,  Phosph.,  Stann.,  Stdph., 
Vei\  Cough  with  pain,  as  if  from  a  blow  or  bruise  in  the  chest : 
Am.,  Ferr.,  Veratr.,  Zinc     In  the  hypochondria:  Nux  v.     Cough  with 


cough.  253 

burning  in  the  chest:  Card.  v.,  Ant.,  Caustic.,  Seneg.,  Iod.,  Magn., 
Spong.,  Zinc.  With  coldness  *  in  the  chest  (after  coughing)  :  Zinc. 
With  constriction  in  the  chest  (while  coughing) :  Ars.',  Lack.,  Sulph. 
With  pain,  as  from  excoriation  or  soreness  in  the  chest ;  Carl,  v., 
Tills.,  Phosph.,  Stann.,  Caust.,  Am.  c,  Sulph., — Nux  v.,  Lack.,  Acid,  nitr., 
Calc,  Magn.  m.,  Magn.  s.,  Merc,  Natr.  s.,  Nitr.  ac,  Sep.,  Sit.,  Spig., 
Spong.,  Zinc,  Sec.  Cough  with  rattling  (mucus)  in  the  chest :  Ipec, 
Tart.,  Natr.  m.,  Bella., — Puis.,  Sep.,  Arg.,  Sec.  Cough  with  shooting 
pains  in  the  chest:  Aeon.,  Bryon.,  Phosph.,  Nitr.,  Squil.,  Sulph., — Bella., 
Lack.,  Merc,  Ac.  nitr.,  Kali,  Bids.,  Natr.  m.,  Sep.,  Con.,  Bros.,  &c^ 
Cough  with  pain  as  if  the  chest  wrould  burst :  Bryon.,  Merc,  Zinc, 
Sec.  Cough  with  pain  in  the  chest  as  if  arising  from  ulceration, 
Staph.,  Bat.,  Sec.  Cough  followed  by  eructations,  or  regurgitation  of 
ingesta:  Ac.  sulpk.  Cough  attended  with  pain  in  the  eyes,  Bach. 
Cough  accompanied  by  sensations  of  shocks  or  concussions  in  the 
head :  Ipecac,  Bach.,  Natr.  m.,  Rhus.  Cough  with  pain  in  the  head  : 
Nux  v.,  Bryon.,  Sulph.,  Calc,  Arnica,  Ipecac,  Bella.,  Con.,  Merc,  Phosph., 
Card,  v.,  Rhus,  Bycopod.,  Alum.,  Ambr.,  Natr.  m.,  Nitr.,  Nitr.  ac,  Squil., 
Salad.  With  pain  as  if  the  head  would  split :  Nux  v.,  Bryon.,  Sulph., 
Phosph.,  Natr.  m.,  Caps.  With  pains  in  the  hips :  Sulphur,  Causticum, 
Bella.  With  pains  in  the  hypochondria :  Nux  v.,  Brosera,  Bryonia, 
Bycopod.,  Bachesis,  Am.,  Arsenic,  Bryon.,  Bachesis,  Am.  m.,  Hellel., 
With  pain  in  the  loins  :  Merc,  Sulph.,  Am.  c,  Acid.  nitr.  With  pain 
in  the  nape  of  the  neck :  Bella.,  Alum.  With  pain  in  the  occiput : 
Merc,  Ferr.  Cough  preceded  by  pain  in  the  stomach :  Bella.  Cough, 
with  pain  in  the  stomach,  (epigastric  region)  :  Bryon.,  Baches.,  Arsen.,, 
Am.  c,  Phosph.,  Thuja.  Cough  accompanied  by  a  sensation  as  if  the 
stomach  turned  round  during  the  paroxysms,  Pulsatilla.  Cough 
with  scraping  or  a  feeling  of  roughness  in  the  larynx  :  Kreos.,  Natr.  s. 
With  pains  in  the  throat :  Nux  v.,  Hep.,  Phosph.,  Caps.,  Magn.  s.,  China,: 
Carl.  a.  Cough  with  lancinating  pains  in  the  throat :  Nux  v.,  Merc,, 
Kali,  Acid.  nitr.  With  involuntary  emission  of  urine:  Puis.,  Sulph ., 
Kreos.,  Natr.  m.,  Ant.,  Staph.,  Squilla,  Zinc  (See  the  additional  indica- 
tions which  have  been  given  under  some  of  the  foregoing  remedies, 
at  the  commencement  of  this  chapter ;  as  also  those  which  are  men- 
tioned in  the  articles  on  Bronchitis,  Croup,  and  Hoarseness.) 

Unmedicated  jujubes,  sugar-candy,  or  gum  arabic  may  be  allowed 
occasionally,  to  moisten  the  throat  or  mouth,  in  cases  of  dry  irritat- 
ing coughs. 


25 A  RESPIRATORY     SYSTEM. 


HOOPING-COUGH. 

Tussis   Convulsiva.     Perttcssis. 


This  is  almost  peculiarly  a  disease  of  childhood,  and  one  which  few 
individuals  escape  during  that  period ;  it  generally  appears  as  an 
epidemy ;  and  is,  by  the  majority  of  physiologists,  acknowledged  to 
be  communicable  by  contagion ;  we  seldom  find  an  instance  of  a 
person  suffering  a  second  time  from  its  attacks. 

Over  many  the  affection  passes  lightly,  but  in  the  majority  of 
cases  it  proves  a  distressing,  and  in  some,  a  fatal  malady,  baffling 
especially  all  the  ill-directed  efforts  of  the  allopathic  physician  to 
conduct  it  to  a  favorable  termination. 

Under  the  old  practice,  not  only  was  a  great  deal  of  valuable  time 
frequently  lost  in  endeavouring  to  subdue  inflammation  by  antiphlo- 
gistic measures,  but  the  patient's  vital  energies  were  weakened,  and 
rendered  less  capable  of  contending  with  the  disease,  when  it  assumed 
the  spasmodic  type. 

Now,  however,  on  the  contrary,  we  have  it  in  our  power,  by  the 
administration  of  remedies  specific  to  the  affection,  sometimes  to 
check  the  inflammation  at  its  outset,  subdue  the  distressing  attendant 
symptoms,  and  almost  invariably  to  shorten  the  duration  of  the  com- 
plaint, without  allowing  it  to  leave  after  it  any  of  those  evil  conse- 
quences, such  as  debility  and  emaciation,  which  oblige  the  patient  to 
endure  a  tedious  and  protracted  period  of  convalescence. 

Diagnosis.  Paroxysms  of  violent  and  convulsive  expirations,  in 
rapid  succession,  interrupted  by  long  whistling  inspirations,  and  in 
young  subjects  a  loud  shrill  whoop,  terminated  by  the  expectoration 
of  a  quantity  of  mucus,  or  a  fit  of  vomiting,  after  which  the  attack 
ceases  for  some  time.  If  the  case  is  severe,  the  features  swell  and 
become  livid ;  blood  escapes  from  the  nose,  and  mouth,  and  even 
from  the  ears.  A  complete  cessation  of  respiration  with  threatening 
suffocation  takes  place  in  the  more  violent  paroxysms,  as  if  from 
spasm  of  the  lungs.  The  attacks  return  every  three  or  four  hours^ 
and  oftener  in  severe  cases ;  the  least  excitement  brings  them  on ; 
they  are  more  frequent  and  violent  at  night.  Respiration  is  free  during 
the  intervals,  and  the  patient  in  every  respect  healthy,  although  suf- 
fering from  weakness. 

Pathologists  generally  consider  this  disease  under  three  stages ; 


HOOPING-COUGH,  255 

the  distinction  between  the  second  and  third  is,  however,  not  often 
very  clearly  marked. 

The  first  or  febrile  stage  commences  with  the  symptoms  of  an 
ordinary  catarrh,  attended  with  slight  fever,  which  gradually  increases, 
the  breathing  becomes  more  difficult,  and  is  accompanied  with  irri- 
tative cough  and  pains  in  the  chest. 

In  the  second  or  convulsive  stage  *  the  febrile  activity  disappears, 
and  the  characteristic  cough  and  other  symptoms  of  the  disease 
develop  themselves. 

In  the  third  or  nervous  stage  there  are  longer  intermissions  be- 
tween the  paroxysms,  but  increased  weakness  from  the  duration  of 
the  cough,. 

Therapeutics.  In  the  incipient,  febrile,  irritative,  or  catarrhal 
stage  of  the  cough,  the  most  appropriate  remedies  are  to  be  found 
amongst  those  we  have  already  pointed  out  in  the  treatment  of  com- 
mon Cough,  and  must  be  selected  according  to  the  indications  there 
given,  and  administered  in  the  same  manner,  unless  otherwise  speci- 
fied. By  a  careful  selection  of  these  remedies  it  is  frequently  pos- 
sible to  check  the  disorder  in  the  first  stage.  Accordingly,  the  most 
suitable  medicaments  for  this  purpose  are  Dulcamara,  Pulsatilla,. 
Mercurius,  Belladonna,.  Hepar  sulphuris,  Chamomilla,  Nux  vomica,  Arnica, 
Ipecacuanha,  Aconite,  Bryonia^  and  Phospkoms. 

Dulcamara  :  — When  the  attack  has  apparently  been  excited 
by  exposure  to  wet  (a  thorough  wetting);  the  cough  loose,  with 
copious  and  easy  expectoration. 

Pulsatilla  : — Cough  loose,  and  accompanied  with  laehrymation, 
weakness  of  the  eyes,  sneezing,  thick  discoloured  coryza  and  slight 
hoarseness,  and  inclination  to  vomit  after  coughing ;  occasional  diar- 
rhoea, especially  at  night. 

Mercurius  : — Hoarseness,  watery  coryza,  with  soreness  of  the 
nostrils ;  dry  fatiguing  cough,  generally  occurring  in  two  successive 
fits. 

Belladonna  is  one  of  the  most  important  remedies  in  the 
catarrhal  stage  of  hooping-cough,  when  there  is  dry,  hollow,  or 
harsh  and  barking  nocturnal  cough,  or  which  becomes  materially 
aggravated  at  night.  This  medicine  is  also  particularly  well  adapted 
to  the  angina  or  sore  throat,  which  is  not  an  unfrequent  concomitant 
at  the  commencement  of  the  affection. 

*  The  congestive  and  nervous  of  some  authors. 


256  RESPIRATORY  SYSTEM. 

Hepar  sulphuris: — Cough  worse  at  night,  but  looser  than  that 
indicating  Belladonna.  This  medicine  is  also  useful  in  forwarding  the 
secretory  process. 

Chamomilla  : — Dry  hoarse  cough,  or  cough  with  difficult  expec- 
toration of  tenacious  mucus,  followed  by  a  feeling  of  soreness  at  the 
part  from  which  the  mucus  seems  to  have  been  detached.  The 
paroxysms  of*  coughing  are  excited  by  an  almost  incessant  irritation 
of  the  larynx,  and  in  the  upper  part  of  the  chest. 

Nux  vomica,  is  of  great  service,  when  the  cough  approaches  the 
second  stage.  It  is  indicated  by  the  following  symptoms:  dry, 
fatiguing  cough,  attended  with  vomiting,  and  occurring  particularly 
from  about  midnight  until  morning,  the  paroxysms  so  protracted  and 
Violent  as  to  produce  apparent  danger  of  suffocation,  with  blueness 
of  the  face,  and  occasionally  bleeding  from  the  mouth  and  nose. 
(Arnica  is  better  adapted  to  this  latter  symptom,  when  it  occurs 
with  a  copious  discharge  of  blood). 

Ipecacuanha  is,  like  the  former,  of  great  value  wrhen  the  cough 
is  attended  with  danger  of  suffocation,  and  each  inspiration  appears 
to  excite  a  fresh  fit  of  coughing.  It  is  further  indicated  when  the 
fits  are  attended  with  spasmodic  stiffness  cf  the  body,  and  blueness 
of  the  face,  great  anxiety,  and  accumulation  of  mucus  in  the  chest. 

Aconite  may  be  had  recourse  to  from  time  to  time,  when  marked 
febrile  or  inflammatory  symptoms  are  present,  it  being  carefully 
borne  in  mind  that  the  action  of  this  medicine  is  of  short  duration, 
and  may  be  followed  in  a  few  hours  by  any  other  of  the  remedies 
which  appear  more  particularly  indicated.  Bryonia  and  Phosphorus 
are  chiefly  called  for,  when  the  cough  threatens  to  become  associated 
with  inflammatory  action  in  the  lungs,  &c. 


Second,  or  convulsive   stage.      Therapeutics. 

Veratrum   album.    Cuprum   aceticum,   Arnica,   Ferrum   metallicum,   and 
Conium  maculatum. 

Drosera  is  one  of  the  principal  remedies  in  the  treatment  of  the 
disease,  when  it  has  reached  this  stage ;  and  in  cases  where  the  con- 
stitution has  not  been  enfeebled  by  the  transmission  of  hereditary 
weakness  or  other  causes,  it  will  speedily  declare  its  beneficial  effects, 
and  materially  shorten  this  trying  and  painful  period  of  the  disorder. 
The  particular  indications  for  the  use  of  this  medicine  are  :  violent 
paroxysms  of  cough,  occurring  in  such  rapid  succession,  as  to  threaten 


HOOPING-COUGH.  257 

suffocation,  and  attended  with  the  characteristic  shrill  sound 
during  inspiration,  and  sometimes  fever ;  after  each  fit  of  coughing, 
vomiting  of  food,  or  of  stringy  mucus ;  relief  on  moving  about. 

Veratrum  album  is  indicated  when  the  child  has  become 
reduced  in  strength  and  emaciated ;  or  when  it  suffers  from  cold  sweats, 
particularly  on  the  forehead,  with  excessive  thirst,  involuntary  emission 
of  urine,  vomiting,  and  other  symptoms  common  to  this  stage;  also 
pain  in  the  chest  and  inguinal  region ;  fever.* 

When  the  vomiting,  as  also  the  cough,  become  more  distressing  at 
night  than  at  any  other  time,  Conium  may  follow  Veratrum,  if  the 
latter  fails  to  relieve  this  peculiarity. 

Cuprum  aceticum.  This  remedy  is  found  most  useful  in  the 
nervous  stage,  particularly  when  convulsions  with  loss  of  consciousness 
ensue  after  each  paroxysm.  Also  when  we  find  vomiting  after  the 
attacks,  and  rattling  of  mucus  in  the  chest,  and  wheezing  at  all 
times.  In  almost  all  cases  a  marked  benefit  has  followed  the  employ- 
ment of  this  remedy;  sometimes  it  has  been  found  sufficient  of 
itself  to  cut  short  the  disease,  and  in  others,  has  so  far  modified  it, 
that  other  remedies,  which  had  before  seemed  to  fail,  have,  after  its 
exhibition,  acted  with  the  most  marked  effect,  and  completed  the 
cure.f 

Arnica  is  serviceable  as  an  intercurrent  medicine  when  the  epistaxis 
or  hemorrhage  from  the  mouth  is  considerable;  and  also  against  the 
affection  itself,  when  each  paroxysm  is  succeeded  by  crying.  (Hepar  s. 
is  also  useful,  when  the  latter  symptom  followed  a  hoarse  dry 
cough.) 

Ferrum  metallicum,  is  often  very  efficacious  as  an  intermediate 
remedy,  when  there  is,  invariably,  vomiting  of  food  on  coughing 
soon  after  a  meal. 

Conium  : — When  the  paroxysms  occur  particularly  at  night,  and 
with  great  severity,  and  are  generally  followed  by  vomiting  of  mucus 
or  of  ingesta,  (Veratr.  and  Tartarus  emet.  are  also  useful  when  the 
vomiting  is  liable  to  take  place  during  the  night.) 


*  Carlo  vegetaUlis  is  frequently  useful  in  bringing  this  stage  of  the  affection  to  an  early 
and  successful  termination,  after  the  previous  use  of  Veratrum  or  Drosera,  or  both  of  these 
important  remedies  ;  particularly  when,  notwithstanding  the  decrease  of  cough,  the  tendency 
to  vomit  still  remains.     (See  also  Ferrum.) 

t  Cina  is  also  a  useful  remedy  when  there  are  convulsions,  or  tetanic  rigidity  of  the  whole 
body  during  or  immediately  after  the  fits  of  coughing,  particularly  in  children  affected  with 
worms, 

17 


258  RESPIRATORY  SYSTEM. 

Third  or  nervous  stage.  Therapeutics.  The  same  medi- 
cines as  have  already  been  given.,  according  to  the  indications  that 
present  themselves.  On  the  suppression  of  all  the  more  serious 
symptoms,  the  remedies  which  have  been  recommended  in  the  first 
stage,  are  also  useful  in  removing  any  catarrhal  cough  which  may 
remain  behind.     Change  of  air  is  likewise  beneficial.* 

Diet.  The  diet  must  be  light  and  of  easy  digestion ;  bread- 
pudding,  semolina,  and  other  light  puddings  of  this  description,  pro- 
vided the  fever  be  not  high,  in  which  case,  weak  gruel,  barley-water, 
and  the  like,  must  alone  be  partaken  of;  when  the  more  serious 
symptoms  have  been  subdued,  or  in  all  mild  cases,  we  may  give  a 
little  chicken-broth,  or  beef- tea, — and  so  on,  gradually  increasing  the 
amount  of  nutriment,  as  the  disease  declines.  The  drinks  should 
consist  of  toast-water  or  barley-water. 


CROUP. 

Angina  membranacea.    Angina  pemiciosa.    Cynanclie  laryngea.     Cynanche 

tracheitis,  s.  trqchealis,  &c.  &c. 

Diagnosis.  Short,  difficult,  and  hoarse  respiration,  accompanied 
by  a  shrill  whistling,  squeaking,  harsh,  rattling,  or  metallic  sound, 
with  cough  of  the  same  character ;  the  patient  throws  the  head  back  \ 
fever,  and  sometimes  comatose  state  of  the  brain. 

This  well-known  disease  is  one  that  requires  the  promptest  treat- 
ment, to  avert  the  danger.  From  the  moment  we  are  assured  of  the 
nature  of  the  complaint,  recourse  must  be  had  to  the  remedy  most 
clearly  indicated  by  the  assemblage  of  the  symptoms,  so  that  not  an 
instant  be  lost  in  arresting  its  further  progress,  since,  if  not  skilfully 
kept  in  check,  it  sometimes  runs  to  a  fatal  termination  within  twenty- 
four  hours ;  although  in  the  generality  of  cases,  when  such  an  event 
does  take  place,  it  happens  about  the  fourth  or  fifth  day. 

Croup  consists  of  a  peculiar  inflammation  of  the  lining  membrane 
of  the  windpipe,  causing  the  secretion  of  a  thick,  viscid  substance, 
generally  opaque,  of  about  the  consistency  of  the  boiled  white  of  an 
egg,  which  adheres  to  the  interior  of  the  windpipe,  and  takes  the 

*  In  neglected  or  obstinate  cases  occurring  in  delicate  constitutions,  Sulphuris  tinctura 
and  Sepia  have  been  found  useful.  See  also  the  remedies  Jfor  coughs  of  a  bad  character 
under  the  head  of  cough. 


croup.  259 

form  of  the  parts  it  covers ;  when  this.,  generally  denominated  the 
false  membrane,  has  been  allowed  to  form,  the  case  becomes  extremely 
critical. 

That  crousp  arises  from  inherent  constitutional  taint  is  evident, 
from  the  fact  of  some  families  having  a  peculiar  tendency  to  this 
disorder.  It  particularly  affects  early  childhood.  The  principal 
exciting  causes  seem  to  be  exposure  to  cold  or  damp,  and  derange- 
ment of  the  digestive  functions,  from  a  too  nutritious  or  heating  diet, 
too  much  animal  food,  or  stimulants,  such  as  wine  or  coffee.  It 
seldom  attacks  adults,  though  we  occasionally  see  exceptions  to  this 
rule,  and  is  not  unfrequently  found  in  complication  with  other  affec- 
tions both  of  the  lungs  and  windpipe. 

The  attack  generally  commences  with  the  symptoms  of  a  common 
catarrh,  such  as  cough,  sneezing,  and  hoarseness,  with  a  greater  or 
less  degree  of  fever ;  in  a  day  or  two  the  cough  changes  its  character 
and  becomes  shrill  and  squeaking,  or  deep,  hoarse,  or  sonorous, 
attended  with  a  ringing  sound  during  speaking  and  respiration,  as  if 
the  air  were  passing  through  a  metallic  tube ;  as  the  disease  pro- 
gresses, the  cough  becomes  more  shrill,  and  when  long  continued, 
resembles  the  crowing  of  a  young  cock.  There  is  seldom  much 
expectoration,  and  when  any  matter  comes  up  in  coughing,  it  has  a 
stringy  appearance,  resembling  portions  of  a  membrane.  After 
inflammation  has  set  in,  considerable. fever  and  restlessness  continue, 
occasionally  varying  in  intensity,  but  never  wholly  remitting ;  the 
countenance  expresses  great  anxiety,  and  alternates  from  a  red  to  a 
livid  hue ;  the  paroxysms  are  followed  by  a  profuse  and  clammy  per- 
spiration of  the  whole  body,  more  particularly  of  the  head  and  face. 
When  danger  threatens,  the  pulse  is  hard,  frequent,  and  occasionally 
intermittent ;  the  breathing,  particularly  during  inspiration,  difficult 
and  audible;  the  features  become  livid,  and  almost  purple  from  the 
sense  of  suffocation ;  the  head  is  thrown  back ;  the  cough  assumes  a 
veiled  and  husky  tone ;  the  voice  sinks  to  a  whisper ;  the  eye  has  a 
dull,  glassy,  or  dilated  appearance,  and  the  whole  system  seems  in  a 
state  of  utter  prostration. 

Therapeutics.  The  medicines  which,  for  the  most  part,  will  be 
found  most  appropriate  to  meet  the  incipient  catarrhal  symptoms, 
and  thereby  prevent,  in  many  cases,  the  development  of  croup,  are 
Chamomilla,  Bryonia,  and  Aconitum  (see  Cough  for  indications)  ;  but 
those  upon  which  the  greatest  reliance  is  to  be  placed  in  the  treat- 


260  RESPIRATORY  SYSTEM. 

ment  of  the  disease  itself,  are  Aconite,  Hepar  sulphuris,  Spongia,  and 
Lachesis. 

Aconite  is  called  for  during  the  inflammatory  period  of  this  dan- 
gerous disease,  when  attended  with  great  febrile  burning  heat, 
thirst,  short  dry  cough,  and  hurried,  laborious  breathing.  It  may 
be  exhibited  as  below  specified,  until  these  symptoms  begin  to 
abate. 

R  Tinct.  Aeon.  3,  gtt.  ij. 
Aq.  pur.  Jij. 
Dose.  A  teaspoonful  every  half  hour  to  six  hours,  according  to  the 
violence  of  the  fever. 

Hepar  sulphuris  : — Either  when  the  febrile  symptoms  are  par- 
tially subdued  by  Aconitum,  the  skin  having  become  moist  or  covered 
with  a  profuse  sweat,  the  cough  more  loose  and  the  breathing 
freer,  but  there  remains  a  dry,  harsh,  deep,  hollow  cough,  with  a 
weak,  hoarse  voice,  and  more  or  less  difficulty  of  breathing ;  or  when, 
from  the  commencement,  the  cough,  so  peculiar  to  croup  has  already 
set  in,  and  is  accompanied  by  a  constant  mucous  rattling  in  the  respi-. 
ratory  organs,  during  which  the  patient  is  incessantly  but  ineffectually 
occupied  in  endeavouring  to  obtain  relief  by  expectoration ;  or  fre- 
quently grasps  at  his  throat  and  tosses  back  the  head ; — when,  more- 
over, there  is  a'  considerable  degree  of  fever  and  restlessness,  together 
with  a  burning  hot  skin,  and  excessively  quick  and  laborious  respi- 
ration.* 

R  Hepar  Sulph.  Calc.  3,  gr.j. 
Aq.  pur.  Jj. 
M.     Dose.     A  teaspoonful  every  two  to  six  hours,  or  oftener  ^even 
every  half  or  quarter  of  an  hour)  if  required.     So  soon,  however,  as  the 
medicine   begins  to  make  a  favorable  impression,   the   doses  must  be 
given  at  much  longer  intervals  until  recovery  is  complete. 

Spongia,  is  chiefly  useful  after  Aconitum  or  Hepar,  w7hen  the  skin 
has  become  moist,  the  breathing  somewhat  easier,  but  still  very 
laboured,  loud,  grating,  and  wheezing,  the  patient  appearing  to  carry  on 
the  process  of  respiration  more  readily  with  the  head  thrown  back- 


*  This  remedy  is  of  itself  sufficient,  in  many  instances,  to  arrest  the  progress  of  the  dis- 
ease, if  administered  as  soon  as  the  incipient  symptoms  of  the  attach  are  observed ;  but 
Aconite,  Hepar  sulphuris,  and  Spongia,  generally  in  alternation,  become  necessary  when  the 
affection  is  more  developed.    Gross. 


croup.  261 

wards,  yet,  is  even  then  occasionally  threatened  with  suffocation; 
further  when  the  cough  is  hoarse,  ringing,  hollow,  and  squeaking. 

R  Spong.  tost.  3,  gr.  j. 
Aq.  pur.  g. 
M.     Dose.     A  teaspoonful  every  quarter  or  every  half  hour,  or  only 
every  three  to  six  hours,  according  to  the  intensity  of  the  symptoms,  and 
the  effects  produced  by  each  dose. 

Phosphorus  has  been  recommended  in  cases  where  Hepar  might 
fail  to  relieve  the  symptoms  we  have  enumerated  under  that  remedy ; 
or  when  Aeon,  and  Spong.,  as  well  as  Hepar  have  been  merely  pro- 
ductive of  temporary  benefit. 
.  Lachesis  :— In  very  serious  and  obstinate  cases,  to  which  there  is 
short  dry  cough  with  hoarseness ;  great  sensitiveness  of  the  larynx  and 
trachea  to  the  touch,  the  slightest  pressure  affecting  abnost  to  suffocation  ; 
voice  very  low  and  hollow,  with  a  sound  like  that  of  a  person  speak- 
ing through  the  nose ;  fainting ;  nausea ;  swooning ;  loss  of  sense ; 
rigidity  of  frame ;  great  prostration  of  strength,  especially  towards 
evening. 

Yk  Laches.  6,  glob.  vj. 
Aq.  pur.  3j. 
Dose.    A  teaspoonful  every  half-hour,  hour,  or  two  hours,  according  to 
the  intensity  of  the  symptoms,  and  their  abatement. 

After  having  subdued  these  threatening  symptoms  by  the  adminis- 
tration of  the  last-mentioned  remedy,  we  may,  if  the  disease  is  not 
wholly  vanquished,  again  fall  back  upon  Hepar  sulphuris,  or  Spongia, 
according  to  the  indications  given  for  those  remedies. 

There  are  other  remedies  which  may  afford  valuable  assistance  in 
the  treatment  of  complicated  attacks ;  but  in  truth  it  may  be  said, 
that  in  the  majority  of  cases,  Aconitum,  Hepar  sulphuris,  and  Spongia, 
administered  alternately,  when  individually  inadequate,  are  sufficient 
to  effect  a  cure  in  a  few  hours.  It  need  scarcely  be  stated,  however, 
that  it  will  be  imperative  to  discontinue  the  administration  of  these 
remedies  when  improvement  does  not  soon  become  apparent  during 
their  employment,  or  to  select  others  from  the  commencement,  if, 
from  the  symptoms  and  character  of  the  case,  they  distinctly  seem 
to  merit  a  preference. 

It  may  consequently  be  added,  that  Tartarus  emeticus  has  been 
found  valuable  after  Phosphorus,  in  some  apparently  hopeless  cases 
with  threatening  paralysis   of  the  lungs ;    Arsenicum,  Sambucus,  and 


262  RESPIRATORY  SYSTEM. 

Moschus  in  complications  with  Asthma  Millari ;  and  Iodium  either 
alone  or  in  repeated  doses,  or  alternately  with  Aconite,  has  been  much 
recommended  in  obstinate  cases,  particularly  when  occurring  in 
plethoric  subjects.  Kali,  Bulph.,  Kali  hydriod.,  Bella.,  Bryon.,  Cham., 
Can.,  Mosc/i.,  Sanguinaria  canad.,  Cup.,  Bros.,  Merc.,  Veratr.,  etc.,  may 
be  found  useful  in  particular  cases,  either  of  croup  or  of  affections  of 
the  air-passages,  bearing  a  close  analogy  thereto.* 

Hepar  sulplmris,  Phosphorus,  and  Lycopodium  have  been  found  useful 
in  eradicating  a  susceptibility  to  this  affection.  (See  also  Laryngitis, 
Raucitas,  and  Bronchitis.) 


INFLUENZA. 

Diagnosis.  Catarrh  appearing  in  an  epidemic  form,  attended,  in 
addition  to  the  symptoms  described  at  the  commencement  of  the 
article  on  common  cold,  with  extreme  oppression  and  prostration  of 
strength ;  sleepiness,  followed  by  shuddering  and  general  chilliness ; 
rheumatic  pains,  or  pains  as  if  caused  by  contusions,  in  the  back 
and  limbs;  intense  frontal  headache,  sometimes  extending  to  the 
bones  of  the  face,  with  pressive  aching  pains  in  the  other  parts  of 
the  head,  giddiness,  earache ;  slight  redness  of  the  eyes,  with  painful 
weight  or  heaviness,  and  sensibility  to  light ;  coryza,  or  obstruction 
of  the  nose  ;  dry  shaking  cough,  which  produces  distressing  fatigue 
in  the  chest ;  dryness  of  the  throat,  and,  subsequently,  dry,  burning 
heat  of  the  skin,  loss  of  appetite,  nausea,  together  with  soreness  of 
the  throat  and  some  degree  of  hoarseness;  and,  in  some  'cases, 
swelling  of  the  parotid  glands,  or  offensive  sweats. 

Therapeutics.     The  principal  medicines  in  ordinary  cases  are 

Camphor  a,  Aconitum,  Mercurius,  Arsenicum,  Phosphorus,  Belladonna, 
Pulsatilla. 

Camphora.  One  or  two  drops  of  weak  spirits  of  Camphor  when 
taken  at  the  commencement  of  the  attack,  and  repeated  until  the 
chilliness  or  shivering  begins  to  subside,  will  frequently  check  the 
further  progress  of  the  disease. 

In  a  more  advanced  stage  of  the  affection,  with  (laborious)  asth- 

*  From  some  provings  and  experiments  which  were  made  with  Bromium,  it  would  appear 
to  be  a  medicine  which  bids  fair  to  be  of  great  value  in  croup.  (Vide  Arch.,  II  Bd.?  2 
Heft ;  as  also  Noack  and  Trink's  A.  M.  L.) 


INFLUENZA.  263 

matic  breathing,  accumulation  of  mucus  in  the  bronchi,  and  cold, 
dry  skin,  Camphora  is  further  of  considerable  service, 

Aconitum  : — When  the  disorder  assumes  an  inflammatory  cha- 
racter, with  quickness  of  pulse,  dry  hot  skin,  and  short,  harsh, 
shaking  cough. 

Nux  vomica: — This  remedy  has  repeatedly  proved  of  great 
efficacy  in  influenza  or  grippe,  after  the  previous  employment  of 
Aconite,  when  the  inflammatory  action  predominated  in  the  chest ; 
or  when  the  symptoms  complained  of  were  chiefly  as  follows :  ob- 
struction of  the  nose,  hoarse  hollow  cough,  excited  by  tickling  in  the 
throat,  and  attended  with  severe  headache,  confusion  in  the  head, 
giddiness,  want  of  appetite,  or  sickness,  thirst,  pain  as  from  a  bruise 
in  the  hypochondria,  aching  pain  in  the  lower  part  of  the  back,  con- 
stipation, pain  in  the  chest  as  if  from  excoriation. 

Mercurius  : — Dry  ox  fluent  coryza  ;  pains  in  the  head,  face,  teeth, 
and  chest ;  sore  throat ;  swelling  of  the  parotids ;  violent  shaking 
cough,  at  first  dry,  but  subsequently  moist,  the  paroxysms  being 
commonly  excited  by  irritation  in  the  throat  and  chest;  shivering 
or  heat  with  profuse  perspiration  ;  aching  in  the  bones  and  slimy 
bilious  diarrhoea,  attended  with  tenesmus.  This  remedy  has  also 
proved  of  great  efficacy  when  symptoms  of  pleurisy  with  copious, 
unmitigating  perspiration,  supervened ;  as  also  when  the  liver  became 
implicated  in  the  general  derangement,  the  pains  in  that  organ  par- 
taking more  of  an  obtuse  than  an  acute  description. 

Arsenicum.  The  following  are  the  characteristic  indications  for 
the  employment  of  this  important  remedy :  heaviness  and  rheumatic 
pain  in  the  head  ;  profuse  watery  and  corrosive  discharge  from  the  nose, 
causing  a  disagreeable  burning  sensation  in  the  nostrils;  violent 
sneezing ;  shiverings  and  shudderings,  with  severe  pains  in  the  limbs ; 
oppression  of  the  chest ;  difficulty  of  breathing ;  thirst ;  anxiety ;  rest- 
lessness ;  great  prostration  of  strength,  with  aggravation 
of  sufferings  at  night,  or  after  a  meal ;  inflammation  of  the  eyes,  with 
sensibility  to  light.  These  symptoms  may  be  attended  with  a  deep, 
dry,  fatiguing  cough,  exacerbated  in  the  evening,  at  night,  or  after 
drinking,  or  sensations  of  dryness  and  burning,  with  mucus  in  the 
throat,  which  is  difficult  to  detach. 

If  this  remedy  be  not  sufficient  to  remove  the  disorder,  we  may 
have  recourse  to  the  following  medicines :  Camphora,  Aconitum,  Nux 
vomica,  Mercurius,  Phosphorus^  Belladonna,  Pulsatilla. 

Phosphorus  has  frequently  been  found  exceedingly  useful  when 


264  RESPIRATORY  SYSTEM. 

there  was  excessive  irritation  in  the  larynx  and  bronchi,  bordering 
on  inflammation,  with  alteration  of  the  voice,  and  pain  during 
articulation. 

Bryonia  has  often  proved  of  great  service  in  relieving  the  violent, 
pressive,  aching,  bursting,  frontal  headache,  and  cough  with  easily 
loosened  mucous  sputa.  It  has  further  been  found  of  great  efficacy 
when  the  liver  was  tumefied,  painful  to  the  touch,  or  on  coughing, 
or  taking  a  full  inspiration  ;  also  when  vomiting  was  liable  to  take 
place  after  coughing,  or  when  the  cough  produced  pain  in  the  upper 
part  of  the  abdomen,  and  caused  a  pain  as  if  arising  from  the  effects 
of  a  blow  beneath  the  shorts  ribs.  (See  Nux,  which  accords  with 
Bryonia  in  the  latter  case.) 

Belladonna  ; — Dry  spasmodic  cough,  aggravated  towards  night; 
sore  throat,  excessive,  almost  insupportable,  headache,  increased  by 
talking,  moving,  or  bright  light ;  fixed  look ;  confusion  of  ideas  on 
closing  the  eyes. 

Carbo  v,  has  been  found  useful  in  old  people,  sometimes  in  alter- 
nation with  Bryonia,  when  the  chest  was  considerably  affected,  the 
breathing  oppressive,  the  extremities  cold,  with  threatening  paralysis 
of  the  lungs. 

Pulsatilla; — Loose  cough  day  and  night,  exacerbated  by  lying 
down,  thick  offensive  coryza,  tendency  to  relaxation  in  the  bowels, 
loss  of  appetite,  foul  tongue,  disagreeable  or  insipid  taste  in  the  mouth. 

Rhus  : — In  cases  arising  after  exposure  to  a  thorough  wetting, 
and  accompanied  by  great  anxiety,  frequent  involuntary  fetching  of 
a  deep  inspiration,  corporeal  restlessness  with  incessant  changing  of 
posture,  this  remedy  is  indicated. 

Distressing,  dry  cough,  or  cough  with  difficulty  in  expectorating 
the  sputum  which  has  been  detached,  the  paroxysms  of  which  were 
always  followed  by  yawning,  has  frequently  been  cured  by  Opium, 
after  many  other  remedies  had  failed  to  relieve. 

Sulphuris  tinct.  has  repeatedly  proved  useful  when,  at  the  termi- 
nation of  the  disorder,  dull  pricking  pains  are  experienced  in  the  chest 
on  taking  a  deep  breath,  or  after  a  severe  fit  of  coughing  ;  also  when 
there  is  oppressed  respiration  as  if  arising  from  a  heavy  weight 
resting  on  the  chest. 

Senega  : — Tickling  irritation  and  continual  burning  in  the  larynx 
or  throat,  with  loud  mucous  rale,  and  fear  of  suffocation  on  lying 
down.  Stanntm  in  neglected  or  protracted  cases,  with  easy  but 
excessive  expectoration  of  mucus,  and  great  weakness.     Cinchona  may 


DETERMINATION  OF  BLOOD  TO  THE  CHEST.  265 

advantageously  follow  the  last  remedy  when  the  expectoration  has 
diminished,  or  when  the  fits  of  coughing  are  excited  by  a  rattling 
under  the  sternum  as  if  arising  from  an  accumulation  of  mucus. 

Finally : — Arnica  may  be  administered  with  advantage  in  some 
cases,  particularly  when  pricking  pains  are  experienced  in  the  chest 
during  inspiration  (pseudo-pleurisy),  with  aching  pains  over  the  whole 
body,  headache,  and  hemorrhage  from  the  nose  ;  Ipecacuanha,  after 
Arsenicum  or  any  of  the  other  prescribed  remedies,  when  there  is 
vomiting  or  violent  retching  during  or  after  each  fit  of  coughing; 
Hyoscyamus,  and  in  some  cases  Belladonna,  against  distressing  spas- 
modic cough  remaining  after  the  acute  symptoms  of  influenza  have 
been  subdued;  or  Conium,  when  the  cough  continued  almost  in- 
cessantly during  the  night  until  relieved  by  vomiting  a  quantity  of 
frothy  mucus ;  Ferrum  aceticum,  cough  after  eating,  with  vomiting  of 
the  ingesta ;  Kali  hydriod.,  cough,  with  wheezing  arid  rattling  in  the 
chest,  and  expectoration  of  a  gray  coloured,  saline  or  sweetish  tasted 
sputum.  Stannum  and  Carlo  v<,  in  alternation  frequently  served  to 
prevent  the  development  of  phthisis,  where  there  was  a  predisposition 
to  that  disease  before  the  invasion  of  influenza ;  and  Arsenicum  and 
Lachesis  have  been  employed  with  much  success  against  sequelas  in  the 
form  of  obstinate  inflammation  of  the  eye  and  ulceration  of  the  cornea. 
(See  also  art.  Cough.) 


DETERMINATION  OF  BLOOD  TO  THE  CHEST. 

Congestio  ad  Pecttis. 

Diagnosis.  Sensation  of  great  fulness,  throbbing,  weight,  or 
pressure  in  the  chest  and  palpitation  of  the  heart,  attended  with 
anxiety,  short  sighing  respiration,  and  dyspnoea. 

We  find  that  the  predisposition  to  affections  of  the  chest  and  lungs 
is  greater  during  the  period  preceding  puberty,  and  for  some  years 
after,  than  at  any  other  epoch  of  man's  existence. 

As  remarked  in  the  Diseases  of  Children,  in  infancy  and  during 
very  early  childhood,  from  the  disproportion  between  the  cerebral 
system  and  other  portions  of  the  economy,  the  diseases  which  the 
physician  has  chiefly  to  combat,  are  those  arising  from  over-excite- 
ment of  the  nervous  organization.  In  maturer  years  the  tendency 
to  abdominal  congestion  generally  develops  itself.      This  is  easily 


266  RESPIRATORY  SYSTEM. 

explained  by  entering  into  the  physiology  of  these  different  periods 
of  human  life ;  but  as  my  object  is  rather  the  treatment  of  disease 
than  the  elucidation  of  these  interesting  points,  I  shall  here  content 
myself  with  briefly  alluding  to  them. 

There  is  no  doubt,  as  already  remarked,  that  a  particular  period 
of  human  life  is  peculiarly  liable  too  chest  affections,  and,  among 
others,  to  this  disorder,  which  is  but  too  frequently  the  precursor  of 
other  more  serious  maladies.  Some  constitutions,  however,  especially 
those  in  which  an  hereditary  phthisical  taint  exists,  exhibit  a  marked 
predisposition  to  pectoral  congestion.  Amongst  the  most  frequent 
causes  of  this  predisposition  being  called  into  dangerous  activity  are, 
exposure  to  extremes  of  heat  or  cold ;  stimulants,  such  as  alcoholic, 
vinous,  or  fermented  beverages,  or  coffee  ;  the  abuse  of  narcotic 
drugs ;  violent  exercise,  such  as  running,  dancing,  &c,  or  over- 
exertion even  of  the  voice  in  speaking  or  singing ;  a  sudden  check 
of  perspiration ;  cold  or  damp  feet ;  sedentary  habits ;  metastases  \ 
repercussed  cutaneous  eruptions ;  or  suppression  of  customary  dis- 
charges, such  as  the  catamenial  and  hemorrhoidal  flux. 

Therapeutics.  Aconitum,  Nux  vomica,  Ipecacuanha,  Belladonna, 
Aurum  foliatum,  Mercurius,  Pulsatilla,  Spongia,  Cinchona,  Sulphur  are 
the  best  remedies  in  general  cases. 

Aconitum  is  especially  indicated,  when  there  is  violent  oppression 
with  great  heat  and  thirst,  palpitation  of  the  heart,  great  anxiety,  and 
shaking  cough.  It  will  be  found  particularly  valuable  for  plethoric 
females  of  sedentary  habits,  who  suffer  considerably  from  congestion 
before  and  during  the  catamenia.  In  such  cases  it  may  be  advan- 
tageously followed  by  Mercurius,  to  prevent  a  relapse,  (in  others  by 
Belladonna.) 

Nux  vomica; — When  the  affection  has  been  developed  by 
sedentary  habits  or  by  habitual  indulgence  in  the  stimulants  already 
alluded  to,  or  from  hemorrhoidal  metastasis  or  suppression:  in  which 
cases  this  remedy  is  frequently  sufficient  to  effect  a  radical  cure. 

Ipecacuanha  will  frequently  complete  the  cure,  when  Nux  vomica 
has  not  removed  the  whole  of  the  symptoms.  In  other  cases  Sulphur 
will  answer  better  after  the  previous  employment  of  Nux.  (See  Sul  ph.) 

Belladonna: — Oppression  and  throbbing  at  the  chest,  with 
shortness  of  breath  and  strong  palpitation  of  the  heart,  extending 
into  the  head  ;  short  cough,  chiefly  at  night ;  internal  heat ;  and 
considerable  thirst. 


DETERMINATION  OF  BLOOD  TO  THE  CHEST.  267 

Aurum  : — Extreme  oppression  of  the  chesty  as  if  suffocation  im- 
pended^ sometimes  with  loss  of  consciousness  and  livid  hue  of 
countenance ;  palpitation  of  the  heart ;  and  excessive  anguish. 

Mercurius,  as  already  remarked,  is  valuable  after  Aconitum,  on 
certain  occasions  (see  that  remedy) ;  and  also  when  there  is  burning 
heat  and  oppression  at  the  chest,  and  frequent  desire  to  take  a  deep 
inspiration ;  or,  cough  with  expectoration  streaked  with  blood,  and 
palpitation  of  the  heart. 

Pulsatilla  : — Ebullition  of  blood  in  the  chest  with  external 
heat;  constriction  in  the  chest  with  impeded  respiration;  palpitation 
of  the  heart;  anxiety  and  aggravation  of  the  symptoms  towards 
evening ;  also  when  pectoral  congestion  has  arisen  in  phlegmatic  sub- 
jects from  hemorrhoidal  suppression,  or  in  females  from  stoppage  of  the 
menstrual  flux. 

Spongia  tosta  : — When  the  symptoms  are  provoked  by  the 
slightest  exertion  or  even  movement,  and  are  attended  with  anguish, 
sensation  of  threatened  suffocation,  nausea,  prostration,  and  fainting. 

Bryonia  : — Burning  heat  in  the  chest,  with  a  sensation  of  tight- 
ness, dyspnoea,  and  anxiety ;  palpitation  of  the  heart,  occasional  prick- 
ings in  the  chest  during  inspiration. 

Cinchona,  when  we  can  trace  the  affection  to  debilitating  losses, 
with  palpitation  of  the  heart  and  oppressed  breathing. 

Sulphur: — Ebullition  of  blood,  weight,  fulness,  and  pressure  in 
the  chest,  aggravated  by  coughing,  palpitation  of  the  hearty  dyspnoea, 
chiefly  on  lying  down  at  night ;  it  is  also  most  serviceable  in  sup- 
pressed hemorrhoids,  after  Nux  vomica  or  Pulsatilla,  and  after  the  latter 
remedy  in  checked  catamenia. 

Phosphorus.  In  some  obstinate  cases  this  remedy  is  often 
successful  in  affording  speedy  relief,  particularly  when,  in  addition  to 
the  more  usual  symptoms,  shooting  or  pricking  pains  are  frequently 
experienced  on  laughing,  speaking,  or  walking  quickly ;  palpitation 
of  the  heart,  anxiety,  sensation  of  heat  extending  from  the  chest  into 
the  throat. 

Some  one  or  more  of  the  preceding  remedies,  if  judiciously  selected, 
and  timely  administered,  will  generally  check  the  disease,  and  pre- 
vent it  assuming  a  more  dangerous  form :  as,  for  example,  running 
into  hemoptysis,  phthisis,  pneumonia,  carditis,  &c.  The  following, 
among  others,  have  also  been  found  useful  in  peculiar  cases :  Rhus 
toxicodendron,  Sepia,  Natrum  muriaticum,  Phosphorus,  Carlo 
Acidum  nitricum,  Ammoniacum  carhonicum,  and  Ferrum  metallicum. 


268  RESPIRATORY  SYSTEM. 


INFLAMMATION  OF  THE  MUCOUS  MEMBRANE  OF  THE   BRONCHIAL  TUBES. 
COLD  ON  THE  CHEST.     PULMONARY  CATARRH. 

Bronchitis* 

This  disease  consists  of  a  greater  or  less  degree  of  inflammation 
of  the  mucous  membrane  of  the  bronchi,  and  is  divided  into  acute 
and  chronic.  Of  the  former  it  is  intended  more  particularly  to  treat. 
The  disorder  is  of  frequent  occurrence  both  as  an  idiopathic  affection, 
and  as  a  concomitant  of  measles,  scarlatina,  smallpox,  hooping-cough, 
&c. 

Symptoms  of  Acute  Bronchitis.  Chilliness,  succeeded  by 
fever;  hoarseness,  difficulty  of  respiration;  severe,  frequent,  and 
distressing  cough,  at  first  dry  or  with  scanty  expectoration  of  frothy 
or  viscid  mucus,  which  subsequently  becomes  copious  and  occasionally 
streaked  with  blood  ;  excessively  laborious  respiration,  attended  with 
a  feeling  of  constriction  and  oppression  of  the  chest,  which  sometimes 
increases  to  such  a  degree  as  to  threaten  suffocation ;  general  weak- 
ness, foul  tongue,  and  loss  of  appetite ;  paleness  of  the  lips,  cadaverous 
and  anxious  countenance,  loud  wheezing,  and,  on  applying  the  ear 
to  the  chest,  a  louder  sound  is  heard  than  the  natural  respiration, 
either  rattling,  whistling,  or  droning,  or  harsh  and  broken,  according 
to  the  advance  of  the  disease.* 

In  the  cases  which  terminate  favorably,  the  first  symptom  of  im- 
provement which  sets  in,  is  a  greater  freedom  of  breathing,  with 
remission  of  the  fever,  and  an  alteration  in  the  expectoration,  which 
becomes  thicker,  whiter,  and  diminished  in  quantity.  But  when  the 
disease  takes  an  unfavorable  turn  the  difficulty  of  breathing  increases  ; 
a  state  of  excessive  debility  and  collapse  supervenes ;  the  face  becomes 
livid,  the  body  covered  wdth  a  cold  and  clammy  sweat ;  the  mucus 
accumulates  rapidly  in  the  bronchial  tubes,  and  the  cough  which 
has  become  feeble  through  the  exhausted  and  sinking  energies  of  the 
patient,  is  insufficient  for  its  ejection ;  aeration  of  the  blood  in  the 
cells  of  the  lungs  is  prevented  ;  cerebral  symptoms  declare  themselves 
from  impeded  circulation,  or  the  effect  of  unarterialised  blood  circu- 

*  Sibilant  and  sonorous  rhonchi,  in  the  early  stage,  and  mucous  or  bubbling  rhonchus 
when  the  secretion  becomes  increased,  indicate  both  the  nature  and  extent  of  the  disease. 


BRONCHITIS.  269 

lating  in  the  brain,  and  the  patient  is  carried  off  in  a  state  of 
asphyxia. 

In  many  cases  of  acute  bronchitis,  although  a  degree  of  oppression 
at  the  chest  be  present,  no  particular  pain,  heat  of  skin,  or  fever 
may  exist ;  this  is  a  most  insidious  form  of  the  disease,  and  one  in 
which  the  complaint  is  but  too  frequently  neglected  until  beyond  the 
power  of  the  physicians  art :  it  occurs  most  frequently  in  children 
who  may  apparently  be  only  troubled  with  a  slight  wheezing,  of  wThich 
scarcely  any  notice  is  taken  or  any  medical  aid  called  in,  until 
suddenly  suffocation  threatens,  or  some  organic  lesion  is  produced, 
so  that  an  affection  which  probably  might  have  been  easily  subdued 
at  the  commencement,  is  now  beyond  control. 

The  frequency  of  the  disease  in  infancy  and  early  life  deserves  a 
particular  notice.  It  generally  begins,  as  in  adults,  with  the  symp- 
toms of  a  common  catarrh;  the  breathing  becomes  quick  and  op- 
pressed, and  from  the  increased  action  of  the  diaphragm,  the  abdo- 
men is  rendered  prominent ;  both  the  shoulders  and  nostrils  are  in 
continual  motion,  but  the  wheezing  is  often  more  marked  than  the 
difficulty  of  respiration,  and  on  applying  the  ear  to  the  chest  a  mu- 
cous rattle  is  heard  over  almost  every  part ;  expectoration  sometimes 
temporarily  relieves,  and  occasionally  the  mucus  is  expelled  from  the 
air-passages  by  vomiting ;  the  countenance  is  pale  and  anxious,  and, 
somewhat  livid: — these  symptoms  are  interrupted  and  relieved  by 
occasional  remissions,  during  which  the  child  generally  appears 
drowsy ;  but  they  return  with  additional  severity,  and,  if  not  checked, 
an  accession  of  extreme  dyspnoea  ensues,  and  death  takes  place  from 
suffocation.  When  sore  throat  is  also  present,  coughing  produces 
considerable  pain,  and  the  child  for  that  reason  frequently  endeavours 
to  suppress  it.  There  is  also  impaired  appetite  with  thirst,  although 
when  the  disease  has  advanced,  it  is  found  difficult  to  take  a  long 
draught  from  its  impeding  respiration  :  this  is  very  observable  with 
children  at  the  breast,  who,  after  eagerly  seizing  the  nipple,  will  bite 
it,  and  discontinue  sucking,  cry,  and  throw  back  the  head,  and  even 
after  vomiting  up  the  phlegm,  continue  for  some  time  in  that 
position. 

In  some  cases,  from  the  character  of  the  voice  and  cough,  bron- 
chitis has  been  mistaken  for  croup. 

The  tubes  of  one  lobe,  or  of  one  lung  only,  may  be  affected,  but 
frequently  those  of  both  lungs  are  attacked  by  the  disease. 


270  RESPIRATORY  SYSTEM. 

The  exacerbation  of  suffering  at  night  is  a  very  remarkable  symp- 
tom in  this  complaint. 

The  causes  are  the  same  as  those  of  common  catarrh. 

Therapeutics.  The  remedies  which  are  the  most  appropriate  in 
ordinary  cases  of  this  affection  are  :  Aconitum,  Bryonia  alba,  Pulsatilla, 
Spongia,  Belladonna,  Nitx  vomica,  Lachesis,  Phosphorus,  Mercurius, 
Cannabis,  &c. 

Aconitum  is  the  remedy  upon  which  we  must  place  our  chief 
reliance  in  the  inflammatory  stage  of  the  disease,  and  throughout  its 
course  whenever  high  febrile  action  sets  in.  Its  more  marked  indi- 
cations are  hot,  dry  shin,  with  strong,  hard,  and  accelerated  pulse  ;  hoarse- 
ness^ with  roughness  of  the  voice ;  short,  dry,  and  frequent  cough, 
excited  by  tickling  in  the  throat  and  chest ;  obstructed  respiration, 
sibilant  or  sonorous  rhonchus,  anxiety,  restlessness,  headache,  and 
thirst,  with  occasionally  scanty  expectoration  of  viscid  mucus. 

R  Tinct.  Aeon.  3,  gtt.  iij. 
Aq.  pur.  Jiij. 
M.     Dose.  To  adults  a  tablespoonful,  to  children  a  teaspoonful  every 
three  to  six  hours,  according  to  the  urgency  of  the  case,  until  relief  be 
obtained,  after  which  we  may  either  lengthen  the  intervals,  or  select 
some  other  remedy  more  appropriate  to  the  remaining  symptoms. 

It  will  sometimes  be  found  necessary,  as  above  remarked,  to  return  to 
this  remedy,  during  the  course  of  the  disease,  particularly  during  the 
nocturnal  febrile  exacerbations. 

Should  the  skin  not  become  moist,  the  respiration  easier,  and  the 
cough  looser  after  the  second  or  third  dose  of  Aconitum,  Bryonia 
will,  in  most  cases,  be  required  (see  Bryonia).  But  it  rarely  hap- 
pens that  Aeon.,  when  at  all  indicated,  does  not  produce  a  favorable 
effect,  even  after  the  first  dose.  As  soon  as  a  decided  melioration 
has  been  effected,  the  repetition  of  the  dose  must  be  restricted  to 
intervals  of  eight  to  twelve  hours,  or  even  longer ;  or  another  medi- 
cine must  be  selected  if  Aeon,  be  found  inadequate  to  complete  the 
cure.     (See  Pulsatilla.) 

Bryonia  is  of  great  service  in  a  large  number  of  cases  of  bron- 
chitis, at  the  commencement  of  the  attack.  We  should  therefore 
not  hesitate  to  prescribe  it  immediately  when  we  meet  with  labo- 
rious, rapid,  and  anxious  breathing,  with  constant  inclination  to  take 
a  deep  inspiration ;  hoarseness;  headache;  dry  cough,  attended  with 


BRONCHITIS.  271 

a  burning  pricking  pain  extending  from  the  throat  to  the  middle  of 
the  sternum ;  or  cough  with  scanty  and  difficult  expectoration  of 
viscid  sputa,  in  some  instances  streaked  with  blood;  sibilant  rhon- 
chus ;  dryness  of  the  mouth  and  lips,  excessive  thirst.  When,  more- 
over, the  respiration  is  impeded  by  shootings  in  the  chest,  and  the 
affection  threatens  to  become  complicated  with  pleurisy,  this  remedy- 
is  still  more  particularly  called  for.  (Hepar  s.  is  sometimes  required 
after  Bryon.  in  bronchitis,  particularly  when  the  latter  remedy  pro- 
duces only  temporary  relief.) 

Form  of  prescription,  same  as  Aconite. 

Spongia  is  often  of  great  service  after  the  previous  administration 
of  Aconite,  when  there  still  remains  a  considerable  degree  of  inflam- 
mation in  the  bronchial  tubes,  especially  the  larger,  with  sibilant  or 
sonorous  rhonchus ;  and  also,  at  a  more  advanced  stage  of  the  disease, 
when  the  mucous  rhonchus  is  distinctly  audible;  with  hollow,  dry- 
cough  day  and  night,  but  worse  towards  evening ;  or  cough  with 
scanty,  viscid,  ropy  expectoration  ;  heat  in  the  chest,  burning,  tick- 
ling irritation  in  the  larynx,  quick,  anxious,  laborious  respiration ; 
inability  to  breathe  unless  the  head  is  thrown  backwards;  hoarseness, 
(Hepar  s.  is  sometimes  useful  after  Spongia,  especially  when  the 
mucous  rhonchus  is  predominant,  the  skin  hot  and  dry,  and  the 
efforts  to  expectorate  ineffectual.) 

Belladonna.  This  remedy  is  useful  when  there  is  severe  head- 
ache, materially  aggravated  by  coughing ;  oppression  of  the  chest,  and 
constriction,  as  if  bound,  with  loud,  wheezing,  and  rattling  of  mucus 
in  the  bronchi ;  short,  anxious,  and  rapid  respiration  ;  dry,  fatiguing 
cough,  especially-  at  night,  which  is  endeavoured  to  be  suppressed  on 
account  of  the  pains  it  creates ;  heat  of  the  skin  and  thirst ;  soreness 
of  the  throat.  Belladonna  is  often  exceedingly  efficacious  in  children, 
particularly  in  those  insidious  cases  which  commence  with  a  slight 
wheezing,  and  then  suddenly  become  aggravated  to  such  a  degree  as 
to  threaten  suffocation ;  the  heat  of  skin  being  at  the  same  time 
considerable,  and  the  pulse  excessively-  rapid,  and  sometimes  even 
intermittent.  Sulphur  is,  in  some  instances,  required  to  establish  the 
cure  after  Bella* 

Form  of  prescription,  the  same  as  Aconite,  but  the  repetition  of  the 
dose  at  intervals  of  eight  or  twelve  hours. 

Nux  vomica; — Dyspnoea,  with  excessive  tightness  of  the  chest, 
particularly  at  night;  hoarseness;  dry  cough,  worse  towards  morn- 
ing, attended  with  pain  as  if  caused  by  a   blow  or  bruise,  in  the 


272  RESPIRATORY  SYSTEM. 

epigastric  or  hypochondriac  regions ;  cough,  with  difficult  and  scanty 
expectoration  of  viscid  mucus;  dryness  of  the  mouth  and  lips,  thirst, 
constipation,  peevishness. 

Prescription,  the  same  as  directed  under  Belladonna. 

Lachesis  :  —  Oppression  at  the  chest,  with  short  and  hurried  respi- 
ration, anxiety,  and  dejection;  mucous  rale;  dry,  fatiguing  cough, 
sometimes  followed  by  the  expectoration  of  a  little  tenacious  or  frothy 
mucus,  after  much  effort,  occasionally  streaked  with  blood;  hoarseness. 

Prescription,  as  directed  under  Belladonna. 

Phosphorus.  This  important  remedy  is  frequently  of  great 
utility  in  bronchitis  when  the  more  inflammatory  symptoms  have  been 
subdued  by  Aconite,  but  the  respiration,  continues  much  oppressed, 
accompanied  with  great  anxiety,  and  heat  in  the  chest ;  dry  cough, 
excited  by  tickling  in  the  throat  or  chest,  aggravated  by  talking  or 
laughing,  and  followed  by  expectoration  of  stringy  mucus  of  a  saltish 
taste.  Further,  when  the  disease  has  been  neglected,  or  when,  from 
the  phenomena  which  present  themselves  at  the  commencement,  we 
have  reason  to  dread  complication,  or  an  extension  of  the  inflamma- 
tion to  the  substance  of  the  lungs,  which  we  generally  recognise  by 
the  invasion  of  crepitation,  rusty  sputa,  &c- — there  will  be  additional 
reason  for  employing  Phosphorus.     (See  Pneumonia.) 

Pulsatilla.  This  remedy  is  often  required  in  the  second  stage 
to  complete  the  cure,  after  the  previous  exhibition  of  Aconitum,  when 
the  acute  inflammatory  symptoms  have  been  subdued,  and  the 
expectoration  has  become  thicker  and  more  copious.  It  may,  how- 
ever, be  prescribed  before  or  after  any  of  the  medicaments  wre  have 
named,  especially  when  the  disease  occurs  in  persons  of  mild  dispo- 
sition, or  of  lymphatic  constitution,  and  the  symptoms  are  as  follows  : 
Respiration  short,  accelerated,  and  impeded,  attended  with  rattling 
of  mucus,  heat  in  the  chest,  and  anxiety ;  hoarseness ;  shaking 
cough,  worse  towards  evening,  at  night,  or  in  the  morning,  accom- 
panied with  considerable  expectoration  of  tenacious,  or  thick,  yellow- 
ish mucus,  sometimes  mixed  with  blood ;  coryza  with  copious  dis- 
charge of  thick,  discoloured  mucus. 

Prescription  and  dose  the  same  as  mentioned  under  Belladonna. 

Sepia  may  be  selected  in  preference  to  Pulsatilla,  when  the  expec- 
toration is  very  copious,  though  somewhat  difficult,  and  of  a  salt  taste  ; 
exacerbation  of  cough  in  the  morning  and  towards  evening.  (If  the 
sputa  be  still  profuse,  but  more  easily  detached  and  ejected,  greenish, 
and  less  saline,  or  of  a  sweetish  taste,  Stannum  may  follow  Sepia.) 


BRONCHITIS.  273 

Lycopodium  : — When  the  cough  is  materially  worse  at  night,  and 
attended  with  thirst  and  quickness  of  pulse,,  but  moist  skin  or  ten- 
dency to  sweat ;  the  sputa  yellowish  gray,  and  of  a  saltish  taste; 
oppression  at  the  chest. 

Mercurius.  This  remedy  may  occasionally  be  found  useful 
when  the  symptoms  of  bronchitis  are  accompanied  by  excessive  per- 
spiration; when  the  cough  is  fatiguing,  worse  in  the  evening,  and  at 
night,  and  excited  by  a  tickling  irritation,  or  sensation  of  dryness  in 
the  chest,  with  quick,  short,  oppressed  breathing,  and  louder  respira- 
tion than  ordinary ;  hoarseness ;  coryza  with  watery,  acrid  discharge ; 
swelling  of  nose.  Dulcamara  is  occasionally  serviceable  after  Mer- 
curius,  when  there  is  a  continuance  of  night  sweats  of  an  offensive 
odour. 

Chamomilla  is  often  a  most  useful  remedy  in  cases  of  children, 
after  the  previous  exhibition  of  Aconite,  when  a  slight  degree  of 
whistling  or  sonorous  rhonchus  still  remains ;  dry  cough  worse  at 
night,  occurring  even  during  sleep.  For  further  indications,  see  this 
remedy  under  the  head  of  Cough. 

Ipecacuanha  is  also  very  valuable  as  a  remedy  for  children,  but 
generally  at  a  more  advanced  stage  of  the  disorder,  writh  mucous 
rhonchus  in  the  chest,  and  when  on  coughing  they  are  almost  suffo- 
cated by  the  excessive  secretion  of  mucus,  and  become  livid  in  the 
face ;  shortness  of  breath,  and  perspiration  on  the  forehead  after 
each  fit  of  coughing. 

Dose.  One  globule  of  the  sixth  dilution,  in  a  teaspoonful  of  water, 
every  two  to  six  hours,  until  improvement  results.* 

There  are  other  remedies  which  have  been  found  of  great  value  in 
the  treatment  of  this  affection,  such  as  Tartarus  emeticus,  Arsenicum, 
Sulphury  &c. 

Tartarus  emeticus  is  chiefly  found  useful  in  those  extreme 
cases  where  the  smaller  tubes  are  clogged  with  mucus,  and  suffoca- 
tion threatens ;  when  the  cough  suddenly  ceases  either  from  weak- 
ness or  other  causes. 

Dose.  A  grain,  of  the  second  or  third  trituration,  in  four  dessert- 
spoonfuls of  water,  one  dessert-spoonful  to  adults  and  a  teaspoonful  to 
children  every  quarter,  every  half,  every  hour,  or  every  three  or  four 
hours,  according  to  the  severity  of  the  symptoms,  or  the  effects  pro- 
duced. 

*  See  the  "  Rules  for  the  administration  of  the  remedies, "  given  in  the  Introduction. 

18 


274  RESPIRATORY  SYSTEM. 

Arsenicum  is  occasionally  of  the  utmost  service  in  those  unfavor- 
able cases  in  which  the  pulse  becomes  very  quick,  feeble,  and  irre- 
gular, and  the  patient  is  reduced  to  a  state  of  extreme  debility  and 
collapse. 

Dose.     One  or  two  drops  of  the  sixth  dilution  to  an  ounce  of  water,  a 
teaspoonful  to  be  given  from  time  to  time,  as  required.* 

Sulphur  is  frequently  useful  in  winding  up  a  cure,  and  preventing 
the  disease  running  on  to  the  chronic  form,  or  when  the  expectoration 
has  increased  in  quantity  and  become  wThitish  and  less  viscid. 

It  may  be  added  that  Hepar  sulp/mris,  Ammonium  carhonicum,  Can- 
nabis, Brominmfy  &c,  may  also  be  found  useful  in  some  particular 
cases ;  and  that  Belladonna,  Lachesis,  and  perhaps  also  Opium,  in  addi- 
tion to  Tart,  em.,  may  prove  serviceable  against  the  symptoms  of 
stupor,  which  are  so  liable  to  set  in  in  severe  attacks  of  this  disorder. 
Where  there  is  a  peculiar  tendency  to  inflammation  or  cold  on  the 
chest,  whenever  an  easterly  wind  prevails,  Aconitum  and  Belladonna 
have  been  recommended  as  two  of  the  most  useful  remedies  by 
means  of  which  this  predisposition  is  to  be  overcome.  (Gross,  Allg. 
Horn.  Zeit.  No.  12,  19terBd.) 

Diet.  In  the  severe  forms  of  bronchitis,  the  diet  to  be  observed, 
should  be  the  same  as  that  mentioned  under  Fever ;  but  when  the 
febrile  and  inflammatory  symptoms  have  been  completely  removed,  the 
patient  should  gradually  return  to  a  more  nutritious  diet,  even  though 
a  considerable  degree  of  cough  and  expectoration  remain. 

In  the  slighter  forms  of  the  complaint,  spare  diet,  confinement  to 
the  house,  in  short,  the  simple  measures  laid  down  for  the  treatment 
of  common  colds  in  another  part  of  this  work,  will  frequently  check 
or  at  all  events  materially  shorten  the  attack.  See  also  article 
Cough,  in  which  further  indications  will  be  found  for  the  selection 
of  the  remedies. 

Chronic  bronchitis.  Bronchitis  chronica.  This  complaint  may 
be  the  result  of  the  acute  affection,  or  it  may  arise  as  a  gradual  and 
insidious  inflammation  of  the  mucous  membrane  of  the  bronchial 
tubes,  or  proceed  from  the  inhalation  of  dust  or  other  minute  par- 
ticles carried  into  the  lungs ;  it  may  also  be  coeval  with  diseases  of 

*  See  the  "  Rules  for  the  administration  of  the  remedies,"  given  in  the  Introduction. 
f  The  provings  of  this  medicine  are  given  in  the  '  Nues  Arch/     Zweiter  band,  Drittes 
heft. 


BRONCHITIS.  275 

the  heart,  or  declare  itself  after  eruptive  fevers.  It  differs  from  acute 
bronchitis  chiefly  in  the  greater  mildness  and  longer  duration  of  its 
symptoms,  the  continuance  of  which  varies  from  several  weeks  or 
months  to  many  years.  It  affects  elderly  persons  more  frequently 
than  the  young,  but  is  of  course  liable  to  occur  at  all  ages  as  the 
result  of  an  acute  attack  (although  such  a  circumstance  is  compa- 
ratively of  rare  occurrence  under  proper  homoeopathic  treatment), 
the  sequel  of  measles,  &c.  A  comparative  exemption  from  cough,  is 
frequently  experienced  during  summer ;  but  in  winter,  or  in  incle- 
ment springs,  the  patient  is  tormented  with  harassing  cough,  and 
copious  viscid  expectoration,  especially  in  the  morning,  which  in  the 
severer  forms  of  the  disorder  is  peculiarly  distressing.  The  expec- 
torated matter  in  the  chronic  affection  is  of  a  different  nature  from 
that  in  the  acute,  being  of  a  thicker  consistence,  and  of  a  greenish 
or  yellowish- white  colour,  it  is  not  unfrequently  muco-purulent,  and 
sometimes  decidedly  purulent,  and  occasionally  streaked  with  blood, 
particularly  in  obstinate,  inveterate  cases.  There  is  generally  more 
or  less  dyspnoea,  with  acceleration  of  pulse  after  slight  corporeal 
exertion  ;  but  in  other  respects  the  health  may  be  good,  and  continue 
so.  In  the  more  trying  forms  of  the  disorder,  an  aggravated  state  of 
all  the  symptoms  enumerated  is  met  with ;  moreover  where  the  sputa 
is  of  a  purulent  nature,  hectic  fever,  extreme  emaciation,  nocturnal 
sweats,  and  occasional  attacks  of  diarrhoea  are  frequent  adjuncts : 
the  latter  symptoms  are  sometimes  liable  to  cause  the  disease  to  be 
mistaken  for  tubercular  consumption ;  but  in  the  majority  of  cases, 
auscultation,  and  percussion,  together  with  a  careful  attention  to  the 
symptoms  and  the  history  of  the  case,  enable  us  to  form  an  accurate 
diagnosis  between  them. 

In  chronic  bronchitis,  the  resonance  of  the  chest  is,  on  percussion, 
little  if  at  all  diminished.  On  applying  the  ear  or  stethoscope  to  the 
chest,  the  respiratory  murmur  is  found  to  vary  much  in  intensity, 
but  is  never  permanently  absent  in  any  part  of  the  chest,  and  is 
frequently  even  puerile.  The  mucous  rhonchus,  in  most  of  its  diver- 
sified forms,  is  heard  in  various  parts  of  the  chest  at  different  times, 
and  occasionally  the  whistling  and  sonorous  rattles  are  discernible. 
When  the  dilatation  of  the  bronchial  tubes  is  considerable,  as  is  not 
unfrequently  the  case  in  this  affection,  a  loud  bronchophony  is  heard, 
which  is  with  difficulty  if  at  all  to  be  distinguished  from  pectoriloquy, 
and  a  rale,  closely  resembling  the  cavernous,  is  apparent  in  the 
vicinity  of  the  dilated  tube.     The  sound  on  percussion  will,  however, 


276  RESPIRATORY  SYSTEM. 

generally  enable  us  to  form  a  distinction ;  the  dullness  of  tone  being 
not  so  great  over  a  dilated  tube,  as  it  is  in  the  vicinity  of  a  vomica ; 
the  difference  of  the  situation  of  the  cavity  in  the  two  cases,  is  also  a 
useful  discriminating  guide  ;  dilated  bronchi  being,  as  is  well  known, 
most  frequently  detected  in  the  scapular,  mammary,  and  lateral 
regions,  and  vomicae  in  the  subclavian  and  axillary  regions.*  How- 
ever^ as  before  said,  we  must,  in  all  doubtful  cases,  combine  the 
history  of  the  attack,  the  constitution  of  the  patient,  the  progress  of 
emaciation,  &c,  with  the  symptoms  to  be  heard  by  the  ear  after 
repeated  examinations,  ere  we  come  to  a  definite  conclusion  as  to  the 
exact  nature  of  the  complaint,  where  that  is  of  material  consequence ; 
but  as  regards  the  prognosis,  chronic  bronchitis,  with  purulent  expecto- 
ration, dilated  tubes  and  hectic  fever,  has  been  truly  considered  to  be 
nearly  as  formidable  and  serious  a  malady  as  phthisis  itself,  and  hence 
ultimate  recovery  almost  as  doubtful. 

As  this  is  a  disease  which  requires  a  long  and  judicious  treatment 
for  its  removal,  I  shall  merely  confine  myself  to  the  enumeration  of 
the  remedies  hitherto  found  most  useful  in  cases  of  this  nature. 

These  are  Sulphur,  Calcarea  carbonica,  Carbo  vegetabilis, .  Pulsatilla, 
Hepar  sulphuris,  Phosphorus,  Stannum,  Sepia,  Lycopodium,  Kali  c, 
Natrum  carbonicum,  Natrum  muriaticum,  Baryta  c,  Lachesis,  Causticum, 
Arsenicum,  Silicea,  Staphysagria,  Acidum  nitricum,  and  Conium  mam- 
latum. 

See,  however,  the  article  Cough,  where  indications  for  the  selection 
of  most  of  the  above  remedies  will  be  met  with. 


INFLAMMATION  OF  THE  LUNGS. 
Pneumonia  vera,  Peripneumonia,  Pneumonitis,  Pulmonitis. 

This  disorder  consists  in  an  inflammation  of  the  parenchyma  of 
the  lungs. 

Diagnosis.  Rigor,  followed  by  heat ;  dyspnoea;  respiration  short 
and  hurried ;  cough,  short,  continuous,  and  distressing,  dry  at  the 
commencement,  afterwards  attended  with  scanty  expectoration  of 
viscid,  lumpy,  and  extremely  tenacious  or  glutinous  mucus,  of  various 

*  A  peculiar  fetor  of  the  sputa  is  deemed  by  M.  Louis  as  a  characteristic  indication  of  a 
dilated  state  of  the  tubes. 


INFLAMMATION  OF  THE  LUNGS.  277 

shades  of  colour,  but  generally  of  a  dingy,  brick-red,  or  rusty  hue,* 
when  the  proportion  of  colouring  matter  is  greater.  The  cough  is 
invariably  excited  or  aggravated  by  every  deep  inspiration,  or  on 
every  attempt  to  speak ;  the  speech  is  interrupted,  or  there  is  a 
pause  after  every  articulation ;  the  respiration  is  abdominal ;  a  dull 
pain  is  occasionally  felt  in  the  chest,  but  more  frequently  rather  a 
tightness  than  pain ;  the  pulse  is  variable,  sometimes  not  beyond  the 
normal  standard,  but  more  generally  full,  strong,  and  quick  at  the 
commencement,  or,  when  the  inflammation  runs  high,  hard,  wiry, 
and  greatly  accelerated  ;  the  tongue  parched  and  dark-coloured.  The 
fever  is  usually  of  the  inflammatory  type,  but  is  sometimes  typhoid. 
The  patient,  particularly  in  severe  attacks,  lies  upon  his  back. 

In  the  first  stagef  of  many  cases,  when  not  marked  by  complica- 
tion with  bronchitis,  on  application  of  the  stethoscope,  or  the  ear  to 
the  chest,  the  crepitous  rale  may  be  heard ;  but  the  sound  on  per- 
cussion may  appear  to  be  only  slightly  impaired.  As  the  inflam- 
mation gains  ground,  and  the  substance  of  the  lung  becomes  altered 
in  structure  (second  stage  or  that  of  hepatization),  bronchial  or  tubular 
respiration  is  perceptible,  with  louder  respiratory  murmur  than 
natural,  in  the  sound  parts  of  the  lung,  particularly  in  severe  attacks  ; 
also  bronchophony  may  be  present,  andthe  tone  elicited  by  percussion, 
(excepting  when  the  inflammation  is  restricted  to  a  small  central  spot 
in  the  parenchymatous  substance,)  more  or  less  dull  according  to 
the  seat  of  the  structural  derangement,  but  rarely  so  complete  or 
extensive  as  in  pleuritis  with  copious  liquid  effusion. 

In  the  third,  or  suppurative  stage  of  the  disorder,  the  sound  on 
percussion  becomes  more  dull,  the  tubular  respiration  and  vocal 
resonance  commonly  disappear  (a  gurgling  mucous  rale  is  occasionally 
substituted,  denoting  the  existence  of  a  fluid  in  the  larger  bronchi), 
and  the  expectoration  becomes  muco-purulent  or  converted  into  a 
brown  serous  fluid.  Slight  shiverings  generally  attend  the  invasion 
of  suppuration,  and  the  pain,  or  sense  of  fulness  or  tightness  becomes 
abated  ;  the  patient  is,  moreover,  commonly  enabled  to  lie  on  the 
side  which  was  affected,  without  much  inconvenience. 

If  the  disease  be  not  checked  in  the  second  stage,  the  face  becomes 
patched  with  red,  and  sometimes  livid,  and  is  of  considerable  extent, 

*  This  rusty  or  sanguinolent  hue  is  intimately  combined,  not  in  streaks.  It  appears 
usually  about  the  second  or  third  day,  and  is  a  characteristic  indication  of  the  presence  of 
the  disease  in  question  ;  at  the  same  time  it  must  be  borne  in  mind,  that  its  absence  is  by 
no  means  a  certain  criterion  of  the  non-existence  of  inflammation  of  the  lungs. 

f  That  of  simple  inflammatory  injection  or  engorgement. 


278  INSPIRATORY  SYSTEM. 

the  vessels  of  the  neck  swollen  and  turgid,  the  pulse  weak  and 
irregular,  and  the  patient  is  deprived  of  life  by  the  obstruction  which 
is  offered  to  the  circulation  in  the  lungs.  In  the  third  stage  the 
pulse  becomes  weak  and  thready,  and  the  strength  commonly  sinks 
rapidly;  but  a  fatal  result  is  often  averted  by  proper  homoeopathic 
treatment.  When  an  abscess  forms  in  the  solidified  lung,  a  cavernous 
or  gurgling  rhonchus  will  be  heard,  as  the  air  passes  through  the 
pus ;  and  pectoriloquy  with  cavernous  respiration  will  supervene, — 
when  the  cavity  has  been  emptied  of  the  fluid  by  expectoration. 

Such  are  the  general  symptoms  of  pure  Pneumonia,  but  in  severe 
cases  it  is  often  found  combined  with  pleurisy,  in  which  case  the 
pains  of  the  chest  are  intense,  and  mostly  of  an  acute  shooting  cha- 
racter. Another  and  still  more  frequent  complication  is  formed  with 
bronchitis.  When  pneumonia  terminates  by  resolution,  some  striking 
evacuation  frequently  attends  it,  such  as  a  very  free  and  abundant 
expectoration  of  thick  white  or  yellow  matter,  often  slightly  streaked 
with  blood ;  or  a  profuse  and  general  sweat ;  diarrhoea ;  a  profuse 
discharge  of  urine,  with  a  copious  sediment ;  or  an  attack  of  epistaxis. 

If  no  hepatization  have  taken  place,  the  crepitous  rale,  at  first 
audible,  becomes  gradually  less  perceptible,  and  the  natural  respira- 
tion is  heard,  till  at  last  the  former  wholly  disappears ;  if  the  lung 
have  already  partly  solidified,  but  the  disease  is  approaching  a  cure, 
the  crepitous  rale  is  first  heard,  then  gradually  yields  to  the  natural 
respiration  ;  in  fact,  the  disease,  so  to  speak,  runs  its  course  back  again. 

Therapeutics.  Aconitum,  Bryonia  alha,  phosphorus ',  Tartarus  emeticus, 
Tinctura  sulplmris,  Rhus  toxicodendron ,  Belladonna,  &c. 

Aconite.  In  the  stage  of  simple  inflammatory  congestion,  with 
severe  inflammatory  fever,  whether  or  not  accompanied  or  followed 
by  severe  shooting  pains  in  the  chest,  this  remedy  is  unquestionably 
of  great  service. 

Form  of  prescription,  the  same  as  in  Inflammatory  Fever. 

Bryonia  is  frequently  the  best  remedy  to  follow  Aconite,  when 
the  more  severe  febrile  symptoms  have  been  lowered  by  that  medicine. 
But  Belladonna*  is  generally  required  before  Bryonia,  when  the  fever 

*  When  Aconitum  does  not  effect  the  desired  amendment,  Belladonna  is  generally  of 
greater  service  than  Bryonia  in  pulmonic  inflammation.  Again,  if  Aconitum  produces  only 
a  slight  degree  of  improvement  when  prescribed  at  the  third  or  sixtn  dilution,  the  employ- 
ment of  a  higher  attenuation,  such  as  the  twelfth  or  twenty-fourth,  is  often  followed  by  the 
happiest  success.  I  consider  Aconitum,  Belladonna,  and  Phosphorus  to  be  the  most  impor- 
tant remedies  in  pneumonia. — Rummell.  Allg.  Horn.  Zeit.    No.  21.    32ster  Bd. 


INFLAMMATION  OF  THE  LUNGS.  279 

returns  after  having  been  apparently  subdued  by  Aconitum,  and  the 
difficulty  of  breathing,  and  pain,  or  feeling  of  uneasiness  in  the  chest 
continue  (particularly  when  the  pain  experienced  seems  more  at  the 
sternum),  the  sputa  tinged   with, blood,  and  difficult  to  expectorate, 
the  cheeks  flushed,  lips  and  tongue  dry  and  parched,  the  skin  hot, 
and  the  thirst  incessant.     In  young  plethoric  subjects,  Aconitum  and 
Belladonna  may  be  given,  in  rapid  alternation,  with  the  most  satis- 
factory results  during  the  first  or  congestive  stage.     In  such  cases 
indeed  the  further  progress  of  the  disease  is  not  unfrequently  arrested, 
or  at  all  events  such  a  degree  of  improvement  is  effected,  that  any 
remaining  symptoms,  such  as  some  degree  of  oppression,  expectora- 
tion of  viscid  sputa,  with  little   or  no  dullness  of  percussion  or  other 
signs  of  hepatization,  readily  yield  to  the  employment  of  Bryonia* 
Bryonia  may,  however,  be  prescribed  at  the  commencement,  when 
the    following    indications    present     themselves : — cough,    attended 
with  expectoration  of  viscid    or  tenacious  mucus,  of  a  brick-dust 
colour,  oppression  at  the  chest  accompanied  by  acute  shooting  pain, 
or  rheumatic  pains  in   the  pleura,  and  pectoral  muscles,  or  in  the 
extremities,  with  increase  of  pain  on  movement ;  foul  tongue,  consti- 
pation, and  other  signs  of  gastric  derangement.     A  complication  with 
pleurisy  (pneumo-pleuritis),  indicated  by  increased  dullness  on  per- 
cussion, and   in    some   instances  a  double-sounding  voice,  central 
bronchial  respiration,  and  bronchophony,  is  often  an  additional  reason 
for  the  selection  of  this  remedy.     (See  also  Pleuritis.) 

R  Tinct.  Bryon.  alb,  3,  gtt.  iij. 
Aq.  pur.  3  iij. 
Dose.     A  dessert-spoonful  every  four,   six,  or  eight  hours,   according 
to  the  severity  of  the  case.* 

PHOSPHORUS.f  This  remedy  has  been  lately  almost  exclusively 
employed  by  Dr.  Fleischmann,  of  Vienna,  in  almost  every  stage  of 
pneumonia,  under  whatever  form  it  may  present  itself,  and  with  the 
most  marked  success,  even  when  extreme  hepatization  has  taken  place. 
Although  the  homoeopathic  treatment  hitherto  adopted  with  Aconitum, 
Bryonia,  Merc,  Sulpk.,  &c,  has  proved  eminently  successful,  yet  this 
remedy,  which  seems  to  have  such  a  specific  influence  over  this  serious 
disease,  deserves  a  more  extensive  trial :  at  the  same  time  we  cannot 
too   strongly   reprobate   the   impropriety   of  blindly   selecting   this 

*  Vide  "  Rules  for  the  repetition  of  the  dose,"  in  the  Introduction. 

+  I  have  cured  some  of  the  most  desperate  cases  of  pneumonia  by  means  of  Phosphorus, 
although  prescribed  only  in  the  form  of  globules,  but  always  at  low  potencies,  (3—6.) — 
Kummell,  Allg.  Horn.  Zeit.  No.  21.  32ster  Band. 


280  RESPIRATORY  SYSTEM. 

remedy,  when  others,  such  as  Bryonia,  Tartarus,  Sulphur,  &c,  may, 
on  a  careful  comparison  of  the  symptoms,  be  found  better  indicated ; 
or  of  persevering  in  its  employment,  in  cases  where  no  signs  of  im- 
provement have  set  in,  after  we  have  allowed  a  sufficiency  of  time  to 
elapse  to  admit  of  the  manifestation  of  its  favorable  action. 

R  Tinct.  Phosph.  3,  gtt.  vj. 
Aq.  destil.  Jij. 
Dose.     One  dessert-spoonful  every  four  hours,  lengthening  the  inter- 
vals according  to  the  effects  produced. 

Tartarus  emeticus  s.  stibiatus  has  been  chiefly  recommended 
as  valuable  in  promoting  resolution  after  hepatization  has  taken  place 
(which  is  indicated  by  the  greater  or  less  degree  of  dullness  on  per- 
cussion, the  bronchial  or  tubular  respiration,  and  the  peculiar  pectoral 
sounds  given  by  the  voice.  Oppression  at  the  chest,  laborious 
respiration,  no  expectoration,  or  expectoration  of  mucus  (untinged 
with  blood)  chiefly  during  the  night ;  or,  mucus  rattling  in  the  chest 
with  temporary  diminution  of  the  obstructed  respiration  after  ex- 
pectorating the  sputa  detached  by  the  cough,  appear  to  be  the 
principal  general  indications  for  the  selection  of  Tartarus  emeticus.* 

R  Tart,  stibiat.  3,  gr.  iv. 
Aq.  dest.  ^iij. 
Dose.     A  dessert-spoonful  three  times  a  day. 

Tinctura  sulphuris  may  deserve  a  preference  to  the  last-men- 
tioned remedy  in  similar  cases,  when  they  occur  in  strumous  habits, 
also  where  hepatization  has  advanced  to  some  extent,  and  where 
Phosphorus,  or  other  remedies,  may  have  only  effected  a  degree  of 
improvement ;  also  where  there  is  complication  with  pleurisy,  and 
obstinate  constipation. 

R  Tinct.  Sulph.  3,  gtt.  iij. 
Aq.  dest.  Jij. 
Dose.     A  dessert- spoonful  every  six  to  twelve  hours,  according  to  cir- 
cumstances ;  if  amendment  ensues,   the  medicine  should  be  allowed  to 
continue  its  action  undisturbed,  as  long  as  the  improvement  continues. 

*  Bosch,  in  his  remarks  on  the  treatment  of  pneumonia,  states,  that  although  the  fever 
may  have  abated  under  the  employment  of  Aeon.,  Bella.,  or  Bryon.,  whenever  the  oppression 
at  the  chest  and  anxiety  continue  or  increase,  the  pulse  at  the  same  time  becoming  small, 
soft,  and  irregular,  and  auscultation  clearly  indicating  the  establishment  of  hepatization,  he 
resorts  to  Tartarus  stibiatus,  and  with  such  striking  success,  as  cannot  be  surpassed  by  any 
remedy,  not  even  by  Phosphorous.  The  latter  he  always  considered  called  for  when  solidifi- 
cation had  made  some  progress,  and  was  accompanied  by  signs  of  incipient  paralysis  of  the 
lungs  ;  symptoms  which  are  prone  to  threaten  even  in  the  first  stage  of  pneumonia,  when 
the  disease  occurs  in  old  people,  especially  those  who  are  subject  to  asthma,  or  have  been 
affected  with  chronic  mucous  (pituitous)  coughs. — Hygea,  XX  Band,  4  Heft. 


INFLAMMATION  OF  THE   LUNGS.  281 

Bromium  and  Nitrum,  particularly  the  former,  promise  to  be  of  as 
much  importance  as  Phosphorus  in  so-called  complicated  cases  of 
pneumonia,  and  where  there  is  incipient  hepatization.* 

In  obstinate  or  chronic  cases,  with  weak,  thread-like  pulse  and 
clammy  sweats,  Lachesis.  and  Lycopodmm  have  been  found  very  useful 
after,  or  in  alternation  with,  Sulphur,  Kali  n.,  &c.  Carb.  v.  and 
Am.  m.  have  also  been  suggested  as  likely  to  be  of  service  in  some 
cases  of  the  foregoing  description. 

The  preceding  are  the  principal  remedies  used  in  the  majority  of 
cases  of  this  disease ;  but  the  following  have  likewise  been  found 
excellent  auxiliaries  in  some  instances,  and  merit  attention. 

Acidum  nitricum  has  been  of  service  in  some  cases,  where,  after 
Aconite,  a  cessation  of  pain  has  taken  place  with  increase  of  fever. 

Squilla  has  been  recommended  as  useful  in  forwarding  the  crisis : 
further,  in  pneumonia  accompanied  with  gastric  symptoms,  and 
where  the  expectoration  is  copious,  or  in  cases  which  had  previously 
been  treated  by  venesection,  and  China  has  not  proved  sufficient  to 
rouse  the  sinking  energies  of  the  patient. 

Mercurius,  when  the  fever  has  been  lowered  by  the  employment 
of  Aconite,  but  pain  and  difficulty  of  breathing  remain,  or  copious 
nocUirnal  sweats,  exhaust  the  patient's  strength,  and  the  pulse  is  small 
and  quick ;  also  where  there  is  prominent  bronchitic  complication. 
In  the  latter  instance  Capsictcm,  Nux  v.,  Pulsatilla,  and  Bryonia,  have 
also  proved  efficacious :  Capsicum  particularly  in  the  case  of  phleg- 
matic subjects ;  Nux  v.,  alternately  with  Phosphorus,  especially  in  the 
case  of  drunkards ;  and  Pulsatilla  in  chlorotic  females.  The  indica- 
tions for  Bryonia  have  already  been  given.  Cannabis  has  also  been 
found  useful  in  this  frequent  complication,  and,  moreover,  in  one  or 
two  cases  where  there  was  disease  of  the  heart  and  large  vessels,  writh 
greenish  vomiting  and  delirium.t 

Arnica — against  effusion  into  the  air-passages,  with  local  con- 
gestions and  hemoptysis,  {pulmonary  hemorrhage  or  apoplexy  of  the 
kings,) 

Rhus  toxicodendron  may  be  found  serviceable  in  the  congestive  stage 
of  pneumonia,  when  we  meet  with  extreme  restlessness,  anxiety,  palpi- 
tation of  the  heart,  and  excessive  redness  of  the  face.     But   should 

*  Neues  Arch.,  Zw.  Bd.,  Drit.  Heft,  p.  113. 

t  Cannabis  is  sometimes  useful  in  pneumonia,  when  the  oppression  and  dyspnoea  is  greater 
than  the  other  symptoms,  such  as  the  state  of  the  pulse,  etc.,  would  lead  us  to  anticipate.— 
Rummell.. 


282  RESPIRATORY  SYSTEM. 

diarrhoea  supervene,  accompanied  by  clammy  sweats  and  great  fre- 
quency of  pulse,  Arsenicum  will  generally  be  required. 

Banguinaria  canadensis.  This  important  medicament  is  considered 
by  Constantine  Hering  as  likely  to  prove  a  valuable  remedy  in 
certain  cases  of  pneumonia.  Cantharides  seems  calculated  to  prove 
serviceable  in  pneumo-pleuritis. 

When  the  inflammatory  symptoms  have  been  subdued,  but  the 
expectoration  presents  a  muco-purulent  appearance,  and  there  is 
great  prostration  with  nocturnal  sweats,  Lycopodium  has  been  found 
very  efficacious.  When  the  disease  has  gone  on  to  the  third  stage, 
announced  by  attacks  of  shivering  succeeded  by  heat,  and  other 
signs  of  suppurative  fever,  together  with  the,  physical  changes  already 
mentioned,— Sulphur,  Lycopodmm,  and  Kali  c,  form,  along  with  others, 
such  as  Merc,  Hepar,  China,  &c,  the  principal  remedies  by  means  of 
which  we  may  entertain  some  hope  of  averting  a  fatal  issue. 

Lachesis  has  proved  beneficial,  sometimes  in  alternation  with  Ar- 
senicum and  Cinchona,  in  those  almost  desperate  cases  which  threaten 
to  turn  to  gangrene  of  the  lungs,  (with  fetid  breath  and  sputa.) 

Phosphorus,  Kali,  and  Lycopodium  are  efficacious  remedies  in  pneu- 
monia occurring  in  phthisical  subjects.  When  there  exists  a  tendency 
to  suffer  from  inflammatory  injection  in  the  chest,  whenever  an 
easterly  wind  prevails,  Aconitum  and  Belladonna  {Bryonia  ?)  have  been 
recommended  as  prophylactic  remedies.  The  state  of  the  digestive 
functions  ought,  at  the  same  time,  to  be  attended  to.  But  when 
this  predisposition  arises  in  consequence  of  an  attack  of  pneumonia, 
which  had  degenerated  into  the  chronic  form,  and  left  certain  portions 
of  the  lung  in  an  indurated  state,  with  more  or  less  bronchial  voice- 
and  breath-sounds  at  the  seat  of  the  previous  inflammation,  such 
remedies  as  Stilph.,  Lachesis,  Phosph.,  and  Lycopoch,  must  be  resorted  to. 

Ere  we  conclude  this  chapter,  we  trust  we  shall  be  excused  for 
introducing  the  following  somewhat  diffuse  but  important  remarks 
of  Dr.  C.  M  tiller,*  on  the  employment  of  Tartarus  emeticus  and 
Phosphorus  in  pneumonia,  as  also  some  extracts  from  the  observations 
of  Dr.  H.  G.  Schneidert  and  Dr.  WatzkeJ  on  the  treatment  of  pneu- 
monic inflammation. 

"  The  information  to  be  gleaned  from  homoeopathic  authors,  as  to  the 
efficacy  of  Tartarus  emeticus  in   pulmonary  affections,   is   nearly  as 

*  Tartarus  emeticus  und  Phosphorus  in  Lungenentziindungen,  von  Dr.  CI.  Midler.    Allg. 
Horn.  Zeit.,  No.  4—5.  30  Bd. 
f  Ibid.    No.  1.    21  Bd.  %  Ibid.    No.  7.     21  Bd. 


INFLAMMATION  OF  THE  LUNGS.  283 

follows  :  Dr.  Wurm  (Hygea,  xii,  1,  p.  41)  recommends  it  in  pleuritis 
complicated  with  bronchitis,  when  the  expectoration  is  difficult. 

Dr.  Buchner  (Hygea,  xv,  6,  p.  509)  recommends  its  employment 
in  pneumonia  when  the  fever  and  the  typical  signs  have,  for  the 
most  part,  disappeared,  but  the  patient  is  affected  with  constant 
rattling  in  the  chest,  and  expectorates  large  confluent  masses ;  the 
expectoration  being,  at  the  same  time,  difficult,  the  respiration  op- 
pressive, the  chest  affected  with  a  burning  sensation  extending  to  the 
throat,  and  gastric  symptoms  predominating. 

An  anonymous  writer  (Horn.  Archiv,  xix,  2,  p.  31)  considers 
Tartarus  emeticus  the  only  specific  remedy  in  Pneumonia  gastrica,  and 
in  the  second  stage  of  pure  pneumonia. 

Dr.  Bosch  (Hygea,  xx,  4,  p.  304)  gives  several  detailed  cures  of 
pneumonia  by  means  of  emetic  tartar,  and  intimates  that  he  has 
always  found  it  useful  when,  on  the  abatement  of  the  symptoms  of 
inflammatory  fever,  the  oppression  at  the  chest  and  the  anxiety 
increased,  the  pulse  became  small,  soft,  and  frequently  unequal, 
and  the  physical  signs  afford  distinct  indications  of  hepatization, 
(dull-stroke  sound,  and  crepitation  or  bronchial  respiration.)  Dr. 
Kurtz  (Hygea,  v,  2,  p.  141)  holds  Tart.  emet.  to  be  a  really  specific 
remedy  only  in  the  stage  of  hepatization. 

The  following  pathogenetic  effects  of  Tart.  emet.  denote  its  action 
on  the  bronchi,  lungs,  and  pleura :  much  coughing,  and  sneezing 
violent,  tickling  in  the  air-passages,  which  provokes  cough;  loose 
night  cough;  mucous  rhonchus ;  cough  after  a  meal,  with  vomiting 
of  the  contents  of  the  stomach;  gasping  for  breath  at  the  commence- 
ment of  every  paroxysm  of  coughing  ;  burning  sensation  under  the 
sternum ;  continuous  violent,  rheumatic  pain  in  the  (left)  side  of  the 
thorax ;  fits  of  soreness  in  the  chest,  attended  with  hopeless  despair ; 
sensation  as  if  the  chest  were  lined  with  velvet;  short,  laborious 
breathing,  rendering  it  necessary  to  sit  up  in  bed, — relieved  after 
coughing  and  expectorating;  nocturnal  paroxysms  of  orthopncea; 
irregular  or  unequal,  intermittent  respiration  during  sleep ;  less  fre- 
quent inspiration;  interrupted  or  oppressed  breathing,  with  dys- 
phagia ;  unusual  oppression  at  the  chest. 

The  symptoms  which  have  been  attained  from  animals  that  have 
been  poisoned  by  Tartarus  emeticus  are  as  follows :  lungs  congested  and 
distinctly  inflamed,  and  in  a  state  of  splenization,  in  some  parts  even 
in  that  of  hepatization,  of  a  violet  colour,  and  deprived  of  crepitation. 
(Magendie — arising  from  the  injection  of  6 — 8  grs.  into  a  vein.  Orfil. 


284  RESPIRATORY  SYSTEM. 

Toxicologia,  Bd.  1,  p.  460) ;  lungs  materially  altered,  of  an  orange- 
yellow  or  violet-blue  colour,  increpitating,  gorged  with  dark  blood, 
and  of  dense  texture ;  inflammation  of  the  bronchial  tubes,  and,  to 
a  greater  extent,  of  the  lungs  also.  (Schropfer,  in  Christison's  c  Treatise 
on  Poisons/  p.  503,  from  1  scr.  injected  into  the  trachea  of  a  dog.) 
The  lungs  of  those  of  the  human  species  who  have  been  poisoned 
by  Tart,  emet.,  exhibit  black  discoloration  in  several  parts.  That 
emetic  tartar  exerts  a  specific  action  on  the  bronchi,  pleura,  and  lungs, 
and  that  the  alterations  which  it  is  capable  of  producing  on  these 
parts  correspond  to  those  which  are  commonly  and  intrinsically  met 
with  in  inflammatory  affections  of  these  organs,  there  cannot  be 
the  slightest  shade  of  doubt;  the  more  precise  indications  for  its 
application  are,  however,  less  determined. 

The  majority  of  physicians  (allopathic)  understood  the  multifarious 
recommendations  of  Tart.  emet.  in  the  sense  that  it  was  immaterial 
in  what  description  of  inflammation  in  the  chest  it  was  employed,  pro- 
vided only  the  affection  was  either  pneumonia  or  pleuritis ;  the 
solitary  question  on  which  they  were  not  united  was,  whether  blood 
should  be  abstracted  or  not  in  the  first  instance.  The  result  of  this 
summary  mode  of  proceeding  was  naturally  very  variable ;  and  it 
accordingly  happened  that,  whilst  one  party  spoke  in  the  most 
enthusiastic  terms  of  praise,  another  gave  a  depreciatory  opinion ; 
others,  again,  felt  that  the  sphere  of  its  efficacy  must  be  somewhat 
narrowed,  and  therefore  recommended  Tart.  emet.  in  those  instances 
of  pectoral  inflammation  in  which  it  was  uncertain  wThether  to  bleed 
or  not.  (Bersius,  Miguel,  and  others.)  A  similar  discrepancy  of 
opinion  arose  as  to  the  time  and  stage  of  the  disease  in  which  the 
remedy  was  more  appropriate ;  some  employed  it  at  the  very  com- 
mencement of  the  disorder,  others,  particularly  in  pleuritis,  only  when 
effusion  had  taken  place,  making  the  Tart.  emet.  a  sort  of  resolvent 
and  substitute  for  the  ordinary  mercurial  friction.  As  already  shown, 
the  homoeopathic  physicians  have,  upon  the  whole,  employed  Tart, 
emet.,  but  rarely  in  thoracic  inflammations,  and  that  more  apparently 
from  the  circumstance  that  they  conceived  they  possessed  sufficient 
resources  in  their  other  remedies,  or  because  they  attached  but  little 
credit  to  recommendations  emanating  from  allopathic  practitioners, 
rather  than  that  any  want  of  confidence  in  the  remedy  had  arisen 
from  established  trials.  No  homceopathist,  however,  ever  expected  to 
find  in  Tart.  emet.  a  never-failing  specific  in  pulmonic  inflammations. 
It  therefore  remains  for  us,  from  the  physiological  effects  of  this 


INFLAMMATION  OF  THE  LUNGS.  285 

remedy,  and  the  experience  which  has  been  derived  from  clinical 
observation,  to  consider  more  narrowly  those  symptoms  which,  when 
encountered  in  pulmonic  inflammation,  justify  us,  according  to 
homoeopathic  principles,  in  selecting  emetic  tartar  as  an  appropriate 
remedy.  In  the  first  place,  then,  as  regards  the  painful  sensations 
which  Tart.  emet.  is  capable  of  exciting  in  the  chest,  we  find 
only  a  single  symptom:  violent  fixed  rheumatic  pain  in  the  (left) 
side  of  the  thorax.  Now,  we  know^  that  in  pneumonia  the  pain  is 
commonly  either  very  trivial  or  altogether  absent,  from  the  circum- 
stance that  the  parenchymatous  substance  of  the  lungs  is  but  little 
qualified  to  give  rise  to  painful  sensations.  With  the  serous  covering 
of  the  lungs,  howrever,  it  is  far  otherwise  ;  for  if  the  pleura  be  affected, 
and  particularly  when  inflamed,  acute  pain  is  always  present,  but 
this  pain  is  almost  constantly  of  a  shooting  or  cutting  description  (as 
is  for  the  most  part  the  case  in  all  serous  membranes),  and  conse- 
quently not  continual  or  incessant,  but  intermitting,  excited  by 
movement,  breathing,  &c.  As  the  above-mentioned  pain  is,  strictly 
speaking,  the  only  one  that  is  proper  to  Tart,  emet.,  it  therefore  follows 
that  its  applicability  in  pleuritis,  at  least  in  the  first  two  stages  of 
that  complaint,  is  untenable. 

Concerning  the  phrase  "  rheumatic  pain,"  there  is  some  difficulty 
in  finding  a  positive  definition  :  if  employed  to  designate  the  chang- 
ing or  erratic  nature  of  the  pain,  it  contradicts  the  succeeding  term 
"  fixed ;"  if,  on  the  other  hand,  the  expression  is  received  in  the 
sense  in  which,  in  popular  language,  it  is  commonly  employed  in  refer- 
ence to  pains  arising  from  exposure  to  cold,  such  a  signification 
ought  not  to  find  place  in  a  scientific  (homoeopathic)  work ;  most 
probably,  therefore,  it  is  intended  to  be  implied  that  the  pain  has  its 
seat  in  the  pectoral  muscles,  inasmuch  as  rheumatic  affections  are 
especially  seated  in  fibrous  structures.  Consequently,  although 
Peschier  regarded  pricking  or  darting  pains  in  the  chest  as  an  espe- 
cial indication  for  Tart.  emet.  in  pleurisy,  his  opinion  would  seem  to 
be  unjustifiable,  since  the  aforesaid  pains  counter-indicate  the 
employment  of  this  remedy.  The  paucity  of  painful  pectoral  symp- 
toms speaks  much  more  in  favour  of  the  application  of  Tart.  emet.  in 
pneumonia. 

The  following  three  symptoms  ought  to  be  taken  into  consideration 
here :  sensation  as  if  the  chest  were  lined  with  velvet ;  soreness  or 
pain  as  from  excoriation  in  the  chest,  occurring  in  paroxysms  ;  burn- 
ing sensations  behind  the  sternum,  evidently  arising  from  affections  of 


286  INSPIRATORY  SYSTEM. 

the  mucous  lining  of  the  bronchi,  and  their  ramifications ;  they 
therefore  denote  the  existence  of  common  catarrh,  or  of  the  catarrhal 
affection  which  always  accompanies  inflammation  of  the  lungs, 
and  do  not  correspond  to  pleurisy,  from  the  circumstance  that 
catarrhal  symptoms  more  rarely  attend  the  latter  affection.  The 
symptoms  of  abnormal  respiration  are  strongly  marked  :  short, 
oppressed  breathing,  rendering  it  necessary  for  the  patient  to  sit  up 
in  bed  ;  frequent  fits  of  unequal,  intermittent  respiration  during 
sleep  ;  extreme  pectoral  oppression ;  dyspnoea,  compelling  the  pa- 
tient to  sit  up,  meliorated  after  coughing  and  expectorating ;  noctur- 
nal attacks  of  orthopncea ;  respiratory  disturbance  with  dysphagia. 
When  we  compare  these  numerous  symptoms  with  those  which  the 
few  which  were  previously  mentioned  as  appertaining  to  Tart,  emet., 
it  wall  be  seen  that  they  predominate  so  much  over  the  latter,  as  to 
be  evidently  of  much  greater  importance,  and  correspond  particu- 
larly with  those  of  pneumonia,  for  in  that  affection,  as  is  well  known, 
the  oppression  and  disturbance  to  the  respiratory  functions  hold  a 
prominent  place,  and  the  remaining  symptoms  are  of  a  less  decided 
character.  The  symptoms  referring  to  the  expectoration  are  of  a 
less  satisfactory  nature ;  the  cough  is  certainly  chiefly  loose,  and  even 
accompanied  with  mucous  rhonchus,  but  with  regard  to  the  character 
of  the  sputa,  a  point  of  considerable  moment  in  inflammation  of  the 
lungs,  we  have  not  the  slightest  notification.  But  although  this 
deficiency  of  observation  is  much  to  be  regretted,  we  yet  may  reason- 
ably conclude  that  sanguineous  sputa  can  hardly  have  been  met  with 
either  during  the  provings  of  Tartarus,  or  in  *cases  of  poisoning 
therefrom,  otherwise,  so  important  a  symptom  would  most  assuredly 
have  been  recorded.  The  following  two  symptoms  may  also  be  said 
to  be  of  considerable  importance :  gasping  for  breath  at  the  com- 
mencement of  every  fit  of  coughing ;  and  dyspnoea,  diminished  after 
coughing  and  expectorating;  since  this  dependence  of  the  oppression 
on  the  accumulation  of  mucus  in  the  bronchi,  and  its  disappearance 
and  cessation  for  some  time  after  expectorating,  is  in  like  manner  to 
be  observed  in  certain  forms  of  pneumonia,  viz.  after  the  act  of 
coughing,  or  merely  by  expectoration,  the  bronchial  ramifications 
which  intercept  the  hepatized  portion  of  lung  may  be  cleared  of 
the  fluids  or  the  hard  substances  which  have  been  secreted,  or  the 
communication  between  the  bronchi  and  the  trachea,  which  had 
been  obstructed  by  mucus,  may  be  restored  by  the  aforesaid  means  ; 
which  fact  can  in  some  measure  be  accounted  for,  by  the  sudden 


INFLAMMATION  OE  THE  LUNGS.  287 

decrease  of  the  oppression  subsequent  to  expectorating,  and  also  by 
the  circumstance  that  bronchophony,  the  bronchial  respiration,  the 
simultaneous  rattling  rhonchi,  sibilus,  etc.,  previously  absent,  often 
follow  a  paroxysm  of  coughing.     (Vide  Scoda,  p.  251.) 

Had  any  doubt  remained  as  to  the  specific  relation  of  Tartarus  to 
the  lungs  and  pulmonic  inflammations,  it  would  have  been  uncon- 
ditionally removed  by  the  results  which  have  been  obtained  from 
post-mortem  examinations  after  cases  of  poisoning.  The  pheno- 
mena there  met  with  having  exhibited  the  greatest  possible  similarity 
to  those  which  are  found  after  pulmonic  inflammation.  The  symp- 
toms indicated  unequivocally  that  stage  of  pneumonia  in  which  the 
lung  or  a  portion  of  the  same,  after  previous  simple  engorgement 
with  blood  (engouement),  has  become  more  solid',  compact,  heavy,  and 
no  longer  possessed  crepitation ;  which  condition  has  been  named 
that  of  the  red  hepatization  by  most  authors,  and  ramollissement  rouge 
by  Andral. 

Taking  everything  into  consideration  therefore,  we  shall  find  that 
the  following  are  the  indications  for  Tartarus  emeticus :  it  is  particu- 
larly applicable  in  pneumonia,  and  especially  in  the  so-called  second 
stage,  when  little  or  no  pain,  but  an  extreme  degree  of  oppression 
and  obstructed  respiration,  is  encountered ;  when  there  is  a  loose 
cough  attended  with  mucous  rattling  and  considerable  expectoration, 
followed  by  melioration  of  the  pectoral  oppression ;  when  the  sputa 
contains  very  little  or  no  blood,  and  consists  chiefly  of  mucous 
masses ;  and  when  percussion  and  auscultation  demonstrate  that  a 
portion  of  the  lung  no  longer  contains  air,  and  is  consequently 
hepatized.  With  reference  to  the  said  physical  signs,  the  following 
particulars  may  be  determined  :  percussion  will  elicit  a  dull  sound 
over  a  greater  or  lesser  extent  of  surface,  with  increased  resistance, — 
but  it  may  also  yield  a  hollow  or  tubulous  tone  (viz.  when  the  subja- 
cent portion  of  lung  is  hepatized  throughout);  the  parts  of  the  chest 
immediately  adjacent  to  this  spot,  may  emit  a  tympanitic  sound, 
(when,  as  is  often  the  case,  the  portions  of  the  lung  bordering  on 
that  which  is  hepatized,  are  emphysematous,)  or,  like  the  remaining 
extent  of  the  lung,  the  usual  normal  sound.  Should  the  hepatized 
portion  be  very  small  in  circumference  and  diameter,  the  percussion- 
sound  would  again  be  normal,  but  this  is  naturally  of  rare  occurrence. 
Auscultation,  over  the  spot  where  the  stroke-sound  was  dull,  will 
afford  more  or  less  distinct  bronchophony  (when,  namely,  the  hepa- 
tized portion   is   sufficiently  large  to    embrace   one  of    the   larger 


288  RESPIRATORY  SYSTEM. 

bronchial  ramifications,  and  the  latter  is  not  filled  with  fluid,  or  a 
dense  exudation,  or  a  coagulum  of  blood,  and  the  communication 
with  the  trachea  thereby  intercepted),  and,  further,  bronchial  respira- 
tion and  consonant  rattling,  or  one  or  the  other.  The  presence  of 
bronchophony  does  not,  however,  necessarily  imply  the  existence  of 
bronchial  respiration  or  consonant  sibilus,  or  rhonchi,  and  vice  versa, 
bronchophony  is  not  always  heard  when  bronchial  respiration  is 
present ;  these  signs  are  sometimes  only  perceptible  after  the  act  of 
expectoration,  as  has  been  stated  above.  At  those  parts  of  the 
thorax  where  the  lung  is  not  hepatized,  auscultation  will  detect  weak, 
vesicular,  or  puerile  respiration,  or  indefinite  respiration,  and  various 
kinds  of  rhonchi.  It  must  yet  be  observed  that  the  cited  physical 
signs  remain  the  same  in  the  third  stage  of  pneumonia,  the  so-called 
gray  hepatization,  hepatisation  grise,  ramollisement  gris  (in  which  Tart, 
emet.  is  inapplicable,  at  least  the  symptoms  do  not  indicate  it)  :  but 
this  conversion  of  the  effused  lymph  in  the  hepatized  lung  into 
purulent  matter  will  not  be  readily  mistaken  or  confounded,  because 
the  accompanying  group  of  characteristic  general  symptoms  would 
lead  sooner  to  the  selection  of  Phosph.,  Ars.,  RJms,  Lachesis,  &c,  than 
to  Tart,  emet.,  which  has  either  none  or  but  a  limited  number  of  the 
said  symptoms. 

It  now  remains  to  be  ascertained  whether,  in  addition  to  the  symp- 
toms which  have  already  been  notified,  there  are  any  peculiar  general 
indications  for  the  employment  of  Tart.  emet.  According  to  the  usual 
opinions,,  derived  from  theory  and  practice,  it  is  in  pneumonia  attended 
with  gastric  or  bilious  derangement,  the  so-called  pneumonia  biliosa 
{erysipelas pulmonum)  that  emetic  tartar  is  particularly  appropriate.  The 
characteristic  marks  which  distinguish  the  said  form  of  pneumonia 
from  the  common  species  are,  the  light  bilious  discoloration  of  the 
skin,  and  especially  of  the  albuginea,  alae  nasi,  and  corners  of  the 
mouth;  further,  the  coating  of  the  tongue,  merging  from  light  yellow 
into  a  brownish  colour,  the  bitter  taste,  nausea,  or  vomiting,  the 
brownish-yellow  bilious  urine,  (the  blood  drawn  by  venesection  is  also 
stated  to  exhibit  instantaneously  a  saffron-yellow  colour  under  the 
test  of  nitric  acid.)  Along  with  the  foregoing,  a  lancinating  pain  is 
commonly  experienced  under  the  right  false  ribs,  or  pain  and  dis- 
tension are  complained  of  in  the  scrobiculus,  with  frequent  eructa- 
tion and  hiccough ;  moreover,  a  peculiar  pressive,  severe  piercing 
pain  is  centered  in  the  forehead,  which  sometimes  gives  place  towards 
evening  to  violent  delirium  ;    frothy  mucus  of  a  saffron-yellow  or 


PNEUMONIA,  289 

greenish  hue,  rarely  combined  with  blood,  is  ejected  after  the  fits  of 
coughing,  which  are  often  accompanied  by  vomiting. 

Amongst  the  pathogenetic  symptoms  of  Tart.  emet.  will  certainly 
be  found  the  majority,  but  not  the  whole,  of  those  above  given. 
The  fellow  colour  of  the  skin,  for  instance,  as  also  the  brownish- 
yellow  coating  of  the  tongue  and  the  bitter  taste  are  wanting ;  it 
must  be  admitted,  however,  that  even  in  pneumonia  biliosa,  the 
bilious  aspect  of  the  skin  is  only  occasionally  a  well-marked  symp- 
tom. On  the  other  hand,  the  distension  and  sensibility  of  the 
epigastrium  and  hypochondria,  together  with  the  eructations,  hic- 
cough, and  vomiting,  the  dark  reddish-brown  coloured,  cloudy  urine, 
the  pressive  frontal  headache,  and  the  cough  with  vomiting,  are  well 
determined  symptoms  of  Emet.  tart. ;  concerning  the  sputa,  as  has 
already  been  observed,  wTe  are  in  the  possession  of  no  positive  testi- 
mony. It  therefore  follows  that  Tartarus  (as  also  Senega,  Mere.,  or 
Nux  v.)  may  without  doubt  be  deemed  a  useful  remedy  in  pneumonia 
associated  with  so-called  bilious  and  gastric  states ;  but  to  maintain 
that  it  alone  corresponds  to  pneumonia  with  such  complications  is 
unjustifiable. 

Phosphorus.   The  experience  of  homceopathists  as  to  the  efficacy 
of  Phosphorus  in  inflammations  of  the  respiratory  organs,  is  more 
extensive  ;    the   observations  detailed  thereon,  in    various    journals 
and  essays,  are  so  numerous  that  we  shall  here  quote  merely  a  selec- 
tion of  the  most  appropriate  and  authentic  amongst  them. 

Dr.  Wurm  (Hygea,  xii,  1,  p.  38,  and  ix,  1,  p.  55)  recommends 
it  inpleuritis  and  pneumonia,  in  connexion  with  tuberculosis  pulmonum  ; 
as  also  in  complications  of  pleuritis  with  pneumonia  or  bronchitis. 
Dr.  G.  Schmidt  expresses  himself  in  accordance  with  the  foregoing. 
(Hygea,  iv,  p.  68.) 

Dr.  Griesselich  (Hygea,  xiii,  6,  p.  528)  cured  a  case  of  pleuro- 
pneumonia by  Phosphorus  which  had  continued  to  gain  ground  not- 
withstanding the  employment  of  Aeon.,  Bryonia,  Mosch.,  and  Arnica, 
w7hen,  in  consequence  of  the  existence  of  muttering  delirium  and 
carpologia,  paroxysms  of  threatening  suffocation,  extremely  laborious 
respiration,  critical  debility,  small,  quick  pulse,  paralysis  of  the  lungs 
was  momentarily  to  be  dreaded ;  in  the  right  lung  there  was  no 
longer  any  respiratory  murmur,  but  loud  rubbing  sound  was  distinctly 
audible.  Very  shortly  after  the  administration  of  Phosphorus  ex- 
pectoration set  in,  and  the  breathing  became  freer,  so  that  after 

19 


290  RESPIRATORY  SYSTEM. 

twenty-four  hours  incipient  slight  respiratory  murmur,  pectoriloquy, 
cegophony  became  audible,  and  recovery  followed  soon  afterwards. 

Dr.  Buchner  (Hygea,  xv,  6,  p.  507)  recommends  Phosphorus  where 
great  prostration,  paleness  of  face,  dimness  of  the  eyes,  powerless, 
dry  cough,  particularly  at  night,  are  encountered ;  further,  when  the 
following  state  of  matters  is  met  with :  difficult  expectoration  from 
exhaustion,  burning,  darting,  rattling  in  the  chest,  danger  of  paralysis 
of  the  lungs,  complication  with  bronchitis,  imperfect  crisis  from 
depressed  physical  power. 

Dr.  Horner  (Archiv,  xx,  1,  p»  118)  found  Phosphorus  curative  in 
an  extremely  severe  case  of  peripneumony,  in  which,  after  the  em- 
ployment of  Aconitum  and  Bryonia,  exhausting  epistaxis,  subsultus 
tendinum,  delirium  furibundum  and  involuntary  stools  had  super- 
vened. 

Schellhammer  (Archiv,  xx,  3,  p.  120)  found  benefit  still  to  arise 
from  the  employment  of  Phosphorus  in  neglected  pulmonic  inflam- 
mations, where  there  was  coldness  of  the  breath,  cold,  clammy 
sweats,  tremulous,  scarcely  perceptible  pulse,  rusty,  with  difficultly 
expectorated  sputa,  extreme  anxiety,  facies  hippocratica,  and  fre- 
quently such  absolute  dullness  of  tone  on  percussion,  that  it  seemed 
as  if  a  wall  were  struck  instead  of  the  chest. 

Dr.  Eichhorn  (Hygea,  xix,  1,  p.  31)  found  Phosphorus  particularly 
to  be  approved  of,  when  incipient  hepatization,  in  pure  and  (so-called) 
asthenic  pneumonia,  is  indicated,  in  addition  to  the  known  physical 
signs,  by  the  livid,  sharp  face,  cold  sweats,  small,  quick,  and  hard 
pulse,  frequent  cough,  with  frothy  or  brown  (sometimes  gelatinous  - 
looking)  sputa,  &c. ;  and  also  in  those  cases  of  typhus,  where,  not- 
withstanding the  pneumonic  concentration,  sensibility  to  the  touch, 
and  borborygmus  in  the  caecal  region  as  well  as  diarrhoea,  are  present. 

Dr.  Schneider  (A.  H.  Zeitung,  21  Bd.,  p.  4)  saw  greater  benefit 
from  Phosphorus  in  1839-40  than  from  any  other  remedy;  in  general 
he  also  found  this  remedy  indicated,  where  Aeon.,  Bryon.,  Merc,  had 
not  rendered  the  expected  relief  before  the  pneumonic  crisis ;  and  in 
neglected  cases  with  rattling  rhonchus  in  the  bronchi,  difficult 
purulent-looking,  copious  sputa,  and  great  debility. 

Dr.  Watzke  (A.  H.  Zeitung,  21  Bd.,  p.  109)  states  Phosphorus  to  be 
appropriate  in  the  second  stage  of  primary  pneumonic  croup ;  further, 
in  pneumonia  complicated  with  pleuritic  exudation,  or  with  bron- 
chitis. 


PNEUMONIA*  291 

The  most  decided  defender  of  Phosphorus  in  pneumonia*  is  Dr. 
Fleischmann ;  in  the  year  1840  he  employed  it  (Hyg.,  xiv,  4,  p.  358) 
exclusively  with  success  in  51  cases  of  inflammation  of  the  lungs, 
and  found  it  equally  useful  in  nearly  every  stage  of  the  disease ;  the 
same  striking  results  ensued  in  the  following  year,  (Hyg.,  xviii,  5, 
p.  468.)  The  physical  signs  were  almost  constantly  as  follows  :  dull- 
ness of  sound  on  percussion,  bronchial  respiration,  frequently  attended 
with  crepitation  or  rattling. 

Descriptions  of  cures  performed  by  means  of  Phosphorus  in  severe, 
partly  so-termed,  nervous  pulmonic  inflammations,  have  also  been 
given  by  Dr.  A.  Noack  (A.  H.  Zeit.,  21  Bd.  p.  321  ;)  Dr.  Bethmann 
( Annalen,  14  Bd.,  3  Stuck,  p.  459 ;)  Dr.  Hartlaub  (Annalen,  4  Bd., 
4  Stuck,  p.  459.) 

The  known  pathogenetic  symptoms  which  Phosphorus  exerts  upon  the 
organs  of  respiration  are  about  as  follow:  shooting  and  violent 
stiches  in  various  parts  of  the  thorax,  right  and  left  side,  sometimes 
with  burning  at  rest  and  during  movement,  especially  while  sitting 
and  during  respiration ;  pain  in  the  chest,  particularly  during  inspira- 
tion, itching  in  the  interior  of  the  chest  with  dry  cough.  Oppression 
at  the  chest;  precordial  anxiety  with  obstructed  respiration,  and 
throbbing  in  the  right  side  of  the  chest  ;  great  oppression  and  short- 
ness of  breath;  tightness  of  chest  as  if  caused  by  a  band;  tension 
and  dryness  in  the  chest;  constrictive  pressure  in  the  upper  part  of 
the  thorax ;  loud  rattling  respiration;  dry,  hollow  cough  without 
subsequent  expectoration  ;  hacking  cough,  with  a  suffocating  sensa- 
tion in  the  chest,  and  some  mucous  expectoration ;  cough  with  ex- 
pectoration of  transparent  mucus  accompanied  by  tensive  and  sub- 
sequently pricking  pain  in  the  chest ;  straining  cough  with  white, 
viscid  sputa,  which  is  difficult  to  loosen  or  detach  ;  streaks  of  blood 
in  the  mucous  sputa;  muco-purulent  sputa;  expectoration  of  blood 
with  mucus  during  a  short,  slight  cough ;  pricking  pain  in  the  scro- 
biculus  cordis  while  coughing,  rendering  it  necessary  to  support  the 
part  with  the  hand:  great  startness  after  each  fit  of  coughing. 

The  symptoms  which  have  been  obtained  from  the  dissection  of 
dogs,  which  had  been  poisoned  by  Phosphorus,  are  as  follows :  "  A 
few  minutes  after  the  introduction  of  a  solution  of  Phosphorus  in  oil 
into  the  jugular  vein,  the  dog  emitted,  at  each  respiration,  a 
voluminous  white  vapour,  which  contained  a  considerable  quantity 
of  phosphoric  acid,  and  died  soon  aftei*wards ;  on  dissection  the 
vessels  of  the  lungs  exhibited  a  state  of  obstruction  (hepatization.") 


292  RESPIRATORY  SYSTEM. 

(Magendie,  Experiences  pour  servir  a  Phistoire  de  la  transpiration 
pulmonaire,  1811,  p.  19.)     In  like  manner  Orfila  observed:     "The 
dog  soon  began   to  pant  and   breathe  with  extreme  difficulty,  and 
vomited  a  large  quantity  of  a.  bloody  serous-looking  substance.     At 
the  sectio  cadaveris,  the  lungs  presented  several  blue  patches  of  a 
dense  and  less  crepitating  texture  than  in  the  normal  state;  in  the 
remainder  of  their  extent  they  were  of  a  rose  colour.    In  another  dog 
the  lungs  were  found  red  and  congested,  and   did  not  crepitate/5 
(Orfil.  Toxicol.  Gener.,  Bd.  I,  p.  56.)     In  cases  of  poisoning  in  the 
human  subject,  the  inferior  lobes  were  of  firm  consistence  and  gorged 
with  venous  blood.  (Oesterreich.  Med.  Wochenschrift,  1843,  No.  39.) 
The  above-mentioned   symptoms   of  Phosphorus  are  characteristics, 
and  distinctly  correspond  to  the  appearances  which  are  commonly 
observed  in  certain  inflammations  of  the  lungs.     The  sensations  of 
pain  which  Phosphorus  is  capable  of  producing  consists,  for  the  most 
part,  of  stitches  and  shootings,  which  are  more  particularly  excited 
or  increased  by  respiration,   coughing,   and  movement.      Identical 
symptoms  are   met  with   in  pleuro-pneumony,  the  pain,  which  is 
almost  constantly  of  a  shooting  or  darting  description,  being,  in  the 
said  disease,  all  but  exclusively  experienced  during  a  deep  inspiration 
or  the  act  of  coughing.     The  symptoms  of  tightness  of  chest  and 
dyspnoea  form  a  prominent  feature  in  the  pathogenesy  of  Phosphorus, 
but  they  undergo  no  mitigation  from  the  acts  of  coughing  and  ex- 
pectorating, as  is  the  case  with  Tart.  emet. ;    on  the  contrary,  each 
paroxysm  of  coughing  is  productive  of  increased  difficulty  of  breath- 
ing.    The   cough  is  either  perfectly  dry  and  hollow,  or  it  is  loose, 
yet  straining,   fatiguing,  and   generally  productive  of  severe  pain ; 
the   sputa  consists   of  white,  transparent,   tenacious   mucus,  or  of 
mucus  intermingled  with   blood,  or   it   is  purulent.      The   results 
obtained  from  the  cases  of  poisoning,  and  post-mortem  examinations 
are  very  similar  to  those  detailed  under  Tart,  emet.^  i.  e.  the  lung  or 
a  portion  of  the  same  wras  firmer,  more  solid  and  impermeable,  and 
consequently  in  a  state  of  so-called  hepatization.     If,  from  the  fore- 
going, we  now  attempt  to  determine  the  kinds  of  pneumonia,  the  time 
and  stage  in  which  Phosphorus  is  appropriate,  it  is  requisite  in  the 
first  place  to  point  out  those   pulmonic  inflammations,   where   (in 
contradistinction  to  Tart,  emet.)  the  shooting  pectoral  pains,  as  well 
as  the  dyspnoea  and  the  respiratory  disturbances,  are  especially  excited 
and  aggravated  by  coughing   and  respiration, — and  these   are  the 
so-called  pleuro -pneumonic  inflammations  in  which   the   pleura  is 


PNEUMONIA.  293 

pretty  extensively  (for  perhaps  in  no  case  of  pneumonia  does  it  wholly- 
escape)  implicated^  and  more  particularly  in  the  second  stage  when 
mucus  or  sanguineous  mucus  is  expectorated,  and  the  physical  signs 
are  the  same  as  those  mentioned  under  Tart.  emet.>  viz.  dull  stroke- 
sound  and  bronchophony  or  bronchial  respiration,  and  perhaps  con- 
sonant rales.  So  far,  therefore,  it  would  seem  that  Phosphorus  cor- 
responds somewhat  closely  with  Tart.  emet.  in  its  sphere  of  action, 
differing  only  from  the  latter  in  certain  isolated  instances.  But  there 
yet  remains  a  group  of  symptoms  under  the  head  of  Phosphorus  which 
have  not  yet  been  taken  into  consideration,  and  in  reference  to  which 
the  sphere  of  action  of  Phosphorus  is  altered  and  considerably  extended, 
viz.  those  general  appearances,  which,  without  inducing  any  peculiar 
change  in  the  local  and  physical  symptoms,  sometimes  connect 
themselves  with  pneumonic  inflammations,  and  have  by  the  older 
physicians  been  denominated  nervous.  These  "  nervous"  appearances 
develop  themselves  probably  only  when  the  pulmonic  inflammation 
enters,  unchecked,  into  the  third  stage,  that  of  the  gray  hepatization 
(hepatisation  grise,  ramollisement  gris)  with  threatening  paralysis  of  the 
lungs;  and  perhaps  also  in  the  first  stage  of  those  inflammations 
which  occasionally  occupy  the  lungs  in  typhus.  When  pneumonia  is 
verging  on  the  third  stage,  the  purulent  infiltration  of  the  parenchyma, 
the  following  symptoms  chiefly  declare  themselves :  mental  depression, 
slight  delirium,  with  carphologia  and  subsultus  tendinum,  rapid 
prostration  of  strength,  cold,  clammy  sweats,  small,  feeble,  frequent 
pulse,  dim  eyes,  sunken  features,  dry  lips  and  tongue,  short,  laborious 
breathing,  oppression  and  anxiety,  tedious  cough  and  expectoration, 
frequently,  loose  and  involuntary  stools.  The  physical  symptoms,  as 
already  stated,  remain  the  same  as  in  the  second  stage,  excepting  that 
the  sound,  on  percussion,  becomes  perfectly  dull  and  deprived  of 
resonance  over  a  larger  surface,  and  the  respiratory  murmur,  at  that 
spot,  inaudible  or  extremely  faint.  The  expectoration  either  ceases 
altogether  or  consists  of  a  purulent  mucus  or  a  brown  serous  liquid. 
Nearly  the  whole  of  these  symptoms  are  also  to  be  found  amongst 
the  pathogenetic  properties  of  Phosphorus  ;  and  more  particularly  the 
delirium  with  carphologia,  the  sunken,  hippocratic  visage,  with 
deep-set  eyes,  dryness  of  the  lips  and  tongue  without  thirst,  the 
short  and  anxious  respiration,  with  slight,  tedious  cough  and  ex- 
pectoration, the  purulent  sputa,  clammy  sweat  with  coldness  of  the 
face,  small,  quick  pulse.  Hereunto  must  be  added  the  numerous  and, 
in  great  part,  authentic  clinical  observations  which  almost  unanimously 


294  RESPIRATORY  SYSTEM. 

recommend  Phosphorus  in  the  so-called  slow,  asthenic,  nervous  pneu- 
monic inflammations, — corroborated,  moreover,  by  the  testimony  of 
Dr.  Fleischmann,  whose  position  as  the  physician  to  an  hospital  gives 
additional  weight  to  his  evidence.  It  consequently  follows  that 
Phosphorus,  according  to  homoeopathic  principles,  must  prove  valuable 
at  the  commencement  of  the  third  stage,  with  so-called  nervous  symp- 
toms and  threatening  paralysis  of  the  lungs,  as  well  as  in  the  second 
stage.  On  comparing,  therefore,  its  sphere  of  action  with  that  of 
emetic  tartar  it  will  be  seen,  in  addition  to  the  distinctive  marks 
already  given,  that  the  field  embraced  by  Phosphorus  is  greater  than 
that  of  Tart,  emet.,  and  that  the  former  may  be  advantageously  em- 
ployed in  pneumonic  inflammations  of  a  more  advanced  stage  than 
where  there  could  be  the  slightest  prospect  of  obtaining  a  favorable 
result  from  the  administration  of  the  latter.  But  that  Phosphorus 
should  still  be  capable  of  effecting  a  cure,  when  extensive  purulent 
infiltration  of  the  parenchymatous  substance  of  the  lungs  has  taken 
place,  is  as  little  to  be  expected  as  the  attainment  of  so  desirable  an 
event  by  means  of  any  other  remedy. 

Dr.  Schneider  *  writes  :— 

i.  For  the  last  eight  years — i.e.  from  the  time  that  I  commenced 
to  substitute  the  specific  or  homoeopathic  for  the  antiphlogistic  me- 
thod, I  have  usually  seen  pneumonia  last  only  four  to  five  days,  and 
terminate  on  the  fifth  inclusive,  at  most  on  the  seventh  inclusive,  by 
profuse  sweats  and  hypostatic  urine. 

II.  I  seldom  met  with  epistaxis  in  pneumonia, — although  arti- 
ficial bleedings  had  not  been  employed,  and  I  never  (which  may 
certainly  depend  upon  the  stadium)  saw  this  or  any  other  hemorrhage 
appear  critically. 

I  have  moreover  never  observed  critical  diarrhoeas  in  pneumonia. 

in.  If,  in  addition  to  critical  sweats  and  urine,  the  evolution  of  a 
scabby  eruption  about  the  mouth  appeared*  to  be  necessary  to  ensure 
the  termination  of  the  inflammation,  the  decrease  of  the  disease 
proceeded  somewhat  slower,  and  that  more  especially  when  the  urine 
was  at  the  same  time  of  a  light  colour. 

iv.  If  critical  sweats  made  their  appearance  on  the  fourth  or 
fifth  day,  without  effecting  a  decrease  of  the  pneumony,  and  they 
wrere  moreover  accompanied  by  anxiety  and  restlessness,  with 
increased  oppression,  cough,  and  pain  during  the  act  of  coughing, 
the  eruption  of  a  critical  miliaria  was  to  be  expected. 

*  Klinische  Aphorismen.     Allg.  Horn.  Zeit.  No.  1,  21ter  Band. 


PNEUMONIA. 


295 


v.  A  miliary  eruption  (consisting  of  small  whitish  vesicles  on  a 
red  ground)  was  always  sufficient  (when  the  inflammation  could  not 
otherwise  be  removed)  to  terminate  the  pneumony  within  nine  days. 
In  the  meanwhile  the  sweats  diminished,  and  the  miliaria  soon  after- 
wards scaled  off. 

vi.  In  one  case,  where  the  patient  had  wantonly  exposed  herself 
to  cold  on  the  fifth  day  of  the  disease,*  about  the  termination  of  the 
crisis  bona  (by  sweat,  hypostatic  urine,  and  eruption  about  the  mouth) 
relapse  took  place,  accompanied  by  great  anxiety,  restlessness,  and 
sleeplessness,  excessive  oppression  and  tightness  of  the  chest,  and 
very  difficult,  painful  cough,  which  indicated  a  termination  (on  the 
ninth  day,  reckoned  from  the  first  appearance  of  the  disease)  in  a 
miliary  eruption. 

vn.  On  the  decline  of  the  pneumonic  inflammation,  the  op- 
pression at  the  chest,  and  the  obstructed  inspiration,  as  also  the 
pricking  pain  whilst  making  a  moderate  inspiration,  and  the  frequent 
pulse,  were  generally  the  first  symptoms  that  were  alleviated ;  at  the 
same  time  the  rust-coloured  sputa  became  more  and  more  light- 
coloured,  (subsequently  dirty- white  and  globular,)  the  cough  gra- 
dually easier  and  the  expectoration  less  troublesome ;  somewhat 
later,  the  stitches  during  coughing  disappeared,  and  lastly  the  cough 
itself,  after  having  (in  the  form  of  a  normal  cough)  removed  the  last 
trace  of  the  disease. 

viii.  For  the  last  eight  years  I  have  invariably  seen  pneumonia 
simplex,  when  treated  homceopathically,  (provided  the  treatment 
commenced  as  early  as  the  third  day  of  the  existence  of  the  disease,) 
terminate  favorably,  and  always  more  regularly  and  speedily  than 
during  the  ten  preceding  years,  when  the  treatment  was  conducted 
according  to  the  principles  of  the  old  school. 

ix.  During  the  last  eight  years  I  have  lost  eight  patients, 
of  neglectedf  and  badly-treated  pneumonia:  two  women  of  the 
age  of  60 ;  two  men  of  the  same  age ;  one  man  of  40,  one  man 
of  30,  and  two  children.  The  person  of  the  age  of  30  was  already 
in  a  dying  state  when  I  arrived. 

On  the  other  hand,  I  have  saved,  during  the  same  space  of  time, 

*  The  patient,  a  woman  of  very  violent,  impatient  temper,  being  tired  of  the  sweating,  and 
feeling  herself  otherwise  well,  left  the  bed  and  seated  herself  in  the  passage,  in  a  current  of 
air,  coming  from  two  opposite  open  doors. 

f  By  neglected  pneumonia,  I  mean  a  case  in  which  the  period  of  the  first  normal  crisis 
has  passed  unfavorably. 


296  RESPIRATORY  SYSTEM. 

six  other  patients  similarly  affected :  four  men  in  the7third  stage  of 
the  disease,  one  boy  of  12,  and  one  girl  of  13  years,  both  were  in  a 
hectic  state,  &c,  and  had  already  commenced  to  expectorate  large 
quantities  of  purulent  matter,  of  an  offensive,  pungent  smell. 

x.  Two  cases  of  pneumony  occurring  in  previously  diseased 
lungs  terminated  fatally, — the  one  on  the  seventh  day  suddenly,  in 
consequence  of  the  bursting  of  a  vomica,*  the  other  on  the  sixth 
day,  through  paralysis  of  the  lungs.f  Some  other  cases,  in  phthisis 
exulcerata,  terminated  favorably. 

With  the  exception  of  those  mentioned  under  ix.  and  x,  I  have 
never  met  with  a  fatal  case  of  pneumonia  during  the  last  eight 
years. 

xi.  I  generally  prescribed  Aconitum  for  only  one  day  at  the 
utmost  in  pneumonia ;  I  only  continued  it  the  day  following  if  the 
fever  was  still  very  violent  ;  and  in  that  case  I  gave  it  alternately 
with  the  other  appropriate  remedy. 

xn.  If  the  patient  came  under  my  treatment  only  on  the  third 
day  of  the  existence  of  pneumonia,  I  immediately  gave  Aconit,  alter- 
nately with  the  other  medicine  indicated. 

xin.  If  the  vascular  irritation  was  very  great  at  the  beginning 
of  the  pneumony,  and  accompanied  by  determination  of  blood  to 
the  head,  or  also  by  talking  in  the  sleep,  I  gave  Aconite  and  Belladonna 
alternately. 

xiv.  The  second  remedy  which  I  employed  in  pneumony  was 
generally  Bryonia;  I  soon  discovered,  however,  that  this  medicament 
operated  much  better  when  given  alternately  with  some  other  which 
was  appropriate  to  the  genus  morhorwm,  or- the  individuality  of  the 
patient,  or  also  the  causa  occasionalis  of  the  pneumony,  with  Belladonna 
or  Mercury  (most  frequently  with  the  latter)  or  with  Nux  v.,  (e.-g.  with 
drunkards)  or  with  Arnic.  or  Rhus  (after  external  causes). 

xv.  In  1839  and  1840,  about  the  time  when  ganglionic  typhus 
prevailed,  Phosphorus  proved  more  effective,  than  any  other  remedy  in 
pneumonia.     During  the  prevalence  of  scarlet  fevers  and   anginse, 

*  The  patient  had,  several  years  before,  been  severely  contused  by  being  pressed  by  his 
horse  against  a  tree,  and  subsequently  suffered  from  frequent  attacks  of  pneumonia,  accom- 
panied by  very  copious  expectoration. 

t  The  patient,  a  woman,  had  suffered  two  years  before  she  was  attacked  with  this  fatal 
(asthenic)  pneumonia,  from  complaints  of  the  chest ;  and  during  the  latter  months  she  had 
experienced  increasing  tightness  about  the  chest,  attended  with  cough  and  expectoration, 
and  very  perceptible  emaciation  and  diminution  of  strength.  I  saw  her  for  the  first  time  on 
the  third  day  of  the  disease.     The  expectoration  was  nearly  black. 


PNEUMONIA.  297 

Belladonna  deserves  particular  attention;  and  during  that  of  influenza, 
Mercury. 

xvi.  I  usually  employed  Mercurius  with  good  effect  with  that 
otherwise  indicated  remedy,  if  a  critical  eruption  about  the  mouth 
was  to  be  foreseen. 

xvii.  When  a  critical  eruption  about  the  mouth  was  fore- 
seen, the  employment  of  Mercurius  in  alternation  with  the  remedy 
otherwise  indicated,  was  attended  with  good  results.  If  all  remedies 
above-mentioned  did  not  effect  the  desired  amendment  before  the 
crisis  of  the  pneumonia,  I  usually  found,  after  a  renewed  examina- 
tion, Phosphorus  or  Sulph.  indicated,  more  rarely  Rhus,  or  Sepia,  or 
Squilla,  and  still  more  so,  some  other  remedy. 

xv in.  On  appearance  of  great  anguish  and  restlessness,  and 
oppression  in  the  chest  (iv),  &c,  before  the  evolution  of  miliaria,  I 
found  either  Arsen.  or  Veratr.,  or  Hyoscyam.  indicated,  and  effective. 

xix.  In  neglected  pneumony,  with  rattling  noise  in  the  bronchi, 
difficult,  purulent  and  copious  expectoration,  great  weakness,  &c,  I 
have  found  Belladonna,  Arsen*,  Phosphor,  and  By  cop.  very  beneficial. 

xx.  In  neglected  pneumony,  with  copious,  very  offensive, 
purulent  expectoration  (ix)  I  found  especially  Sepia,  Conium,  Card., 
Silic.  and  China  effective. 

xxi.  Latterly,  I  commonly  prescribed  Aconitum,  Bryon.,  and 
Bettad.  in  the  I — I  dilution,  and  the  other  medicines  in  the  4 — II, 
as  follows  :  gtt.  iv.— gtt.  viij  in  |iv.  of  water,  1  tablespoonful  to  be 
taken  every  1 — 2  hours." 

Dr.  Watzke*  states  that— 

"  The  homoeopathic  or  specific  treatment  of  pneumonia  presents 
very  considerable  advantages — although  more  in  reference  to  the 
direct  and  indirect  consequences,  and  period  of  convalescence,  than 
with  regard  to  the  course  of  the  disease.  In  our  hands,  as  a  general 
rule,  more  or  less  distinct  indications  of  critical  symptoms  make 
their  appearance  on  the  fifth  day ;  on  the  seventh,  the  perfect  crisis 
takes  place,  and  on  the  fourteenth  day  the  patient  is  enabled  to 
attend  to  his  usual  occupations. 

Aconitum  has  been  too  unconditionally  and  generally  recommended 
and  employed  against  pneumonia.  We  only  expect  direct  benefit 
from  it  in  active  hyperemia,  and  incipient  splenization. 

*  Allg.  Horn.  Zeit.  No.  7.  21ter  Band. 


298  RESPIRATORY  SYSTEM. 

Bryonia  we  employ  only  in  those  forms  of  pneumonia  which  are 
sympathetically  founded  on  pleuritic  inflammation  with  predomi- 
nating plastic — serous  exudations. 

In  the  first  stage  of  pneumony  in  robust  individuals,  with  exist- 
ing consensual  irritation  of  the  brain,  as  also  in  pulmonic  inflamma- 
tions in  general,  resulting  from  severe  and  continuous  exertion,  or 
from  mechanical  lesion,  the  best  remedies  are  Arnica,  Rhus,  and 
Conium, 

Belladonna  is  indicated  when  pneumonia  is  accompanied  by  an 
acute  exanthema,  with  violent  cerebral  symptoms  and  general  turgor 
venoms.  In  pneumonia  occurring  in  females  labouring  under  primary 
or  secondary  chlorosis,  or  associated  with  chronic,  neglected,  or  acute 
bronchial  catarrh,  measles,  or  smallpox,  Pulsatilla  will  not  easily  be 
excelled  by  any  other  remedy. 

"  In  the  second  stage  of  primary  pneumonic  croup  we  would  call 
attention,  besides  to  the  well-known  and  successfully  employed 
Phosphor,  and  Antimonium,  to  Bismuth  magesterium,  and  Arg.  nitr. :  in 
addition  to  the  well-known  and  successfully  employed  Phosphorus  and 
Antimon.  tart.  Arg.  nitr.  promises  to  be  more  especially  of  service 
against  lobular  hepatization  occurring  as  a  sequela. 

In  the  stage  of  purulent  or  serous  infiltration  Bromium  is,  next  to 
Sulphur,  Senega  and  Carbo  v.  the  most  worthy  of  attention. 

In  irregular  reactions,  insufficient  crisis  in  asthenic,  torpid  inflam- 
mations of  the  lungs,  which  frequently  take  place  in  consequence 
of  bleedings,  China,  Camphor,  01.  tereb.,  and  Moschus,  are  often  bene- 
ficial even  in  apparently  hopeless  cases. 

Opium,  Nux  vomica,  Hyoscyarmis,  Lachesis,  Conium,  Cocculus,  Stram., 
do  not  appear  to  have  any  primary  and  direct  effect  upon  the  lungs ; 
they  are  indicated  in  secondary  pneumonic  processes,  in  pneumo- 
typhus,  in  delirium  tremens  complicated  with  inflammations  of  the 
lungs,  and  in  various  forms  of  so-  called  nervous  pneumony. 

In  pneumonia  catarrhalis,  or  in  pneumony  occurring  in  lymphatic, 
flaccid,  fat  habits,  Senega  is  indicated;  in  pneumonia  complicated  with 
bronchitis,  Senega,  Mercury,  Phospor.,  Brom.,  Nux  mosch.;  in  that  with 
hepatitis  (pneumonia  biliosa?)  Senega,  Mercury,  Nux  vomica,  and  in 
pneumonia  interstitialis — aur-chlor. 

Pneumonic  states,  which  originate  from  tubercles  in  the  lungs  are 
sometimes  to  be  cured  by  means  of  Mercury,  Iod.,  Sulphur,  Spongia,  and 
Ol.jecoris  aselli. 

In  the  pneumonia  of  old  persons,  Arsenicum  is  the  principal  remedy ; 


SPURIOUS  PERIPNEUMONY.  299 

in  that  arising  from  repercussed  eruptions,  Arsenicum  and  Sulphur ; 
in  complications  with  endocarditis  Arsenicum,,  Camphora,  Mercurius, 
Bromium ;  and  in  those  with  pleuritic  exudations  Arsenicum,  Cam- 
phora, Phosphorus,  Scilla,  and  Acidum  mwriaticvm  are  the  most  important 
medicaments." 

Diet.  It  is  scarcely  necessary  to  remark  that  during  the  inflam- 
matory period  of  pneumonia,  an  almost  total  abstinence  must  be 
observed :  even  during  convalescence  there  is  caution  required,  and 
care  must  be  taken  not  to  allow  the  patient  to  over-indulge  his 
returning  appetite,  as  any  error  in  this  respect  may  entail  troublesome 
consequences.  The  drinks  may  consist  of  water,  toast-water,  and 
sometimes  whey,  rice-  or  barley-water,  sweetened  with  a  little  sugar 
if  desired. 


PERIPNEUMONIA  NOTHAS.     OCCULTA.     CATARRHUS  BRONCHIORUM. 

Spurious  Peripneumony. 

This  affection,  which  is  usually  most  insidious  in  its  approach,  is 
more  frequently  met  with  in  old  than  in  young  or  middle-aged  sub- 
jects, and  is  liable  to  terminate  in  paralysis  of  the  lungs.  Sometimes 
the  attack  is  preceded  by  a  feeling  of  general  prostration ;  or  comes 
on  like  an  attack  of  common  cold,  with  cough  and  alternate  heats 
and  chills.  The  cough  is  generally  loose  from  the  commencement ; 
the  sputa,  white,  yellow,  slimy  and  generally  blood-streaked.  There 
is  great  weight  or  oppression  at  the  chest,  with  quick  laborious 
breathing  ;  pain  only  when  taking  a  deep  inspiration,  and  generally 
in  a  small  circumscribed  spot.  All  these  symptoms  are  usually 
aggravated  by  anything  which  calls  for  an  increased  play  of  the  lungs, 
such  as  talking,  or  laughing  loudly,  ascending  stairs,  &c,  lying  upon 
either  side,  particularly  in  the  more  severe  attacks,  becomes  oppressive, 
so  that  the  decubitus  is  generally  on  the  back.  Pulse  soft  but  quick, 
the  cheeks  slightly  flushed;  the  skin  moist  and  damp, and  sometimes 
there  is  nocturnal  sweating  which  affords  no  relief;  towards  morning 
the  febrile  action  subsides  a  little,  and  the  patient  feels  somewhat 
easier.  The  voice  is  low  and  weak,  occasionally  dying  away  to  a 
whisper.  In  the  treatment  of  this  affection  a  dose  or  two  of  Aconite 
may  be  given  when  the  fever  runs  rather  high,  but  Mercurius  is  more 
frequently  called  for  even  at  the  very  commencement,  and  particularly 


300  RESPIRATORY   SYSTEM. 

when  there  is  nocturnal  sweating,  and  moist  or  clammy  skin  during 
the  day;  after  the  employment  of  Mercurius,  Belladonna  will  generally 
be  found  useful,  and  especially  when  a  short  dry  cough  remains, 
attended  with  spasmodic  constriction  in  the  chest  which  impedes 
respiration  and  causes  an  oppressive  sensation  of  suffocation.  If 
Belladonna  does  not  complete  the  cure,  and  the  cough  is  accompanied 
with  sibilant  or  wheezing  respiration,  a  dose  of  Aconite  may  be  given, 
followed,  after  an  interval  of  a  few  hours,  by  Chamomilla,  Nux  vomica 
is  serviceable  when  there  is  dry  cough,  or  cough  with  difficult  ex^ 
pectoration  of  a  little  slimy  mucus,  and  excessive  tension  and  op- 
pression in  the  chest.  In  those  cases  in  which  Mercurius  affords 
little  relief,  and  the  breathing  continues  quick  and  laborious,  and  the 
countenance  is  expressive  of  great  anxiety,  Ipecacuanha  in  repeated 
doses  is  frequently  followed  by  satisfactory  results ;  but  should  the 
extremities  become  cold,  and  the  sensation  of  constriction  in  the 
chest,  with  extreme  anxiety  increase,  Veratnim  should  be  prescribed ; 
on  the  other  hand,  if  the  paroxysms  of  threatening  suffocation  become 
more  and  more  distressing,  and  the  patient  appears  sinking  from 
exhaustion. 

Arsenicum  must  claim  a  preference,  and  will  often  succeed  in 
restoring  the  expiring  energies  of  the  patient  when  the  case  has 
assumed  an  almost  hopeless  appearance.  {Tartarus  emet.  may  be 
substituted  for,  or  administered  alternately  with  Arsenic,  when  there 
is  an  excessive  accumulation  of  mucus  in  the  bronchial  tubes. 

It  may  be  added  that  Arnica  has  been  found  useful  in  some 
instances,  in  the  early  stage  of  the  disorder,  when  the  pleura  costalis 
and  the  intercostal  muscles  seemed  to  be  the  principal  seats  of  pain, 
which  was  rendered  more  acute  by  pressing  the  fingers  against,  or 
drawing  them  along  the  spaces  between  the  ribs ;  or  when  a  bruised 
or  beaten  pain  was  experienced  in  the  chest,  and  the  cough  not  very 
troublesome,  but  attended  with  blood-streaked  slimy  sputa.  Pulsatilla 
has  been  employed  with  advantage  after  Arnica,  as  soon  as  the 
expectoration  became  more  considerable,  attended  with  melioration 
of  the  pectoral  symptoms.  Pulsatilla  and  Sulphur  are  two  of  the  best 
remedies  to  prevent  the  disease  from  assuming  the  chronic  form, 
when  the  more  acute  symptoms  have  become  subdued.  (See  also 
Bronchitis  Pneumonia  vera,  and  Pleuritis,  and  select  any  of 
the  remedies  given  under  these  different  heads,  if  the  symptoms, 
general  or  physical,  call  for  them.) 


TYPHOID  PNEUMONIA.  301 


TYPHOID  OR  CONGESTIVE  PNEUMONIA. 

In  this  variety  of  pneumonia  the  local  symptoms  are  usually  very 
obscure,  and  the  accompanying  fever  is  of  the  typhoid  kind,  the 
pulse  quick  and  very  weak,  the  skin  harsh,  dry,  or  clammy,  tongue 
brown  and  parched,  and  the  urine  of  greatly  diminished  quantity  and 
high  coloured. 

In  some  cases  the  following  physical  signs  can  be  detected :  dull- 
ness on  percussion,  and  absence  of  respiratory  murmur  in  the  lower 
and  back  parts  of  the  chest,  and  occasionally  bronchophony  and 
bronchial  respiration  when  the  central  or  middle  portion  of  the  lung 
is  the  part  affected. 

The  remedies  which  have  been  used  with  the  most  advantage  in 
typhoid  pneumonia,  are  Opium,  Arnica,  Veratrum,  Arsenicum,  Phos- 
phorus, &c. 

Opium.  This  remedy  is  generally  the  most  appropriate  as  soon 
as  the  disease  becomes  clearly  defined,  and  may  be  repeated  once  or 
twice,  after  which,  if  no  change  be  effected,  Arnica  should  be  em- 
ployed. 

If  no  improvement  result  from  the  foregoing  remedies,  Veratrum 
may  be  administered,  particularly  when  there  is  clammy  sweat  on  the 
forehead,  with  coldness  of  the  extremities  and  great  weakness,  and 
the  respiration  unequal^  laborious,  and  rattling. 

Arsenicum  may  follow  Veratrum  if  the  prostration,  and  rattling 
respiration  increase,  the  pulse  become  irregular,  and  the  tongue 
dark  brown  or  black  :  the  alternate  administration  of  these  two 
remedies  every  half  hour,  to  every  hour  or  two  hours,  according  to 
the  urgency  of  the  symptoms,  is  frequently  attended  with  the  best 
results ;  in  other  cases,  Veratrum,  Ipecacuanha,  and  Arsenicum  answer 
better.  But  when  only  temporary  improvement  results,  a  few  glo- 
bules of  Sulphur  may  be  administered ;  and  then  again  Veratrum,  and 
Arsenicum,  or  Veratrum,  Ipecacuanha,  and  Arsenicum  alternately,  or  any 
one  of  these  remedies  alone  from  which  any  marked  degree  of 
improvement  may  previously  have  been  observed  to  arise.  Bryonia 
Rhus,  Senega,  and  Phosphorus  will  be  found  useful  in  certain  cases. 
Some  of  the  leading  indications  for  the  employment  of  the  two 
former  will  be  found  under  the  head  of  Nervous  Fever  (which 
see).      Senega  is  chiefly  serviceable  when  the  lungs  are  loaded  with 


302  RESPIRATORY  SYSTEM. 

mucus.  Phosphorus  when  we  find  great  debility,  black  incrustations 
on  the  lips,  rapid  and  laborious  breathing,  and  bronchial  respiration. 
Belladonna  will  commonly  be  found  serviceable  when  temporary 
blindness  is  complained  of,  and  Natrum  m.  when  the  prostration  of 
strength  increases,  notwithstanding  the  administration  of  Arsenicum 
which  is  generally  so  valuable  in  such  cases.  When  galling  or 
excoriation  has  ensued  from  lying  in  bed,  Cinchona  and  Arsenicum 
must  be  administered  alternately  ;  in  milder  cases,  Arnica  in  the 
form  of  lotion  (one  part  in  ten)  will  frequently  remove  this  evil. 


INFLAMMATION  OF  THE   PLEURA.     PLEURISY. 

Pleuritis. 

Diagnosis.  Severe  cutting,  lancinating  pain  in  the  side,  con- 
fined to  one  circumscribed  spot,  interfering  with  breathing,  and 
acutely  increased  by  taking  a  deep  inspiration,  or  by  coughing  ;  dif- 
ficult and  anxious  respiration,  but  not  so  oppressed  as  in  pneumonia 
and  bronchitis ;  quick  hard  pulse ;  hot  skin,  particularly  over  the 
chest,  or  the  seat  of  the  disease  ;  (short  dry  cough ;)  parched  tongue ; 
scanty  and  high-coloured  urine ;  and  occasional  cerebral  symptoms, 
position  in  bed,  usually  dorsal ;  and  if  the  effusion  be  free  and  par- 
tial, a  change  to  the  sound  side  creates  great  uneasiness.  The  pro- 
gnosis must  be  formed  according  to  the  severity  and  character  of  the 
symptoms.  If  the  heat  and  other  febrile  indications  gradually  sub- 
side, and  if  the  performance  of  the  act  of  respiration  becomes  more 
free  and  less  painful,  and  a  copious  and  free  expectoration  ensues,* 
an  early  recovery  may  be  expected ;  but  if  the  fever  and  inflamma- 
tion have  been  intense,  and  the  pain  should  suddenly  terminate, 
followed  by  sinking  of  the  pulse  and  a  change  of  countenance,  danger 
is  to  be  apprehended. 

Pleurisy  seems  to  consist  in  a  peculiar  inflammation  in  the  pleura, 
with  a  disposition  to  effusion  or  to  the  secretion  of  plastic  lymph ; 
and  it  may  run  its  whole  course  without  any  of  the  symptoms  above 
given,  declaring  themselves. 

*  Care  should  be  taken  not  to  allow  this  profuse  expectoration  to  go  on  too  long,  which 
it  is  sometimes  prone  to  do  in  certain  constitutions,  otherwise  it  might  degenerate  into  a 
chronic  affection.  Its  suppression,  when  called  for,  may  be  effected  by  means  of  such  reme- 
dies as  Pulsatilla,  Dulc,  Stann.,  Sulph.,  Ipecac,  Seneg.,  Scilla,  Bryon.,  Sep.,  Lack.,  Calc,  &c. 


INFLAMMATION  OT  THE  PLEURA.  303 

At  the  commencement  of  the  disease  there  is  diminution  of  motion 
and  respiratory  murmur  from  pain  (subsequently  these  abnormal  signs 
arise  from  effusion,)  and  a  rubhing  sound  is  not  unfrequently  heard, 
generally  about  the  centre  of  the  chest,  accompanying  the  pectoral 
movements.  Soon  after  the  onset  of  the  inflammation,  in  the  greater 
number  of  cases,  exudation  ensues,  and,  if  not  encysted,  accumulates 
at  the  lowest  parts  of  the  chest.  When^  in  such  instances,  the 
quantity  exuded  is  considerable,  and  the  lung  is  not  restrained  by 
adhesions,  that  organ  will  be  floated  upwards  to  some  extent,  and  a 
dull  stroke-sound  elicited  from  the  parts  beneath  it,  whilst  the  upper 
parts  will  be  found  unusually  resonant. 

As  the  fluid  accumulates  and  ascends  in  the  chest,  the  antecedent 
clearness  of  stroke-sound  becomes  impaired,  as  is  more  especially 
obvious  on  gentle  percussion, — the  breath-sound  diminished,  and 
respiration  more  impeded.  When  these  latter  abnormal  symptoms 
are  met  with  as  high  as  the  middle  regions  of  the  thorax,  the  vocal 
resonance  there,  and  particularly  anteriorly,  becomes  preternatural  ly 
distinct,  and  is  changed  to  a  small,  sharp  and  tremulous  note  resem- 
bling the  bleating  of  a  goat,  and  hence  termed  cegophony;  posteriorly 
the  resonance  partakes  somewhat  more  of  the  character  of  broncho- 
phony from  the  greater  caliber  of  the  tubes  at  the  root  of  the  lung. 
(Egophony  and  all  sound  of  the  voice  ceases  at  the  affected  side  of 
the  chest,  as  the  liquid  effusion  increases,  except  at  those  portions 
where  the  lung  may  have  been  adherent,  or  at  the  space  within  an 
inch  or  two  of  the  spine ;  percussion  now  gives  an  extremely  dull 
sound  from  the  lung  being  deprived  of  and  rendered  impermeable  to 
air  by  compression,  and  the  respiratory  murmur  is  no  longer  audible, 
or  only  heard  in  the  interscapular  and  subclavicular  regions,  parti- 
cularly the  former. 

In  those  cases  in  which  the  effusion  is  very  considerable,  enlarge- 
ment of  tJie  affected  side  takes  place.  This  enlargement  is  generally 
discernible  only  during  expiration  at  first,  but  as  the  exudation 
increases,  the  difference  can  readily  be  detected  during  the  entire 
performance  of  respiration.  In  attenuated  subjects,  the  intercostal 
spaces  will  also  be  observed  to  have  become  prominent  instead  of 
presenting  their  natural  depression.  But  should  absorption  be 
effected  after  such  an  enlargement,  the  state  of  matters  is  reversed, 
and  the  side  which  was  previously  enlarged  becomes  abnormally 
contracted— the  result  of  atmospheric  pressure,  and  unantagonised 
muscular  action. 


304  RESPIRATORY  SYSTEM. 

Displacement  of  organs  adjoining  the  seat  of  the  effusion,  such  as 
the  heart,  liver,  and  mediastinum,  is  also  an  occasional  result  of 
extensive  effusion. 

On  examining  the  sound  side  of  the  chest,  in  addition  to  the 
negative  proofs  of  the  absence  of  disease,  an  excess  of  the  usual 
normal  signs  will  also  be  perceived,  indicated  by  an  accelerated  and 
deeper  action,  together  with  a  greatly  increased  degree  of  respiratory 
murmur,  resembling  that  of  children,  and  hence  denominated 
puerile. 

The  signs  »of  improvement  and  approaching  recovery  are  marked 
by  a  diminution  of  pain,  fever,  dyspnoea,  and  enlargement  of  the 
side ;  and  by  a  return  of  the  respiratory  murmur,  together  with  an 
increasing  clearness  of  sound  on  percussion.  When  the  result  is 
fatal,  death  occasionally  supervenes  very  rapidly  from  the  compression 
of  both  lungs ;  but  in  most  cases,  this  event  is  more  gradual,  and 
arises  from  atrophy  of  the  lungs,  as  also  affections  of  the  heart,  with 
consequent  dropsy,  caused  by  the  efforts  required  to  propel  the 
blood  through  the  compressed  lung. 

In  all  cases  of  pleurisy  the  whole  of  the  above-detailed  symptoms 
are  not  to  be  deemed  constant,  or  even  certain  diagnostic  signs. 

The  absence  of  marked  dullness  on  percussion,  is  not  a  conclusive 
test  that  effusion  has  not  taken  place.  The  greater  or  less  degree  of 
clearness  of  tone  appears  to  depend  upon  the  condition  of  the  lung 
under  effusion,  and  the  elasticity  of  the  parietes  that  cover  it.  If 
the  quantity  of  the  effusion  be  very  considerable,  and  the  lung 
deprived  of  its  air  by  compression,  the  sound  on  percussion  is  neces- 
sarily almost  uniformly  dull ;  but  when  the  exudation  is  inconsider- 
able and  the  compression  is  not  sufficient  to  deprive  the  lung  of  its 
air,  the  stroke- sound  will  be  found  to  consist  more  of  a  tympanitic, 
and  frequently  even  a  louder  tone,  than  that  of  the  normal  expanded 
lung.  Subsequently,  however,  if  the  pressure  be  unrestrained,  the 
lung  will  be  deprived  of  its  air,  and  the  part  formerly  so  resonant 
will  then  yield  a  dull  sound.  The  auscultatory  phenomena  are,  in 
like  manner,  naturally  liable  to  be  materially  modified  by  circum- 
stances. Much  depends  on  the  extent  of  the  exudation,  and  also  on 
the  state  of  the  lung  on  which  it  rests.  If  the  lung  still  contain  air, 
both  voice  and  respiratory  sound  will  be  found  indistinct  or  inaudible. 
If,  from  the  extent  of  the  effusion,  or  from  the  long  continuance  of 
the  disorder,  the  portion  of  lung  be  entirely  emptied  of  air,  weak 
bronchophony  and  bronchial   respiration  will  be  discernible  ;    but 


INFLAMMATION  OF  THE  PLEURA.  305 

when  the  amount  of  effusion  is  very  great,  possibly  filling  the  whole 
cavity  of  the  pleura,  no  sound  whatever  will  be  heard.*  On  the 
other  hand,  when  the  quantity  effused  is  inconsiderable,  the  normal 
sounds  frequently  remain  unchanged.  Again,  the  physical  signs  are 
liable  to  be  further  modified  by  old  and  close  adhesions  of  the  lung 
to  the  walls  of  the  chest,  resulting  from  previous  disease,  which 
renders  the  lung  adherent  to  the  walls  of  the  chest.  The  upper  lobes 
are  the  most  subject  to  these  adhesions ;  and  in  such  cases  the  free 
portion  of  the  lung  is  pressed  upwards  by  the  subjacent  effusion, 
against  the  superior  part  of  the  thorax.  And  although  the  lung 
may  yet  admit  air,  still,  from  the  degree  of  compression  to  which  its 
vesicular  structure  is  subjected,  both  breath-  and  stroke- sound  will  be 
bronchial,  and  loud  bronchophony  will  pervade  the  upper  part  of 
the  affected  side.  The  lower  part  of  the  chest,  from  whence  the 
lung  has  been  separated  or  raised  upwards  by  the  effusion,  will 
necessarily  emit  decided  dullness  on  percussion. 

Finally,  it  may  be  added  that  wgopliony,  although  a  frequent  phe- 
nomenon in  pleuritis,  has  no  necessary  connexion  Mdth  the  presence 
of  liquid  in  the  pleural  sac,  and  is  consequently  not  to  be  held  as  an 
essential  link  in  the  chain  of  evidence  for  determining  the  existence 
of  this  disease. 

The  same  remarks  will,  in  a  great  measure,  apply  to  the  intercepted 
vibration  of  the  voice,  usually  felt  by  the  hand  when  placed  against 
the  chest, — for  this,  although  a  very  useful  and  early  corroborative 
indication  of  the  accumulation  of  fluid  in  the  cavity  of  the  pleura,  is 
yet  liable  to  some  exceptions  both  positive  and  negative. 

The  rubbing  sound  already  referred  to  is  an  important  sign ;  is  is 
not  so  audible  at  the  commencement  of  the  attack,  as  it  is  at  a  later 
period  when  the  effusion  becomes  more  consistent,  and  then  it  is 
rarely  absent. 

Pain  is,  with  few  exceptions,  an  invariable  concomitant  on  pleurisy, 
still  if  it  be  unaccompanied  by  the  confirmatory  evidence  of  other 
important  symptoms,  it  must  not  be  implicitly  relied  on,  as  it  may 
arise  from  a  totally  different  cause  than  an  inflammatory  condition  of 
the  pleura.  But  when  taken  in  combination  with  other  signs,  its 
presence  and  intensity  have  been  found  of  great  use  in  estimating 
the  amount  as  well  as  the  quality  of  the  effusion ;  for  it  has  been 
ascertained  that  the  greater  the  quantity  of  plastic  lymph  it  contains 

*  British  Journal  of  Homoeopathy,  vol.  i,  p.  42. 

20 


306  RESPIRATORY  SYSTEM. 

the  greater  will  be  the  pain.#  Great  rapidity  of  effusion  is  also  a 
frequent,  though  not  an  infallible  source  ef  extreme  pain.  The 
greater  or  minor  degree  of  dyspnoea  depends  on  the  quantity  and 
rapidity  of  the  effusion,  as  well  as  on  the  condition  of  the  lungs ; 
when  both  sides  of  the  chest  are  the  seat  of  the  effusion,  the  op- 
pression is  usually  excessive.  The  fever  is  in  like  manner  modified 
by  the  nature  and  extent  of  the  exudation,  being  generally  slight,  or 
altogether  absent,  w7hen  the  quantity  is  trivial ;  slow,  and  not  unfre- 
quently  intermittent,  when  more  extensive  but  of  a  serous  character ; 
and  highly  inflammatory,  when  much  plastic  lymph  is  contained  in 
the  effusion.f 

From  what  has  been  stated,  it  will  be  seen  that  most  of  the  so- 
called  characteristics  of  pleurisy  cannot,  individually  considered,  be 
taken  as  conclusive  indications  of  the  existence  of  that  disease.  The 
collective  physical  signs,  however,  in  the  majority  of  cases,  are  far 
from  equivocal,  and  are  mainly  to  be  depended  on  in  forming  the 
diagnosis. 

Cough  is  not  an  accompaniment  of  simple  pleurisy,  so  that  when 
this  symptom  is  present  there  is  either  bronchitic  or  pneumonic 
complication,  or  the  case  may  be  one  of  hemorrhagic  pleuritis. 

Therapeutics.  The  chief  remedies  are  Aconitum  napellus, 
Bryonia  alba.  Sulphur,  Belladonna,  Mercurius,  Arsenicum,  Arnica  Montana, 
Hepar  sulphuris  calcarea,  Phosphorus,  Zycopodium  clavatum,  Carlo  vege- 
tabilis  et  animalis,  Cinchona  officinalis,  Digitalis  purpurea,  Kali  carbonicum, 
Ipecacuanha,  Helleborus  niger,  Sabadilla,  Scilla  maritima. 

Aconitum — is  an  indispensable  remedy  in  allaying  inflammatory 
fever  when  attendant  on  pleurisy;  and  is  in  many  cases,  indeed, 
when  timely  administered,  alone  sufficient  to  cure  the  disease.  It 
rarely  fails  to  produce  a  favorable  impression  in  from  six  to  eight 
hours ;  should  it  not  do  so  in  that  space  of  time,  another  remedy 
must  be  selected.  In  most  instances  Bryonia  will  be  the  most  appro- 
priate, but  we  must  not  hesitate  to  select  Sulphur  in  preference,  if 
called  for,  or  indeed  any  other  remedy  that  may  seem  more  strikingly 
indicated. 

R  Tinct.  Aeon.  3,  gtt.  vj, 
Aq.  pur.  1  iij. 
Dose.     A  few  globules  every  two  hours  ;  or  one  drop  of  the  tincture  to 
an  ounce  of  water ;  a  dessert-spoonful  every  two  to  six  hours.J 

*  Brit.  Homoeop.  Journ.,  vol.  i,  p.  44.  f  Ibid. 

I  Vide  Rules  for  the  repetition  of  the  dose  in  the  Introduction. 


INFLAMMATION  OF  THE  PLEURA.  307 

Bryonia  alba  should,  in  general  cases,  follow  Aconitum  when 
the  fever  has  been  somewhat  allayed  by  that  remedy.  It  is  more 
particularly  indicated,  either  in  simple  or  complicated  pleurisy,  when 
the  following  symptoms  are  encountered  at  an  early  stage  of  the 
disease ;  aching,  burning,  but  more  especially  'acute  shooting  or  cutting 
pains  in  the  chest,  much  increased  during  inspiration  or  on  movement  ; 
dry  cough,  or  dry  sounding  cough,  followed  by  expectoration  of  dirty 
yellow-coloured  mucus,  streaked  or  tinged  with  blood,  and  attended 
with  great  aggravation  of  pain  ;  oppressed  and  anxious  respiration  ;  pal- 
pitation of  the  heart;  dry,  cracked,  brown,  ox 'yellow  coated  tongue  ; 
bitter  taste,  nausea*  and  occasionally  vomiting  of  mucus,  or  of  a  bitter 
bilious-looking  fluid ;  aching  or  painful  pressure  at  the  scrobiculus 
and  hypochondria ;  intense  thirst,  especially  at  night ;  constipation  ; 
head  confused  and  heavy ;  giddiness  on  sitting  up  in  bed ;  aching 
and  shooting  pains  in  the  head,  or  pain  as  if  the  head  would  burst, 
particularly  at  the  temples,  with  exacerbation  on  coughing,  or  mov- 
ing ;  fiery,  or  blueish  redness,  and  puffiness  of  the  face ;  restless, 
disturbed  sleep,  frequent  startings ;  nocturnal  delirium,  with  alterna- 
tions of  comatose  sleep ;  burning  heat  of  skin  ;  occasionally,  partial, 
clammy  perspiration ;  pulse  generally  frequent,  hard  and  small,  but 
sometimes  full,  unequal,  intermittent,  and  weak  ;  aching  in  the 
limbs.  Lastly,  when  in  connexion  with  any  of  the  above,  the  follow- 
ing symptoms  are  met  with :  dullness  on  percussion,  with  puerile 
respiration ;  cough  on  lying  on  the  side,  or  impossibility  of  lying 
otherwise  than  on  the  I  ach,— Bryonia  will  rarely  fail  to  render  unde- 
niable service,  and  can  indeed  with  difficulty  be  dispensed  with. 
(See  the  symptoms  mentioned  under  this  remedy  in  the  chapter  on 
Pneumonia.) 

R    Tinct.  Bryon.  alb..,  3,  gtt.  vj. 
Aq.  pur.  -pij. 
Dose.     A  dessert-spoonful  every  three  to  six  hours. 

Sulphur  may  with  advantage  follow  Bryonia  when  the  pain  men- 
tioned has  been  removed  by  that  medicine,  but  the  inflammation  is 
not  wholly  subdued,  and  often  completes  the  cure.  It  is  also  of 
value  when  the  fever  continues  after  the  administration  of  Aconite, 
and  may  be  administered  without  the  previous  employment  of  Aconi- 
tum,  when,  although  the  fever  is  not  violent,  we  have  reason  to  sus- 
pect recent  effusion  of  plastic  lymph.  Again,  when  the  affection  has 
already  been  of  some  days*  duration,  and  is  complicated  with  pneumonia, 


308  RESPIRATORY  SYSTEM. 

it  is  our  chief  stay  in  preventing  solidification,  or  effecting  resolution 
where  that  has  already  commenced,  and  may  therefore  generally  be 
selected  in  preference  to  Bryonia,  in  such  cases,  unless  the  latter  be 
otherwise  strongly  indicated,  in  which  event  a  dose  or  two  of  that 
medicine,  previous  to  the  employment  of  Sulphur,  will  be  found 
serviceable. 

R  Tinct.  Sulph.  6,  gtt.  vj. 
Aq.  pur.  Siij. 
Dose,    A  dessert-spoonful  every  six  hours ;  or,  in  very  severe  cases, 
every  two  hours. 

These  three  are  the  most  important  remedies  in  the  greater  num- 
ber of  cases  of  pleuritis,  and  are  frequently  found  sufficient  to  effect 
a  speedy  cure.  There  are  often  occasions,  however,  in  which  it  will 
be  found  necessary  to  select  one  or  more  of  the  following  remedies : 

Belladonna,  Mercurius,  Arnica,  Arsenicum,  Hepar  s.,  Phosphorus,  Carlo  v., 
China,  Lycopodium,  Digitalis,  &c.  v 

Belladonna  has  been  recommended  in  cases  where  the  fever 
returns,  and  pain  and  dyspnoea  continue  notwithstanding  the  employ- 
ment of  Aconite : 

R  Tinct.  Bellad.  6,  gtt.  iij., 
Aq.  pur.  Jij 
Dose.    A  dessert-spoonful  every  six  hours. 

Mercurius  has  been  found  very  useful  in  cases  where  the  fever 
has  been  subdued,  but  pain  and  dyspnoea  have  not  been  relieved  by 
Aconite,  and  the  patient's  strength  is  becoming  exhausted  by  copiotis 
nocturnal  sweats : 

R  Merc.  v.  6,  gtt.  iij. 
Aq.  pur.  Jij. 
Dose.     Same  as  Belladonna. 

Arnica  Montana, — principally  when  pleuritis  has  been  caused 
by  external  injury ;  but  also  in  other  cases  when  the  more  inflam- 
matory symptoms  have  been  subdued  by  Aconite,  &c. ;  and  pain  in 
the  chest,  with  oppressed  respiration,  only  remains ;  it  is  also  useful 
to  promote  absorption  when  considerable  effusion  has  taken  place  : 

R  Tinct.  Arn.  Mont.  3,  gtt.  iij. 
Aq.  pur.  Jij. 
Dose.    A  dessert-spoonful  every  three  or  four  hours,  until  the  pain 
begins  to  yield,  and  the  breathing  becomes  freer,  when  the  intervals  be- 


INFLAMMATION  OF  THE  PLEURA.  309 

tween  the  doses  must  be  lengthened,  or  the  medicine  discontinued,  and 
only  resumed  should  the  improvement  proceed  tardily ;  but  if  pain  re- 
turn, Aconitum,  must  again  be  resorted  to,  after  which,  Belladonna  is 
often  of  great  efficacy.  In  other  cases,  Bryonia  or  Sulphur  will  be  seen 
to  be  more  appropriate,  and  must  be  selected  accordingly. 

Arsenicum  is  the  remedy  on  which  we  mainly  depend  in  those 
serious  cases,  where  serous  effusion  to  a  very  great  extent  has  taken 
place,  and  where  the  respiration  is  painfully  impeded  and  asthmatic, 
attended  with  extreme  prostration  of  strength. 

R  Arsenic,  alb.  6,  gtt.  iij. 
Aq.  pur.  Jij, 
Dose.    A  dessert-spoonful  every  two  hours,  until  a  beneficial  effect  is 
produced. 

Hepar  sulphuris  has  been  particularly  recommended  when 
the  effusion  is  plastic,  and  the  disease  is  of  some  duration  (chronic 
plastic  pleurisy),  or  where,  even  at  the  commencement,  there  appears 
— from  the  pain,  fever  and  dyspnoea,  continuing  with  but  slightly 
diminished  severity  after  Aconite, —  every  probability  that  the  case 
will  prove  extremely  obstinate  and  tenacious.  Complication  with 
pericarditis  or  bronchitis  is  an  additional  indication  for  the  employ- 
ment of  Hepar  under  the  above  circumstances.  {Lachesis,  Digitalis, 
Arsenicum  and  Belladonna  are  also  deserving  of  attention  when  there 
is  pericarditic  complication.) 

R  Pulv.  Hep.  3,  gr.  vj. 
Dose.  As  much  as  will  lie  on  the  point  of  a  penknife,  every  two  to  six 
hours,  according  to  circumstances. 

Phosphorus.  From  what  has  been  said  of  this  remedy  in 
Pneumonia,  it  will  readily  be  conjectured  to  be  useful  in  cases  of 
complication  of  pleuritis  therewith,  as  indeed  it  has  repeatedly 
proved.  In  complications  with  bronchitis,  and  in  that  form  of 
pleuritis  which  so  frequently  shows  itself  in  phthisis  pulmonalis,  it 
has  further  been  found  of  essential  service.  (Vide  Pneumonia 
and  Bronchitis.) 

R  Tinct.  Phosph.  3,  gtt.  vi. 
Aq.  destil.  Jiij. 
Dose.     A  dessert-spoonful  every  three  or  four  hours,  or  oftener  if 
necessary,  until  the  respiration  becomes  easier. 

Carbo  vegetabilis  is  a  good  remedy  when  pleuritis  is  compli- 
cated with  chronic  bronchitis  ;  or  at  an  advanced  stage  of  the  dis- 
order, when  the  patient  is  much  emaciated  and  hectic  at  night, 
presenting  in  short  the  usual  symptoms  of    threatening  purulent 


310  RESPIRATORY  SYSTEM. 

degeneration.    It  is  also  peculiarly  useful  against  asthmatic  sufferings 
resulting  from  an  attack  of  pleurisy,  in  chronic  cases. 

Dose.     Same  as  Arsenicum,  except  in  the  latter  instance,  when  it 
must  be  given  at  longer  intervals. 

Cinchona  is  chiefly  useful  after  severe  depletion,  to  restore  the 
energies  of  the  patient* 

Lycopodium  will  be  found  serviceable  in  similar  cases  to  those  in 
which  both  Arsenicum  and  Curb,  vegetabilis  (or  animalis)  have  been 
found  applicable,  also  where  there  are  considerable  dropsical  swell- 
ings and  obstinate  constipation. 

Digitalis  has  proved  useful  in  many  cases  of  serous  pleurisy 
with  slow  fever,  small  weak  pulse,  accelerated  by  the  slightest  move- 
ment ;  and  coldness  of  the  extremities,  with  internal  heat.#  In 
conclusion,  Kali  carbonicum  may  be  instanced  as  serviceable  in  pleu- 
ritis  occurring  in  tuberculous  subjects ;  and  Ipecacuanha  as  a  useful 
palliative  against  dyspnoea  and  convulsive  cough  in  complications 
with  bronchitis.  Helleborus  niger  has  been  recommended  in  some 
cases  of  serous,  and  Scilla  in  plastic  pleurisy,  but  they,  as  well  as 
Colchicum,  Lachesis,  and  some  others  which  need  not  be  mentioned 
here,  require  the  test  of  further  experience  to  corroborate  even  the 
little  that  has  been  adduced  in  their  favour  in  the  treatment  of 
pleuritis.f 

When,  either  through  neglect  or  otherwise,  pleuritis  has  termi- 
nated in  purulent  degeneration,  and  become  chronic,  Arsenicum,  Carbo, 
Lycopodium,  Hepar  s.,  and  Kali  carbonicum,  are  the  principal  remedies 
from  which  the  greatest  assistance  can  be  obtained  where  the  cure  is  at 
all  practicable.  (See  also  Hydrothorax.)  Pains  in  the  chest  arising 
from  adhesions  or  from  thickening  of  the  pleura,  after  an  attack  of 
pleuritis,  are  often  relieved  by  Ranunculus  bulbosus,  Miphorb.,  Mez., 
Nitr.,  Thuja,  may  also  be  found  serviceable.  In  chronic  pleurisy, 
Sulphur,  Sepia,  Kali  c,  Ammon.  <?.,  Lgcopodmm,  and  Mezereum,  may 
prove  useful. 

Diet.     The  same  rules  are  to  be  observed  as  in  Pneumonia. 


*  British  Journal  of  Homoeopathy,  No.  1,  p.  53. 

f  Rhus  toxicodendron  has  been  strongly  recommended  in  serous  pleurisy.  When  low, 
typhoid  symptoms  become  apparent,  this  remedy  will  deserve  an  additional  claim  on  our 
attention.  Typhoid  appearances,  and  important  complications  of  any  kind,  a  bad  habit  of 
body,  or  indications  of  a  purulent,  sanious,  or  hemorrhagic  effusion,  are  all  to  be  held  as 
unfavorable  signs. 


PLEURODYNIA.  311 


SPURIOUS  OR  BASTARD  PLEURISY. 

Pleurodynia,  Pseudo-Pleuritis,  Pleuritis  Muscularis. 

By  these  terms  is  here  meant  that  painful  affection  usually  referred 
to  the  intercostal  muscles,  which  is  productive  of  many  of  the  symp- 
toms described  under  true  pleurisy,  and  is  consequently  liable  to  be 
mistaken  for  that  disease,  particularly  when  attended  with  febrile 
excitement,  as  is  frequently  the  case  in  hysterical  females.  The 
history  of  the  commencement  of  the  affection,  together  with  the  aid 
of  auscultation  and  percussion,  enables  us  to  draw  a  correct  distinc- 
tion between  the  two  diseases. 

When,  therefore,  we  have  satisfied  ourselves  from  the  normal 
condition  of  the  auscultatory  phenomena,  &c,  that  the  case  we  have 
to  deal  with  is  one  of  pseudo-pleurisy,  we  must  select  a  remedy  from 
amongst  the  following :  Arnica  Montana,  Bryonia,  Nux  v.,  Pulsatilla, 
Ranunculus  hulbosus,  Sahaclilla. 

In  the  majority  of  cases  Arnica  is  the  principal  remedy,  and  is 
occasionally  sufficient  to  effect  a  speedy  cure  after  a  single  dose.  In 
other  instances,  however,  the  disorder  does  not  yield  so  readily,  and 
consequently  one  or  more  of  the  other  remedies  enumerated  must  be 
had  recourse  to. 

Bryonia  : — When  the  pain  is  of  an  acute  darting  description,  as  if 
from  a  sharp  instrument  running  into  the  side,  and  is  at  times  almost 
insupportable  during  inspiration  or  even  the  slightest  movement  of  the 
body,  and  when  the  patient  is  of  a  nervous  or  bilious  temperament. 

Pulsatilla.  This  remedy  is  frequently  very  useful  in  alterna- 
tion with  Arnica ;  it  is  more  particularly  indicated  when  the  pain  is 
occasionally  of  a  fugitive  character,  moving  from  one  part  of  the 
chest  to  another,  becoming  increased  towards  evening,  and  some- 
tines  experienced  more  during  expiration  than  inspiration.  Tem- 
perament phlegmatic. 

Nux  vomica.  Shooting  pains  in  the  hypochondria,  increased  by 
the  respiratory  movements  of  the  chest ;  especially  when  the  affection 
occurs  in  hypochondriacal  subjects,  or  in  those  who  are  addicted  to 
indulgence  in  vinous  or  spirituous  drinks.  Temperament  bilious  or 
sanguine. 


812  RESPIRATORY  SYSTEM. 

It  is,  moreover,  one  of  the  best  remedies  in  this  complaint ;  the 
characteristic  indications  are  as  follows,  and  show  a  marked  resem- 
blance to  the  symptoms  which  are  so  frequently  met  with  in,  and  are 
in  some  respects  peculiar  to  pseudo-pleurisy :  stitch  in  the  side,  or 
shootings,  with  painful  sensibility  of  the  external  parts  of  the  chest,  but 
particularly  of  the  intercostal  spaces,  aggravated  by  any  movement, 
and  especially  by  taking  a  deep  inspiration,  yawning,  or  stretching. 

Ranunculus  bulbosus.  The  value  of  this  medicine  in  pains 
resulting  from  adhesions  of  the  pleura  has  already  been  alluded  to. 
(Vide  Pleuritis.) 

In  acute  pains  in  the  chest  of  every  description  of  a  purely  nervous 
character,  depending  upon  an  abnormally  exalted  sensibility  of  the 
pleura,  this  remedy  is  one  of  primary  importance. 

Sabadilla  has  also  been  recommended  as  a  useful  medicine  in 
pseudo-pleuritis. 

Administration  of  the  remedies.  In  some  cases  a  single 
dose  of  one  or  two  globules  is  sufficient  to  effect  a  cure,  in  others  it 
will  be  found  necessary  to  repeat  the  dose  every  six,  twelve,  or 
twenty-four  hours,  according  to  the  severity  of  the  attack,  until 
relief  is  obtained, 

DIAPHRAGMITIS. 

Inflammation  confined  to  the  muscular  structure  of  the  diaphragm 
is  considered  to  be  of  extremely  rare  occurrence,  the  disorder  in 
almost  every  case  appearing  in  combination  with  inflammation  of  the 
pleural  or  peritoneal  covering ;  in  either  of  which  investing  mem- 
branes, moreover,  the  disease,  for  the  most  part,  seems  primarily  to 
commence,  and  only  subsequently  to  extend  itself  to  the  connecting 
cellular  tissue  and  muscular  or  tendinous  substance  of  the  diaphragm. 
Whether  the  disease  arises  in  the  upper  or  lower  surface  or  covering, 
the  symptoms  are  closely  analogous.  If  the  inflammation  be  ex- 
tensive the  pain  is  extremely  violent,  spreading  from  the  lower  ribs 
to  the  dorsal  vertebrae,  and  accompanied  with  intense  fever.  The 
upper  part  of  the  abdomen,  and  particularly  the  scrobiculus  cordis, 
is  usually  hot,  very  sensitive  to  the  touch,  and  retracted,  but  often 
distended,  tense,  and  accompanied  with  throbbing  and  deep-seated 
burning.  There  is  often  at  first  low  muttering  delirium,  but  as  the 
fever  increases  it  becomes  more  violent ;  simulating  phrenitis,  from 


DIAPHRAGMITIS.  313 

the  circumstance,  as  has  been  supposed,  of  the  irritation  which  is 
communicated  to  the  phrenic  nerve. 

Owing  to  the  interruption  which  is  caused  to  the  functions  of  the 
diaphragm  the  respiration  is  always  impeded,  and  a  dry,  extremely 
distressing  cough  is  commonly  present,  especially  when  the  upper  or 
pleural  surface  of  the  diaphragm  is  the  principal  seat  of  the  inflam- 
mation. 

Along  w7ith  the  foregoing  symptoms  there  is  frequently  obstructed 
deglutition,  severe  hiccup  or  vomiting,  extreme  anxiety  and  restless- 
ness, twitchings,  or  spasmodic  retractions  of  the  angles  of  the  mouth, 
(risus  sardonicus.)  The  exacerbations  on  movement  or  on  attempting 
to  take  a  deep  breath  are  excessive,  and  the  only  position  in  which 
the  patient  experiences  any  degree  of  amelioration  is  when  sitting  up 
with  the  body  inclined  forwards.  The  affection  may  terminate  in 
resolution,  or  in  the  effusion  of  fluid  either  into  the  cavity  of  the 
pleura  or  peritoneum,  or  the  patient  may  speedily  sink  under  the 
intensity  of  the  fever. 

Therapeutics.  When  the  fever  runs  high  and  is  of  the  synochal 
type  it  is  necessary  to  exhibit  Aconitum  in  repeated  doses  ;  but  when 
the  accompanying  fever  partakes  of  the  character  of  synochus,  Bryonia 
is  to  be  preferred,  and  may,  in  most  cases  of  the  said  description,  be 
prescribed  at  the  very  commencement  of  the  attack.  If  the  scro- 
biculus  and  the  region  of  the  false  or  lower  ribs  be  swollen,  and 
pressure  increase  the  short  and  distressingly  interrupted  breathing, 
as  also  the  pulsating  burning  pain,  which  extends  from  the  stated 
points  backwards  towards  the  spine  ;  moreover  when  there  is  a  dry, 
fatiguing  cough,  or  violent  vomiting  and  convulsions,  great  agitation 
and  constant  moaning, — Chamomitta  is  the  best  remedy.  But  should 
there  be  great  tightness,  as  if  caused  by  the  constriction  of  a  cord 
drawn  around  the  chest,  with  dry,  short  cough,  anxiety,  and  consti- 
pation,— Nux  vomica  is  the  most  appropriate  remedial  agent.  Cannabis, 
Pulsatilla,  CoccuUis  have  been  recommended  as  being  useful  where 
the  symptoms  of  inflammation  continue  to  occupy  a  prominent  place ; 
and  Hyoscyamus,  Veratrum  album,  Arsenicum,  Stramonium,  and  Ipe- 
cacuanha where  a  nervous  condition  predominates. 

When  diaphragmitis  exists  in  connexion  with  pleuritis  Bryonia  is 
one  of  the  most  important  remedies  ;  as  also  when  it  is  symptomatic 
of  pneumonia,  peritonitis,  splenitis,  and  hepatitis,  particularly  when 
the  pains  are  aggravated  by  the  slightest  movement  and  are  attended 


314  INSPIRATORY  SYSTEM. 

with  violent  fever,  small,  quick,  hard  pulse,  delirium,  extreme  agita- 
tion, cough. 

Nux  v.  is  equally  useful  when  the  disease  occurs  as  symptomatic 
of  the  above-named  disorders,  provided  the  symptoms  encountered 
are  analogous  to  those  we  have  given  as  characteristic  indications 
for  its  selection.  (See  also  Pjleuritis,  Pneumonia,  Peritonitis, 
Splenitis,  and  Hepatitis.)  Diaphragmitis  arising  from  antecedent 
gout  or  rheumatism,  is  the  most  dangerous  and  fatal  form  in  which 
the  affection  is  met.  The  remedies  chiefly  to  be  relied  on  under  such 
serious  circumstances  are  the  same  as  the  foregoing. 


spitting  of  blood,    hemorrhage  from  the  lungs* 

Sputum  Oruentum.     Hmmorrhagia  Fulmonum.     Hcemojotysis* 

Diagnosis.  Expectoration  of  blood  by  coughing,  in  greater  or 
less  quantity,  attended  by  symptoms  more  or  less  severe. 

This  disease  displays  itself  in  three  varieties :  first,  by  an  effusion 
of  blood  from  the  mucous  lining  of  the  bronchial  tubes;  secondly, 
by  congestion  of  the  lungs,  with  engorgement  of  the  parenchyma 
from  effusions ;  and  thirdly,  by  the  rupture  of  a  blood-vessel  in  the 
tubercular  qavity  of  the  lungs,  during  the  course  of  phthisis  pulmo- 
nalis.  It  is,  however,  proposed  to  deal  generally  with  the  subject, 
and  to  point  out  the  different  remedies  found  useful  in  the  treatment, 
according  to  the  symptoms  present.  We  must  be  careful  not  to 
confound  this  disease  with  affections  of  the  mouth  or  gums,  or  the 
occurrence  of  blood  from  the  nose  escaping  through  the  posterior 
nares,  and  being  returned  by  the  mouth.  When  the  blood  proceeds 
from  the  chest,  it  is  almost  invariably  attended  with  a  sensation  as  if 
it  came  from  a  deep-seated  source,  is  warm,  generally  tastes  sweet, 
and  there  is  frequently  a  simultaneous  burning  and  painful  sensation 
in  the  thorax. 

When  the  attack  is  preceded  by  well-known  premonitory  symp- 
toms, the  patient  should  refrain  from  loud  or  prolonged  speaking, 
calling,  singing,  blowing  wind  instruments,  violent  exercise  of  the 
arms,  running,'  ascending  stairs,  or,  in  short,  anything  calculated  to 
increase  the  respiratory  action,  or  otherwise  fatigue  the  chest. 

When  spitting  of  blood  occurs  in  a  robust  and  healthy  person  of 
sound  constitution,  it  is  not  very  dangerous,  but  when  it  attacks 


SPITTING  OF  BLOOD.  315 

slender  and  delicate  persons  of  weak  lax  fibre,  it  is  more  serious  and 
delicate  of  removal.  It  is,  however,  chiefly  when  the  patient  has  had 
a  succession  of  severe  attacks,  and  the  blood  is  discharged  in  a  large 
quantity,  that  the  case  may  be  considered  dangerous; 

The  disease  may  present  itself  without  any  marked  pains  or  diffi- 
culty of  breathing,  and  pass  off  with  no  return  of  the  attack ;  or  be 
preceded  by  dry  cough,  oppression,  or  tightness  at  the  chest,  shiver- 
ing, coldness  of  the  extremities,  great  lassitude,  and  high  pulse, — 
and  be  accompanied  by  hacking  or  husky  and  distressing  cough, 
anxiety,  quick  pulse,  pale  and  livid  countenance, — cease,  and  then 
return  in  a  few  hours,  and  be  followed  by  difficulty  of  respiration 
and  cough ;  in  still  more  serious  cases,  when  a  marked  tendency  to 
phthisis  exists,  anxiety,  oppression  at  the  chest  and  febrile  symptoms 
are  more  severe,  pure  blood  is  coughed  up,  and  the  paroxysms  fre- 
quently return.  The  rupture  of  a  blood-vessel  is  a  rare  occurrence, 
although  it  sometimes  occurs  in  phthisis.  When,  however,  a  blood 
vessel  of  any  consequence,  included  in  a  tuberculous  excavation,  does 
give  way,  the  result  is  generally  fatal. 

Causes.  Indulgence  in  spirituous  beverages,  overheating  the 
body  by  immoderate  exertion,  or  too  great  external  heat;  blowing 
wind  instruments ;  contusion  of  the  chest  or  back ;  falls ;  lesion  of 
the  lungs  ;  breathing  a  vitiated  atmospnere,  or  vapours  charged  with 
acrid  substances;  colds  or  coughs  ;  violent  mental  emotions;  diseased 
state  of  the  lungs,  whether  from  pneumonia  or  phthisis ;  a  general 
strumous  habit ;  suppressed  menstrual,  hemorrhoidal,  or  other  dis- 
charges ;  or  repercussed  cutaneous  eruptions. 

Therapeutics.  In  by  far  the  greater  number  of  cases,  the  dis- 
charge or  spitting  of  blood  soon  ceases  of  its  own  accord ;  the  most 
important  object,  therefore,  is  to  seek  to  cure  the  complaint  when  the 
hemorrhage  has  ceased,  and  thereby  prevent  its  return,  or  check  the 
development  of  organic  disease  of  the  lungs.  The  principal  homoeo- 
pathic remedies  are :  Pulsatilla,  Nuos  vomica,  Bryonia,  Sulphur,  Arnica 
montana,  Aconitmn,  Ipecacuanha,  Acidum  sulphur icum,  Arsenicum,  Opium, 
Cinchona,  Carlo,  Ferrum  metallicum,  Mhus,  Phosphorus  and  Sepia,  These 
are  not  only  calculated  to  arrest  the  hemorrhage,  but  also  to  prevent  a 
relapse,  where  that  is  practicable. 

Pulsatilla  : — In  cases  of  females,  arising  from  suppression  of 
the  monthly  discharge,  or,  in  either   sex,  of  a   hemorrhoidal  flux, 


316  RESPIRATORY  SYSTEM. 

(particularly  when  the  individual  is  of  leucophlegmatic  tempera- 
ment^) and  also  in  other  instances,  with  the  following  symptoms : 
expectoration  of  dark  coagulated  blood,  attended  with  shivering, 
especially  towards  evening,  or  at  night,  and  great  anxiety ;  pain  in 
the  lower  part  of  the  chest ;  feeling  of  flaccidity  in  the  epigastrium, 
and  weakness.     (Hamoptysis  vicaria.) 

When,  in  females,  the  menses  do  not  return,  notwithstanding  the 
employment  of  Pulsatilla, — Cocculus,  Sepia,  Sulphur,  or  any  other 
remedy  better  adapted  to  the  entire  case,  should  be  selected.  (Vide 
Chlorosis,  Amenorrhea,  or  Catamenia,  Suppression  of.) 

Bryonia  is  a  good  remedy  in  cases  where  the  expectorated  blood 
is  excited  by  a  tickling  cough,  and  is  often  in  a  coagulated  state ; 
and  where  there  is  oppression  at  the  chest,  with  frequent  necessity 
to  take  a  deep  inspiration ;  anxiety  and  irascibility. 

Nux  vomica  is  adapted  to  individuals  of  an  irritable  temper,  in 
whom  this  affection  owes  its  origin  to  a  hemorrhoidal  suppression,  a 
fit  of  passion,  or  exposure  to  cold.  (Haemoptysis  vicaria.)  It  is  further 
indicated  by  dry  cough,  which  causes  headache,  with  excessive 
tickling  in  the  chest  and  exacerbation  of  the  symptoms  towards 
morning. 

When  Nux  v.  does  not  afford  speedy  relief,  Sulphur  will  generally 
be  found  to  succeed;  but  should  any  other  remedy  appear  to  be  more 
appropriate,  it  should  unhesitatingly  be  selected  in  preference. 

Rhus  : — When  the  blood  expectorated  is  of  a  bright  red,  the  mind 
much  agitated,  and  the  patient  irritable  and  rendered  worse  after  the 
slightest  vexation  or  contradiction. 

Arnica  Montana  : — Principally  in  cases  arising  from  external 
lesion,  such  as  a  severe  blow  in  the  chest,  or  from  lifting  a  heavy 
weight,  or  any  other  exertion,  even  blowing  wind  instruments ;  but 
also  in  almost  all  cases,  where  the  stethoscope  detects  effusion  of 
blood  into  the  parenchyma,  attended  with  a  sensation  of  constriction 
and  burning  in  the  chest,  pain  as  from  contusion  in  the  scapular  and 
dorsal  regions,  and  dyspnoea.  Moreover,  profuse  .expectoration  of 
dark-coloured  blood  or  coagula,  brought  up  without  much  exertion, 
or  bright  frothy  blood,  mixed  with  mucus  and  clots;  sensation  of 
tickling  behind  the  sternum ;  general  heat,  great  weakness  and 
syncope.  (Aconite  is  sometimes  necessary  before,  or  alternately  with 
Arnica,  &c.) 

Acidum  sulphuricum  is  frequently  of  service  after  Arnica  when 
the  cough  continues,  and  brings  on  fresh  bleeding. 


SPITTING  OF  BLOOD.  317 

In  severe  cases  attended  with  manifest  danger:  Aconitum,  Ipecacuanha, 
Arsenicum,  Opium,  Cinchona,  and  Kreosotum  are  the  most  useful,  and 
must  as  usual  be  selected  according  to  the  prevailing  symptoms. 
When  one  of  these  is  insufficient  to  check  the  hemorrhage  entirely, 
another  must  be  chosen  to  meet  the  remaining  symptoms. 

Aconitum  is  often  found  exceedingly  serviceable  in  warding 
off  an  attack,  by  the  great  power  it  possesses  in  controlling  the  cir- 
culation, and  is  indicated,  previous  to  the  paroxysm,  by  the  premo- 
nitory symptoms  of  shivering,  with  accelerated  pulse,  palpitation  of 
the  heart,  a  sensation  of  ebullition  of  blood  in  the  chest,  with  burn- 
ing and  fulness  in  the  same  region  ;  paleness  and  expression  of 
anxiety  in  the  face ;  great  anguish  and  anxiety,  aggravated  by  lying 
down ;  or  during  the  attach  when  the  expectoration  is  profuse,  coming 
on  in  gushes,  and  excited  by  a  slight  dry  cough.  {Hemoptysis 
plethorica.) 

Ipecacuanha: — When  a  taste  of  blood  remains  in  the  mouth  a 
few  hours  after  the  employment  of  Aconite  has  been  commenced, 
when  there  is  frequent  tussiculation,  with  nausea,  weakness,  and 
expectoration  streaked  with  blood. 

Arsenicum: — When  the  anxiety,  anguish,  and  palpitation  of  the 
heart  increases,  notwithstanding  the  administration  of  Aconite ;  and 
when,  in  addition,  we  find  extreme  restlessness  and  general  dry 
burning  heat. 

The  employment  of  this  remedy  alternately  with  Ipecacuanha  has 
been  found  to  succeed  in  many  instances,  when  neither  of  them 
separately  have  been  found  sufficient  to  conquer  the  disease  ;  an 
occasional  dose  of  Nux  vomica  should  be  prescribed  as  soon  as  the 
hemorrhage  has  in  a  great  measure  been  checked,  to  such  indi- 
viduals as  have  been  in  the  habit  of  indulging  in  spirituous,  vinous, 
or  fermented  liquors,  or  coffee.  Should  hemorrhage  return  after  a 
temporary  cessation,  Sulphur  may  be  given,  followed  in  turn,  if 
required,  by  Arnica. 

Opium  : — Heat,  dyspnoea,  with  sensation  of  burning  heat  at  the 
region  of  the  heart;  coldness,  particularly  of  the  extremities;  tremor 
in  the  arms ;  dry  hollow  cough,  with  expectoration  of  blood  and 
frothy  mucus,  and  sometimes  also  weakness  of  the  voice;  drowsiness, 
with  sudden  starts  ;  aggravation  of  cough  after  swallowing.  It  will 
be  found  useful  in  the  most  serious  cases,  particularly  to  persons 
addicted  to  spirituous  liquors ;  in  the  latter  case  it  may  be  useful  to 
follow  up  the  treatment  with  Nux  vomica. 


318  RESPIRATORY   SYSTEM. 

Cinchona,  as  already  mentioned  in  several  places  in  this  work, 
is  one  of  our  best  remedies  in  restoring  the  vital  energies  of  the 
patient  after  considerable  loss  of  fluids,  whether  of  blood  or  other 
secretions ;  it  is  therefore  particularly  efficacious  after  a  severe*  attack 
of  this  affection,  but  is  also  indicated  during  its'  course,  when  the 
spitting  of  blood  takes  place  after  a  violent  cough,  or  when  there  is  a 
continual  taste  of  blood  in  the  mouth,  or  when  we  find  shivering  alter- 
nately with  accesses  of  heat,  frequent  and  short-lived  perspirations ; 
tremor,  and  confusion  of  vision,  with  a  sensation  of  vacuity  or  light- 
ness in  the  head,  weakness  and  desire  to  remain  constantly  recumbent. 

Ferrum  metallicum,  may  be  used  with  advantage  after  Cinchona 
in  severe  cases,  or  may  be  preferred  if  the  expectoration  follows  a 
slight  cough,  and  is  scanty,  but  consists  of  pure  bright  red  blood, 
attended  with  pain  between  the  scapulae,  with  inability  to  remain 
long  in  a  sitting  posture  :  the  patient  feels  the  concomitant  symp- 
toms relieved  by  movement,  but  is  speedily  fatigued,  especially  by 
conversation.  It  may,  in  some  cases,  be  advantageously  alternated 
with  Cinchona,  Carlo  v.,  Arnica  and  Arsenicum? — in  others  Sulphur  may 
be  required  to  complete  the  cure  in  some  cases. 

Sulphur.  This  remedy  is  frequently  useful  in  winding  up  the 
treatment  after  the  employment  of  other  medicines ;  and  it  is  also 
particularly  suitable  for  individuals  disposed  to  hemorrhoidal  affec- 
tions, in  derangement  of  the  menstrual  flux,  or  hemoptysis  arising 
from  suppressed  cutaneous  eruptions,  such  as  scabies,  &c.  {Hemo- 
ptysis vicaria,  &c.)  Nux  v.  and  Arsenicum  may  occasionally  be  advan- 
tageously given  in  alternation  with  Sulphur  at  intervals  of  five  to  ten 
days,  particularly  when  the  disease  occurs  in  drunkards. 

Kreosotum  has  been  found  of  great  efficacy  in  cases  where  the 
patient  has  had  a  succession  of  severe  attacks,  and  the  blood  is  thrown 
off  in  large  quantities ;  also  when  the  patient  complains  of  w  feeling  of 
burning  heat  in  the  chest,  or  a  pain  as  if  from  a  bruise,  together  with 
oppression  in  the  chest  and  frequent  desire  to  take  a  deep  inspiration. 

x\fter  hemoptysis  has  disappeared  (besides  having  to  guard  against 
a  relapse,  in  which,  as  above  stated,  Sulphur  is  our  chief  auxiliary), 
we  have  to  take  every  precaution  lest  inflammation  arise  in  the  part 
primarily  affected,  or  the  disease  degenerate  into  Phthisis,  which 
objects  will  sometimes  be  best  attained  by  the  administration  of 
Phosphorus,  in  combination  with  a  strict  observance  of  an  antiphlo- 
gistic regimen,  and  the  other  rules  about  to  be  given  for  the  conduct 
of  patients  suffering  from  this  affection. 


CONSUMPTION.  319 

Pkosjohorus,  it  may  be  added,  is,  in  conjunction  with  Aconitum,  one 
of  our  chief  remedies  in  hemorrhages  from  the  lungs  -during  the 
course  of  phthisis. 

Sepia  is  also  useful  in  this  affection  occurring  in  Phthisis,  but 
when  it  is  rather  to  be  looked  upon  as  one  of  the  general  symptoms, 
than  as  forming  a  disease  of  itself;  by  its  powrer  over  the  economy 
of  the  uterus,  it  is  also  of  great  service  in  cases  of  hemoptysis,  arising 
from  derangements  connected  with  that  organ.  (Hemoptysis phthisica 
et  vicaria.) 

The  following  remedies  may  also  be  noted  as  worthy  the  atttention 
of  the  practitioner  in  peculiar  cases:  Kreosotum,  Belladonna,  Acid, 
nitricum,  Bryonia,  Carlo  vegetahilis,  Hyoscyamus,  Ignatia,  Dulcamara, 
Cocculus,  Crocus,  Conium  macttlatum,  Lachesis,  Acidum  sulphuricum,  Ledum 
palustre,  Bycopodium,  Millefolium,  Silicea,  Staphysagria,  and  Cuprum 
metallicum,  Sec. 

Diet,  &c.  The  rules  given  under  H^ematemesis  ought  to  be 
observed  as  regards  regimen  ;  both  mind  and  body  should  be  kept 
perfectly  quiet ;  the  patient  should  speak  as  little  as  possible,  and  be 
kept  in  a  semi-recumbent  posture,  or,  if  his  strength  allow,  sit 
upright. 

PULMONARY  CONSUMPTION. 

Phthisis  Pulmonalis. 

One  of  the  earliest  symptoms  of  tuberculous  phthisis  is  a  short 
cough,  which  is.  either  dry  or  accompanied  by  the  expectoration  of 
a  frothy  mucus,  and  is  generally  slight  at  the  commencement,  but 
more  or  less  constant.  Shortness  of  breath,  proceeding  from  ob- 
struction, caused  by  the  granular  and  diffused  indurations,  is  another 
early  symptom  of  consumption.  It  is,  at  first,  experienced  only  during 
exertion,  but  subsequently  comes  on  after  every  fit  of  coughing, 
or  on  lying  on  the  one  or  the  other  side,  and  is  much  increased  by 
the  slightest  movement.  Symptoms  of  gastric  derangement  are 
frequently  present,  with  redness  of  the  tongue,  or  white  furred  centre, 
with  inflamed  and  projecting  papillae,  and  vivid  red  tip  and  margins ; 
the  patient  falls  off  in  flesh,  becomes  indolent,  dejected,  and  over- 
powered with  languor.  A  feeling  of  soreness  is  often  complained  of 
behind  the  sternum,  or  under  the  clavicles,  particularly  after  any 
fatigue,  or  after  a  fit  of  coughing,  and  sometimes  on  exposure  to 


320  RESPIRATORY  SYSTEM. 

cold  air.  The  pulse  is  often  normal  in  the  first  stage  of  the  disease, 
but  soon  becomes  full,  hard,  and  accelerated.  Fever  of  an  intermittent 
character  soon  makes  its  appearance ;  it  declares  itself  most  towards 
night,  remits  from  about  two  in  the  morning  until  the  following  day 
at  noon,  when  it  returns  in  a  slighter  degree,  and  continues  until  about 
five  in  the  afternoon,  and  is  then  followed  by  another  remission. 
This  hectic  fever  is,  in  the  first  instance,  chiefly  manifested  by  flush- 
ing of  the  face  (which  is  often  most  apparent  after  a  meal),  and  heat 
in  the  palms  of  the  hands  and  soles  of  the  feet ;  but,  as  the  disease 
advances,  night  sweats  supervene,  which  leave  the  patient  in  a  state 
of  great  exhaustion  in  the  morning.  As  the  expectoration  increases 
it  becomes  more  viscid  and  opaque,  and  is  often  tinged  with  blood, 
or  a  considerable  quantity  of  florid,  frothy  blood  is  ejected  in  conse- 
quence of  the  obstruction  offered  to  the  blood-vessels,  by  the  indura- 
tions or  granulations  already  alluded  to.  As  the  disease  advances 
and  passes  into  the  second  stage,  or  that  in  which  the  dark  red  or 
grayish  indurations  are  converted  into  crude  yellow  tubercles,  the 
respiration  becomes  more  difficult,  the  emaciation  and  debility  go  on 
increasing,  the  cough  is  rendered  more  severe  and  troublesome,  par- 
ticularly at  night,  and  the  fever,  though  of  shorter  duration,  is 
attended  with  more  profuse  sweating,  and  the  pulse  loses  tone.  The 
expectoration  becomes,  at  the  same  time,  more  free  and  copious, 
particularly  towards  morning,  and  is  less  thin  and  transparent. 

During  the  febrile  exacerbations,  or  after  meals,  or  at  times  of 
excitement,  a  circumscribed  red  patch  still  appears  on  each  cheek, 
but  at  other  times  the  colour  of  the  cheek  is  faded,  and  the  counte- 
nance wears  a  dejected  expression. 

In  the  third  (or  suppurative  and  ulcerative)  stage  of  the  disorder 
the  tubercles  become  soft,  and  are  expectorated  at  first  in  the  form 
of  curd  or  cheese-like  particles,  and  subsequently  mixed  up  with 
pus,  mucus,  shreds  of  lymph,  blood,  and  occasionally,  though  rarely, 
portions  of  pulmonary  tissue.  The  bowels,  from  having  been  more 
inclined  to  be  costive  at  the  commencement  of  the  disease,  are  now 
more  prone  to  be  relaxed,  so  that  attacks  of  diarrhoea  often  recur 
frequently,  and,  by  alternating  with  colliquative  sweats,  induce  an 
excessive  degree  of  weakness  and  prostration.  In  this,  the  last  stage 
of  the  disease,  the  patient  becomes  reduced  to  a  skeleton ;  the  face  is 
thinned,  the  cheek-bones  prominent,  the  eyes  look  hollow,  the  hair  falls 
off,  the  nails  are  livid  and  incurvated,  and  the  feet  eedematous  ;  but, 
notwithstanding  all  this,  the  countenance  presents  a  degree  of  clear- 


CONSUMPTION.  321 

ness,  and  the  eyes  a  lustre  that  are  rarely,  if  ever,  met  with  in  other 
maladies,  moreover,  the  state  of  mind  is  generally  so  serene  and 
hopeful,  that  the  patient  seems  often  quite  unconscious  of  his  dangerous 
condition,  and  speaks  and  acts  as  if  in  full  anticipation  of  a  speedy 
recovery.  The  senses  commonly  remain  entire  and  collected  to  the 
end  of  the  disorder,  but  in  some  cases  delirium  precedes  death  and 
continues  until  life  is  extinct.  The  usual  duration  of  phthisis  pul- 
monalis  is  from  eight  or  nine  months  to  a  year  and  a  half;  but 
circumstances  tend  much  to  vary  the  length  of  the  disease ;  and  there 
is  a  rapidly  fatal  form  which  runs  its  course  in  from  two  to  three 
months,  sometimes  indeed  only  in  one.  When  the  malady  makes 
slow  progress,  the  patient  is  affected  with  cough,  weakness,  and 
emaciation  chiefly  in  winter  and  spring,  and  in  many  respects  restored 
to  comparative  health  in  summer ;  but  is  always  extremely  susceptible 
to  cold,  and  commonly  complains  of  breathlessness  on  the  slightest 
exertion.  In  this  state  the  patient  continues  for  a  considerable  time, 
sometimes  even  for  several  years,  until  at  length  the  symptoms  of 
confirmed  consumption  are  developed  by  the  invasion  of  an  inflam- 
matory attack  proceeding  from  cold  or  some  other  irritating  cause.* 

When  we  take  the  general  symptoms  in  conjunction  with  the 
physical  signs,  the  diagnosis  of  phthisis  pulmonalis  is,  in  general, 
unattended  with  difficulty.  It  is  true  that  in  the  early  stage,  when 
the  miliary  indurations  are  equally  diffused  or  scattered  through 
both  lungs,  they  do  not  give  rise  to  any  marked  diminution  or  change 
in  the  respiratory  murmur,  or  in  the  resonance  of  the  thorax  on 
percussion.  But  it  much  more  frequently  happens  that  the  indura- 
tions, even  in  the  early  stage,  accumulate  in  clusters,  particularly 
about  the  apices  of  the  lungs,  and  usually  more  on  one  side  than  the 
other.  The  sound,  on  percussion,  will  therefore  generally  be  found 
dull  at  the  clavicle  (more  commonly  the  left)  and  the  subclavicular 
region;  the  breath-sound  during  expiration  will,  at  the  same  time, 
be  unusually  audible,  and  the  voice  will  transmit  a  diffused  resonance 
or  preternatural  clearness. 

When  the  spaces  immediately  beneath  the  clavicles  give  no  signs 
of  disease  or  discrepancy  of  sound,  the  regions  below,  at  the  sides, 
and  at  the  back  should  be  examined  (between  the  scapulas  in  the  case 

*  Hoarseness  is  often  an  early  accompanying  symptom  of  phthisis.  Laryngeal  phthisis, 
with  thickening  and  ulceration  of  the  lining  membrane  of  the  larynx,  independently  of  its 
own  serious  character  as  a  disease,  is  moreover  very  frequently  complicated  with  tubercular 
formations  in  the  lungs. 

21 


322  RESPIRATORY  SYSTEM. 

of  children  in  particular).  A  slight  flattening  is  sometimes  observable 
under  the  clavicles.  On  comparing  the  movements  of  the  two  sides 
of  the  chest,  when  the  patient  breathes  deeply,  a  difference  in  their 
individual  mobility  will  frequently  be  perceived.  When  the  disease  has 
attained  the  suppurative  stage,  and  the  tubercles  have  consequently 
become  soft,  or  entirely  liquid,  a  clicking  or  bubbling  sound  will  be 
heard  either  under  one  of  the  clavicles  or  above  the  spine  of  one,  of 
the  scapulae.  As  the  evacuation  of  the  softened  matter  of  the  vomica 
progresses,  a  more  continued  gurgling,  or  the  so-called  cavernous 
rhonclms,  will  then  be  heard.  Again,  when  the  vomica  or  abscess  has 
become  completely  softened  and  evacuated  by  ulceration  into  the 
bronchial  tubes,  a  cavity  is  left,  over  the  seat  of  which,  cavernous 
respiration  and,  when  the  patient  speaks,  the  phenomenon  designated 
pectoriloquy  are  encountered. 

Therapeutics.  It  would  require  a  separate  treatise  to  do  justice 
to  the  treatment  of  this  deplorable  disease,  by  giving  or  attempting 
to  give  a  full  and  minute  description  of  the  characteristic  indications 
for  the  medicines  which  are  appropriate  to  the  various  forms  of  the 
different  stages  of  the  disorder.  We  must  therefore  content  our- 
selves here,  by  presenting  our  readers  with  a  brief  notice  of  the 
principal  remedies  which  are  employed  in  homoeopathic  practice 
against  the  inflammatory,  suppurative,  and  ulcerative  stage  of  tuber- 
cular consumption. 

In  \he  first  stage  of  the  malady,  when  the  tubercles  are  in  a  crude, 
unsoftened  state,  or  when  they  are  inflamed  and  commencing  to 
soften,  the  remedies  by  means  of  which  the  malady  may  be  retarded, 
if  not  arrested,  and,  with  due  collateral  precautions,  kept  harmless 
for  years,  are  chiefly  Aconitum,  Bryonia,  Belladonna,  Lachesis,  Hepar, 
Spongia,  Phosphorus,  Dulcamara,  Pulsatilla,  Arsenicum,  Nux  v.,  Hyo- 
scyamus,  Silicea,  Calcarea  c,  Carlo  v.,  Acidum  nitricum,  and  Sulphur. 
These  must  be  selected  according  to  the  aggregate  symptoms  of  the 
case  under  treatment.  Their  leading  indications  may  be  gleaned  from 
the  chapters  on  Cough,  Pleuritis,  Pneumonia,  and  Hemoptysis. 

In  the  second  stage,  with  more  free,  copious,  and  somewhat  purulent 
expectoration,  the  most  important  remedies  are :  Acidum  nitricum, 
Silicea,  Kali  c,  Sulphur,  Calcarea,  Natrum  m.,  Mercurius,  Lachesis, 
Phosphorus,  Lycopodium,  Carlo  v.,  Samlucus,  Hepar  sulphuris,  Spongia, 
Cinchona,  Ferrum,  Conium,  Zincum,  Ammon.  c,  Laurocerasus,  Graphites, 
Nitntm,  Iodium,  Drosera,  Plumlum,  etc. 


CONSUMPTION.  323 

In  the  third,  or  ulcerative  stage,  the  same  remedies  as  the  fore- 
going, together  with  Guaiacum,  Sepia,  Stannum,  Stapliysagria,  Acidum 
pliosphoncum,  Sangninaria  canadensis,  are  those  by  means  of  which  the 
symptoms  may  be  materially  mitigated,  and  the  fatal  issue  of  the 
disease  postponed.  A  few  general  indications  for  most  of  these  will 
be  found  in  the  chapter  on  Cough.  When  the  colliquative  sweats  are 
peculiarly  distressing,  "  Sambucus,  Stannum,  Cinchona,  Phosphorus, 
Arsenicum,  Carlo  v.  et  a.,  Silicea,  Mercurius,  Nitrum,  Lachesis,  Sulphur, 
and  Lycopodium  are  the  medicines  which  are  of  the  greatest  service.  The 
remaining  morbid  symptoms  must  regulate  their  selection.  When  col- 
liquative diarrhoea  predominates  :  China,  Ferrum,  Arsenicum,  Phosphorus, 
Acid. phosphoricum,  and  Sepia  are  the  most  useful.    (See  Diarrhoea.) 

In  phthisis  resulting  from  imperfectly  treated  pulmonic  inflammation, 
or  from  excessive  pulmonary  hemorrhage,  and  occurring  in  habits 
which  are  not  of  the  consumptive  diathesis,  the  remedies  which  are 
best  calculated,  under  favorable  circumstances,  to  effect  a  cure  are : 
Lachesis,  Lycopodium,  Sulphur,  Mercurius,  and  Ledum.  But,  in  some 
cases,  one  or  more  of  the  other  medicaments  noticed  under  tubercular 
consumption,  may  be  better  indicated.  (See  also  Pneumonia.) 

In  pittcitous  phthisis,  or  blenorrhcea  of  the  lungs,  the  most  effective 
medicines  are  Stannum,  Dulcamara,  Pulsatilla,  Sulphur,  Sepia;  and 
Calcarea,  Lycopodium,  Cinchona,  Phosphorus,  Silicea,  Arsenicum,  Zincum,. 
Capaiva,  &c. 

While  conducting  the  treatment  of  consumption  the  state  of  the 
digestive  functions,  and  in  females  the  condition  of  the  uterine 
system  likewise,  must  be  strictly  attended  to.  This  is,  however, 
a  superfluous  precaution  to  the  homoeopathic  practitioner,  as  he  is 
ever  careful  to  pay  due  regard  to  every  symptom  not  only  in  this, 
but  in  every  other  disease.  Should  none  of  the  remedies  above 
quoted  correspond  to  the  derangements  alluded  to  in  particular 
cases,  although  they  may  be  otherwise  indicated,  an  intercurrent 
remedy  may  be  selected  from  amongst  those  we  have  mentioned  in 
the  articles  on  Dyspepsia,  Chlorosis,  &c.  The  temperament  and 
constitution  of  the  patient  ought  also  to  claim  attention  in  the 
selection  of  the  remedies. 

In  conclusion,  it  must  be  remarked  that  as  the  irritation  which  is 
so  repeatedly  created  in  the  lungs  by  the  vicissitudes  of  climate^  so 
constantly  occurring  in  most  parts  of  this  country,  forms  a  great 
drawback  to  the  more  or  less  successful  treatment  of  pulmonary 
consumption,  it  is  of  great  moment  that  every  possible  means  be 


324  RESPIRATORY  SYSTEM. 

taken  to  avoid  that  pernicious  influence.  It  has  been  much  in 
vogue  with  man)''  medical  men  to  recommend  warm  climates,  or 
well-sheltered  situations,  even,  although  the  atmosphere  might  be  of 
a  humid  and  relaxing  nature.  But  we  confess  that  wre  are  inclined 
to  side  with  those  who  do  not  object  to  a  somewhat  bracing  and 
cold  atmosphere,  provided  it  be  dry  and  not  of  very  variable  tem- 
perature. Much,  however,  depends  upon  the  peculiarity  of  the  case, 
—the  air,  as  well  as  the  food,  which  may  be  well  adapted  to  one 
patient,  being  often  perfectly  inappropriate  and  therefore  injurious 
to  another. 

ASTHMA. 

This  affection  is  characterised  by  the  following  phenomena :  dif- 
ficulty of  breathing,  recurring  in  paroxysms,  attended  with  a  sensa- 
tion of  suffocating  constriction  in  the  chest,  cough,  and  wheezing. 
The  paroxysm  is  frequently  preceded  by  a  sense  of  coldness,  languor, 
headache,  heaviness  over  the  eyes,  sickness  or  flatulence,  and  a  sense 
of  oppression  in  the  chest.  During  the  attack,  the  patient  feels 
much  wrorse  in  the  recumbent  posture,  and  consequently  sits  up, 
requests  the  door  or  window  to  be  thrown  open,  to  admit  more  air 
into  his  apartment,  and  uses  every  effort  to  dilate  and  empty  the 
lungs.  He  also  experiences  great  restlessness,  making  frequent 
attempts  to  force  something  out  of  the  air-passages,  which  he  thinks 
impedes  the  breathing,  by  coughing.  The  face  is  pale  or  livid,  and 
wears  an  anxious  expression.  The  extremities,  and  even  the  nose 
and  ears,  are  frequently  cold,  and  the  face  and  chest  are  covered  with 
cold  perspiration ;  the  heart  palpitates  ;  the  pulse  is  variable,  being 
quick  and  full,  or  small  and  quick,  or  weak  and  irregular ;  often  inter- 
mitting. These  symptoms  continue  with  a  greater  or  less  degree  of 
violence  for  some  hours  or  even  days,  until  expectoration  takes  place, 
which  affords  relief  as  it  increases  in  quantity.  A  remission  also 
sometimes  takes  place  soon  after  an  accession  of  copious  perspiration 
or  a  profuse  discharge  of  urine.  The  disease  is  more  frequently  met 
with  at  an  advanced  than  an  early  stage  of  life,  and  oftener  in  men 
than  women.  The  attacks  occasionally  come  on  in  the  afternoon,  or 
on  retiring  to  rest,  but  much  more  frequently  during  the  night,  and 
in  the  midst  of  a  sound  sleep,  from  which  the  patient  is  suddenly 
awoke  by  a  sense  of  suffocation. 

The   recurrence,  as  well  as  the  duration,  of  the  attacks  is  very 


ASTHMA.  325 

various.  One  attack  generally  leads  to  another,  and  the  paroxysms 
commonly  become  more  and  more  frequent  and  distressing ;  still  if 
no  organic  disease  result,  patients  who  are  subject  to  returns  in  con- 
siderable frequency,  sometimes  survive  to  an  advanced  age.  But 
this  is  unfortunately  not  often  the  case,  for  unless  the  disease  be 
arrested,  the  repeated  obstruction  and  disturbance  which  is  offered 
to  the  respiration  and  circulation  seldom  fails,  in  the  majority  of 
cases,  to  induce  organic  lesions  either  of  the  heart  or  large  vessels,  or 
of  the  lungs,  with  the  usual  concomitants  of  water  in  the  chest  or 
abdomen.  The  quantity  of  expectoration  is  small,  and  even  entirely 
absent  in  some  cases  of  asthma,  whilst  in  others  it  is  excedingly 
copious;  and  hence,  the  disease  has  been  divided  into  dry  and  humid 
asthma.  In  the  former  {Asthma  siccum),  the  attack  is  usually  sudden, 
violent,  and  of  short  duration ;  the  cough  slight ;  the  expectoration 
scanty,  appearing  only  towards  the  termination  of  the  fit,  and  in 
some  instances  entirely  wanting.  In  the  latter  [Asthma  Immidum), 
the  paroxysm  is  gradual  and  protracted ;  the  cough  severe ;  the 
expectoration  supervenes  early,  is  at  first  scanty  and  glutinous,  and 
afterwards  copious,  and  productive  of  great  relief. 

Therapeutics.  In  nervous  or  convulsive  asthma  [Asthma  siccum), 
the  remedies  which  have  been  employed  with  the  most  satisfactory 
results  are  :  Arsenicum,  Cuprum,  Ipecacuanha. — Nux  v.,  Bryonia, 
Pulsatilla.  —  Opium,  Tartarus,  Sambucus.  —  Aconitum,  Belladonna, 
Phosphorus. — Sulphur,  Lachesis,  Sambucus, — Ferrum,  Veratrum,  Moschis, 
Stannum,  Hyoscyamus,  Stramonmm,  Chamomilla,  Carlo  v.,  Aurum,  Lyco- 
podium, Acidum  nitr.,  Ignatia,  Kali,  Ambra,'  Mercurius,  Silicea,  Calcarea, 
Dulcamara,  Coffea,  Lobelia  infiatai  &c.  In  moist,  humid,  pituitous 
asthma  [asthma  humidum)  :  Pulsatilla,  Dulcamara,  Stannum. — StilpJmr, 
Sepia,  Tartarus,  Cuprum,  Sambucus —Ipecacuanha,  Belladonna,  Bryonia. 
— Ferrum,  Calcarea,  Lachesis,  Graphites,  China,  Silicea,  Hepar,  Baryta  c, 
Conium,  Camphor  a,  Zincum,  Mercurius.  In  flatulent  asthma  :  Nux  v., 
Cinchona,  Carbo  v.,  Lycopodium,  Chamomilla,  Phosphorus,  Sulphur,  Opmm, 
Zincum,  &c.  In  spasmodic  asthma,  pulmonary  spasm  [cramps  in  the 
chest)  ;  Cuprum,  Nux  v.,  Bryonia,  Belladonna,  Hyoscyamus,  Arsenicum, 
Lachesis,  Stramonium,  Cocculus,  Nux  m.,  Sambucus,  Tartarus,  Zincum, 
Sulphur,  Kali,  Causticttm,  Sepia,  Stannum,  Lycopodium,  &c.  Asthma 
arising  from  exposure  to  irritating  vapours,  such  as  copper  or 
arsenic  [asthma  vapor  osum) :  Ipecacuanha,  Mercurius,  Hepar  s. — Camphor  a, 
Cuprum,  or  Arsenicum.       From  the    vapour  of   sulphur;    Pulsatilla 


326  RESPIRATORY  SYSTEM. 

chiefly  ;  and  when  caused  by  the  continued  inhalation  of  stone-dust, 
and  other  irritating  particles :  Sulphur,  Calcarea,  Silicea,  Hepar,  have 
principally  been  recommended,  and  in  some  cases,  also,  the  follow- 
ing :  Arsenicum,  Belladonna,  Nux  v.,  Phosphorus,  Ipecacuanha,  and 
Cinchona.  Where  the  repercussion  or  retropulsion  of  an  eruption,  or 
the  suppression  of  an  habitual  discharge  has  been  the  occasional 
cause  [asthma  metastaticum) :  Sulphur,  Carho  v.,  Arsenicum,  Bryonia,  and 
Phosphorus  are  the  most  appropriate  remedies  in  the  majority  of  cases. 
If  the  affection  is  attributable  to  suppressed  catarrh:  Arsenicum, 
Ipecacuanha,  Nux  v.,  &c.  Where  a  chill  has  given  rise  to  an  attack 
of  asthmatical  breathing :  Ipecacuanha  and  Arsenicum  ;  or,  Dulcamara, 
Aconitum,  Belladonna,  Bryonia,  Chamomilla,  And  when  mental  dis- 
turbance has  brought  on  a  paroxysm  of  dyspnoea :  Aconitum-,  Chamo- 
milla,  Ignatia,  Coffea,  Nux  v.,  Pulsatilla,  Veratrum.  When  congestion  of 
blood  in  the  chest  forms  the  occasional  cause  of  dyspnoea,  see  that 
article.  When  the  disorder  occurs  as  a  sequela  of  bronchitis,  see 
Bronchitis. 

The  remedies  which  are  best  calculated  to  afford  relief  during  a 
paroxysm  of  asthma  are,  Ipecacuanha,  followed,  if  it  produces  but 
little  benefit,  by  Arsenicum.  In  other  cases  Cuprum,  Moschus,  Opium, 
Tartarus  and  Sambucus ;  or,  Nux  v.,  Bryonia,  Chamomilla,  Belladonna , 
Cinchona,  Nux  moschata,  or  Pulsatilla  will  prove  more  useful.  And 
those  which  have  principally  been  recommended  to  eradicate  the 
tendency  to  suffer  from  continual  recurrences  of  the  disorder, — 
where  that  is  practicable  from  the  absence  of  serious  organic  disease, 
&c. — are  as  follows  :  Sulphur,  Calcarea,  Arsenicum,  Nux  v.,  Antimonium, 
— Stannum,  Sepia,  Silicea,  Cuprum,  Lachesis,  Carho  v., — Bycopodium, 
Causticum,  Graphites,  Acidum  nitricum,  Phosphorus,  Ammonium  c, 
Ferrum,  Zincum,  Tussilago.  In  ordinary  cases  the  subjoined  remedies 
wrill  be  found  serviceable,  when  the  leading  symptoms  are  in  accord- 
ance with  those  which  are  described. 

Ipecacuanha.  During  the  paroxysm  of  acute  asthma,  this 
remedy  is  one  of  the  most  frequently  useful,  whether  the  attack 
occurs  in  children  or  adults.  It  is  more  especially  indicated  when 
the  patient  is  awoke  from  a  sound  sleep,  with  a  suffocating  sensation 
of  constriction  in  the  windpipe,  with  quick  laborious  breathing  and 
gasping  for  breath :  wheezing  and  mucous  rattling  in  the  chest ; 
short  dry  cough ;  paleness  and  coldness  of  the  face,  sometimes  alter- 
nately with  heat  and  redness:  coldness  of  the  feet ;  anxiety  and 
dread  of  suffocation;  feeling  as  if  dust  were  inhaled  during  the  act 


ASTHMA.  327 

of  respiration,  and  caused  the  suffocating  sensation  in  the  chest ; 
spasmodic  rigidity  of  the  body,  and  livid  hue  of  the  face.  After  a 
dose  or  two  of  Ipecac,  it  is  occasionally  requisite  to  have  recourse  to 
Arsenicum  to  afford  further  relief.  In  other  instances  Nux  v.  or 
Bryonia  will  be  found  better  adapted  to  remove  the  remaining 
symptoms. 

Arsenic um,  is  chiefly  called  for  (either  in  acute  or  chronic 
asthma),  when,  during  the  attack,  the  respiration  appears  to  become 
more  and  more  laborious,  and  is  attended  with  extreme  agitation, 
moaning,  and  jactitation ;  great  exhaustion  and  anguish,  as  if  at  the  point 
of  death,  %vith  cold  perspiration.  In  confirmed  asthmatics,  it  forms  a 
most  important  remedy,  when  the  breathing  is  liable  to  become  much 
oppressed  when  walking  rather  quickly,  or  when  going  up  a  hill,  or 
ascending  stairs ;  and  when,  particularly  in  the  case  of  old  people, 
even  the  effort  of  laughing,  or  the  exertion  of  getting  into  bed 
brings  on  a  fit  of  dyspnoea.  Arsenicum,  as  well  as  Ipecacuanha,  is 
further  indicated  when  the  paroxysms  of  asthma  are  most  liable  to 
occur  on  retiring  to  rest,  or  before  midnight,  the  patient  being  dis- 
turbed from  sleep  by  a  sense  of  spasmodic  constriction  in  the  chest  and 
larynx,  which  is  soon  followed  by  laborious,  panting,  and  whistling 
respiration  with  gasping  for  breath.  These  symptoms  are  occasion- 
ally relieved  by  remissions,  but  the  attack  is  prone  to  recur  on  using 
the  slightest  exertion :  for  the  most  part,  however,  the  paroxysm 
continues  with  more  or  less  intensity  until  relieved  by  the  accession 
of  a  fit  of  coughing,  with  expectoration  of  viscid  mucus  filled  with 
vesicles.  Arsenicum,  though  principally  called  for  in  cases  in  which 
the  attacks  come  on  at  night,  is  also  useful  when  they  are  liable  to  be 
excited  during  the  day,  on  exposure  to  a  cold  bracing  air,  or  on 
going  out  during  the  prevalence  of  disagreeable,  damp,  or  stormy 
weather.  Likewise  when  changes  of  temperature,  or  tight  and  very 
warm  clothing  are  frequent  sources  of  fits  of  dyspnoea.  Sensation  of 
burning  heat  in  the  chest  during  the  fit  of  asthma,  as  an  additional 
indication  fox  Arsenicum.  {Acid,  hydrocy.  or  Kali  hydro,  may  some- 
times be  had  recourse  to  with  decided  advantage  when  Arsenicum 
fails  to  give  much  relief.) 

Bryonia.  This  medicine,  as  already  mentioned,  is  frequently  useful 
after  the  previous  employment  of  Ipecacuanha.  The  indications 
are  chiefly :  obstructed  respiration  at  night  or  towards  morning,  with 
frequent  cough,  pains  in  the  hypochondria,  and  inability  to  recline 
on  the  right  side,  and  not  without  inconvenience  on  the  left,  so  that 


328  RESPIRATORY  SYSTEM. 

the  patient  is  constrained  to  lie  on  the  back ;  frequent  coughing, 
with  expectoration  at  first  frothy,  and  subsequently  thick  and  glu- 
tinous,, and  frequently  attended  with  retching  or  vomiting ;  aggra- 
vation of  the  dyspnoea  from  talking,  or  from  the  slightest  movement ; 
frequent  efforts  to  obtain  sufficient  air  by  deep  inspirations,  accom- 
panied with  moaning,  palpitation  of  the  heart,  and  great  anxiety. 
The  attacks  are  often  attended  by  shootings  in  the  chest  on  taking  a 
full  inspiration,  also  on  coughing,  or  after  any  movement  of  the  arms 
or  trunk.  At  other  times  there  is  colic,  eructations  of  the  taste  of 
the  food  partaken  of,  irritability  of  temper,  and  disposition  to  find 
fault  with  everything.  [Bryonia  and  Mix  v.  are  often  administered 
with  great  advantage  in  alternation.) 

Nux  vomica  : — Nocturnal  attacks  of  suffocating  tightness,  especially 
at  the  lower  part  of  the  chest,  preceded  by  disagreeable  or  anxious 
dreams  ;  also  when  the  paroxysms  are  prone  to  occur  in  the  morning 
or  after  a  meal,  and  are  attended  with  anxiety,  aching  and  pressive 
pains  in  the  precordial  region,  as  also  in  the  hypochondria ;  feeling  of 
distension  in  the  abdomen  and  epigastrium ;  flatulence  ;  tension,  pres- 
sure, and  aching  in  the  chest ;  palpitation  of  the  heart  ;  short  hacking 
cough,  with  difficult  expectoration ;  inability  to  bear  the  slightest 
pressure  from  the  clothing,  particularly  around  the  chest  and  waist ; 
the  clothes  seem  to  fit  tightly  and  increase  the  difficulty  of  breathing, 
whilst  in  reality  they  are  quite  the  reverse ;  dyspnoea  when  walking  and 
conversing  in  the  open  air,  especially  if  the  temperature  be  somewhat 
cold ;  dyspnoea  after  trivial  corporeal  exertion  of  any  kind.  Meliora- 
tion of  the  asthmatic  sufferings  when  reclining  on  the  back,  or  on 
changing  from  one  posture  to  another,  such  as  sitting  up,  and  then 
lying  down  again,  or  turning  from  one  side  to  the  other.  Disposition 
irritable  and  passionate. 

Pulsatilla: — Oppressed,  rapid,  and  laborious  breathing  from  a 
feeling  of  spasmodic  constriction  in  the  chest,  especially  at  the  inferior 
portions;  or  suffocating  feeling  in  the  windpipe  as  if  caused  by  the 
vapour  of  sulphur :  tension,  and  sensation  of  fulness,  pressure  and 
aching,  attended  with  mucous  rattling  in  the  chest ;  short  fits  of 
coughing  in  rapid  succession,  and  appearing  to 'threaten  suffocation ; 
or  cough  with  copious  expectoration  of  mucus.  The  attacks  usually 
coming  on  at  night,  or  in  the  evening  when  in  a  horizontal  posture ; 
extreme  anguish,  palpitation  of  the  heart,  and  sometimes  lancinating 
pains  in  the  chest  during  the  paroxysms. 

Pulsatilla,  is  generally  more  suitable  for  hysterical  females,  or  indi- 


ASTHMA.  329 

viduals  of  a  mild,  timid,  sensitive,  or  fretful  disposition.  In  dys- 
pnoea, with  mucous  rattling,  and  cough,  occurring  in  children  from 
taking  cold,  it  is  likewise  a  most  useful  remedy. 

Tartarus  emetic  us  : — Dyspnoea  with  suffocating  cough  and 
anxious  oppression  at  the  precordia,  arising  from  an  excessive  secretion 
of  mucus  in  the  bronchi;  this  remedy  is  frequently  of  great  service, 
either  in  aged  persons  or  in  children. 

Opium  : — Obstructed  breathing,  either  from  congestion  or  from  pul- 
monary spasms,  with  suffocating  cough  and  livid  hue  of  the  face ; 
loud  mucous  rattling  in  the  chest,  with  extreme  anguish  from  dread  of 
suffocation;  dyspnoea  during  sleep  resembling  nightmare  (incubus). 

China; — Paroxysms  of  asthma  at  night,  as  if  caused  by  an  ac- 
cumulation of  mucus  in  the  windpipe :  wheezing  in  the  chest  during 
inspiration;  difficult  expectoration  of  thick  transparent  mucus;  op- 
pression at  the  chest,  palpitation  of  the  heart,  and  inability  to 
breathe,  unless  the  head  and  shoulders  are  propped  up  with  pillows  ; 
great  weakness,  and  tendency  to  copious  sweating  at  the  slightest 
exertion,  or  when  too  warmly  clothed. 

Sambucus  : — Rapid  and  laborious  respiration  with  loud  wheezing  ; 
oppression  at  the  chest  as  if  from  a  weight,  attended  with  anguish 
and  dread  of  suffocation,  and  sometimes  swelling  and  livid  hue  of  the 
face  and  hands,  general  heat,  tremor,  inability  to  talk  much  above  a 
whisper ;  suffocating  cough  ;  aggravation  of  the  symptoms  in  the 
recumbent  posture.  In  the  case  of  children  this  remedy  is  often  of 
great  service,  when,  in  consequence  of  a  chill,  they  are  seized  with 
spasm  in  the  chest,  and  awake  from  sleep  with  a  start,  and  exhibit 
many  of  the  symptoms  detailed.      (See  Spasms  in  the  Chest.) 

Moschus  : — Acute  asthma  occurring  in  hysterical  females,  or  in 
children  from  exposure  to  cold ;  sense  of  spasmodic  constriction  in  the 
larynx  and  bronchi  ;  or  oppression  at  the  chest  with  paroxysms  of  suffo- 
cating feelings,  as  if  caused  by  the  inhalation  of  the  vapour  of  sulphur, 
commencing  with  a  fit  of  coughing  and  succeeded  by  distressing  op- 
pressive constriction,  sometimes  to  such  a  degree  as  almost  to  drive 
the  patient  to  exasperation  and  distraction. 

Belladonna  :- — Difficulty  of  breathing,  particularly  when  occur- 
ring in  females  of  an  irritable  habit,  and  subject  to  spasms,  with  tension 
in  the  chest,  and  lancinating  pain  behind  the  sternum ;  dry  cough  at 
night,  with,  moaning  respiration,  which  is  sometimes  deep  and  full,  and  at 
others  short  and  rapid,  with  gasping  for  breath  and  great  efforts  to 
dilate  the   chest  to  the  utmost  to  obtain  a  sufficient  supply  of  air  ; 


330  RESPIRATORY  SYSTEM. 

sensation  of  constriction  in  the  larynx,  and  feeling  as  if  suffocation 
would  ensue  on  putting  the  hand  to  the  larynx,  or  on  turning  the 
neck ;  paroxysms  of  asthma,  with  loss  of  consciousness,  &c. 

Laches  is  is  often  useful  when  only  partial  relief  has  been  effected 
by  the  action  of  Belladonna. 

VeratruMo  In  violent  attacks  of  acute  spasmodic  asthma,  with 
symptoms  of  threatening  suffocation,  cold  perspiration,  coldness  of 
the  nose,  ears,  and  lower  extremities,  this  remedy  will  often  afford 
relief  when  Cinchona,  Ipecacuanha,  and  Arsenicum  have  failed  to  do  so. 

Dulcamara.  In  moist  asthma  [Asthma  humidum)  this  medicine  is 
one  of  the  most  useful  remedies,  particularly  when  the  attacks  are 
liable  to  be  excited  by  a  cold  and  damp  state  of  the  atmosphere.  In 
severe  dyspnoea,  with  loose  sounding  cough,  rattling  of  phlegm  in 
the  chest,  and  copious  expectoration,  arising  from  exposure  to  wet,  it 
is  likewise  a  valuable  remedy. 

Stannum  : — Humid  asthma,  with  wheezing  and  obstructed  respira- 
tion, particularly  at  night,  or  on  preparing  for  bed ;  but  also  when 
the  paroxysms  come  on  during  the  day,  and  render  it  necessary  to 
loosen  the  clothing.  The  attacks  are  attended  with  oppression  at 
the  chest,  and  mucous  rattling :  cough,  with  copious  expectoration  of 
viscid  or  grumous,  or  transparent  and  watery,  or  yellowish  mucus  of 
a  sweetish  or  saline  taste.  Phosphorus,  Sulphur,  Calcarea,  Sepia,  and 
Lycopodium,  are  also  of  much  value  in  humid  asthma,  and  of  great 
service  in  some  of  the  most  obstinate  cases.  In  chronic  asthma,  a 
dose  of  the  medicine  required  may  be  taken  at  intervals  of  from 
four  to  eight  days  or  so ;  but  in  acute  cases,  or  when  the  remedy  is 
prescribed  during  the  paroxysm,  the  dose  may  be  repeated  at 
intervals  of  from  half  an  hour  to  two  hours  and  upwards,  according 
to  the  severity  of  the  case.  When  the  medicine  first  prescribed 
affords  no  relief  after  from  two  to  three  repetitions,  another  must  be 
selected,  preference  being  given  to  that  remedy  which  corresponds 
the  nearest  to  the  existing  symptoms. . 


DISEASES   OF  OR    CONNECTED    WITH    THE    BRAIN, 
AND  OTHER  PARTS  OF  THE  NERVOUS  SYSTEM. 


DETERMINATION  OF  BLOOD  TO  THE  HEAD. 

Congestio  ad  Caput. 

This  is  an  affection  to  which  many  individuals  who  lead  a 
sedentary  life  are  subject :  intense  mental  application  and  habitual 
indulgence  in  the  use  of  spirituous  liquors,  or  other  stimulating 
liquids,  such  as  coffee,  &c,  are  also  its  frequent  exciting  causes, 
particularly  in  those  who  inherit  a  predisposition  to  the  disorder. 

Diagnosis.  Fulness  of  the  vessels  of  the  head  and  neck,  the 
pulsation  of  which  the  patient  experiences  through  the  entire  frame ; 
heat,  redness,  and  turgidity,  or  pallor  and  puffiness  of  the  face,  with 
anxious  expression  of  countenance  ;  repeated  attacks  of  giddiness, 
particularly  after  sleeping,  or  sitting  in  a  warm,  confined  apartment, 
or  on  exposure  to  the  rays  of  the  sun  when  exercising  in  the  open 
air;  headache,  generally  above  the  orbits,  and  in  the  forehead, 
increased  by  stooping  or  coughing ;  dimness  of  vision ;  buzzing  in 
the  ears  ;  tightness  around  the  throat ;  oppressed  breathing ;  furred, 
red-pointed,  or  enlarged  and  very  red-looking  tongue;  dyspepsia, 
constipation,  disturbed,  unrefreshing  sleep  ;  drowsiness  during 
the  day. 

Therapeutics.  Aconitum  napellus,  JSfux vomica,  Belladonna,  Opium, 
Coffea,  Chamomilla,  Ignatia,  Arnica,  Mercurius,  Pulsatilla,  Dulcamara, 
Cinchona,  Sanguinaria  canadensis,  &c. 

Aconitum.  This  is  the  principal  remedy  to  commence  within  all 
recent  cases,  and  is  alone  sufficient  speedily  to  remove  the  affection, 
particularly  in  children,  when  fright  and  anger  combined  have  been 
the  exciting  causes. 

Nux  vomica.  As  has  already  been  repeatedly  observed,  this 
remedy  is  exceedingly  efficacious  in  complaints  arising  from  sedentary 
habits,  intense  study,  or  that  much  more  culpable  habit,  the  ex- 


332  NERVOUS  SYSTEM. 

cessive  indulgence  in  spirituous  or  vinous  liquors,  &c. ;  it  is  accord- 
ingly one  of  the  most  useful  remedies  in  determination  of  blood  to 
the  head,  induced  by  such  causes ;  it  is  also  very  serviceable  in  cases 
arising  from  a  violent  fit  of  passion,  and  is  more  particularly  indicated 
when  we  meet  with  the  following  symptoms  :  distension  of  the  veins, 
with  violent  pulsation  in  the  head ;  heat  and  redness,  or  paleness  or 
sickly  hue  of  the  face ;  attacks  of  giddiness,  violent  headache, 
particularly  in  the  forehead  and  over  the  orbits,  aggravated  by 
reflecting,  or  by  any  attempts  at  mental  application,  also  by  stooping 
or  coughing ;  disturbed  sleep ;  nervous  excitability,  and  disposition 
to  be  angry  at  trifles  ;  constipation.  Calcarea  will  frequently  be 
found  of  signal  benefit  after  Nux  v.,  in  obstinate  cases  occurring  in 
persons  addicted  to  indulgence  in  spirituous  liquors. 

Belladonna.  After  a  previous  administration  of  Aconite,  when 
necessary,  this  is  one  of  our  most  important  remedies  in  the  treat- 
ment of  congestion  to  the  head.  Indications :  great  distension  of 
the  vessels  of  the  head,  attended  with  severe  jerking  burning  pains 
in  one  half  of  the  head,  aggravated  by  the  slightest  movement  or  the 
least  noise ;  fiery  redness  and  bloatedness  of  the  face,  redness  and 
protrusion  of  the  eyes,  sparks  before  them,  and  sometimes  dimness  of 
vision;  darkness  before  the  eyes  (obscurity);  diplopia ;  buzzing  in  the 
ears  ;  bright  redness  of  the  throat ;  attacks  of  fainting ;  somnolency. 

Opium  is  of  speedy  service  in  cases  arising  from  fright ;  but  it  is, 
moreover,  a  remedy  of  extreme  value  in  the  most  serious  cases  of 
congestion,  either  arising  suddenly  from  the  effects  of  a  draught  of 
cold  or  iced  water,  especially  when  heated,  or  from  other  causes,  with 
the  following  symptoms  ;  vertigo,  heaviness  of  the  head,  humming 
in  the  ears,  dullness  of  hearing,  stivpor ;  also  when  the  attack  is 
occasioned  by  constipation,  or  the  effects  of  a  debauch,  with  pressure 
in  the  forehead  from  within  outwards,  with  redness  and  bloatedness 
of  the  face,  great  depression,  fugitive  heat ;  violent  thirst ;  dryness 
of  the  mouth ;  acid  regurgitations,  nausea  or  vomiting. 

Coffea.  In  cases  arising  from  excessive  joy,  this  remedy  will  be 
found  to  exert  a  salutary  influence.  Symptoms:  excessive  and 
uncontrollable  liveliness  ;  great  heaviness  of  the  head,  or  aggravation 
of  the  sensations  when  speaking ;  sleeplessness. 

Ch  amomilla.  Congestion  caused  by  vexation,  or  a  fit  of  passion, 
particularly  in  children,  is  speedily  relieved  by  this  remedy. 

Jgnatia,  when  induced  by  stifled  vexation,  or  harrowing,  concen- 
trated grief. 


DETERMINATION  OF  BLOOD  TO  THE  HEAD.  333 

Arnica.  In  cases  arising  from  external  violence,  such  as  severe 
falls  or  contusions,  followed  by  stupefaction,  vertigo,  sensation  of 
pressure  or  coldness  over  a  small  circumscribed  space ;  tendency  to 
close  the  eyes  ;  disposition  to  be  frightened,  and  vomiting, — the  ex- 
ternal and  internal  administration  of  Arnica,  when  timely  had  recourse 
to,  will  frequently  be  found  specific.  This  remedy  is,  however, 
equally  useful  in  other  cases  with  the  following  symptoms  :  heat  in 
the  head,  with  coldness  of  other  parts  of  the  body ;  sensation  of 
obtuse  pressure  on  the  brain ;  painful  burning  or  throbbing  in  the 
cranium  ;  humming  in  the  ears ;  vertigo,  with  confused  vision,  espe- 
cially on  assuming  the  erect  posture  after  sitting  for  some  time. 

Mercurius  : — Congestion  with  sensation  of  fulness,  or  as  if  the  head 
were  compressed  ly  a  band;  nocturnal  aggravation  with  darting,  piercing, 
tearing,  or  burning  pains ;  disposition  to  sweating.  After  Arnica, 
Belladonna,  or  Opium,  Mercurius  is  frequently  found  serviceable  in 
completing  the  cure. 

Pulsatilla.  This  remedy,  as  wTill  be  found  stated  in  the  proper 
place,  is  well  adapted  to  many  cases  of  congestion  occurring  in  young 
girls  at  the  critical  age,  or  to  all  cases  occurring  in  cold,  lymphatic 
temperaments  with  the  following  symptoms  :  distressing  semi-lateral 
pain  in  the  head,  particularly  of  a  pressive  character,  or  if  the  pain 
in  the  head  commences  at  the  occiput  and  extends  to  the  root  of  the 
nose,  or  invertedty.  Amelioration  of  the  symptoms  from  exercise,  or 
from  pressing  or  binding  the  head ;  exacerbation  wThile  sitting :  sense 
of  weight  in  the  head ;  vertigo ;  face  pale  and  wan-like,  or  red  and 
bloated ;  inclination  to  wTeep ;  anxiety ;  coldness,  or  shivering. 

Lyco podium  is  a  valuable  remedy  in  some  obstinate  cases  of 
congestion  attended  with  giddiness,  ebullition,  flatulence,  anxiety, 
and  habitual  constipation. 

Dulcamara  : — Congestion  attended  with  continual  buzzing  in 
the  ears,  dullness  of  hearing,  and  particularly  when  the  affection  has 
arisen  from  getting  the  feet  wet,-  or  from  a  chill  in  cold,  damp 
weather. 

Sanguinaria  canadensis  : — Distension  of  the  vessels,  heaviness 
of  the  head,  with  fulness  and  aching  as  if  the  head  would  burst ; 
pressure  behind  the  orbits.  The  pains  are  chiefly  complained  of  in 
the  forehead,  sinciput  and  right  side  of  the  head. 

Cinchona.  Congestion  occurring  after  repeated  bloodlettings, 
or  hemorrhage  in  general,  is  generally  relieved  by  this  remedy. 

After  the  completed  action  of  Cinchona,  a  dose  or  two  of  Sulphur 


334  NERVOUS  SYSTEM. 

and  Calcarea  carbonica,  at  intervals  of  about  a  week,  will  materially  tend 
to  strengthen  the  impaired  constitution,  when  Cinchona  is  not  of  itself 
sufficient  to  effect  that  desirable  object. 

Nux  v.,  Veratrum,  and  Valerian  are  also  valuable  remedies  in  par- 
ticular cases  arising  from  debilitating  losses.  Attention  may  also 
be  directed  to  the  following  remedies :  Rhus  toxicodendron,  Bryonia 
alba,  Cicuta  virosa,  Hepar  sulphuris,  Silicea;  the  two  latter,  together 
with  Sulphur  and  Calcarea,  are  more  particularly  adapted  to  the  treat- 
ment of  chronic  cases.     (See  also  Dyspepsia  and  Apoplexy.) 

In  those  cases  where  patients  have  habituated  themselves  to  the 
periodical  abstractions  of  blood,  as  a  temporary  mode  of  relief,  the 
employment  of  Aconitum  and  Belladonna,  in  alternation,  commonly 
suffices  to  obviate  the  necessity  of  having  recour'se  to  such  a  culpable 
practice.  Occasionally,  it  will  be  found  requisite  to  select  other 
remedies,  such  as  Nux  v.,  Sulph.,  China,  &c,  in  addition,  or  in  pre- 
ference to,  Aconitum  and  Belladonna. 

In  cases  of  giddiness  simply,  or  when  that  is  the  prevailing  symptom, 
the  following  remedies  are  amongst  the  most  useful :  Mercurius, 
when  the  giddiness  pomes  •  on  only  in  the  evening,  especially  on 
assuming  the  erect  posture ;  or  in  the  morning  on  getting  out  of 
bed ;  and  is  attended  with  nausea,  dimness  of  sight,  heat,  anxiety, 
and  desire  to  lie  down.  Nux  vomica, — giddiness  during  mental 
application,  or  after  a  meal,  or  when  in  the  recumbent  posture,  particularly 
in  nervous  or  bilious  subjects ;  and  in  cases  where  sedentary  habits  or 
dissipation  have  given  rise  to  the  affection.  Pulsatilla, — giddiness, 
especially  on  looking  upwards,  or  when  sitting,  or  at  other  times,  such 
as  during  or  after  meals,  attended  with  heaviness  of  the  head,  buzzing 
in  the  ears,  headache,  and  paleness  of  the  face,  sometimes  alternating 
with  heat ;  confusion  of  sight ;  lowness  of  spirits  ;  nausea,  and  incli- 
nation to  vomit;  phlegmatic  temperament.  CinchonAj— giddiness 
on  elevating  the  head,  or  during  movement,  relieved  by  reclining. 
Rhus, — giddiness  on  lying  down>  but  which  becomes  relieved  after 
retaining  the  recumbent  posture  for  some  time,  and  then  returns  on 
assuming  the  erect  posture,  sometimes  to  such  an  extent  as  to 
occasion  falling,  attended  with  fear  of  dissolution;  giddiness  after 
a  hearty  meal.  Chamomilla, — giddiness  on  rising,  with  tendency 
to  faint :  giddiness  during  a  meal ;  irritability.  Arnica, — violent 
giddiness  during  dinner  or  after  a  hearty  meal ;  in  the  latter  instance, 
Nux  v.,  Pulsatilla,  Rhus,  or  Chamomilla,  are  also  very  useful,  and 
must  be   selected  according   as   they  may  be  otherwise  indicated. 


INFLAMMATION  OF  THE  BRAIN.  335 

Giddiness  on  rising  from  the  recumbent  posture,  or  on  stooping  • 
Aconitum,  followed  by  Belladonna,  particularly  if,  in  addition  to  the 
foregoing  symptoms,  there  is  frequently  partial  loss  of  consciousness, 
with  cloudiness  of  vision.  Giddiness  from  the  motion  of  a  carriage, 
sometimes  with  disposition  to  faint :  Hepar  s., — followed  by  Silicea, 
should  the  former  not  suffice,  or  afford  only  a  slight  degree  of  im- 
provement. Sulphur  is  often  very  serviceable  after  Pulsatilla, 
when  the  attacks  of  giddiness  are  most  liable  to  come  on  while  sitting  ; 
or  it  may  be  selected  in  preference  to  the  said  remedy,  when  the 
giddiness  generally  comes  on  whilst  walking  up  a  hill  or  ascending 
stairs ;  or  is  at  other  times  attended  with  nausea,  fainting,  or  bleed- 
ing from  the  nose.  Lycopodium, — giddiness  with  tendency  to  con- 
gestion, accompanied  with  flatulence,  headache,  anxiety,  and  obstinate 
constipation.  Lachesis, — giddiness  with  confusion  of  ideas,  or 
paleness  of  the  face,  nausea,  and  vomiting ;  fainting,  bleeding  from 
the  nose,  particularly  when  the  attacks  come  on  chiefly  in  the  morn- 
ing on  waking. 

Opium: — Threatening  vertigo  with  confusion  of  ideas ;  or  decided 
giddiness,  with  humming  in  the  ears,  and  clouded  vision  on  sitting  up 
in  bed,  which  renders  it  necessary  to  lie  down  again ;  vertigo  from 
fright. 

Conium  : — Violent  giddiness,  with  dread  of  falling  to  one  side  when 
looking  backwards. 

Giddiness  arising  from  disordered  stomach,  with  nausea  or  vomit- 
ing :  Aconitum,  followed  by  Antimonium  crudum,  and  subsequently 
Pulsatilla,  if  necessary  from  a  continuance  of  the  symptoms  in  a  greater 
or  less  degree. 

Diet.  The  homoeopathic  regimen  already  given  in  the  Introduc- 
tion should  be  rigidly  adhered  to,  and  stimulants  of  all  kinds  care- 
fully avoided  ;  moreover,  early  rising,  and  daily  exercise  in  the  open 
air  should  not  be  neglected ;  the  use  of  the  flesh-brush  in  the  evening 
is  also  of  some  service. 


INFLAMMATION  OF  THE  BRAIN  AND  ITS  TISSUES.     BRAIN  FEVER. 

Phrenitis.     Encephalitis. 

Diagnosis.     Goma,  or  constant  delirium,  or  both,  with  signs  of 
determination  of  blood  to  the  head ;  fulness  and  redness  of  the  face 


336  NERVOUS  SYSTEM. 

and  eyes ;  breathing  of  the  carotid  and  temporal  arteries ;  occasional 
attempts  to  grasp  the  head. 

When  it  is  caused  by  inflammation  of  the  tissues,  the  pain  is  more 
acute  than  that  arising  from  inflammation  of  the  substance  of  the 
brain-     Paralysis  also  more  frequently  accompanies  the  latter  form. 

In  inflammation  of  the  brain  or  its  membranes,  the  symptoms  are 
exceedingly  diversified;  the  extent  and  duration  of  the  disease,  the 
age,  the  sex,  and  constitution  of  the  patient  all  combine  to  give 
to  the  affection  a  variety  of  character.  Much  assistance  may  be 
derived,  in  ascertaining  whether  the  brain  is  affected  or  not,  from 
examining  the  eyes  and  general  expression  of  the  countenance.  The 
pupils  in  the  first  stages  are  commonly  found  more  or  less  contracted, 
but  as  the  disease  advances,  they  often  become  dilated.  Occasionally 
the  attack  is  preceded  by  premonitory  symptoms,  such  as  congestion 
of  blood  to  the  head,  attended  with  sensations  of  weight  or  stupefying, 
pressive,  constrictive,  and  sometimes  shooting  pains  in  the  head. 
In  some  instances  slight  feverish  symptoms  are  complained  of,  with 
ringing  in  the  ears  for  about  the  space  of  a  week;  giddiness,  and  a 
sense  of  weight  on  the  crown  of  the  head ;  pulse  rather  quick,  and 
the  heat  of  the  skin  somewhat  increased  at  night,  attended  with 
restlessness  and  a  difficulty  of  lying  long  in  one  position;  moreover, 
the  patient  is  observed  to  be  irritable  and  annoyed  at  trifles ; 
anomalies  in  the  mental  powers  may  next  be  observed,  such  as  ob- 
stupefaction,  drowsiness,  with  slight  delirium ;  or  a  high  degree  of 
excitement,  in  which  the  patient  is  affected  by  the  slightest  noise,  and 
the  eyes  have  a  brilliant  and  animated  expression,  or  are  bloodshot, 
with  fiery  redness  of  the  face,  violent  delirium  [delirium fer ox).  Accord- 
ing to  the  seat  of  the  inflammation,  or  the  constitution  of  the  patient, 
the  accompanying  fever  is  of  greater  or  less  intensity ;  the  pulse  is  very 
variable  in  the  course  of  the  same  day ;  it  may  be  regular,  intermit- 
ting, quick  and  weak,  or  very  slow  and  strong.  A  very  slow  or  very 
quick  pulse  generally  indicates  danger.  The  patient  frequently  com- 
plains of  heat  in  the  head,  whereas  the  extremities  are  cold.  When 
there  is  stupor,  or  a  tendency  to  it,  the  eyes  look  heavy  and  void  of 
all  expression;  vomiting  sometimes  takes  place,  and  proves  very 
intractable ;  the  stupor  becomes  more  profound,  convulsions  appear, 
and  death  sooner  or  later  ensues.  The  peculiar  and  delicate  structure 
of  the  brain  and  its  membranes  in  children,  renders  them  much  more 
susceptible  of  the  attacks  of  this  serious  disease,  and  great  attention 
ought  to  be  paid  to  the  following  symptoms  :  heaviness  and  tendency 


INFLAMMATION  OF  THE  BRAIN.  337 

of  the  head  to  gravitate  backwards,  attended  with  pain  (of  which 
latter  circumstance  we  are  sometimes  made  aware,  in  very  young 
children,  by  the  little  sufferer  frequently  raising  its  hands  to  the 
head;  alternation  of  temper;  intolerance  of  light;  nausea,  occasionally 
followed  by  vomiting ;  tendency  to  costiveness ;  drowsiness;  wake- 
fulness, or  starting  during  sleep.  Secondly,  continuous  boring  of  the 
head  against  the  pillow ;  a  high  state  of  excitement,  in  which  the 
slightest  noise  or  ray  of  light  throws  the  child  into  a  fit  of  screaming, 
or  a  state  of  discontentment ;  heavy  sleep  ;  great  heat  in  the  head; 
redness  and  swelling  of  the  face,  with  perceptible  throbbing  in  the 
vessels  of  the  head  and  neck  ;  great  agitation,  with  continued  tossing 
about,  especially  at  night ;  eyes  red,  sparkling,  convulsed,  or  fixed ; 
pupils  immovable,  and  generally  dilated. 

Causes.  Anything  tending  to  irritate  the  brain,  such  as  extremes 
of  heat  or  cold ;  the  abuse  of  ardent  spirits ;  external  injuries  of  the 
head ;  concussion  from  falls ;  mental  emotions,  or  over-exertion  of 
the  faculties ;  excesses  of  all  kinds ;  sanguineous  congestion ;  metas- 
tases ;  contagious  diseases ;  repressed  eruptions,  &c. 

Therapeutics.  We  should  have  immediate  recourse  to  Aconite 
at  the  commencement  of  the  attack,  when  the  skin  is  hot  and  dry, 
and  the  pulse  rapid,  with  the  ordinary  indications  of  pure  Inflam- 
matory Fever,  which  is  especially  liable  to,  be  the  case  in  young  ple- 
thoric subjects. 

After  the  employment  of  Aconite  we  may  have  recourse  to  any  of 
the  following  remedies]  as  indicated ;  namely,  Belladonna,  Hyoscyamus, 
Opium,  Stramonium,  and  Cuprum  aceticum. 

Belladonna.  This  medicine  seems  to  possess  a  certain  specific 
influence  over  inflammation  of  the  brain  and  its  meninges  J  and  is 
generally  the  remedy  we  should  select,  when  the  following,  amongst 
other  symptoms,  present  themselves:  great  heat  of  the  head;  redness 
and  bloatedness  of  the  face,  with  violent  pulsation  of  the  carotids  ; 
boring  of  the  head  in  the  pillow,  and  increase  of  suffering  from  the 
slightest  noise,  with  extreme  sensibility  to  light ;  violent  shooting  and 
burning  pains  in  the  head ;  eyes  red  and  sparkling,  with  protrusion  or 
wild  expression ;  contraction  or  dilatation  of  the  pupils ;  violent  and 
furious  delirium;  loss  of  consciousness;  sometimes  low  muttering; 
convulsions,  occasionally  symptomatic  hydrophobia;  vomiting;  in- 
voluntary evacuations  of  faeces  and  urine. 

22 


338  NERVOUS  SYSTEM. 

Bryonia.  This  remedy  will  frequently  be  found  of  great  efficacy 
in  children,  when  Aconite  and  Belladonna  have  produced  but  trivial 
improvement,  and  the  symptoms  indicate  a  tendency  to  rapid 
effusion  ;  in  wich  case  also  Helleborus  may  follow  Bryonia  if  required. 
(Vide  Hydrocephalus.) 

Hyoscyamus  is  appropriate  when  there  is  drowsiness,  loss  of  con- 
sciousness, delirium  about  one*s  own  affairs;  inarticulate  speech; 
tongue  coated  white,  with  frothy  mucus  about  the  lips;  dilatation  of 
the  pupils ;  fixedness  of  vision  ;  skin  dry  and  parched  ;  redness  of  the 
face ;  and  picking  of  the  bedclothes  with  the  fingers. 

Opium: — When  there  is  lethargic  sleep,  with  stertorous  breathing ; 
half  open  eyes,  and  confusion  or  giddiness  after  waking ;  sanguineous 
congestion ;  complete  apathy  and  absence  of  complaint. 

Stramonium: — When  there  is  starting  or  jerking  in  the  limbs; 
sleep  almost  natural,  followed  by  absence  of  mind  after  waking,  but 
sometimes  attended  with  moaning  and  tossing  about ;  vision  fixed, 
and  the  patient  frequently  appears  in  a  state  of  dread,  and  utters 
cries;  redness  of  the  face;  feverish  heat,  With  moisture  of  the  skin; 
In  many  of  the  symptoms  this  remedy  bears  a  close  resemblance  to 
Belladonna,  with  the  exceptions  of  being  indicated  by  the  more  pro- 
minent existence  of  spasms,  and  less  acuteness  of  pain  in  the  head. 

Zincum  may  be  employed  after,  or  in  alternation  with  Belladonna, 
when  that  remedy  produces  only  a  partial  degree  of  amendment.  In 
those  extreme  cases  where  symptoms  of  threatening  paralysis  of  the 
brain  are  manifested  by  the  following  indications :  loss  of  conscious- 
ness ;  half  closed  eyes ;  dilated,  insensible  pupils ;  icy  coldness  of  the 
extremities,  or  of  the  entire  body  ;  blueness  of  the  hands  and  feet ;  impeded 
respiration  ;  small,  weak,  scarcely  perceptible  pulse— Zincum\&&  repeatedly 
been  found  effectual  in  preventing  a  fatal  issue.* 

Dose.  Gr.  ss.  to  gr.  j  of  the  first  trituration,  every  hour,  until  signs  of 
improvement  set  in,  in  which  case  the  intervals  between  the  doses  must 
be  lengthened.     (See  also  Hydrocephalus). 

Cuprum  aceticum  : — The  reputed  value  of  this  remedy  in  cases 
of  repercussed  exanthemata,  and  the  consequences  therefrom  arising;, 
have  been  already  noticed  under  Scarlet  Fever;  under  which 
also  some  of  the  symptoms  indicating  its  employment  are  commented 
upon  ;  it  is  also  called  for  in  a  peculiarly  sensitive  rather  than  an  inflam- 

*  Allg.  Horn.  Zeit.  No.  15.  31ster  Bd. 


APOPLEXY.  339 

matory or  irritable  state  of  the  brain,  which  not  linfrequently  appears: 
in  children,  during  the  course  of  catarrhal  fever  or  difficult  dentition, 
of  which  affection  the  following  are  the  symptoms :  at  the  commence-: 
ment,  crossness  or  fretfulness,  or  apathy  and  indifference  ;'  sleep  dis- 
turbed and  restless.  As  the  disease  gains  ground,  drowsiness,  with 
inability  to  sleep  ;  incapability  of  holding  the  head  erect,  and  flushing 
of  the  face  ;  dryness  of  the  mouth  without  increase  of  thirst ;  disgust 
to  food,  nausea,  even  vomiting ;  torpor  of  the  bowels,  rarely  diarrhoea ; 
shudderings;  followed  by  heat,  and  occasionally  burning,  unfrequent 
perspiration;  pulse  variable,  generally  rather  accelerated  and  full; 
exacerbations  of  fever  (synocha)  towards  evening  and  at  night;  sub- 
sultus  tendinum,  and  grinding  of  the  teeth  during  the  exacerbations. 

Belladonna,  Rhus.  Lachesis,  and  Mercurius  have  also  proved  service- 
able in  cases  arising  from  repercussed  exanthemata. 

Cina  is  useful  in  irritation  of  the  brain  in  children,  apparently 
arising  from  helminthiasis. 

In  chronic  cases,  Sulphur,  Hellehorus  niger,  Arsenicum,  and  Lachesis, 
are  the  more  generally  useful. 

It  may  be  added,  that  Aconite  followed,  if  required,  by  Belladonna, 
Camphora,  or  Lachesis,  is  the  most  appropriate  course  of  treatment, 
when  the  affection  has  arisen  from  exposure  to  the  sun  {coup  de  soleil)* 

Aconite,  Bryonia,  Arsenicum,  Hyoscyamus,  when  resulting  from  a 
violent  chill  in  the  head.  From  suppressed  otorrheea,  Sulphur,  Pulsar 
tilla.  External  injury,  Arnica,  Belladonna,  Mercurius.  Abuse  of  ardent 
spirits,  Opium,  Lachesis.  And  wThen  from  intense  mental  application, 
Belladonna,  &c,  according  to  the  symptoms. 

Antimon.  tart,  has  been  recommended  as  deserving  of  attention  in 
inflammation  of  the  brain  and  its  membranes. 

APOPLEXY. 

Apoplexia. 

Diagnosis.  Sudden  or  gradual  loss  of  consciousness,  sensation, 
and  motion,  with  greater  or  less  disturbance  of  the  pulse  and 
respiration. 

Few  diseases  offer  a  greater  number  of  varieties  in  form  than  apo- 
plexy ;  and  there  is  scarcely  a  single  classification  of  the  many,  that 
eminent  medical  writers  have  given  to  the  world,  which  is  not  more  or. 
less  liable  to  objection. 

It  is  also  extremely  difficult  to  diagnose  clearly  between  the  diffe- 


340  NERVOUS  SYSTEM. 

rent  varieties,  the  external  symptoms  not  always  bearing  a  uniform 
relation  to  the  internal  injury;  thus  all  the  indications  of  serous 
apoplexy  may  declare  themselves  from  sanguineous  extravasation  ; 
and  it  is  not  always  possible  to  decide  in  apoplexy  whether  effusion 
or  simply  congestion  of  the  vessels  6f  the  brain  has  taken  place. 

Premonitory  Symptoms.  Continued  inclination  to  somnolence, 
heavy  profound  sleep,  with  stertorous  breathing,  incubus,  grinding  of 
the  teeth,  shocks  or  cramps,  a  general  feeling  of  heaviness  or  disin- 
clination to  the  least  exertion;  frequent  yawning  and  fatigue  after 
the  slightest  exercise.  A  sense  of  weight  and  fulness,  and  pains  in 
different  parts  ofcthe  head,  sometimes  very  deep  seated.  Cephalalgia 
and  megrim,  or  vertigo  and  fainting ;  pulsation  of  the  temporal  and 
carotid  arteries,  with  swelling  of  the  veins  of  the  head  and  forehead  ; 
disturbance  of  the  cerebral  system,  evinced  by  loss  of  memory,  for- 
getfulness  of  words  and  things,  irritability  of  temper,  or  mildness  and 
indifference,  despondency  and  weeping ;  infiltration  of  the  conjunc- 
tiva, dimness  of  vision,  specks  or  motes  before  the  eyes,  or  flashes  of 
fire  or  sparks  during  darkness ;  acuteness  of  vision  or  diplopia,  some- 
times also  the  words  in  a  line  appear  to  run  into  one  another ;  diffi- 
culty of  opening  or  closing  the  eyes ;  noises,  humming,  singing,  &c# 
in  the  ears ;  dullness  of  hearing,  dryness  of  the  nostrils,  pinched 
appearance  of  the  nose,  with  false  perception  of  an  unpleasant  odour, 
sneezing,  and  slight  epistaxis ;  stammering,  and  indistinct  enuncia- 
tion ;  difficulty  of  deglutition,  numbness  or  torpor,  or  pricking  sensa- 
tion in  the  extremities,  with  occasional  partial  attacks  of  paralysis  in 
the  face,  distorting  the  features  and  affecting  the  utterance,  or  in  some 
of  the  muscles  of  the  limbs  ;  pains  in  the  joints ;  weak  or  unsteady 
mode  of  progression,  difficulty  of  micturition,  &c. 

Their  Treatment.  Against  the  preceding,  Homoeopathy 
possesses  remedies,  by  whose  proper  application  the  practitioner  may, 
if  consulted  in  time,  succeed  in  warding  off  the  attack  of  this  dreaded 
malady. 

The  following  are  the  medicines  most  appropriate  to  the  treatment 
of  the  foregoing  symptoms,  and  also  most  generally  called  for  in  the 
treatment  of  the  disease  itself:  Aconit%m,  Belladonna,  Nux  vomica, 
Lachesis,  Opium. 

Aconitum.  In  all  cases  where  there  are  evident  symptoms  of 
plethora,  determination  of  blood  to  the  head,  characterised  by  redness 


APOPLEXY.  341 

and  fulness  of  the  face,  distension  of  the  veins  of  the  forehead,  quick 
full  pulse,  restlessness,  and  anxiety.* 

Belladonna  :— Should  the  symptoms  of  congestion  not  speedily 
yield  to  Aconite,  or  should  only  a  partial  degree  of  amelioration  have 
taken  place  ;  or  further,  should  the  following  symptoms  present  them- 
selves :  redness  and  bloatedness  of  the  face,  injection  of  the  conjunc- 
tiva, violent  beating  of  the  carotid  and  temporal  arteries,  noises  in  the 
ears,  darting  pains  in  the  head,  with  violent  pressure  at  the  forehead, 
increased  by  movement,  by  the  least  noise  or  bright  light ;  or  diplopia, 
and  almost  all  the  symptoms  relative  to  the  eyes  already  mentioned; 
dryness  of  the  nose,  with  unpleasant  smell  and  epistaxis;  difficulty 
of  deglutition ;  slight  attacks  of  paralysis  in  the  face ;  paralytic  weak- 
ness or  heaviness  in  the  limbs. 

Nux  vomica  is  particularly  suited  to  cases  in  which  the  apoplexy 
threatens  individuals  of  sedentary  habits  addicted  to  the  use  of  ardent 
spirits,  or  too  great  an  indulgence  in  the  pleasures  of  the  table,  or  in 
those  who  have  long  been  affected  with  dyspepsia,  either  bilious  or 
nervous,  and  have  consequently  more  or  less  of  the  rheumatic  or  gouty 
diathesis,  and  also  when  the  following  symptoms  present  themselves  : 
headache,  deep  seated  or  frontal,  but  more  especially  at  the  right  side, 
with  vertigo,  confusion  and  humming  in  the  ears,  nausea,  and  inclina- 
tion to  vomit ;  turgescence  of  the  capillaries  of  the  face,  or  redness 
only  of  one  cheek;  drowsiness,  feeling  of  languor,  with  great  disin- 
clination to  exertion,  either  mental  or  bodily,  cramps  of  the  limbs, 
especially  at  night,  and  weakness  in  the  joints;  constipation  and 
dysuria,  irritability  of  temper,  aggravation  of  the  symptoms  in  the 
morning,  or  after  a  meal,  and  also  in  the  open  air,  bilious,  sanguine, 
or  nervous  temperament. 

Opium  is  a  most  important  remedy  in  almost  all  severe  attacks, 
but  particularly  in  old  people,  when  we  find  the  following  symptoms : 
marked  congestion  to  the  head,  indicated  by  stupor,  vertigo,  heaviness 
in  the  head,  and  violent  pressure  in  the  forehead,  singing  in  the  ears, 
and  obtuseness  of  hearing,  sleeplessness  or  agitating  dreams,  or  fre- 
quent and  almost  overpowering  drowsiness  during  the  day,  redness 
of  the  face,  and  constipation ;  pulse  slow,  but  full. 

Lachesis   is  indicated  by  many  of  the  same  symptoms  which 

*  Some  homceopathists  persist  in  employing  the  lancet  here ;  but  we  believe  there  are 
few  instances,  if  any,  in  which  the  use  of  Aconite,  followed,  if  required,  by  Belladonna  or 
Opium,  and  sometimes  Nux  v.,  according  to  the  characteristic  features  of  the  remaining 
symptoms  and  the  nature  of  the  case,  will  fail  to  act  as  speedily,  and  certainly  with  more 
beneficial  ultimate  results. 


342  NERVOUS  SYSTEM. 

have  been  enumerated  under Nux  v.,  together  with  the  following 
distinctive  characteristics  :  frequent  abstraction  of  mind,  or  vertigo; 
with  congestion,  pains  deep  in  the  brain,  or  severe  aching  pains 'at 
the  left  side  of  the  head,  and  lowness  of  spirits;  face  pale  and  puffy, 
or  turgid  and  somewhat  livid ;  pulse  weak  and  slow. 

The  moment  any  of  the  symptoms  before  noticed  present  them- 
selves is  the  proper  time  to  prevent  the  attack  running  on  to  apo- 
plexy ;  sometimes  the  signs  are  so  marked,  that  we  can  have  but 
little  doubt  of  the  result,  unless  timely  precautions  are  taken ;  at 
other  times,  so  slightly  as  to  be  almost  imperceptible ;  and  at  others 
again,  the  attack  comes  on  suddenly,  without  any  marked  premoni- 
tory symptoms  whatever.     (See  also  Congestio  ad  Caput.) 

Apoplexy.  The  following  are  the  principal  remedies  which  have 
hitherto  been  chiefly  recommended,  or  found  most  successful,  in  the 
treatment  of  the  disease  itself :— Opium,  Nux  vomica.  Belladonna, 
Lachesis,  Arnica,  Pulsatilla,  Baryta  carboniaa,  Silicea,  Stramonium,  Zincum 
metallicum,  Acidum  hydrocyanicum,  Agaricus,  &c. 

In  sanguineous  or  sthenic  apoplexy,  (generally  characterised  by 
bloodshot  eyes,  redness  of  the  face,  full,  hard  pulse,  oppressed  and 
stertorous  breathing.  The  paroxysm  more  usually  comes  on  without 
warning, — although  sometimes  preceded  by  fulness,  weight,  and  a 
dull  pain  in  the  head,  attended  with  giddiness  and  drowsiness, — the 
patient  suddenly  falling  to  the  ground,  and  seeming  as  if  in  a  heavy 
sleep,)  Opium,  Aeon,,  Bella.,  Nux  v.,  Lack.,  Stram.,  Ant.,  Coff.,  Hyos., 
Puis.,  &c.,  are  the  principal  remedies. 

In  asthenic  apoplexy,  (chiefly  defined  by  pale  and  sallow,  but  puffy, 
bloated  countenance ;  feeble  and  easily  compressible  pulse,  heavy, 
laborious  respiration.  This  variety  is  more  commonly  ushered  in  by 
premonitory  symptoms  than  the  preceding,  such  as  headache,  giddi- 
ness, loss  of  memory,  illusions  of  hearing,  inarticulate  speech,  som- 
nolency, and  a  disposition  to  clonic  spasms,)  Ipecac,  Merc,  Big., 
Am., — Baryl.  c,  Cocc,  Con.,  Nuxw.,  Puis.,  Zinc,  Bella.,  Coff.,  Hyos., 
Stram.,  Cup.,  ho,.,  are  more  frequently  called  for. 

Opium  is  held  as  a  most  important  remedy  in  all  cases  of  apoplexy 
when  the  disease  has  attained  considerable  height.  It  is  one  of  the 
best  remedies  to  commence  with,  when  the  attack  has  arisen  from 
excess  in  drinking,  and  the  symptoms  are  as  follows;  slow,  stertorous, 
breathing  ;  red  and  bloated  face;  heat  of  the  face  and  head,  which 
latter  is  also  covered  with  sweat :  insensible  and  dilated  pupils .; 
stupor ;  tetanic  rigidity  of  the  entire  frame,  or  convulsive  movements 


APOPLEXY.  343 

and  trembling  in  the  extremities  ;  foaming  at  the  mouth.  In  elderly 
persons/ Vpium  is,  as  has  already  been  stated,  a  remedy  of  primary 
importance.  Baryta  c.,  as  will  be  hereafter  noted,  is  also  valuable  in 
such  cases,  but  chiefly,  perhaps,  after  the  previous  use  of  Opium. 
Digitalis,  Mere.,  or  Con.,  &c,  may,  however,  be  required  subsequent 
to  Baryta  or  Opium,  and  even  in  preference  to  these  in  some  instances, 
especially  when  of  the  serous  type. 

Nux  vomica  has  been  found  of  great  service  in  completing  the 
cure  after  the  previous  use  of  the  above  remedy ;  but  may  also  be 
employed  at  the  commencement,  when  the  attack  has  occurred  in  an 
individual  of  bilious,  sanguine  or  nervous  temperament,  and  of  irritable 
temper,  in  consequence  of  over-indulgence  in  vinous  or  spirituous 
liquors ;  or  when  the  attack  has  resulted  during  or  after  a  fit  of 
passion,  and  the  patient  appears' in  a  state  of  drowsiness  approaching 
to  stupor;  the  breathing  stertorous;  eyes  dull  and  glassy;  hanging 
of  the  lower  jaw,  with  copious  secretion  of  saliva ;  paralysis,  parti- 
cularly of  the  inferior  extremities  (paralysis  paraplegica)  ;  hemi- 
plegia. 

Lachesis  is  also  a  valuable  remedy  in  this  disease,  especially 
when  occurring  in  habitual  drunkards ;  or  in  choleric,  hypochon- 
driacal persons,  or  those  who  are  frequently  affected  with  melancholy, 
and  are  of  a  spare  habit,  or  of  exhausted  constitution,  with  drowsi- 
ness or  loss  of  consciousness ;  lividity  of  countenance,  convulsive  move- 
ments or  tremor  in  the  extremities;  stupor  or  paralysis,  especially  of 
the  left  side ;  pulse  weak  and  slow. 

Arnica.  Apoplexy  after  too  hearty  a  meal,  with  loss  of  con- 
sciousness (drowsiness  or  stupor) ;  stertorous  breathing ;  moaning 
or  inarticulate  muttering;  invohmtary  evacuations;  paralysis  of  the 
extremities  (hemiplegia,  left  side) ;  pulse  strong  and  full. 

Belladonna.  Lethargy,  loss  of  consciousness;  the  patient  lies 
speechless,  with  the  mouth  drawn  to  one  side  ;  convulsive  movements 
of  the  limbs  or  facial  muscles ;  hemiplegia,  particularly  of  the  right 
side;  dilated  immovable  pupils  ;  red  and  bloated  face. 

Pulsatilla.  Lethargy,  loss  of  consciousness ;  bloatedness  and 
blueish-red  hue  of  the  face,  occurring  after  a  full  meal,  which  has 
been  hurriedly  swallowed  ;*  or  sudden  loss  of  the  power  of  movement ; 
palpitation  of  heart;  pulse  almost  entirely  suppressed;  respiration 
stertorous ;  temperament  phlegmatic. 

*  Ipecacuanha  is  equally  indicated  when  the  attack  has  arisen  from  such  a  cause,  and  may 
therefore  be  employed  after,  or  in  alternation  with,  Pulsatilla,  should  the  latter  remedy  not 
afford  speedy  relief. 


344  NERVOUS  SYSTEM. 

Baryta  carbonica  :  This  remedy,  like  Opium,,  -is  peculiarly 
well  adapted  to  the  treatment  of  many  of  the  affections  of  old  people. 
It  has  accordingly,  like  the  latter  medicine,  been  found  very  service- 
able, when  the  serious  affection  at  present  under  consideration  is 
met  with  in  patients  of  advanced  age,  particularly  when  the  following 
symptoms  are  encountered :  Coma  somnolentum,  vrith  moaning  and  mut- 
tering, circumscribed  redness  of  the  cheeks  ;  mouth  drawn  to  one  side; 
paralysis  of  the  tongue,  or  of  the  upper  extremities  ;  hemiplegia  (right 
side) ;  confusion  of  ideas ;  childish  manners.  The  following  remedies 
may  also  be  pointed  out  as  being  worthy  of  the  attention  of  the 
homoeopathic  practitioner:  Ignatia,  Tart,  emet.,  China,  and  Cocculus, 
(the  two  last  named,  particularly  in  cases  which  have  been  brought 
on  by  excssive  depletion,  by  loss  of  blood,  &c. ;)  and  in  the  para- 
lysis resulting  from  apoplexy,  Belladonna,  Baryta,  Carbonica,  Nux 
vomica,  Rhus,  Silicea,  Zycqpodium,  Lachesis,  Graphites.  Carl,  v.,  Olean., 
Bryonia,  Cocculus,  Plumbum,  Stramonium,  Stannum,  Sulphur,  Calcarea, 
Zincum  metallicum,  and  Electro-magnetism,  particularly  when  occasional 
twitchings  take  place  in  the  limbs. 

During  the  paroxysm  of  apoplexy,  the  patient  ought  be  be  placed 
in  a  cool  room,  with  the  head  raised,  or  put,  in  short,  in  such  a  posi- 
tion as  will  least  favour  determination  of  blood  to  the  head.  The 
clothes  ought  to  be  loosened,  especially  about  the  neck ;  and  the  feet 
or  legs  allowed  to  hang  down.  It  may  also  be  useful  to  increase  the 
force  of  the  circulation  in  the  feet  and  legs  by  means  of  friction,  or  by 
putting  them  in  warm  water. 

We  cannot  conclude  this  article  without  giving  expression  to  the 
gratification  we  feel,  in  common  with  the  majority  of  the  most 
eminent  of  our  homoeopathic  medical  brethren,  at  the  gradually 
increasing  distaste  to  bloodletting  evinced  by  our  allopathic  col- 
leagues. Many  have  renounced  the  use  of  the  lancet  altogether;  and 
others,  while  they  do  not  wholly  discountenance  its  employment,  sur- 
round the  cases,  in  which  they  allow  it  ought  to  be  had  recourse  to, 
with  so  many  restrictions  as  almost  to  amount  to  a  prohibition  of  its 
use.  At  all  events,  we  may  hope  that  the  time  has  already  arrived, 
at  least  for  the  more  enlightened  of  our  profession,  when  even  those 
who  still  adhere  to  the  practice  in  particular  cases,  will  not  rashly 
prescribe  bleeding  in  all  instances  of  cerebral  compression,  where,  if 
it  be  had  recourse  to  before  a  reaction  has  set  in,  it  may  destroy  the 
patient,  either  by  causing  him  to  sink  under  it,  or  by  producing  effu- 
sion, if  that  has  not  already  taken  place,  or  by  increasing  it  if  it 
has. 


MYELITIS,  345 

ACUTE  INFLAMMATION  OF  THE  SPINAL  CORD  AND  ITS  MEMBRANES. 

Myelitis,     Meningitis  spinalis. 

This  affection  is  indicated  by  pain,  more  or  less  severe,  in  some 
cases  of  an  intermittent  character,  either  confined  to  the  lumbar, 
dorsal,  or  cervical  region,  or  embracing  the  entire  length  of  the 
spine.  The  pain  is  aggravated  by  the  slightest  movement,  and  an 
exalted  sensibility  of  various  parts  of  the  cutaneous  surface  is  often 
perceptible  from  the  dread  and  shrinking,  which  the  patient  exhibits 
at  the  slightest  touch.  Sharp  pain  at  the  epigastrium,  sometimes 
spreading  over  the  whole  of  the  abdominal  region,  and  increased  on 
pressure ;  palpitation  of  the  heart,  sensation  of  constriction  and 
weight  in  the  fore  part  of  the  chest,  with  oppressed  respiration ; 
small,  quick,  hard  pulse, — are  symptoms  which  are  generally  encoun- 
tered in  the  course  of  the  disorder. 

When  the  inflammation  occupies  only  a  part  of  the  cord,  the 
symptoms  vary  according  to  its  locality.  Thus,  when  the  commence- 
ment, or  the  cervical  portion  is  principally  affected,  strabismus, 
spasm  of  the  pharynx,  trismus  with  loss  of  voice,  spasm,  or  other 
abnormal  conditions  of  the  muscles  of  the  neck,  chest,  and  superior 
extremities,  with  general  clonic  convulsions,  declare  themselves. 
When  the  dorsal  portion  of  the  cord  is  the  seat  of  the  inflammation, 
opisthotonos  usually  results ;  and  when  that  of  the  lumbar  region  is 
attacked,  retention  of  urine,  or  paralytic  or  spasmodic  affections  of 
the  pelvic  viscera  generally,  are  met  with.  In  each  of  the  latter 
cases,  the  inferior  extremities  are  commonly  either  convulsed  or 
paralysed. 

When  the  membranes  of  the  cord  are  principally  or  solely  affected, 
the  sensibility  of  the  surface  is  said  to  be  always  increased,  and  the 
spasms  more  frequently  general,  and  of  a  tonic  character.  While  in 
inflammation  confined  to  the  substance  of  the  cord,  the  sensibility  is 
usually  lessened,  the  muscles  of  the  extremities  are  affected  with 
clonic  spasm  or  paralysis,  and  only  those  of  the  back  in  a  state  of 
tonic  contraction.  In  the  former,  moreover,  the  bowels  are  for  the 
most  part  constipated, — while  in  the  latter,  diarrhoea  has  almost 
uniformly  been  found  to  predominate.  Finally,  according  as  the 
power  of  motion  or  the  sensibility  is  abnormally  altered,  so  it  may  be 
concluded  will  the  anterior  or  posterior  columns  of  the  spinal  cord 
form  the  seat  of  the  inflammation. 


346  NERVOUS  SYSTEM. 

Causes.  Exposure  to  cold  and  damp,  and  external  injuries  ap- 
pear to  form  the  leading  exciting  causes  of  this  inflammation. 

Chronic  Inflammation  of  the  spinal  cord  and  its  coverings  is 
generally  accompanied  with  a  trivial  degree  of  local  pain,  and  its 
prominent  features  chiefly  consist  in  derangement  of  the  functions  of 
the  viscera,  deprivation  or  diminution  of  the  sense  of  feeling,  para- 
lysis, cramp,  and  emaciation.  The  chronic  variety  is  even  more 
dangerous  than  the  acute. 

The  disease,  when  confined  to  the  substance  of  the  cord,  may 
terminate  in  softening  (ramollissement) ;  induration ;  suppuration  ; 
gangrene ;  in  effusions  of  serum,  pus,  or  blood ;  or  in  thickening  of 
their  structure,  when  the  membranes  have  been  the  seat  of  the 
inflammation. 

Therapeutics.  Aconitum  must  be  prescribed  in  repeated  doses, 
in  all  cases  where  the  accompanying  fever  is  intense ;  and  on  the 
completion  of  its  beneficial  action,  recourse  must  be  had  to  Belladonna, 
Dulcamara,  Arsenicum,  Digitalis,  Pulsatilla,  Bryonia,  Nux  v.,  Cocculus, 
Rhus,  Ignatia,  Opium,  Veratrum, — according  to  the  portion  of  the 
cord  which  is  evidently  attacked* 

Belladonna  is  the  most  important  remedy  when  the  upper  part 
is  the  seat  of  the  disorder.  If,  from  the  invasion  of  delirium,  &c, 
there  is  some  reason  to  apprehend  an  extension  of  the  inflammation 
to  the  brain,  this  remedy  will  still  be  the  most  appropriate,  and, 
indeed,  that  on  which  we  must  rest  our  chief  hope  in  so  serious  a 
complication  of  a  malady,  sufficiently  dangerous  in  its  simple  form. 
Hyoscyamus,  Stramonium,  Bryonia,  Zincum,  (particularly  with  signs  of 
threatening  paralysis  of  the  brain),  and  in  some  instances  Sulphur 
may,  however,  be  found  necessary  and  prove  useful  in  warding  off  a 
fatal  result.  (Vide  Phrenitis.)  Dulcamara*  may  follow  Aconitum 
and  Belladonna,  when  the  more  acute  symptoms  of  myelitis  have 
been  removed,  and  particularly  when  the  disease  has  been  excited  by 
exposure  to  cold  and  wet.  Arsenicum,  Pulsatilla,  and  Digitalis  have 
been  recommended  as  useful  auxiliary  remedies,  when  the  thoracic 
viscera  are  prominently  affected,  evidenced  by  laborious  and  anxious 
respiration,   palpitation  of    the  heart,  &c. ;    and   Veratrum,   Nux  v., 

*  Rhus  is  perhaps  still  more  appropriate  than  Dulcamara  in  such  cases.  The  instances  in 
which  the  latter  remedy  has  heen  reported  to  have  acted  beneficially  are  involved  in  some 
degree  of  obscurity. 


PALSY.  347 

Cocculus,  and  Ignatia,  when  the  abdominal  viscera  are  seized  with 
coldness  and  spasms. 

Should  opisthotonos  result  from  inflammation  of  the  dorsal  division 
of  the  cord:  Belladonna,  Rhus,  Ignatia,  and  Opium  are  chiefly  to  be 
recommended.  Again,  when  the  inflammation  is  restricted  to  the 
lumbar  portion  of  the  cord:  Nuxv.,  Cocculus,  Digitalis,  and  Bryonia ; 
or  Pulsatilla,  Rhus,  Veratrum,  and  Sulphur,  In  general  tonic  spasms 
resulting  from  inflammation  of  the  entire  cord,  or  rather  its  enveloping 
membranes, — Belladonna,  Lachesis,  Hyoscyamtis,  Opium,  Natrum  m.,  and 
Ignatia  are  the  remedies  from  which,  in  general  cases,  we  may  expect 
to  derive  the  greatest  benefit.  Arnica,  Hyoscyamus,  and  Opium  may 
claim  a  preference  in  myelitis  arising  from  external  injury ;  but  we 
must  be  guided  in  our  selection  by  the  nature  of  the  symptoms,  and 
not  hesitate  to  have  recourse  to  one  or  more  of  the  above-mentioned 
medicines  if  called  for.  (Vide  Hydrophobia  and  Tetanus.) 
In  the  chronic  form  of  the  malady,  the  medicines  from  which 
the  most  benefit  may  be  looked  for,  when  the  disease  has  not 
reached  an  irremediable  stage,  are,  in  addition  to  most  of  those 
required  in  the  acute  variety, — Sulphur ',-  Silicea,  Lachesis,  Baryta  c.s 
w,  &c. 


PALSY.    PARALYSIS. 

This  affection  consists  in  the  abolition  or  diminution  of  the  power 
of  voluntary  motion.  It  usually  comes  on  suddenly,  but  in  some 
instances  it  is  preceded  by  numbness,  coldness,  paleness,  and  slight 
convulsive  jerking  or  twitching  in  the  parts  affected.  The  treatment 
must  be  regulated  according  to  the  originating  cause.  When  it 
results  from  apoplexy,  see  that  article.  When  we  find  it  occurring 
as  a  sequel  of  rheumatism :  Arnica,  Ferrum,  Rnta, — as  also  Bryonia, 
Rhus,  Lycopodium,  Sulphur,  Silicea,  &c.  When  in  consequence  of 
debility  from  loss  of  fluids :  China,  Ferrum,  Baryta  c,  and  Sulphur. 
From  the  sudden  suppression  of  an  eruption,  or  of  a  wonted  dis- 
charge :  Sulphur,  Lachesis,  &c.  And  when  it  is  attributable  to  ex- 
posure to  the  fumes  of  lead,  or  the  frequent  handling  of  white-leadl 
Opium  and  Belladonna ;  or  Platina,  Alumina,  Pulsatilla,  and  Nunc  v. 
(These  remedies   are   equally  useful  in  Lead    Colic,   Colic   of 


348  NERVOUS  SYSTEM. 

Pa i  n t  e  ii s,  Colic  of  Po  i  c  t  o  u,  colica  saturnina,  colica  pictonum,  colica 

phombariorum  s.  pictorum,  colica  damnoniorum.) 

With  reference  to  the  parts  which  are  affected  with  the  disorder; 
Belladonna,  Graphites,  and  Causticum  are  chiefly  recommended  in 
paralysis  of  the  facial  muscles.  Belladonna,  Opium,  Hyoscyamus, 
Stramonium,  Lachesis,  and  Graphites,  in  that  of  the  tongue.    Belladonna, 

.  Nux  v.,  Cocmlus,  Zycopodium,  Calcarea,  Silicea,  Opium,  Zinctom,  Ruta, 
&c,  in  paralysis  of  the  upper  extremities.  And  in  that  of  the  in- 
ferior extremities :  Cocculus,  Nux  v.,  Opium,  Sulphur,  Silicea,  Stannum, 
and  Oleander  principally. 

Electricity  or  galvanism  {electro- magnetism),  in  moderation,  is  fre- 
quently of  considerable  service  in  facilitating  the  cure,  or,  at  all 
events,  in  promoting  improvement  in  obstinate  cases,  and  particularly 
when  painful  jerkings  or :  twitchings  frequently  take  place  in  the 
affected  parts. 

TETANUS. 

This  is  a  disease  characterized  by  a  general  spastic  rigidity  of  the 
muscles.  Its  varieties  are  Trismus,  the  lock-jaw.  Opisthotonos, 
— which  is  the  most  common, — when  the  body  is  drawn  or  bent 
backwards  by  the  spasmodic  contraction  of  the  muscles,  sometimes 
to  such  a  degree  that  the  occiput  touches  the  heels.  Emprostho- 
tonos,  when  the  body  is  bent  forwards ;  a  rare  form  of  the  disease. 
Pleurosthotonos,  in  which  the  body  is  bent  to  one  side;  a  still 
more  rare  variety. 

The  disorder  is  chiefly  occasioned  either  by  exposure  to  cold 
(idiopathic  tetanus),  or  by  some  irritation  of  the  nerves  resulting 
from  local  injury,  particularly  of  tendinous  parts  (traumatic  tetanus). 
It  is  of  much  more  frequent  occurrence  in  warm  than  in  cold  climates* 
In  this  and  in  other  climates  the  amputation  of  a  limb,  or  the 
twitching  of  a  nerve  by  a  ligature,  are  not  unfrequent  sources  of  its 
occurrence.  When  it  takes  place  in  consequence  of  such  a  cause, 
or  of  any  other  external  lesion,  the  symptoms  generally  set  in  about 
the  eighth  day,  and  sometimes  later;  but  when  it  supervenes  on 
exposure  to  cold,  they  usually  declare  themselves  much  earlier.  In 
some  cases  the  attack  comes  on  suddenly,  and  with  extreme  violence . 
l#it  it  more  generally  approaches  in  a  gradual  manner ;  a  slight 
stiffness  being  at  first  experienced  in  the  back  part  of  the  neck, 
together  with  an  uneasy  sensation  at  the  root  of  the  tongue,  and  a 


TETANUS  349 

difficulty  in  performing  the  act  of  deglutition^  an  oppressive  tight- 
ness is  complained  of  in  the  chest,  with  a  pain  at  the  inferior  ex- 
tremity of  the  sternum,  or  the  scrobiculus  cordis,  extending  into  the 
back;  the  respiration  is  impeded;  the  countenance  pale,  pulse  small, 
bowels  constipated,  and  urine  high  coloured ;  a  stiffness  also  takes 
place  in  the  lower  jaw,  which  ere  long  increases  to  such  an  extent, 
and  compresses  the  jaws  so  closely  and  firmly  that  the  smallest 
opening  is  unattainable,  and  the  patient  is  now  afflicted  with  what 
is  termed  lock-jaw.  In  some  instances  the  spasmodic  contractions 
proceed  no  further ;  in  others  they  return  with  great  frequency  and 
increased  severity,  and  also  extend  to  the  arms,  the  abdominal 
muscles,  the  back,  and  inferior  extremities,  so  as  to  bend  the  body 
forcibly  in  one  or  other  of  the  directions  before  stated.  Finally,  the 
arms,  lower  extremities,  head,  and  trunk  become  rigidly  extended, 
from  an  equipoised  spasmodic  action  of  the  flexor  and  extensor 
muscles.  The  tongue  is  also  seized  with  spasm,  and  is,  not  unfre- 
quentlyy  injured  by  the  teeth  becoming  clenched  together,  just  as  it 
happens  to  be  convulsively  darted  out. 

As  the  affection  advances,  the  eyes  become  fixed  and  immovable, 
the  whole  countenance  frightfully  distorted  and  expressive  of  extreme 
anguish,  the  pulse  irregular,  the  strength  completely  exhausted,  and  a 
termination  is  put  to  the  sufferings,  generally  about  the  fourth  day 
in  acute  cases,  by  one  concentrated  spasm.  In  some  cases  the  fatal 
termination  is  protracted  considerably  beyond  the  stated  period. 

The  spasmodic  action  does  not  continue  unremittingly,  the  mus- 
cular contractions  occasionally  admitting  of  some  abatement,  but  is 
generally  immediately  renewed  as  soon  as  the  patient  makes  an 
effort  to  speak,  drink,  or  change  his  posture. 

Thebapeutics.  The  remedies  which  have  chiefly  been  used  in 
homoeopathy,  in  the  treatment  of  this  distressing  disease,  are :  Bella- 
donna,  Stramonium,  Cicuta  virosa,  Arnica,  Opium,  Hyoscyamus,  Angustura, 
Rhus,  Ignatia,  Lachesis,  Natrummuriaticum,  Mercurius,  Aconitum,  Sulphur, 
Veratrum,  Phosphorus,  Camphor,  Staphysagria,  and  Moschus. 

Belladonna  is  one  of  the  most  important  of  these,  particularly 
in  idiopathic  tetanus,  properly  so  called,  or  in  trismus ;  it  has  also 
proved  useful  in  the  traumatic  variety  as  well,  after  the  previous 
employment  of  Arnica.  It  is  principally  indicated  when  a  sensation 
of  constriction  is  experienced  in  the  throat,  with  tightness  at  the  chest, 
grinding  of  the  teeth,  spasmodic  clenching  of  the  jatvs,  distortion  of  the 


350  NERVOUS  SYSTEM. 

mouthy  foaming,  obstructed  deglutition,  and  a  renewal  or  exacerbation 
of  the  paroxysms  on  attempting  to  drink.  In  some  cases  of  trismus 
the  alternate  use  of  Belladonna  and  Lachesis,  or  Belladonna,  Angustura, 
and  Cicuta  virosa  has  been  found  necessary ;  and  of  Belladonna, 
Lachesis,  Hyoscyamus,  and  Stramonium,  or  Opium,  Rhus,  and  Belladonna, 
in  opisthotonos. 

Arnica  Montana.  In  cases  of  traumatic  tetanus,  which  is  by, 
far  the  most  fatal  variety,  this  remedy  is,  in  most  instances,  the  most 
appropriate  to  commence  with,  and  should  be  used  both  internally 
and  externally,  in  the  form  of  an  extremely  weak  lotion  (about  a 
teaspoonful  or  a  drachm  to  half  a  pint  of  water.)  Should  symptoms 
of  improvement  not  set  in  in  twenty-four  to  forty-eight  hours,  Opium 
and  Hyoscyamus  must  be  had  recourse  to.  Any  local  irritation  which 
may  seem  to  have  excited  the  disease  ought,  at  the  same  time,  if 
possible,  to  be  carefully  removed. 

Opium  has  proved  extremely  useful  in  some  of  the  severest  forms 
of  opisthotonos  arising  from  cold ;  but,  as  above  stated,  it  is  also 
valuable  in  traumatic  tetanus.     (Likewise  in  tetanus  from  fright.) 

Rhus  and  Ignatia  have  been  found  very  efficacious  in  severe 
cases  of  opisthotonos,  in  which  the  body  has  been  bent  up  in  the 
form  of  an  arch,  and  on  some  occasions  with  the  back  of  the  head 
touching  the  heels,  when  the  complaint  -has  arisen  from  terror. 

Mercurius  has  frequently  succeeded  in  curing  inflammatory 
trismus,  with  swelling  of  the  angle  of  the  lower  jaw,  and  tension 
of  the  muscles  of  the  throat  and  neck,  from  cold. 

These  are  a  few  general  indications  for  the  employment  of  the 
foregoing  medicines.  The  following  may  also  prove  serviceable  in 
various  forms  of  tetanus :  Aconitum,  Sulphur,  Veratrum,  Phosphorus  $ 
Camphora,  Staphysagria,  Moschus,  Bryonia,  Nux,  Platina,  Ipecacuanha, 
Secale  comutum,  Cannabis  indica,  Cantharides,  Cicuta  virosa,  Cina, 
Rhus  toxicodendron,  Gratiola,  Stannum ;  but  considerable  care  must 
necessarily  be  bestowed  on  the  selection  of  the  proper  remedy. 

When,  from  the  spasmodic  clenching  of  the  jaws,  it  is  found  im-. 
possible  to  •  introduce  the  medicine  into  the  mouth,  -the  .  effect  of 
olfaction  must  be  tried ;  it  has  also  been  found  useful  to  moisten  the 
lips  and  nostrils  with  the  medicine  dissolved  or  diluted  in  water ; 
and  in  some  cases,  the  administration  of  the  remedy  in  the  form  of 
of  enema  (a  few  drops  to  an  ounce  or  two  of  water)  has  been 
found  very  efficacious.  (See  also  Hydrophobia,  Hysteria,  and 
Myelitis.) 


DELIRIUM  TREMENS.  351 


DELIRIUM  TREMENS  POTATORUM. 


This  malady  consists  of  an  affection  of  the  brain,  and  is  so  called 
from  being  nearly  peculiar  to  drunkards.  There  are  a  few  instances 
on  record,  in  which  it  has  arisen  from  exhaustion  caused  by  excessive 
depletion;  from  the  effects  of  lead,  and  also  from  the  prolonged  use  of 
opium.  The  intemperate  use  of  ardent  spirits,  vinous  or  strong  malt 
liquors,  is,  however,  beyond  comparison,  the  exciting  cause  in  by  far 
the  major  number  of  instances.  The  disease  generally  comes  on  in 
drunkards,  during  the  state  of  prostration  which  ensues  when  they 
have  in  a  great  measure  given  up,  or  been  suddenly  deprived  o£ 
their  accustomed  stimulus. 

The  first  symptoms  of  the  malady  are  generally  indicated  by 
extreme  irritability  of  temper,  weakness  of  memory,  but  constant 
activity  of  mind,  anxiety,  and  uncontrollable  restlessness  with  in- 
creased muscular  mobility. 

The  appetite  is  often  pretty  good,  but  more  frequently  impaired 
in  consequence  of  the  previous  habits,  and  the  tongue  is  sometimes 
foul  but  moist.     Soon  after  these  premonitory   signs,  vigilance  sets 
in,  and  little  or  no  sleep  can  be  obtained  ;  or  it  is  unrefreshing  and 
disturbed  by  frightful  dreams,  imaginary  visions  and  sounds.     Fixed 
ideas  then  take  firm  possession  of  the  patient's  mind,  such  as  the 
supposition  that  some  one  is  bent  upon  poisoning  him  or  doing  him 
some  other  grievous  injury,  &c,  yet  he  generally  dreads  being  alone. 
The  speech  is  frequently  stuttering  and  inarticulate ;    the  counte- 
nance quick,  wild,  and  exceedingly  variable,  according  to  the  prevail- 
ing impression  on  the  mind ;  the  face  in  most  cases  pale  or  sallow ; 
the  eye  rolling,  expressive,  and  restless,  and  the  conjunctiva  blanched; 
the  skin  damp,  or  covered  with  sweat,  chilly  and  relaxed,  very  rarely 
above  the  natural  temperature;  the  hands  are  commonly  tremulous, 
and  muscular  twitchings  are   often  observable.     As  the  disease  ad- 
vances,  sleep    is   completely   banished;    loquacity,   with  perpetual 
bustling  occupation,  becomes  incessant ;  and  eventually,  when  it  is 
fully  developed,  delirium  supervenes.     The  pulse  is  soft  and  com- 
pressible, and  rarely  quick  when  unruffled  by  the  struggles  or  exertions 
of  the  patient — for  his  corporal  activity  keeps  pace  with  the  restless- 
ness of  his  mincl,  and  it  is  difficult  to  confine  him  to  his  bed  or 
apartment;  at  the  same  time,  exhaustion  is  liable  to  come  on  very 


352  NERVOUS  SYSTEM. 

rapidly  after  greaj  exertion,  and  the  patient  is  prone  to  drop  down 
from  fatigue.  Occasionally,  convulsions  take  place,  but  though 
sometimes  serious,  they  are  usually  not  of  a  fatal  character.  The 
history  of  the  case,  together  with  the  distinctive  nature  of  most 
of  the  above-described  symptoms,  enables  us  to  discriminate  between 
this  disorder  and  that  of  inflammation  of  the  brain  or  its  membranes. 

Therapeutics.  Nux  v.,  Opium  (provided  of  course,  the  attack 
has  not  been  excited  by  the  effects  of  Opium  or  its  alkaloid,  in  large 
doses),  Aconitum,  Belladonna,  Lachesis,  Hyoscyamus,  Sulphur  and  Calc. 
form  our  main  remedial  agents. 

Nux  v.  is  particularly  useful  in  the  first  stage  of  the  disorder,  and 
may  frequently  be  the  means  of  arresting  its  further  progress,  when 
administered  at  that  period.  The  dose  repeated  in  from  six,  to 
twelve,  or  twenty-four  hours,  according  to  the  effects  produced. 

But  when  the  disease  has  become  fairly  established,  and  the 
patient  is  affected  with  delirium  or  convulsions,  and  we  find  an  aggra- 
vated degree  of  all  the  symptoms  remarked  at  the  commencement  of 
the  attack,  we  must  have  recourse  to  Opium,  in  frequently  repeated 
doses.  The  curative  properties  of  this  drug,  in  the  malady  under 
consideration,  do  not,  as  is  erroneously  supposed  by  the  majority  of 
allopathic  practitioners,  arise  from  its  property  of  producing  sleep, 
but  from  its  komosopatMcity,  or  specificity,  if  I  may  use  the  expressions ; 
the  pathogenetic  effects  which  it  produces  being  exactly  similar  to 
those  symptoms  which  are  developed  in  the  course  of  the  disease  as 
it  occurs  in  drunkards. 

In  some  cases,  particularly  where  the  patient  exhibits  extreme 
irritability  of  temper,  with  more  or  less  derangement  of  the  digestive 
functions,  considerable  advantage  will  be  attained  from  the  alternate 
employment  of  Nux  v.  and  Opium. 

In  some  rarer  varieties  of  the  affection,  which  are  more  liable  to 
occur  in  young,  robust,  or  plethoric  subjects,  we  meet  wdth  symp- 
toms indicative  of  active  cerebral  congestion,  which  call  for  the 
administration  of  a  dose  or  two  of  Aconite,  followed  in  a  few  hours 
hy  Belladonna,  or  by  Belladonna  and  Lachesis  alternately,  if  only  partial 
benefit  is  obtained  from  the  action  of  Belladonna  alone,  and  the 
trembling  of  the  hands  and  arms  forms  a  very  prominent  symptom. 
Hyoscyamus  may  be  prescribed  in  preference  to  Belladonna,  when  the 
patient's  insanity  is  more  particularly  apparent  in  the  exhibition  of 
excessive  and  uncalled-for  jealousy. 


EPILEPSY.  353 

In  extremely  obstinate  attacks,  Sulphur,  Opium,  and  Nux  v.  may 
be  given  in  alternation,  at  longer  or  shorter  intervals  according  to 
the  greater  or  less  severity  of  the  symptoms.  Calcarea  is  also  a  remedy 
of  considerable  importance  in  such  cases,  but  more  especially  when . 
they  occur  in  plethoric  or  lymphatic  habits.  Finally, — Stramonium  may 
be  mentioned  as  likely  to  be  useful  when  Belladonna,  Hyoscyamus,  and 
even  Opium  fail  to  do  much  good,  and  the  spasms  or  convulsions  are 
very  severe.  Coffea  and  Camphora  have  also  been  named  as  likely  to 
prove  serviceable  against  the  vigilance,  or  the  mental  and  bodily 
activity  above  described,  when  the  remedies  already  enumerated  fail 
to  answer  the  purpose  required.  But  it  may  safely  be  averred,  that 
there  are  few  instances  in  which  Nux  v.  and  Opium,  when  timely 
administered,  will  not  succeed  in  subduing  the  more  violent  features 
of  the  disease  \  and  Sulphur,  Opium,  Nux  v.,  and  Calcarea,  in  removing 
any  inveterate  sequelae.  These  medicines,  together  with  Arsenicum 
and  Acid,  sulphuricum*  administered  at  intervals  of  from  four  to  eight 
days,  have  also  been  recommended  as  useful  in  correcting  the  vice, 
which  gives  rise  to  this  disease  as  ordinarily  met  with. f  Delirium 
tremens  arising  from  exposure  to  the  vapour  of  lead,  chiefly  requires 
Opium,  Belladonna,  and  Nux  v. ;  and  that  from  poisonous  doses  of 
Opium,  is  mainly  to  be  subdued  by  Nux  v.  and  Belladonna. 


EPILEPSY. 

Epilepsia,     Morbus  sacer.     Morbus  caducus.      Morbus  divinus. 
Morbus  herculeus.      Morbus  comitialis. 

This  is  a  malady  which  consists  of  clonic  spasms,  or  convulsions, 

*  In  the  morning  sickness  of  drunkards,  Acidum  sulphuricum  is  a  most  useful  medica- 
ment.— Gr.  u  St.  h.  Arch.,  1.  1,  173. 

f  Dr.  Hering,  of  Philadelphia,  recommends,  in  the  case  of  inveterate  drunkards,  a 
drop  of  sulphuric  acid  in  a  tumbler  of  water,  early  in  the  morning,  every  two  or  three  days, 
until  disagreeable  symptoms  arise ;  in  the  event  of  which  he  orders  the  patient  to  smell 
camphor  frequently.  When  the  drunkard  has  an  unconquerable  craving  for  liquor,  he 
advises  his  friends  or  relatives  to  proceed  as  follows:  "Take  pure  sulphuric  acid,  mix  it 
with  a  large  proportion  of  water  so  that  it  may  taste  only  slightly  acid,  and  give  the  mixture 
to  the  patient  in  everything  he  eats  or  drinks,  and  that  as  liberally  and  as  frequently  as 
possible,  although  others  should  occasionally  or  even  constantly  have  to  participate  in  his 
meals,  &c. ;  mix  it  especially  in  acidulated  sauces  or  lemonade.  If  it  impairs  the  digestion, 
give  tea  made  of  bitter  herbs,  roots,  or  oranges,  continuing  the  sulphuric  acid  at  the  same 
time,  but  ceasing  as  soon  as  the  mouth  becomes  sore.  Should  obstinate  diarrhoea,  protracted 
derangement  of  the  stomach,  vomiting,  and  giddiness  result,  give  Pulsatilla;  if  bad  ulcers 


354  NERVOUS  SYSTEM. 

with    loss    of  consciousness  and  voluntary  motion,  and   generally 
foaming  at  the  mouth. 

It  comes  on  by  fits,  and  is  usually  characterised  by  the  suddenness 
of  the  attack,  although  it  is  occasionally  preceded  by  pain  in  the 
head,  dimness  of  vision,  flashes  or  sparks  of  fire,  tinnitus  aurium,  pal- 
pitations, flatulency,  and  languor  ;  or,  by  a  peculiar  feeling, 
partaking  partly  of  pain,  and  partly  of  a  sense  of  cold,  com- 
mencing in  some  remote  part  of  the  body,  as  in  the  toes,  abdomen, 
or  fingers,  and  proceeding  gradually  upwards  towards  the  heart  or 
head.  (Aura  epileptica.)  During  the  paroxysm,  the  muscles  of  one 
half  of  the  body  are  commonly  more  severely  agitated  than  those  on 
the  other,  and  those  concerned  in  the  performance  of  respiration  are 
always  more  or  less  implicated ;  the  eyes  are  hideously  convulsed, 
and  turned  in  various  directions,  but  at  length  become  fixed^  so  that 
the  whites  of  them  alone  are  seen  ;  the  fingers  are  firmly  clenched, 
and  the  muscles  of  the  jaws  are  often  spasmodically  affected,  in 
consequence  of  which  the  tongue  is  sometimes  lacerated  by  being 
thrust  out  immediately  before  the  sudden  and  violent  approximation 
of  the  teeth ;  the  mouth  is  frequently  filled  with  phlegm,  which  is 
expelled  with  considerable  force  in  a  frothy  state.  The  face  is  either 
of  a  dark-red  or  livid  colour,  or  it  is  pale,  or  alternately  pale  and 
red,  or  pale  one  side  and  red  on  the  other.  The  faeces  and  urine  are 
sometimes  passed  involuntarily.  On  the  abatement  of  the  spasms 
the  patient  gradually  recovers.  Sometimes  a  fit  of  vomiting  termi- 
nates the  attack.  The  memory  and  judgment  are  generally  some- 
what impaired  for  some  little  time  after  the  fit,  and  a  sensation  of 
languor  and  exhaustion,  or  weight  and  other  uncomfortable  feelings 
in  the  head  are  complained  of.  Comparatively  few  patients  are 
carried  off  during  a  fit,  but  it  sometimes  happens  that  one  fit  suc- 
ceeds another  in  rapid  succession,  or  with  increasing  intensity,  until 
a  comatose  state  ensues,  and  the  patient  sinks.  Idiotcy  is  an  occa- 
sional melancholy  result  of  this  distressing  malady. 

The  prognosis  is  more  or  less  favorable  according  to  the  age  of  the 

form  in  the  mouth,  give  Mercurius  vivus.  Schreiber's  method  of  attempting  to  cure  the 
pernicious  habit,  consists  in  locking  the  patient  up  by  himself,  allowing  him  to  drink  brandy 
mixed  with  one  third  part  of  water  ad  libitum,  and  adding  one  third  part  of  brandy  to  every 
other  liquid,  and  all  the  food  the  patient  partakes  of.  Although  intoxication  may  be  the 
result  of  this  procedure,  during  the  first  day  or  two,  still,  the  subsequent  disgust  which 
takes  place  (generally  about  the  fifth  day)  commonly  puts  a  stop  to  further  relish  for  the 
intoxicating  beverage.  Carlo  v.  has  recently  been  suggested  as  likely  to  be  of  service  in 
some  cases  of  delirium  tremens.     (Allg.  Horn.  Zeit.,  No.  1,  33  Bd.) 


EPILEPSY.  355 

patient  and  the  species  of  the  epilepsy.  When  the  disease  occurs 
before  the  age  of  puberty,  or  when  purely  sympathetic,  it  is  generally 
cureable  without  much  difficulty  by  means  of  homoeopathic  reme- 
dies. On  the  other  hand,  when  it  comes  on  after  the  age  of  puberty, 
is  idiopathic,  or  of  hereditary  origin,  and  has  been  of  long  duration, 
the  cure  is  not  easily  accomplished.  It  is  generally  possible,  how- 
ever, even  in  the  most  inveterate  cases,  to  lengthen  the  intervals 
between  the  attacks,  and  to  mitigate  their  violence  by  means  of 
steady  and  judicious  treatment. 

Therapeutics.      This  must  be  regulated  by  the  character  and 
causes  as  well  as  by  the  symptoms  of  the  malady ;  the  latter  guiding 
us  in  the  selection  of  one  from  amongst  a  class  of  remedies.     When 
the  disease  proceeds  from  plethora  with  determination  of  blood  to 
the  head,  Aeon.,  Bella.,  Op.,  Nux  v.,  Puis.,  Bry.,  Merc,  Ign.,  Sulph., 
Veratr.,  Silic.,  are  the  most  effective  remedies.  (See  Congestio  ad  caput.) 
When  from  debility,  caused  by  loss  of  humours  (hemorrhage,  venereal 
excess,  masturbation,  etc) :  China,  Phosph.,  Ac.  phosph.,  Nux,  Sulph., 
Calc,  Staph.,  Sil.,  principally.     When  from  the  irritation  of  worms  : 
Hyos.,  Bella.,  Cine,  Cina,  Merc,  Sulph.  (See  Invermination.)   When 
from  that  of  teething:  Bella.,   Cham.,   Cina,  Ign.,  Sulph.,  Calc,  Stann. 
(See    Dentition  and  Convulsions  in  Children.)     When  from 
hysterical  affections  {Epilepsia  uterina)  x  Bella.,  Plat.,  Sep.,  Ign.,  Sulph., 
Mosch.,  Nux,  Cocc,  Veratr.,  Puis.,  Aur.,  Magn.,  Magn.  m.,  Sec   corn., 
Stram.,  Hyos.,  Ac  hydroc     (See  Hysteria  and  Metritis.)     When 
from  the   retropulsion    of  an  eruption  :    Sulph.,  Calc,   Sil.,   Ipecac, 
Tart.,  Bry.,  Lach.,   Nux  v.,  Stram.      From  the   abuse  of  intoxicating 
drinks,  or  narcotics — as  wine,   spirits,  tobacco,  opium,  malt  liquor, 
(adulterated) :  Nux  v.,  Lach.,  Ign., Bell.,  Hyos.,  Cupr.,  Cham.,  Op.,  Calc  &c. 
From  exposure  to  the  fumes  of  arsenic  and  copper:  Camph.,  Cup., 
Merc,   Ipecac,  Chin.,  Nux  v.,    Veratr.,  Ars.       To    those  of  mercury, 
Stramonium  chiefly,  in  the  first  place.     From  checked  perspiration: 
Cham.,  Sulph.,  Aeon.,  Bella.,  Nux  v.,  Lach.,  Cic,  Sil.,  Chin.,  etc.      From 
moral  causes   such   as   fright,  fear,  etc.:    Artem.,  Op.,  Aeon.,  Cham., 
Hyos.,  Nux  v.,  Plat.,  Cupr.    (See  Moral  Emotions.)     From  crudities 
of  the  stomach :    Ipec,   Nux  v.,  Puis.,  etc.       (See  Dyspepsia   and 
Derangement  of  Stomach.)     And  when  from  an  injury  of  the 
head    {Epilepsia  traumatica)  :   Arnica,  Aeon.,   Ang.,    Cic  ;   and  Bella., 
Rhus,  Sulph.     An  operation  may  sometimes  be  necessary  to  remove 
the  source  of  the  irritation,  particularly  when  we  have  reason  to 


356  NERVOUS  SYSTEM. 

apprehend  .that  a  spicula  or  morbid  growth  of  bone  is  pressing  upon 
the  brain. 

In  recent  cases  of  idiopathic  epilepsy,  either  attacking  suddenly 
without  manifest  cause  [Epilepsia  cerebralis),  or  preceded  by  a 
peculiar  and  disagreeable  or  painful  sensation  ascending  from 
some  part  of  the  body  (Epilepsia  sympathica) ,  Bella.,  Hyos.,  Ignatia, 
Nux  v.,  Op.,  Cocculus,  etc.,  are  most  frequently  indicated;  and  those 
which  are  chronic:  Sulphur,  Calcarea  carbonica,  Silicea,  and  Cuprum 
chiefly  ;  but  also,  Bell.,  Lack.,  Hep.,  Stann.,  Stram.,  Ars.,  Agar., 
Cawph ,  Mere.,  etc.,  and  likewise  the  others  which  have  been  named  as 
the  more  appropriate  in  ordinary  cases  of  recent  origin.  The  follow- 
ing are  amongst  the  leading  indications  for  these  remedies : 

Belladonna  : — Commencement  of  the  attack  with  a  sensation  of 
crawling  and  torpor  in  the  upper  extremities ;  jerking  of  the  limbs,  espe- 
cially of  the  arms,  convulsive  movements  of  the  mouth,  muscles  of 
the  face  and  eyes.;  congestion  in  the  head,  with  vertigo,  deep  redness,  heat 
and  bloatedness  of  the  face,  or  paleness  and  coldness  of  the  face,  with 
shivering ;  photophobia ;  convulsed  or  fixed  eyes;  dilated  pupil ; 
cramps  in  the  larynx  and  throat,  with  obstructed  deglutition  and  danger  of 
suffocation ;  foam  at  the  mouth ;  unnoticed  emission  of  faeces  (and  of 
urine),  or  loose  evacuation  of  ingesta ;  oppression  on  the  chest  and 
anxious  respiration ;  renewal  of  the  fits  on  the  slightest  contact  or  the 
least  contradiction ;  dizziness,  or  complete  loss  of  consciousness  ;  sleepless- 
ness between  the  fits,  with  agitation  and  tossing,  or  deep  and  lethargic 
sleep,  with  smiles  and  grimaces  ;  waking  with  a  start,  with  cries.  (Com- 
pare with  Cham.,  Hyos.,  Ign.,  Op.,  Stram.) 

Cuprum  :— Commencement  of  the  paroxysm  in  the  fingers  or  toes, 
or  in  the  arms ;  retraction  of  the  thumbs ;  loss  of  consciousness  and  of 
speech ;  salivation,  sometimes  frothy  ;  redness  of  the  face  and  eyes  ; 
recurrence  of  the  fits  every  month,  and  especially  at  the  catamenia. 

Hyoscyamus  : — Bluish  colour  and  bloatedness  of  the  face,  foam  at  the 
mouth,  prominent  eyes ;  convulsive  movements  of  certain  limbs,  or  of 
the  whole  body;  violent  jactitation;  retraction  of  the  thumbs; 
renewal  of  the  fits,  on  endeavouring  to  swallow  the  least  drop  of 
liquid  ;  cries,  grinding  of  the  teeth  ;  loss  of  consciousness  ;  unnoticed 
emission  of  urine ;  cerebral  congestion ;  deep  and  lethargic  sleep,  with 
snoring,     (See  Bell,  and  Op.) 

I  gnat  i  a  i — Convulsive  movements  of  tjie  limbs,  eyes,  eyelids,  muscles  of 
the  face  and  lips ;  throwing  bach  of  the  head  ;  retraction  of  the  thumbs ; 
red  and  bluish  face,  or  redness  of  one  side  and  paleness  of  the  other, 


EPILEPSY.  357 

or  paleness  and  redness  alternately ;  frothy  salivation  ;  spasms  in  the 
throat  and  larynx,  with  threatening  suffocation  and  difficult  deglutition, 
loss  of  consciousness  ;  frequent  yawning,  or  drowsy  sleep,  great 
anxiety  and  deep  sighs  between  or  before  the  attacks ;  daily 
paroxysms. 

Lachesis  : — Loud  cries,  falling,  and  loss  of  consciousness,  foaming 
at  the  mouth,  cold  feet,  eructations,  pale  face,  vertigo,  heaviness  and 
pain  in  the  head,  palpitatio  cordis,  distended  abdomen,  coma  somno- 
lentum,  nausea,  &c. 

Nux  vomica  ; — Shrieks,  throwing  bach  of  the  head,  trembling  or 
convulsive  jerks  of  the  limbs  or  muscles;  renewal  of  the  fits  after 
contradiction  or  an  angry  emotion ;  unnoticed  evacuation  of  faeces 
and  urine  ;  sensation  of  torpor  and  numbness  in  the  limbs;  vomiting, 
profuse  perspiration,  constipation,  ill-humour  and  irascibility  between 
the  attacks. 

Opium  : — Occurrence  of  the  fits  at  night  or  in  the  evening ;  throwing 
bach  of  the  head,  or  violent  movements  of  the  limbs,  especially  of  the 
arms  ;  loss  of  consciousness,  insensibility,  cries ;  closed  fists  ;  threat- 
ening suffocation;  deep  and  lethargic  sleep  after  or  between  the  pa- 
roxysms.    (See  Bell.,  Hyos.,  Ign.) 

Stramonium  :  —Throwing  back  of  the  head,  or  convulsive  move- 
ments of  the  limbs,  and  especially  of  the  upper  part  of  the  body  and  of 
the  abdomen  ;  pale  and  haggard  face,  with  stupid  expression,  or  redness 
and  bloatedness  of  the  face,  loss  of  consciousness  and  of  sensation,  some- 
times with  cries,  &c,  renewal  of  the  fits  by  contact,  and  also  by  the 
sight  of  bright  and  brilliant  objects.     (See  Bell.) 

Arsenicum — chiefly  when  the  fits  are  attended  with  burning  in 
the  stomach,  vertebrae,  and  abdomen. 

Sulphur  : — Chronic  epilepsy,  often  preceded  by  a  sensation  as  if  a 
mouse,  or  some  other  small  animal,  were  running  over  the  muscles, 
cries,  stiffness  of  the  body,  fits  excited  by  cool  air,  or  by  a  current  of  air. 
{Bella,  is  very  useful  before  or  after  Sulph.  in  some  cases.) 

Calcarea  : — Especially  when  the  fits  occur  at  night,  and  in 
chronic  cases.     (After  Sulph.) 

SiL-iCEA  is  chiefly  useful  in  chronic  epilepsy.     (After  Calc.) 

C amphora — against  epilepsy,  with  snoring,  red  and  puffed  face, 
coma  somnolentum. 

Cicuta  :— Paleness,  or  yellowish  colour  of  the  face,  trismus,  distortion 
of  the  limbs,  cries  and  frothy  salivation,  colic,  as  if  caused  by 
worms,  &c. 


358  NERVOUS  SYSTEM. 

Cocculus — especially  in  women  during  the  catamenia,  or  also 
from  a  traumatic  cause. 

Mebcurius  :— Cries,  rigidity  of  the  body,  distension  of  the  abdo- 
men, itching  in  the  nose,  thirst,  and  nocturnal  attacks. 

St  annum  : — Jactitation  of  the  limbs,  retraction  of  the  thumbs, 
paleness  of  the  face,  backward  traction  of  the  head,  loss  of  conscious- 
ness, appearance  of  the  fits  in  the  evening. 

Veeatrum  : — Loss  of  sense  and  movement,  distortion  of  the 
eyes,  and  convulsive  movements  of  the  eyelids ;  anguish,  discourage- 
ment and  despair,  between  the  fits. 

During  the  epileptic  seizure  or  paroxysms,  the  patient  should  be 
placed  in  the  horizontal  posture,  and  such  precautions  taken  as  will 
obviate  any  injury  which  maybe  sustained  by  the  violence  of  :he 
convulsive  movements.  In  order  to  prevent  any  lesion  of  the  tongue, 
something  ought  to  be  inserted  between  the  teeth.  The  neckcloth 
should  be  removed,  the  stays  loosened,  and  cold  water  sprinkled  over 
the  face,  especially  when  the  breathing  is  much  affected  by  the 
spasms  of  the  muscles  concerned  in  respiration.  A  dose  of  Aconite, 
followed  by  Belladonna  if  relief  be  not  speedily  obtained,  is 
necessary,  when  the  fit  occurs  in  plethoric  subjects,  and  is  attended 
with  strongly  marked  signs  of  congestion  of  the  vessels  of  the  head 
and  neck. 

The  diet  of  epileptic  patients  ought  to  be  very  moderate,  simple, 
and  easy  of  digestion.  Stimulants  ought  to  be  strictly  avoided 
where  there  is  plethora,  with  tendency  to  congestion.  Debilitated 
persons  require  a  somewhat  more  generous  diet  than  the  robust,  but 
in  all  cases  care  should  be  taken  never  to  overload  the  stomach. 
Excessive  corporal  or  mental  exertion  must  be  abstained  from. 


NERVE-PAIN.     FACE-ACHE.     FACE-AGUE. 

Neuralgia,     Neuralgia  facialis.     Tie  douloureux.     Prosopalgia. 

This  distressing  malady  consists  in  an  excruciating  pain,  which  has 
its  most  frequent  seat  in  the  branches  of  the  fifth  pair  of  nerves,  and 
is  accordingly  experienced  with  great  acuteness  under  the  eye,  and 
sometimes  before  the  ear,  from  whence  it  shoots  over  the  entire  half 
of  the  face,  and  frequently  into  the  orbit  and  cranium.  The  paroxysms 
occasionally  continue  with  shorter  or  longer  intervals,  for  several  days 
or  weeks  in  succession. 


NEURALGIA.  359 

The  disease  is,  unfortunately,  generally  of  great  obstinacy,  and,  in 
some  melancholy  instances,  utterly  incurable. 

When  the  malady  is  symptomatic,  remedies  which  are  appropriate 
to  the  primary  disease  must  be  had  recourse  to.  Thus,  when  from 
derangement  of  the  digestive  functions,  Nux  vomica,  Pulsatilla,  Bryonia, 
Chamomilla,  Ipecacuanha  or  Lycopodium,  will  usually  prove  the  most 
serviceable  medicines.  When  arising  from  or  connected  with  uterine 
disease :  Nux  v.,  Puis.,  Plat.,  China,  Ignatia,  Bella.  When  connected 
with,  or  arising  from  invermination  :  Spigelia,  Bella.,  Cina,  Graph.,  Ferr., 
Stann.,  Sulph.,  chiefly. 

In  Rheumatic  face-ache,  or  prosopalgia, — Aconitum,  Bryonia,  Rhus, 
Mercurius,  Phosphorus,  Pulsatilla,  Mezereum,  Sulphur,  Nux  v.,  Lachesis, 
Sec,  are  the  remedies  that  have  generally  proved  the  most  effectual. 

In  Arthritic, — Nux  v.,  Rhus,  Colocynthy  Merctmus,  Causticum, 
etc. 

In  Neuralgia,  with  Inflammation  of  the  Neurilemma: 
Aeon.,  Bella.,  Bryon.,  principally ;  or,  Merc,  Phosph.,  Staph.,  Sulph., 
Am. ;  or,  Spig.,  Bach.,  Plat.,  Veratr.,  Baryta  c.,  Thuja. 

Face-ache  from  the  effects  of  Mercury  chiefly  requires  the  employ- 
ment of  Auriom,  Hepar,  Bella.,  Carlo  v.,  Sulphur,  China,  Mezereum,  &c. 
That  from  periostitis  in  the  vicinity  of  the  affected  nerves :  Aeon., 
Bella.,  Puis.,  Mez.,  Bry.,  Ruta,  Aurum,  Silicea,  chiefly;  and  that  which 
appears  to  arise  from  enlargement  of  a  bone  :  Sulph.,  Calc,  Silic, 
Aurum,  Assa.,  Mez.,  Acid,  nitr.,  Sec.    (See  Bones,  Diseases  of  the.) 

When  Neuralgia  facialis  is  attended  with  purulent  discharge  from 
the  nose  and  thickening  of  the  schneiderian  membrane,  or  with 
obstruction  of  the  lachrymal  duct:  Aurum,  Lach.,  Petrol. ,  Silic,  Ars., 
Marum  verum,  &c. ;  and  when  nerve-pain  has  resulted  from  external 
injuries,  such  as  accidents  or  surgical  operations,  Am.,  Aeon.,  Rhus, 
Calendula,  are  the  medicaments  which  are  chiefly  to  be  relied  on. 

In  neuralgia  occurring  in  young,  plethoric  persons  :  Aconitum  and 
Belladonna  ;  or  Calc,  Phosph.,  Plat.,  Lach.  That  in  nervous  persons : 
Bella.,  Lach.,  Spigel.,  Plat. ;  and  that  in  excessively  debilitated  con- 
stitutions :  Cinchona  and  Ferrum.  When  the  sacro-sciatic  nerve  is 
the  seat  of  the  neuralgia :  Aconitum,  Chamomilla,  Ignatia,  Nux  v., 
Pulsatilla,  Colocynth,  and  Rhus  are,  in  general,  the  most  efficacious 
medicines.  (See  Sciatica.) 

Finally,  in  prosopalgia  generally,  the  following  have  proved  more 
or  less  useful :  Aconitum,  Arnica,  Verhascum,  Sulphur,  Calcarea,  Capsi- 
cum, Pulsatilla,  Stannum,  Conium,  Thuja,  Baryta  c,  Coffea,  Kali,  Cam- 
phora,  Flectro-magnetismus,  Sec. 


360  NERVOUS  SYSTEM. 

In  idiopathic  neuralgia  facialis  or  tic  douloureux,  the  remedies 
which  have  hitherto  been  employed  in  homoeopathic  practice  with  the 
most  success  are :  Belladonna,  Platina,  Zgcopodium,  Colocynth,  Arseni- 
cum, China,  Mezereum,  Veratrum,  Mags,  arc.,  Sulphur,  &c. 

Belladonna.  When  the  pain  chiefly  pursues  the  course  of  the 
infra-orbitary  nerve,  but  sometimes  also  the  other  branches  of  the 
fifth,  and  is  prone  to  be  excited  by  rubbing  the  usual  seat  of  the 
sufferings  :  darting  pains  in  the  cheek-bones,  nose,  jaws,  or  zygoma- 
tic process ;  or  cutting  and  tensive  pains,  with  stiffness  at  the  nape  of 
the  neck,  and  clenching  of  the  jaws ;  twitches  in  the  eyelid,  or  violent 
shooting  and  tearing  and  dragging  pains  in  the  ball  of  the  eye;  jerk- 
ing pains  in  the  facial  muscles,  and  mouth  ;  heat  and  redness  of  the 
face.  The  pain  is  generally  preceded  by  itching  and  creeping  in  the 
affected  side  of  the  face,  and  at  times  becomes  so  severe  as  to  be  almost 
insupportable. 

Platin  a  : — Feeling  of  coldness  and  torpor  in  the  affected  side  of  the 
face,  with  severe  spasmodic  pain,  or  tensive  pressure  in  the  zygoma- 
tic process,  with  a  sensation  of  creeping  or  crawling,  and  aggravation 
or  renewal  of  the  sufferings  in  the  evening,  and  when  in  a  state  of 
rest;  lachrymation ;  redness  of  the  face,  &c. 

Lycopodium  is  often  useful  when  the  symptoms  are  much  the 
same  as  described  under  the  preceding  remedy,  with  the  exception  of 
the  torpor  and  creeping,  and  particularly  when  the  right  side  of  the 
face  is  the  part  affected. 

Colocynth  :  Violent  rending  and  darting  pains,  which  chiefly 
occupy  the  left  side  of  the  face,  are  aggravated  by  the  slightest  touch, 
and  extend  to  all  parts  of  the  head,  temples,  nose,  ears,  teeth,  &c. 

Arsenicum  ; — When  there  is  a  tendency  to  periodicity  in  the 
attacks  or  paroxysms,  and  the  pains  partake,  more  especially,  of  a 
burning,  pricking,  and  rending  character,  and  are  experienced  chiefly 
around  the  eye,  and  occasionally  in  the  temples  :  the  sufferings  being 
occasionally  of  so  severe  a  description  as  almost  to  drive  the  patient 
distracted  ;  great  anguish ;  excessive  prostration,  with  desire  for  the 
recumbent  posture  ;  sensation  of  coldness  in  the  affected  parts ; 
exacerbation  during  repose,  from  fatigue,  in  the  evening,  when  in 
bed,  or  after  a  meal ;  temporary  melioration  from  external  heat. 

China  : — WThen,  as  in.  the  instance  of  the  foregoing  remedy,  there 
is  a  tendency  to  periodicity  in  the  attacks,  and  when  the  pains  are 
excessive,  attended  with  extreme  sensibility  of  the  skin,  and  conse- 
quent aggravation  from  the  slightest  touch ;  sensation  of  torpor  and 
paralytic  weakness  in  the  affected   part;  great  loquacity,  with  ill- 


HEADACHE.  361 

humour,  paleness  of  the  face,  frequently  followed  by  or  alternated 
with  redness  and  transient  heat  of  the  face. 

Mezereum.  Pains  which  occupy  the  left  zygomatic  process,  chiefly 
of  a  spasmodic  stupefying  description,  and  extending  to  the  eye, 
temple,  ear,  teeth,  neck,  and  shoulder,  with  exacerbation  from  par- 
taking of  warm  food  or  drink,  or  on  coming  into  a  warm  room  after 
being  in  the  open  air. 

Veratrum.  Insupportable  pains  which  almost  drive  the  patient 
to  distraction ;  excessive  weakness  even  to  fainting ;  general  chilli- 
ness, exacerbation  of  suffering  on  getting  warm  in  bed,  or  towards 
morning ;  temporary  relief  on  moving  about. 

Assafcetida  may  generally  be  prescribed  with  decided  benefit 
wrhen  the  pain  is  chiefly  of  a  dull,  subdued  description,  and  occurs 
intermittingly  ;  but  also  when  it  partakes  of  a  burning  or  shooting  cha- 
racter, and  proceeds  from  wdthin  outwards. 

Spigelia  is  frequently  a  useful  palliative  remedy  in  all  cases 
when  the  pain  is  excessive ;  but  is  more  especially  required  when  the 
pains  are  of  a  jerking,  tearing  character,  exacerbated  by  the  slightest 
touch  or  by  movement  of  the  affected  parts ;  or  when  they  appear 
to  shoot  from  the  centre  of  the  brain  to  the  sides  of  the  head  or  the 
ears  ;  further,  when  the  pains  partake  of  a  burning  and  pressive  aching 
character,  and  have  their  seat  in  the  zygomatic  process;  glossy 
tumefaction  of  the  affected  side  of  the  face ;  excessive  agitation  and 
anguish. 

In  other  cases :  Lachesis,  Phospkoms,  Hyoscyamus,  Mags,  arc,  Oleand., 
Verb.,  Graph.,  Kali,  Con.,  But  a,  Anac,  Baryta  c,  Magn.  m.,  Manganum, 
Merc,  Rhus,  Ignatia,  Arnica,  Capsictcm,  Staphysagria,  Coffea,  &c.  may  be 
found  useful. 


HEADACHE. 

Cephalalgia.      Cephalcea.      Cephalalgia  arthritica.     Cephalalgia   nervosa. 
Hemicrania  {megrim.)     Clavus  hystericus. 

Headache  is  often  but  symptomatic  of  disease,  and,  in  such  cases 
is  only  to  be  cured  by  the  removal  of  the  primary  affection.  When, 
therefore,  it  arises  from  derangement  of  the  stomach,  or  dyspepsia, 
constipation,  cold  in  the  head,  mental  emotions,  congestion  of  blood 
in  the  vessels  of  the  head,  &c,  the  remedies  most  appropriate  to  the 
treatment  of  these  different  disorders  must  be  had  recourse  to. 

In  the  treatment   of  nervous  headaches,  hemicrania,  or  megrim, 


362  NERVOUS  SYSTEM. 

the  following  remedies  have  generally  been  found  the  most  useful : 

Nux  v.,  Veratrum,  Colocynth,  Pulsatilla,  Sepia,  Ignatia,  Bryonia,  Rhus, 
Ipecacuanha,    Chamomilla,    Coffea,   Hepar,    China,    Cicuta}   Belladonna, 
Arsenicum,  Arnica,   Acid,  nitr.,    Petroleum,    Sulphur,  Silicea,   Platina, 
Causticum,  Graphites,  Natrum  m.,  Phosphorus,  Zincum,  Sec.      Rheumatic 
headaches :  Aconitum,  Chamomilla,  Mercurius,  Nux  v.,  Pulsatilla,  Lyco- 
podium,  Spigelia,  Sulphur,  Bryonia,  Belladonna,  China,  Ignatia,  Phosphorus, 
Sec.     (In  fugitive  rheumatic  pains  in  the  head,  or  pains  which  are 
aggravated  by  movement  and  at  night,  and  are  attended  with  sensi- 
bility to  the  touch,  fits  of  vomiting,  and  frequent  sweating,  Nux  v., 
followed  by  Cham,   and  Puis.)      Arthritic :    Ipecac,  Ignatia,  Mix  v., 
Coloc,  Bryonia,  Belladonna,  Sepia,  Ignatia,  Veratrum,  Sec.      Hysterical : 
Ignatia,  Moschus,   Platina,    Veratrum,    Valeriana,  Sepia,  Aurum,  Acid, 
nitricum,  Magnesia  c.  eJt  m.,   Cocculus,  Phosphorus,  Sec.     Against  head- 
aches occurring  in  extremely  sensitive  individuals  :  Aconitum,  Ignatia, 
Chamomilla,  Coffea,  Spigelia,  Veratrum,  Cina,  ov  Ipecacuanha,  have  usually 
proved  the  most  appropriate.     Headaches  arising  from  the  habitual 
use   of  coffee  are  generally  curable  by  means  of  Nux  v.,  Chamomilla, 
or    Ignatia.       From    gastric    derangement:    Pulsatilla,   Antimonium 
crudum,  Ipecacuanha,  Nux  v.,  Sulphur,  Bryonia,   Cocculus,  Carlo  v.,  or 
Nux  moschata.      From  constipation  :  Bryonia,  Nux  v.,  Opium,  Conium, 
or  Veratrum.     And  those  from  long-continued  excessive  mental  appli- 
cation: Nux  v.,  Opium,  and  Sulphir  chiefly ;  but  also,  Lachesis,  Pulsa- 
tilla, Calcarea,  Aurum,  Natrum  m.,  Silicea,  Lycopodium,  Sec. 

If  the  affection  arises  from  sitting  up  late,  or  prolonged  watching 
at  the  bedside  of  a  sick  person  ;  Cocculus,  Nux  v.,  or  Pulsatilla.  When 
headache  is  always  excited  by  exposure  to  a  current  of  air,  Aconikcm, 
Belladonna,  Colocynth,  Nux  v.,  or  Cinchona  have  often  been  found 
successful,  either  in  removing  the  said  susceptibility,  or  in  shortening 
the  attacks,  and  rendering  them  of  a  much  more  bearable 4  character. 
And  when  cold,  damp,  or  boisterous  weather  is  generally  productive 
of  headache :  Bryonia,  Nux  v.,  Carlo  v. ;  these  last-named  medicines, 
moreover,  together  with  Silicea,  are  frequently  equally  useful,  if  head- 
ache is  always  experienced  during  hot,  sultry  weather, — the  air  being 
overcharged  with  electricity.  Against  headaches  arising  from  the 
effects  of  mercury  in  large  doses :  Carlo  v.,  Pulsatilla,  Cinchona ;  or 
Hepar  sulphuris,  Acidum  nitricum,  Aurum,  or  Sulphur.  Headache  after 
drinking  cold  or  iced  water,  &c. :  Aconitum,  Arsenicum,  Opium,  Bella- 
donna, Pulsatilla,  Sulphur,  and  Natrum.  Headaches  from  congestion  : 
Aconitum,  Belladonna,  Bryonia,  Sanguinaria  canadensis,  Opium,  Mercurius, 
Pulsatilla,  Rhus,  Nix  v.,  Veratrum,  Coffea,  Lachesis,  Chamomilla,  Cocculus, 


HEADACHE.  363 

Sulphur,  Siliceciy  &c.  Headache  from  exposure  to  metallic  vapours, 
Sulphur;  and  from  that  of  copper  especially,  Hepar  $. 

In  general  cases,  the  subjoined  remedies  will  prove  useful,  and 
may  be  selected  according  to  the  indications  given. 

Belladonna.  When  headache  is  periodic,  or  nearly  constant, 
and  the  pain  is  increased  by  the  slightest  movement  either  of  the 
head  or  body,  and  particularly  on  stooping,  or  by  moving  the  eyes  ; 
or  when  a  bright  light,  or  the  most  trivial  noise  tends  to  aggravate 
the  pain,  which  consists  of  a  dull  pressure  at  the  vertex,  or  is  of  a 
lancinating  description,  and  occupies  either  the  entire  head  (cephalaea), 
or  merely  one  side  (hemicrania),  extending  from  the  occiput  into  the 
orbit  and  root  of  the  nose,  and  is  then  described  as  a  violent, 
screwing,  piercing,  bursting,  or  tearing  pain,  sometimes  attended 
with  great  heat  at  the  vertex ;  or  the  seat  of  the  pain  is  in  the  fore- 
head, and  is  of  a  dull,  aching,  or  cutting  description,  attended  with 
a  sense  of  fulness  or  a  feeling  as  if  the  brain  would  be  forced  through 
the  forehead  in  stooping.  At  times  these  pains  become  so  violently 
increased  as  almost  to  deprive  the  patient  of  consciousness  whilst 
they  last ;  or  the  headache  is  attended  with  extreme  restlessness, 
sleeplessness,  and  delirium ;  and  there  is  a  falling  off  of  the  hair,  in 
consequence  of  the  headaches.  Platina  answers  well,  in  some  cases, 
after  Belladonna,  when  the  pain  is  chiefly  lateral,  and  of  the  same 
description ;  or  when  there  is,  at  the  same  time,  coldness  of  one  half 
of  the  face,  &c,  with  humming  or  buzzing  in  the  head.  Mercurius 
and  Hepar  s.,  and,  in  very  obstinate  cases,  Sepia  and  Silicea  are  fre- 
quently very  useful'  after  Belladonna. 

Bryonia  : — Aching,  piercing,  or  digging,  tearing  pain,  at  a  small 
fixed  spot  (clavus  hystericus) ;  or  piercing,  aching  pain  in  the  fore- 
head daily  after  a  meal,  or  coming  on  in  the  morning,  and  afterwards 
becoming  lancinating;  or  pain  coming  on  in  the  morning,  disappear- 
ing in  the  afternoon,  and  returning  again  in  the  evening  with  great 
violence,  when  it  is  attended  with  a  sensation  as  if  the  head  were  pressed 
together,  particularly  at  the  temples ;  burning,  tearing  pain  over  the 
entire  head;  shootings  in  one  side  of  the  head.  The  pains  are  in- 
creased by  movement,  and  are  attended  with  irascibility,  and  dispo- 
sition to  chilliness  or  shivering ;  they  are  sometimes  relieved  or 
terminated  by  a  fit  of  vomiting.  Nux  v.  and  Rhus  often  serve  to 
complete  the  cure  of  the  foregoing  symptoms,  or,  at  all  events,  to 
curtail  or  remove  each  attack,  after  the  previous  administration  of 
Bryonia. 

Rhus  : — Shooting  and  rending  pains,  extending^  to  the  ears  and 


364  NERVOUS  SYSTEM. 

root  of  the  nose ;  burning  or  pulsative  pains ;  headache  after  a  meal, 
with  desire  to  assume  the  recumbent  posture,  and  remain  quiet ;  ful- 
ness and  weight  in  the  head ;  renewal  of  the  headache  at  the  slightest 
contradiction,  or  on  going  into  the  open  air :  undulation  of  the  brain  at 
every  step  j  or  sensation  as  if  water  were  in  the  head,  or  as  if  the  con- 
tents of  the  cranium  were  in  a  relaxed  or  loosened  state,  and  shifted 
about  with  every  movement  of  the  head ;  feeling  of  creeping  or  crawling 
in  the  head. 

Sepia  : — Periodic  cephalalgia,  aggravated  by  mental  emotion, 
particularly  in  hysterical  subjects  ;  the  pain  is  either  of  a  lancinating 
description,  and  affects  the  whole  head,  or  is  merely  seated  under  the 
eye,  or  occupies  one  half  of  the  head  or  forehead ;  in  the  latter  case, 
the  pain  is  experienced  chiefly  in  the  morning,  and  is  frequently 
attended  with  extreme  sensibility  of  the  eyes  to  the  light.  Sepia  is 
also  very  efficacious  in  cases  of  chronic  hemicrania,  with  violent 
piercing  or  rending  pain,  intermingled  with  lancinations,  so  excru- 
ciating that  the  patient  is  afraid  to  move,  and  can  only  obtain  a 
trivial  degree  of  relief  by  remaining  perfectly  quiet  with  the  eyes 
closed ;  at  other  times,  the  pain  is  so  violent  as  to  cause  the  patient 
to  scream  out,  and  is  attended  with  heat  in  the  head,  orfaintness  and 
giddiness,  followed  by  nausea  and  vomiting. 

Sijlicea  is  especially  useful  where  a  sensation  is  experienced  as  if 
the  brain  were  about  to  protrude  through  the  forehead  or  orbits ;  or 
pain  so  severe  that  the  head  feels  as  if  it  would  split;  or  semilateral, 
shooting,  rending  pains,  commencing  at  the  temple,  and  extending  to 
the  nose,  the  upper  and  lower  jaw-bones,  and  teeth  of  the  same  side. 
When  there  is  a  tendency  to  frequent  sweating  of  the  head,  or  when 
there  is  frequently  great  tenderness  of  the  scalp,  Silicea  is  further 
indicated;  as  also  in  cases  wThere  the  parties  affected  are  subject  to 
the  formation  of  small  tubercles  on  the  head. 

Hepar  sulphuris  is  also  a  good  remedy  to  follow  Belladonna  in 
the  treatment  of  headaches,  when  only  partial  relief  has  been  obtained 
from  that  medicine,  or  it  may  be  administered  alternately  with  Silicea 
in  cases  where  there  are  painful  tubercles  on  the  head.  The  pains 
chiefly  piercing,  generally  aggravated  at  night,  and  frequently  limited 
to  a  small  fixed  spot,  with  a  sensation  as  if  a  nail  were  being  driven 
into  the  head.  Against  this  latter  species  of  headache  (clavus  hyste- 
ricus), Nux  vomica,  Ignatia,  Coffea,  Mosch.,  Magn.,  and  Staph,  are  also 
most  important  remedies. 

Nux  vomica  may  be  selected  when  the  following  symptoms  are 
complained  of.     Pain  commencing  with  a  slight  pressure,  or  a  sensa- 


HEADACHE.  365 

tion  of  coldness  at  the  part  which  is  subsequently  affected ;  succeeded 
by  throbbing,  and  then  an  intense  shooting,  piercing,  rending,  or 
stunning  pain  confined  to  a  small  space,  which  can  frequently  be 
covered  with  the  point  of  the  finger,  and  is  extremely  sensitive  to  the 
touch ;  or  the  pain  causes  a  sensation  as  if  a  nail  were  driven 
into  the  head :  at  other  times,  the  pain  extends  over  the  nose  down 
to  the  lip,  and  also  to  the  gums;  or,  on  the  other  hand,  it  commences 
at  the  eyelid  or  the  orbit,  causing  constant  lachrymation,  and  extends 
over  the  forehead  and  temples  to  the  ears,  back  of  the  head,  and  nape 
of  the  neck ;  or  it  is  seated  in  the  crown  of  the  head,  and  produces  a 
sensation  as  if  the  head  would  split,  or  were  being  opened  at  the 
coronal  suture  ;  or  rending,  aching  pain,  affecting  only  one  side  of 
the  head,  sometimes  combined  or  alternating  with  shootings ;  the  pain 
becomes  heightened  to  such  a  degree  occasionally,  and  more  particu- 
larly in  the  morning,  as  wTell  nigh  to  drive  the  patient  to  despair,  or 
deprive  him  of  consciousness  ;*  great  heaviness  of  the  head,  and  sensa- 
tion as  if  the  brain  were  bruised  or  lacerated;  tenderness  of  the  scalp. 
The  pains  are  aggravated  by  movement,  such  as  walking  or  stooping, 
or  by  reflexion ;  also  after  eating,  or  on  going  into  the  open  air,  and 
are  frequently  attended  with  considerable  giddiness  or  confusion  in 
the  head;  the  headache  is  generally  attended  with  extreme  irasci- 
bility, and  is  renewed  or  aggravated  after  partaking  of  coffee,  the 
constant  habit  of  drinking,  which  is  not  an  unfrequent  cause  of  the 
complaint ;  sudden  attacks  of  headache  are  frequently  excited  by  a 
fit  of  passion,  a  fright,  the  effects  of  a  chill,  or  an  overloaded 
stomach. 

Ignatia  is  also  an  excellent  remedy,  as  already  stated,  in  cases  in 
which  the  pain  is  confined  to  a  small  space,  and  causes  a  sensation  as 
if  a  nail  were  driven  into  the  brain;  and  when  there  are  nausea;  dim- 
ness of  the  sight,  and  sensibility  of  the  eyes  to  light ;  paleness  of 
the  face,  and  temporary  alleviation  from  change  of  posture  ;  aggrava- 
tion from  noise  or  strong  odours,  or  after  partaking  of  coffee.  Ignatia 
is  sometimes  serviceable  in  completing  the  cure  after  the  previous 
administration  of  Nux  v.  or  Pulsatilla.  It  is  especially  applicable  to 
nervous,  hysterical  females  of  a  mild  and  sensitive  disposition. 

Coffe a.  In  cases  of  megrim,  brought  on  by  meditation,  vexation, 
or  exposure  to  cold,  attended  with  irritability,  sensibility  to  noise, 
great  anxiety,  and  chilliness,  and  a  sensation  as  if  a  nail  were  driven 

*  Compare  with  Belladonna  and  Arsenicum. 


366  NERVOUS  SYSTEM. 

into  the  brain,  or  a ;  feeling  as  if  the  brain  were  bruised,  occurring  in 
individuals  who  are  extremely  impatient  under  suffering,  and  are  not 
habituated  to  the  use  of  coffee,  this  remedy  is  frequently  a  very  effi- 
cacious one. 

Pulsatilla  : — Megrim,  characterized  by  rending  or  shooting 
pains>  with  heaviness  of  the  head,  dimness  of  the  sight,  sensibility  to 
light |  or  buzzing  or  singing  in  the  ears,  and  earache;  nausea,  pale- 
ness of  the  face,  lowness  of  spirits  ;  headache  with  pain  in  the  nape 
of  the  neck ;  aggravation  of  the  headache,  with  chilliness  towards 
evening,  during  repose,  or  particularly  when  sitting;  melioration  in 
the  open  air.     Disposition  mild ;  temperament  phlegmatic. 

China: — Headache  worse  at  night,  accompanied  with  a  sensation 
as  if  the  head  would  split;  or  dull,  aching,  pressive,  or  boring  pains, 
particularly  at  the  crown  of  the  head,  increased  by  movement,  or  by 
the  open  air :  tenderness  of  the  scalp ;  great  sensibility  to  pain ; 
taciturnity  and  obstinacy. 

Veratrum  : — Headache  preceded  by  coldness  and  shivering;  pain 
in  the  head  as  if  the  brain  were  bruised  or  lacerated;  or  lateral,  ach- 
ing, constrictive,  and  throbbing  pains,  sometimes  attended  with  a 
sensation  of  constriction  or  tightness  in  the  throat ;  feeling  of  coldness 
at  the  crown  of  the  head,  as  if  ice  were  placed  upon  it ;  or  sensation 
both  of  coldness  and  heat  on  the  exterior  of  the  head,  with  deep- 
seated  or  internal  burning  heat ;  headache  with  paleness  of  the  face, 
nausea  and  vomiting,  and  preceded  by  a  copious  discharge  of  colour- 
less urine;  headache,  with  pain  at  the  pit  of  the  stomach,  or  painful 
stiffness  of  the  neck,  headache  with  extreme  weakness  and  melancholy ; 
painful  sensibility  of  the  hair  to  the  touch;  chilliness,  with  general 
cold  perspiration.  Arsenicum  and  Acid.  phos.  are  sometimes  useful 
after  feratrmn. 

Lachesis  : — Deep-seated  pains  in  the  head,  or  severe  aching  pain 
in  the  occiput,  in  the  sockets  of  the  eye  or  above  the  orbits,  with 
stiffness  of  the  neck,  particularly  at  the  nape ;  heaviness  and  feeling 
of  expansive  pressure,  sometimes  to  such  an  extent  as  if  the  head 
would  burst;  tension  in  the  head  as  if  caused  by  strings  or  threads 
drawn  through  the  occiput  towards  the  eyes;  lancinations  in  diffe- 
rent parts  of  the  head ;  headache  every  morning  on  waking,  or  after 
dinner,  or  at  every  change  of  weather. 

Mercurius  :— Rending  and  burning,  or  lancinating  and  piercing 
pains,  generally  lateral,  sometimes  extending  to  the  teeth  and  neck, 
with  shootings  in  the  ears ;    tightness  round  the  head ;  excessive 


HEADACHE.  367 

nocturnal  aggravation  of  the  headaches,  often  accompanied  by  profuse 
sweating. 

Colocynth  : — Nervous  headaches,  attended  with  smarting  in  the 
eyes ;  excruciating  lateral  aching ;  rending,  dragging  pains ;  nausea 
and  vomiting ;  feeling  of  compression  in  the  forehead  increased  by 
stooping  or  lying  on  the  back ;  headache  every  afternoon  or  evening, 
with  great  anguish  and  excessive  restlessness,  so  that  it  is  impossible 
to  remain  in  the  recumbent  posture  ;  offensive  perspiration  ;  profuse 
discharge  of  colourless  urine  during  the  headache. 

Chamomilla  : — Headaches  occurring  in  individuals  who  are 
extremely  impatient  under  suffering,  and  exasperated  by  the  slightest 
pain,  or  who  exhibit  symptoms  and  expressions  of  suffering  appa- 
rently uncalled  for  by  the  nature  of  the  complaint;  the  headaches 
are  often  confined  to  one  side  of  the  head  (hemicrania),  and  the  pains 
are  of  a  rending,  aching,  or  shooting  character,  and  sometimes  extend 
into  the  upper  and  lower  jaw ;  sweating  at  the  head  is  a  frequent 
concomitant  symptom. 

Chamomilla  is  occasionally  very  useful  after  the  previous  adminis- 
tration of  Coffea,  when  not  called  for  from  the  commencement. 
Moreover,  hemicrania  attended  with  extreme  excitability,  arising  from 
the  daily  use  of  black  coffee,  but  which  is  usually  relieved  for  the  time 
by  partaking  of  a  cup  of  that  beverage,  will  generally  be  materially 
relieved,  if  not  cured,  by  Chamomilla  ;  sometimes  a  subsequent  dose 
or  two  oiNux  is  required  to  complete  the  cure. 

Sulphur  : — Chronic  headache ;  headaches  occurring  daily,  or  every 
eight  days,  worse  in  the  morning,  or  during  the  night,  and  attended 
with  heaviness  of  the  head,  aching  or  pressive  pains  in  the  forehead 
above  the  eyes,  (causing  the  patient  to  knit  the  brows,  or  keep  the 
eyes  closed,)  or  over  the  entire  head;  incapability  of  mental  exertion 
from  the  pains  in  the  head;  pains  as  if  the  head  would  split ;  Qr  rend- 
ing, shooting,  dragging,  jerking  pains  on  one  side  of  the  head ;  aggra- 
vation of  the  headaches  from  meditation,  the  open  air,  or  movement; 
extreme  tenderness  of  the  scalp  to  the  touch;  falling  off  of  the  hair. 

Calcarea: — Chronic  headaches,  frequently  attended  with  a  sen- 
sation of  extreme  coldness,  either  interiorly  or  on  the  scalp;  the 
pains  either  affect  the  entire  head,  or  merely  the  forehead,  the  side, 
or  the  crown  of  the  head,  and  are  chiefly  of  a  stunning,  aching, 
throbbing,  or  hammering  description,  compelling  the  patient  to  retain 
the  recumbent  posture ;  at  times  the  head  feels  as  if  compressed  in 
a  vice,  or  the  forehead  feels  as  if  it  would  burst  open,  particularly 


368  NERVOUS  SYSTEM. 

when  in  the  open  air ;  headache,  with  humming  noise  in  the  head, 
confusion  of  ideas,  excited  or  aggravated  by  close  application  to 
study,  or  by  movement;  falling  off  of  the  hair.  Calcarea  is  gene- 
rally very  useful  after  Sulphur ;  and  Silicea,  Lycopod.,  and  Acid.  nitr. 
after '  Calc. 

Arsenicum  : — Headaches  so  intolerable  as  almost  to  drive  the 
patient  to  despair,  occurring  periodically  and  aggravated  by  par- 
taking of  food :  the  pain  sometimes  extends  to  the  gums,  where  it  is 
so  excruciating  as  to  render  it  impossible  to  fall  asleep  ;  tenderness  of 
the  scalp  to  the  touch;  temporary  amelioration  of  the  headaches 
from  the  application  of  cold  water. 

Aurum  :- — Headaches  in  hysterical  persons,  attended  with  buzz- 
ing or  other  noises  in  the  head ;  and  pain  as  if  the  head  had  been 
bruised,  especially  on  rising  in  the  morning  or  during  mental  occu- 
pation. 

Eugenia  : — Severe  one-sided  headache  (megrim)  coming  on  in  the 
evening,  attended  with  a  sensation  of  pressure  or  forcing  ^outwards 
behind  the  eyes,  lachrymation,  and  sometimes  nausea  and  vomiting, 
which  produce  exacerbation  ;  aching  pains  in  the  entire  head  (cepha- 
lsea)  at  night  with  burning  in  the  eyes,  thirst,  and  copious  discharge 
of  urine. 

Bromium  : — Headache  (weight  in  the  forehead),  in  the  heat  of  the 
sun,  disappearing  in  the  shade  j  headache  after  drinking  milk  ;  relieved  by 
resting  on  the  right  side  with  the  arms  over  the  head. 

One  remedy  is  seldom  sufficient  to  effect  a  cure  of  cephalalgia  of 
long  standing,  particularly  when  of  a  nervous  character;  and  indeed, 
in  some. cases  of  this  description,  it  is  only  possible  to  effect  a  degree 
of  melioration.  In  comparatively  recent  cases,  the  medicines  may  be 
repeated  at  intervals  from  an  hour  to  six  or  twelve  hours,  when  the 
headache  is  excessively  severe  ;  but  in  those  of  a  more  chronic  and 
obstinate  nature,  in  which  it  is  necessary  to  have  recourse  to  such 
remedies  as  Sulphur,  Calcarea,  Sepia,  Coriaria  myrtifolia,  Silex,  &c,  con- 
siderably longer  intervals  must  be  observed  between  the  doses^ 
when  our  object  is  to  attempt  to  eradicate  the  disorder,  or  destroy 
the  susceptibility  to  headache  from  trivial  causes.  In  chronic  head- 
aches of  various  kinds,  and  particularly  in  megrim,  or  where  the  pain 
is  for  the  most  part  confined  to  the  right,  side  of  the  head,  or  to  the 
forehead  and  sinciput,  Sanguinaria  canadensis  promises  to  be  one  of  the 
most  valuable  remedies.  It  has  been  employed  with  great  benefit  in 
cases  of  the  following  symptoms.      Headache  commencing  in  the 


HEADACHE.  369 

morning,  relieved  by  sleep,  or  disappearing  after  the  night's  rest  to 
that  of  the  night  following.  The  pain  is  chiefly  experienced  in  the 
right  side  of  the  head,  but  in  some  instances,  it  is  transferred  from 
one  side  to  the  other  during  the  same  or  at  the  succeeding  attack. 
More  rarely,  the  left  side  alone  is  affected.  The  eyes  are  almost 
always  sympathetically  affected;  and  relief  is  sought  by  having  the 
apartment  darkened.  Nausea  is  nearly  uniformly  present;  but 
melioration  is  seldom  derived  from,  or  the  attack  ever  terminated  by, 
a  fit  of  vomiting.  Chronic  headaches  with  the  aforesaid  characteristic 
symptoms  are  frequently  mitigated  (the  attacks  shortened,  and  the 
intervals  between  them  lengthened),  by  means  of  Aconitum,  and 
especially  by  Belladonna.  The  relief  afforded  by  these  remedies  is, 
however,  for  the  most  part,  merely  temporary;  the  radical  cure  being 
commonly  only  attainable  by  the  employment  of  such  medicines  as 
Sulphur,  Sepia,  Sanguinaria  canadensis,  &c.  Dr.  Helfrich  recommends 
chiefly  Aconitum  and  Belladonna,  at  the  commencement  and  during 
the  height  of  the  attack,  and  Sanguinaria  on  its  decline,  in  all  cases 
of  nervous  headaches  where  there  are  no  particular  indications  for 
other  remedies.* 

*  Neues  Archiv.    Zweiter  Band,  Zweites  Heft,  p.  150. 


24 


DISEASES  OF  THE  CIRCULATING  SYSTEM, 


ANGINA  PECTORIS. 


The  pathology  of  this  disease  is  very  obscure.  It  is  frequently 
associated  with  organic  lesions  of  the  heart  and  large  vessels.  Many 
authors  have  accordingly  attributed  such  derangements  as  the  cause 
of  this  disorder ;  others  have  considered  it  as  depending  on  a  species 
of  spasm  of  the  diaphragm  and  other  muscles  concerned  in  the 
process  of  respiration,  on  diseases  of  the  pericardium,  ossification 
of  the  coronary  arteries,  and  on  inflammation  of  the  mediastinum. 
There  are  many,  again,  who  are  of  opinion  that  it  is  produced  by 
asthma,  by  scrofula,  or  by  syphilis, — by  general  plethora  with  ac- 
cumulation of  blood  in  the  heart  and  large  vessels,  or  by  disordered 
action  of  the  cardiac  and  pneumogastric  nerves. 

The  disease  seldom  attacks  individuals  under  forty ;  it  appears 
to  occur  more  frequently  in  men  than  women,  and  particularly  in 
those  wrho  are  of  a  corpulent  make,  of  a  rheumatic  or  gouty  diathesis, 
and  are  exposed  to  much  mental  uneasiness,  or  are  addicted  to  habits 
of  intemperance.  The  pain  of  this  distressing  malady  is  always 
severe,  and  sometimes  excruciating.  The  paroxysm  usually  comes 
on  in  the  following  manner :  the  patient  is  suddenly  seized  with  an 
agonizing  sensation  in  the  chest,  especially  about  the  lower  part 
of  the  sternum,  a  little  towards  the  left  side  ;  a  painful  feeling  of 
constriction  and  suffocation  is  generally  experienced,  and  if  the  party 
affected  be  walking  he  is  compelled  to  stop  until  the  attack  is  over. 
In  the  early  career  of  the  affection,  the  paroxysms  are  commonly 
only  brought  on  by  some  exertion,  such  as  walking  up  a  hill,  but 
when  it  has  reached  a  more  advanced  stage,  the  most  trivial  degree 
of  excitement,  or  mental  or  corporal  exertion,  as  also  an  error  in  diet, 
such  as  partaking  of  some  indigestible  article  of  food,  is  sufficient 
to  excite  an  attack ;  and,  finally,  the  incursions  come   on  suddenly 


ANGINA  PECTORIS.  371 

and  unexpectedly  without  any  manifest  cause,  even  when  in  bed  and 
during  slumber. 

At  the  first  invasion  of  angina  pectoris  the  pain  is  ordinarily  con- 
fined to  the  chest ;  but  subsequently  it  extends  to  the  left  shoulder, 
or  to  the  deltoid  muscle,  and  frequently  it  affects  the  entire  length 
of  both  superior  extremities. 

In  the  milder  forms  of  the  disease  the  paroxysms  terminate  in 
from  a  few  minutes  to  half  an  hour ;  but  in  those  of  a  severer  cha- 
racter it  continues  for  several  hours,  and  in  some  cases  the  un- 
fortunate patient  is  never  perfectly  free  from  distressing  uneasiness 
and  constriction  in  the  chest.  Occasionally  the  attack  goes  off  as 
suddenly  as  it  made  its  onset ;  while  at  other  times  more  or  less 
soreness  remains  about  the  chest  or  in  other  parts  for  many  hours 
or  days. 

In  severe  cases  the  patient  is  pale,  the  features  haggard  and  con- 
tracted, the  eyes  sunk,  and  the  countenance  bears  an  expression  of 
extreme  anguish ;  the  body  is  frequently  cold,  or  covered  with  a  cold 
and  clammy  sweat;  the  action  of  the  heart  and  lungs  variously 
disordered;  and  although  the  patient  is  capable  of  taking  a  full 
inspiration,  his  respiration  is  rapid  and  difficult,  and  is  accompanied 
with  palpitation  of  the  heart,  excessive  anxiety,  and  a  feeling  of 
approaching  dissolution.  The  pulse  is  sometimes  not  much  affected, 
but  in  the  generality  of  cases  it  is  slow,  feeble,  oppressed,  and  inter- 
mittent; occasionally,  however,  it  is  quick,  strong,  and  irregular, 
under  which  circumstances  the  skin  will  usually  be  found  warm  and 
the  face  flushed.  There  is  often  considerable  derangement  of  the 
functions  of  digestion  ;  and  an  attack  is  frequently  terminated  with 
a  discharge  of  flatus. 

Therapeutics.  Aconitwm,  Arsenicum  alhum,  and  Digitalis  piirpurea, 
are  the  remedies  which  have  chiefly  been  recommended  in  the  treat- 
ment of  angina  pectoris. 

Aconitum  is  of  considerable  service  in  recent  cases,  and  even  in 
those  of  a  more  advanced  stage,  occurring  in  strong  plethoric  sub- 
jects, in  whom  the  paroxysms  are  attended  with  flushing  of  the  face, 
some  heat  of  skin,  with  a  full,  strong,  and  throbbing  pulse,  it  is  a 
most  valuable  palliative  when  administered  at  the  commencement  of 
each  attack.  But  in  order  to  diminish  the  frequency  of  the  returns, 
where  there  is  local  congestion,  it  will  be  necessary  to  have  recourse 
to  such  remedies  as  Belladonna,  Lachesis,  Nux  vomica,  Carlo  v.,  and 


372 


CIRCULATING  SYSTEM. 


Sulphur.  The  three  last-named  are,  moreover,  of  service  when  the 
digestive  functions  are  in  a  deranged  state,  and  the  attacks  are 
attended  or  succeeded  by  excessive  flatulence. 

In  cases  of  local  congestion  combined  with  debility :  Ferrum,  Cin- 
chona, Nux  v.,  Acidum  phosphoricum,  and  Sulphur  are  the  most  useful. 

Arsenicum  is  one  of  the  most  important  medicines,  and  one  from 
which  the  most  complete  success  has  been  derived  in  cases  when 
the  sufferings  were  exceedingly  severe,  but  unattended  with  any  signs 
of  serious  organic  lesion.  The  indications  by  which  we  are  chiefly 
to  be  guided  in  prescribing  it  are :  excessive  dyspnoea  from  the  slightest 
movement,  but  especially  on  getting  into  bed,  sometimes  with 
renewal  of  the  paroxysm  on  turning  in  bed  ;  palpitation  of  the  heart, 
extreme  anguish,  and  a  feeling  of  impending  dissolution ;  paleness 
of  the  face,  haggard  and  contracted  features,  great  debility,  with 
feeble,  irregular,  or  intermittent  pulse.  [Kali  hydrocyanicum,  or  Acid, 
hydrocyanicum  may be  substituted  for  Arsenic,  when  the  latter  does 
not  afford  much  relief;  in  other  cases  Ipecac,  and  Veratr.  may  be 
more  useful, — Ipecac,  when  Ars.  or  Kali  hydr.  fail  to  produce  any 
amendment,— Veratr.  when  the  paroxysms  are  accompanied  by  cold- 
ness of  the  extremities,  cold  sweats,  and  slow,  depressed,  intermittent 
pulse.) 

Digitalis  purpurea  : — In  more  advanced  cases,  or  in  those  in 
which  the  attacks  come  on  suddenly  without  any  assignable  reason ; 
also  when  the  intervals  between  each  recurrence  appear  to  decrease 
in  length  with  the  duration  of  the  disorder. 

In  most  cases  of  this  dreadful  affection,  where  no  serious  structural 
derangement  has  taken  place,  the  aforesaid  remedies  are  not  only  of 
great  service  in  alleviating  the  sufferings,  and  in :  curtailing  the  fre- 
quency of  the  attacks,  but  are  even  capable  of  effecting  a  cure  when 
timely  and  appropriately  administered.  In  those  unfortunate  cases, 
on  the  other  hand,  in  which  we  meet  with  unequivocal  symptoms 
ot  concomitant  organic  disease  of  a  formidable  character,  although 
we  cannot  entertain  any  hope  of  correcting  the  dangerous  state  of 
matters,  we  may  yet  succeed  in  affording  some  relief  by  means  of 
Arsenicum  and  Digitalis,  together  with  the  following  in  particular 
instances :  Feratrum,,  Lacfoca  virosa,  Assqfwtida,  Sepia,  SpigeUa,  Can- 
nabis, Aurum,  Natrwm  muriaticum,  Ignatia,  &c. 


PERICARDITIS.  373 


PERICARDITIS. 

Pericarditis,  or  inflammation  of  the  serous  membrane  which  lines 
the  pericardium  and  is  reflected  over  the  heart  and  the  roots 
of  the  large  vessels,  is  a  disease  which  is  frequently  not  well  marked 
in  its  external  characters,  at  least  by  no  means  so  much  so  as  an 
affection  so  intimately  connected  with  an  organ  of  such  importance 
as  the  heart  would  lead  us  to  conceive.  The  symptoms  are  exceed- 
ingly variable,  and  sometimes  so  insidious  and  deceptive  as  to  go  on 
until  considerable  disorganization  is  produced,  before  attracting  our 
attention  by  their  severity.  In  many  instances,  indeed,  the  disease 
has  been  found,  on  dissection,  to  have  existed  to  a  severe  extent, 
where  it  had  entirely  escaped  the  attention  of  the  practitioner. 

The  following  have  been  given  as  the  principal  symptoms  in  the 
general  run  of  cases  of  acute  pericarditis:  sharp,  burning,  pricking, 
or  darting  pain  in  the  region  of  the  heart,  accompanied  by  fever  of 
an  acute  inflammatory  type;  the  pain  shoots  to  the  left  shoulder 
and  scapula,  and  frequently  extends  some  distance  down  the  arm; 
it  is  aggravated  by  a  deep  inspiration,  by  pressure  at  the  intercostal 
spaces  over  the  apex  of  the  heart,  and  on  the  epigastrium;  the 
patient  is  incapacitated  from  lying  on  the  left  side,  and  commonly 
feels  easiest  in  the  dorsal  posture ;  the  breathing  is  accelerated  and 
laborious  or  irregular,  especially  on  moving;  a  feeling  of  con- 
traction is  experienced  in  the  precordial  region,  and  there  is  extreme 
restlessness^  anxiety,  and  frequent  syncope.  The  state  of  the  pulse 
varies  a  good  deal ;  it  is  always  accelerated,  but  is  sometimes  hard,  full, 
and  vibratory,  while  at  others  it  is  feeble,  irregular,  or  intermittent ; 
in  the  advanced  stage  of  the  affection  it  is  usually  feeble  and  irregular, 
although,  on  applying  the  ear  to  the  region  of  the  heart,  the  action 
of  the  latter  will  be  found  tumultuous  and  violent.  This  inequality 
is.of  great  importance  in  the  diagnosis,  since  even  in  insidious  cases 
an  inequality  will  sometimes  be  perceptible  on  comparing  the  strength 
of  the  heart's  action  with  that  of  the  pulse  at  the  wrist.  The  physical 
signs  of  pericarditis  are — increased  and  more  abrupt  impulse  of  the 
heart,  and  an  unusual  dullness  on  percussion  in  the  cardiac  region 
when  there  is  considerable  effusion.  The  sounds  of  superficial 
friction  are  very  generally  discernible  when  there  are  partial  exuda- 
tions of  lymph  on  the  opposite  surfaces  of  the  pericardium.  They 
commonly  set  in  from  twenty-four  to  forty- eight  hours  after  the 
invasion  of  the  inflammation,  but,  for  the  most  part,  do  not  continue 


374  CIRCULATING  SYSTEM. 

for  many  days  in  succession, — the  lymph  being  either  absorbed  or 
changed  into  false  membrane,  forming  a  more  or  less  complete  band 
of  adhesion  between  the  heart  and  the  lung,  which  is  productive 
of  a  gradual  extinction  of  the  sound ;  or  serum  is  secreted  in  such 
abundance  that  the  heart  plays  freely  in  the  distended  sac,  and 
ceases  to  rub  against  it.  At  the  commencement,  the  sound  is  soft, 
resembling  the  rustling  of  silk,  and  is  usually  heard  towards  the  left 
or  about  the  centre  of. the  sternum,  corresponding  with  the  base 
of  the  heart.  Subsequently  it  becomes  louder  and  more  prolonged, 
and  is  audible  beyond  the  immediate  vicinity  of  the  heart,  the  natural 
sounds  of  which  it  considerably  disguises.  In  some  cases  the  peri- 
carditic  friction  resembles  a  crackling  noise ;  but  in  others,  and 
particularly  when  it  has  increased  in  hardness  or  roughness,  it  is 
closely  to  be  compared  to  the  creaking  of  a  new  saddle  (the  new- 
leather  sound).  The  normal  sounds  of  the  heart  are  completely 
muffled  or  disguised  by  a  loud  friction-sound  ;  they  are  sometimes  to 
be  heard,  however,  in  the  carotid  arteries  and  at  the  top  of  the  sternum. 

The  dullness  arising  from  effusion  of  serum  in  the  pericardium, 
may>  when  the  effused  fluid  is  very  copious,  extend  up  the  whole 
anterior  surface  of  the  left  side  of  the  chest  as  high  as  the  second 
rib,  and  spread  even  to  the  right  sternum ;  but  it  is  generally  limited 
to  a  space  or  area  of  two  or  three  inches  at  the  lower  part  and  towards 
the  left  of  the  sternum.  An  extensive  effusion  commonly  renders 
the  sounds  more  distant  and  feeble,  and  impairs  the  impulse  in  a 
greater  or  less  degree.  The  sounds  of  respiration  and  percussion 
being  still  found  good  in  the  back  and  below  the  axilla,  and  not 
much  altered  by  the  change  of  position,  the  case  is  thereby  dis- 
tinguished from  pleuritic  effusion.  Again,  though  the  friction-sound 
is  generally  stopped  and  the  impulse  and  normal  sounds  are  com- 
monly rendered  distant  by  displacement  of  the  heart  from  copious 
effusion,  they  may  be  heard  with  their  usual  distinctness  and  intensity 
on  listening  to  them  in  the  carotid  or  subclavian  arteries,  or  at  the 
head  of  the  sternum.  By  means  of  this  circumstance  we  are  em- 
powered to  draw  a  distinction  between  hydro -pericardium  and  an 
excessively  enlarged  heart  acting  with  great  feebleness ;  for  in  the  latter 
in  addition  to  the  weak  sound  and  impulse  in  the  usual  region,  they 
would,  moreover,  be  weak  in  the  course  of  the  arteries. 

Infiltration  of  the  extremities  is  occasionally  met  with;  when 
present  it  ought  to  claim  attention,  as  it  is  one  of  the  symptoms  of 
disease  of  the  heart.  The  physical  signs,  taken  in  conjunction  with 
the  symptoms,  tend  much  to  remove  obscurity  from  the  diagnosis. 


PERICARDITIS.  375 

The  region  of  the  heart  should  therefore  be  always  examined  whenever 
there  is  a  probability  of  implication  of  that  organ  during  the  pre- 
valence of  some  other  disease.  The  duration  of  the  affection, 
like  that  of  pleuritis,  varies  according  to  the  nature,  rapidity,  and 
extent  of  the  effusion  from  a  few  days,  to  several  weeks. 

Causes.  Pericarditis,  like  other  inflammatory  affections  of  the 
chest,  is  more  prone  to  occur  in  persons  of  a  plethoric  habit,  who 
are  subject  to  derangement  in  the  digestive  organs.  It  is  very 
frequently  occasioned  by  a  metastasis  during  an  attack  of  rheumatism 
or  gout.  Prolonged  grief  or  anxiety,  and  exposure  to  cold  may  be 
named  as  means  which  tend  to  excite  or  develop  it.* 

Therapeutics.     The  under  mentioned  may  be  considered  as  the 
most  important  remedies  in  the  homoeopathic  treatment  of  pericarditis : 
AconiUim,  Belladonna,  Cannabis,  Spigelia,  Bryonia,  S.tilp/mr,  Arsenicum, 
Lachesis,  Arnica,  Oroton,  &c.    In  acute  cases,  accompanied  by  synochal 
fever,  Aconitimi  should  be  given  in  frequently  repeated  doses ;  when 
so  employed  at  a  sufficiently  early  stage,  in   cases  uncomplicated 
with  previous  disease  of  the  heart,  effusion  may  be  prevented,  and 
a  speedy  cure  effected.      In  plethoric  subjects  of  sanguine  lymphatic 
temperament,  it  may  be  found  requisite  to  prescribe  Belladonna  in 
alternation  with  AconiUim.     Should  the  inflammation  not  yield  to  the 
employment  of  these  remedies,  although  the  febrile  symptoms   may 
have  considerably  subsided,  Cannabis  may  be  had  recourse  to  if  the 
action  of  the  heart  continues  to  be  tumultuous,  and  is  attended  with 
oppression,  anxiety,  and  a  feeling  of  constriction  in  the  precordial 
region ;  also  when  signs  of  effusion  have  become  apparent.     Bryonia 
may  claim  a  preference  to  Cannabis,  w7hen  the  patient  complains  of 
sharp,  pricking  pains  in  the  region  of  the  heart,  which  are  increased 
by  taking  a  full  inspiration  and  by  movement ;  and  when  there  are 
symptoms  of  slight  effusion.    Spigelia  may  be  substituted  for  Cannabis, 
in  the  early  stage  of  the  disease,  when  the  patient  complains  of  severe 
lancinations  in  the  cardiac  region,  or  a  pain  as  if  the  heart  were 
violently  compressed  or  squeezed,  and  when  the  oppression  at  the 
chest  is  extremely  distressing,  particularly  on  movement,  or  even 
whilst  speaking ;  also  when  there  is  endocarditic  complication,  with 

*  The  prognosis,  in  the  acute  stage,  may,  generally  speaking,  be  considered  favorable 
when  the  affection  is  not  complicated  with  previous  disease  of  the  heart. 


376  CIRCULATING  SYSTEM, 

valvular  murmur.     Sulphur  may  be  used  with  advantage  after  Bryonia 
in  some  cases. 

Arsenicum  has  been  strongly  recommended  in  diseases  of  the 
heart  of  various  kinds.  In  this  inflammation  it  may  be  employed  imme- 
diately after  Aconitum,,  or  independently  of  that  remedy,  either  in  the 
early  stage — whether  the  attack  has  arisen  from  the  metastasis  of  gout 
or  rheumatism,  or  from  the  repercussion  of  an  eruption,  when  there  is 
violent  palpitation,  excessive  rapidity  of  pulse,  intense  thirst,  burning 
pain  in  the  seat  of  the  surface ;  anxiety,  fainting,  extreme  restlessness, 
and  when  a  burning  pain  is  experienced  in  the  seat  of  the  heart— or  in 
a  more  advanced  stage  of  the  disease,  when  the  respiration  is.  hurried 
and  laborious,  particularly  on  the  slightest  movement,  and  there  is 
incapability  of  lying  on  the  left  side ;  pulse  feeble  and  irregular. 
Veratrum  may  be  administered  to  some  advantage  when  the  extre- 
mities become  cold,  and  a  cold  sweat  covers  the  forehead  and  other 
parts  of  the  body,  the  pulse  slow  and  intermittent,  the  nose  sharp^ 
the  features  sunk  and  contracted,  &c.  {Fades  hippocratica.)  Carlo  v. 
may  also  be  of  service  in  cases  of  this  all  but  hopeless  description. 
It  is  particularly  in  conjunction  with  rheumatism,  and  especially  the 
acute  variety,  that  pericarditis  is  met  with.  We  should  therefore,  as 
already  observed,  never  omit  to  examine  the  region  of  the  heart  in 
such  instances,  otherwise  the  disease  may  attain .  a  dangerous  and 
even  incurable  height  before  it  is  detected,  as  the  general  symptoms 
are  often  so  imperfectly  marked  as  not  to  create  the  slightest  sus- 
picion of  its  existence ;  whereas  the  physical  signs  can  never  fail, 
where  any  ordinary  attention  is  paid,  to  apprize  us  of  the  invasion  of 
pericarditis  before  it  has  reached  a  very  serious,  if  not  an  incurable 
height. 

The  following  cases  are  not  inserted  here  from  anything  very  remark- 
able in  their  features,  but  simply  as  illustrative  of  the  power  of  the 
homoeopathic  remedies  in  arresting  a  disorder  which,  in  allopathic 
practice,  is  considered  to  require  what  are  denominated  the  most  prompt 
and  vigorous  measures,  such  as  a  free  and  bold  use  of  the  lancet,  &c. 

Case  1 .  A.  M.,  13  years  of  age,  of  sanguine  lymphatic  temperament, 
was  seized  on  the  4th  of  March,  1845,  with  acute  rheumatism,  for 
which,  according  to  time-honoured  rule,  an  aperient  was  first;  given, 
and  the  pains  were  sought  to  be  relieved  by  means  of  fomentations, 
and  hartshorn  embrocations.  Delirium  having  supervened,  on  the 
morning  of  the  8th,  I  was  sent  for  in  the  evening,  and  found  the 
patient  lying  on  her  back,  in  bed,  complaining  of  severe  darting, 


PERICARDITIS.  377 

aching,  rending  pains  in  all  the  joints,  but  particularly  those  of  the 
shoulders,  elbows,  and  wrists,  the  affected  parts  being  at  the  same 
time  much  swollen,  tense,  shining,  and  very  sensitive  to  the  touch  ; 
countenance  flushed,  and  wearing  an  expression  of  anxiety ;  tongue 
furred  white;  mouth  parched;  thirst  considerable;  skin  hot  and 
dry;  pulse  130,  full,  bounding,  but  regular;  respiration  hurried,  but 
unattended  with  pain ;  no  cough.  On  examining  the  region  of  the 
heart,  the  impulse  was  abnormally  strong,  the  pulsations  loud,  acce- 
lerated, and  occasionally  reduplicated.  About  the  middle  of  the 
sternum,  a  gentle,  superficial  rustling  sound  was  distinctly  audible, 
particularly  while  I  kept  the  patient  in  the  sitting  posture ;  there 
was  no  dullness  on  percussion,  and  total  absence  of  pain  in  the 
region  of  the  heart. 

R  Tinct.  Aeon.  3,  gtt.  iij. 
Aq.  pur.  J  iij. 
Dosis.     Cochleare  mediocre,  tertia  quaque  hora. 

March  9.  Fever  diminished,  pulse  120,  not  so  full;  skin  moist; 
mouth  not  so  parched ;  thirst  lessened ;  recumbency  on  the  right 
side  supportable,  not  so  on  the  left ;  respiration  laborious  and  quick ; 
sound  of  superficial  friction  increased  in  extent  and  loudness,  audible 
in  all  positions,  and  in  the  interval  beime&n,  the  heart-sounds  as  well 
as  during  their  occurrence ;  no  perceptible  dullness  on  percussion. 
The  patient  had  passed  a  restless  night,  and  was  now  and  then 
delirious  ;  joints  still  inflamed  and  painful. 

R  Tinct.  Bellad.  3,  gtt.  ij. 
Aq.pur.  Jij 
Dosis.    Cochleare  medioc.  tertia  quaque  hora. 

On  repeating  my  visit  in  the  evening,  I  found  the  rheumatic  suffer- 
ings of  the  patient  considerably  alleviated,  the  redness  of  the  joints 
no  longer  so  intense,  and  the  tumefaction  much  reduced ;  heart- 
symptoms  little  changed,  perhaps  a  slight  diminution  of  the  friction- 
sound  ;  skin  inclined  to  be  hot  and  dry,  pulse  the  same  as  in  the 
morning. 

Be  Tinct.  Aeon.  3,  gtt.  ij. 
Aq.  pur.  Jij. 
Dosis.    Coch.  med.  sexta  quaque  hora. 

March  10.  Patient  has  passed  a  good  night,  perspired  copiously 
soon  after  the  first  dose  of  the  medicine ;  skin  still  moist ;  no  thirst, 


378 


CIRCULATING  SYSTEM. 


yellow  furred,  moist  tongue  ;  aversion  to  all  food;  pulse  100,  some- 
what hard ;  patient  cannot  yet  lie  on  the  left  side,  and  on  sitting  up 
in  bed  she  complained  of  a  darting  pain  proceeding  from  the  region 
of  the  heart  to  the  left  shoulder  and  scapula,  with  aggravation  of  the 
pains  in  the  joints  on  movement;  sound  of  friction  same  as  on  the 
previous  evening ;  no  perceptible  dullness  at  or  near  the  sternum, 
and  no  abnormal  sound  in  any  other  part  of  the  chest;  respiration 
free,  slightly  hurried,  but  occasionally  interrupted  by  the  darting 
pain  already  noticed,  on  making  a  succession  of  deep  inspirations. 

R    Tinct.  Bryon.  3,  gtt.  iij. 
Aq.  pur.  Jiij. 
Dosis.     Coch.  med.  quarta  quaque  hora. 

March  11.     Considerable  improvement  in  every  respect. 

Prescription  as  before. 

March  12.  Further  improvement, — the  patient  can  lie  on  both 
sides;  tongue  clean;  appetite  returning;  pulse  84,  feeble  but  regular; 
action  of  the  heart  still  rather  powerful,  particularly  on  the  least 
movement;  friction-sound  only  audible  after  any  slight  exertion, 
such  as  turning  in  bed  or  sitting  up ;  all  redness  and  swelling  of  the 
joints  has  disappeared,  some  stiffness  and  pain  on  movement  alone 
remaining. 

R  Bryon.  6,  glob.  xxiv.  (redig.  in  pulv.) 
Pulv.  Sacch.  lactis  gr.  iv. 
Misce  intime,  et  divide  in  partes  aequales  iv,  quarum  capiat  unam 
quotidie. 

March  17.  Convalescent.  A  year  afterwards  I  saw  the  patient, 
and  discovered  no  traces  of  disease  of  the  heart  of  any  description. 

Case  2.  R.  H.,  21  years  old,  of  bilious  temperament,  was 
attacked  with  rheumatic  fever  about  the  middle  of  November,  1845, 
after  having  been  exposed  to  a  cold  and  damp  atmosphere  for  several 
hours.  During  the  three  following  days  the  sufferings  were  so 
severe  that  the  patient  was  unable  to  remain  at  rest  in  any  posture, 
feeling,  if  anything,  rather  easier  whilst  sitting  up  in  bed  with  his 
head  between  his  hands,  resting  his  elbows  on  his  knees,  and  giving 
a  rocking  motion  to  the  body ;  towards  evening  fits  of  coldness  and 
shivering  alternating  with  heat,  accompanied  the  pains ;  and  about 
midnight  copious  sweats  supervened,  which  were  followed  by 
remission  of  pain  and  some  sleep.  Early  in  the  morning,  however, 
there  was  recurrence  of  sufferings,  with  increased  violence.     On  the 


PERICARDITIS.  379 

evening  of  the  5th  day  of  his  illness  the  patient  was  induced  to 
drink  some  hot  gin  and  water,  in  the  double  hope  of  arresting  the 
chills  and  allaying  the  pain.  The  day  afterwards,  the  rheumatic 
pains  had  nearly  vanished,  but  were  substituted  by  intense  headache, 
nausea,  giddiness,  palpitation  of  the  heart,  and  sharp  pains  in  the 
left  breast.  These  symptoms  continued  in  an  unmitigated  form  for 
five  days,  and  on  the  day  following, — the  tenth  of  the  patient's 
illness — I  was  requested  to  visit  him.  I  found  him  sitting  on  his  bed, 
half  dressed,  having  been  unable  to  complete  his  toilet  in  conse- 
quence of  the  distressing  dyspnoea  and  palpitation  which  he  expe- 
rienced on  making  any  slight  exertion ;  his  countenance  wore  an 
expression  of  intense  anxiety,  which,  together  with  the  history  of 
the  case,  led  me  at  once  to  infer,  before  resorting  to  auscultation, 
that  some  affection  of  the  heart  had  arisen  from  rheumatic  metas- 
tasis ; — no  pain  was  complained  of  beyond  an  occasional  twitch  in 
the  left  side  of  the  chest,  during  the  performance  of  a  somewhat  full 
inspiration,  or  on  turning  the  body  towards  the  right  side  ;  a  degree 
of  stiffness  in  the  back  and  limbs  was  the  only  inconvenience  com- 
plained of  in  the  parts  which  had  been  previously  so  severely  affected 
with  rheumatism,  The  pulse  was  feeble,  irregular,  occasionally 
intermittent,  and  rather  frequent ;  the  tongue  furred  white,  loaded 
with  mucus,  and  increased  in  volume;  appetite  wanting;  taste 
metallic ;  no  thirst ;  bowels  confined  for  four  days.  On  auscultation, 
the  sounds  of  the  heart  were  somewhat  muffled  at  the  cardiac  region, 
but  the  impulse  greater  than  natural,  and  there  was  distinct,  though 
not  loud,  friction- sound  immediately  to  the  left  of  the  inferior  third 
of  the  sternum,  particularly  when  the  patient  inclined  the  trunk 
forwards,  or  made  any  trivial  effort,  such  as  rising  from  his  seat,  or 
raising  up  the  left  arm  quickly.  On  percussion  there  was  decided 
dullness,  confined  to  an  area  of  three  inches,  at  the  lower  end  of  the 
sternum.  In  the  carotid  and  subclavian  arteries,  the  normal  heart- 
sounds  were  audible  in  their  natural  strength.  The  case  thus 
afforded  unequivocal  evidence  of  pericarditis,  from  the  metastasis  of 
rheumatism,  resulting  in  liquid  effusion. 

R  Laches.  6,  gl.  xij. 
Aq.  pur.  gj. 
M.     Dosis.     Cochl.  medioc.  ter  die. 

Nov.  27.      The  patient  intimated  that  he  felt  easier;    had   passed 
a  better  night  than  he  had  done  since   the  day  he  was  first  seized 


380  CIRCULATING  SYSTEM. 

with  indisposition ;  the  bowels  had  been  freely  moved  early  in  the 
morning ;  pulse  same  as  yesterday ;  dullness  on  percussion,  sounds 
and  impulse  of  the  heart  unchanged ;  expression  of  countenance  still 
anxious.     Former  prescription  repeated. 

On  the  28th,  and  two  succeeding  days,  the  patient  remained  in 
much  the  same  state :  he  imagined  himself  better,  but  his  countenance 
bore  the  same  anxious  expression ;  and,  if  anything,  an  increase  of 
dyspnoea  with  tendency  to  syncope  on  movement  seemed  to  have 
taken  place ;  the  pulse  was  rather  more  feeble  and  intermittent : 
Arsenicum  6  (dose,  gl.  6  every  four  hours)  was  substituted  for  Lachesis, 
on  the  1st  of  Dec,  and  continued  until  the  morning  of  the  3d,  when 
the  patient's  state  was  as  follows : 

Dullness  on  percussion  over  a  larger  space,  nevertheless  the  friction- 
noise  at  the  sternum  was  somewhat  stronger  than  it  had  been  the 
four  previous  days .;  the  impulse  was  also  somewhat  more  powerful, 
but  the  natural  heart-sounds  impaired  and  distant;  great  dyspnoea 
and  faintness  on  the  slightest  movement ;  pulse  still  weak  and  quick, 
but  not  so  intermittent;  some  appetite,  but  increased  oppression  on 
the  introduction  of  the  smallest  morsel  either  of  liquid  or  solid  food 
into  the  stomach ;  no  pain  in  the  region  of  the  heart;  sleep  restless; 
decubitus  dorsal,  with  the  head  and  shoulders  raised. 

R  Arsenic,  3,  gtt.  iij. 
Aq.  pur.  Jiss. 
M.     Dosis.     Coch.  med.  quarta  quaque  hora. 

Dec.  4.  Patient  felt  stronger,  and  had  passed  a  tolerable  night; 
no  thirst ;  tongue  foul ;  in  all  other  respects  the  same  as  on  the  day 
previous. 

R  Colch.  3,  gtt.  iij. 

Aq.  pur.  3iij. 

M.     Dosis.    Coch.  ampl.  tertia  quaque  hora. 

Under  the  employment  of  this  remedy,  a  striking  improvement 
soon  became  manifest, — the  patient  began  to  breathe  more  freely, 
and  to  be  enabled  to  move  about  without  much  inconvenience  arising 
from  palpitation,  dyspnoea,  or  faintness ;  the  dullness  on  percussion 
commenced  gradually  to  give  way,  and  the  sounds  of  the  heart 
resumed  a  normal  intensity.  Colchicum  was  continued  for  six  days, 
latterly  at  longer  intervals  between  the  doses.  On  the  1 1th  of  Dec. 
Nux  v.  and  Arsenicum  were  prescribed  in  alternation,  at  intervals  of 
twelve  hours, — the  former  in  consequence  of  the  deranged  state  of 
the  digestive  organs,  and  some  slight  rheumatic  pains,  of  a  dragging, 


PERICARDITIS.  381 

aching  description,  in  the  back,  chest,  and  joints,  accompanied  by 
a  feeling  of  torpor  in  the  fore-arms, — the  latter,  from  the  circumstance 
that  the  patient  complained  of  occasional  attacks  of  dyspnoea,  and 
palpitation  of  the  heart  at  night.  A  week  afterwards  convalescence 
was  not  only  firmly  established,  but  the  patient  wTas,  moreover, 
restored  to  a  much  better  state  of  health  than  he  had  enjoyed  for 
a  year  or  two  past.  No  relapse  has  taken  place,  and  recovery 
appears  to  be  complete. 

Case  3.  C.  W.,  aged  15,  of  melancholic  temperament,  and  some- 
what robust  and  muscular  build  for  his  years,  but  disposed  to  suffer 
from  deranged  digestion  in  consequence  of  frequently  over  indulging 
a  naturally  keen  appetite,  to  which  an  additional  stimulus  was 
usually  given  by  the  amount  of  severe  exercise  he  was  daily  in 
the  habit  of  taking,  had  been  confined  to  the  house  for  a  week  with 
a  severe  attack  of  acute  rheumatism.  March  3d,  1846,  the  patient 
was  seen  by  me  for  the  first  time,  when  I  was  instructed  that,  three 
days  previously,  he  had  been  seized  with  an  increase  of  fever  attended 
with  palpitation  of  the  heart  and  some  oppression  at  the  chest. 
These  symptoms  had  continued  to  gain  ground,  and  formed  the 
reason  that  induced  the  parents  of  the  patient  to  send  for  me, 
(previous  to  which  they  had  been  allowing  the  disease  to  take  its 
course, — the  father  having  become  a  complete  sceptic  in  medical 
science.)  I  found  distinct  indications  of  inflammation  of  the  peri- 
cardium, with  some  symptoms  of  complication  with  endocarditis, 
as  was  evinced  by  the  existence  of  the  following  physical  signs: 
loud  friction-sound,  not  only  about  the  middle  of  the  sternum, 
but  also,  pretty  clearly,  beyond  the  proper  cardiac  region,  in 
various  directions,  and  greatly  disguising  the  natural  sounds  of 
the  heart;  strong  and  very  abrupt  impulse,  accelerated  pulsations, 
and  prolonged  first  sound.  On  listening  at  the  top  of  the  sternum, 
and  also  in  the  carotids,  the  normal  heart-sounds  were  heard  with 
tolerable  distinctness,  attended  with  a  grating  murmur,  which, 
although  somewhat  faint,  was  yet  sufficiently  well  marked  to  denote 
endocarditic  implication  with  regurgitation  through  the  semilunar 
valves  of  the  aorta.  The  expression  of  countenance  was  painfully 
anxious,  the  restlessness  great,  the  skin  hot  and  dry,  and  the  pulse 
full,  strong,  rapid,  but  regular. 

R  Tinct.  Aeon.  3,  gtt.  iij. 
Aq.  pur.  Jiij. 
Dosis.  -  Jss.  quarta  quaque  hora. 


382  CIRCULATING   SYSTEM. 

March  4.  Patient  somewhat  easier ;  perspired  freely  after  the 
second  dose  of  Aconite ;  countenance  not  quite  so  anxious;  physical 
signs  as  before,  impulse  of  the  heart  perhaps  rather  less  violent; 
pulse  still  full,  but  softer  and  rather  slower ;  no  pain  in  the  region  of 
the  heart  when  the  patient  lay  perfectly  quiet,  but  any  sudden  movement 
was  immediately  followed  by  excessively  increased  action  of  the  heart, 
dread  of  suffocation,  and  a  sensation  of  severe  constriction  as  if  the 
heart  were  violently  squeezed  or  drawn  together.  Position  in  bed 
either  dorsal  or  on  the  right  side,  with  the  head  raised, — a  sense  of 
suffocation  being  experienced  whenever  the  patient  attempted  to 
recline  sinistrad. 

R  Tinct.  Spig.  6,  gtt.  iij. 
Aq.  destil.  Jiij. 
M.     Dosis.     Coch.  ampl.  sexta  quaque  hora. 

The  general  symptoms  having  much  improved  under  the  employ- 
ment of  the  Shigella,  that  remedy  was  continued  until  the  7th  of 
March,  on  which  day  the  symptoms  encountered  were  as  follows : 
respiration  freer,  anxiety  of  expression  only  perceptible  after  the 
performance  of  any  slight  exertion,  which  was  still  followed  by  violent 
palpitation ;  valvular  murmur  no  longer  audible ;  friction- sound  only 
perceptible  when  the  heart  is  tumultuously  agitated ;  pulse  quick, 
somewhat  irregular,  and  rather  feeble,  even  when  the  action  of  the 
heart  is  powerful.  On  percussion  a  slight  degree  of  dullness  was 
discernible  to  the  left  of  the  sternum.  The  appetite,  which  had 
returned  immediately  after  the  improvement  effected  by  Aconite,  and 
could  with  difficulty  be  kept  within  the  proper  limits  necessary  in 
such  a  disease,  was  now  supplanted  by  a  strong  aversion  even  to 
the  smell  of  food  of  every  description,  and  there  was  considerable 
thirst,  which  seemed  to  be  materially  caused  by  a  sensation  of  in- 
tolerable dryness  and  burning  heat  in  the  throat,  as  the  patient 
drank  but  little  at  a  time,  and  seemed  to  experience  temporary  relief 
from  sipping  a  little  cold  water  every  now  and  then ;  tongue  rather 
dry  and  furred;  bowels  had  not  been  relieved  for  five  days.  No 
pain  was  complained  of  in  the  region  of  the  heart,' — the  feeling  of 
severe  constriction  having  readily  yielded  to  Spigelia. 

R   Arsenic,  alb.  6,  gtt.  iij. 
Aq.  destil.  Jij. 
Dosis.     3SS.  quartis  horis. 

March  8.  General  symptoms  considerably  amended  ;  physical 
sis;ns  the  same.     Medicine  continued. 


PERICARDITIS.  383 

March  9.  Appetite  returning,  dryness  of  mouth  and  throat, 
together  with  the  thirst,  removed ;  palpitation  of  the  heart  somewhat 
diminished;  friction- sound  still  perceptible  on  particular  occasions, 
such  as  after  a  sudden  movement  of  the  body,  or  even  of  the  arms, 
but  only  to  a  slight  degree ;  dullness  on  percussion  neither  increased 
nor  diminished  since  the  7th ;  bowels  not  yet  relieved ;  spirits  very 
depressed. 

R  Laches.  6,  gtt.  iij. 
Aq.  destil.  Jij* 
Dosis.     Coch.  maj.  j.  quarta  quaque  hora. 

March  10.  Rather  less  dullness  on  percussion  ;  friction-sound 
no  longer  audible ;  pulse  more  regular,  but  still  weak  and  accelerated  ; 
impulse  of  the  heart  stronger,  rather  more  abrupt,  and  the  palpitation 
very  distressing  on  movement,  but  particularly  on  turning  in  bed 
during  the  night;  the  patient  can  lie  on  either  side,  yet  prefers  lying 
on  the  right  or  on  the  back ;  spirits  better,  although  sudden  fits  of 
indescribable  anxiety  still  occur  at  intervals.  Arsenicum,  and  Lachesis 
were  given  in  alternation  every  twelve  hours,  during  the  six  succeed- 
ing days.  At  their  expiration  the  patient  was  convalescent.  The 
bowels  were  copiously  relieved  on  the  12th  without  the  aid  of  an 
enema.  For  the  space  of  a  fortnight  afterwards  there  was  some 
tendency  to  violent  palpitation  of  the  heart  on  going  up  stairs  rather 
quickly,  but  this  completely  subsided  under  the  action  of  the 
remedies  (such  as  Sulphur,  Bryonia,  Nux  v.,  Natr.  m.,  and  Acid,  n.) 
which  were  called  for  by  the  chronic  derangement  of  the  digestive 
functions. 

In  cases  of  pericarditis  arising  from  external  injury,  Aconitum  and 
Arnica  should  be  employed.  When  moral  causes,  such  as  prolonged 
vexation,  seem  to  have  assisted  in  developing  this  disease, — Arsenicum, 
Veratrum,  Lachesis,  Belladonna,  and  perhaps  also  Hyoscyamus,  are 
medicines  which  should  chiefly  claim  our  attention. 

Chronic  pericarditis.  The  symptoms  here  are  the  same  as  those 
of  the  acute  variety,  differing  merely  in  degree.  When  there  is 
fever  it  is  of  the  hectic  type. 

When  dense  adhesions  form  between  the  apex  of  the  heart  and 
the  pericardium,  they,  by  interfering  with,  and  confining  the  motions 
of  the  heart,  are  consequently  sooner  or  later  productive  of  serious 
organic  disease,  more  particularly  hypertrophy  with  dilatation.  The 
signs  by  which  these  adhesions  are  to  be  detected  are  not  always 
distinctly  marked.      They  may  only  be  said  to  be  decidedly  appro- 


384  CIRCULATING  SYSTEM. 

ciable  when  they  are  close  and  rigid,  and  the  pericardium  has,  more- 
over, been  rendered  adherent  to  the  walls  of  the  chest.  In  such  a 
state  of  matters,  the  heart  will  constantly  be  found  pulsating  in  close 
contact  to  the  ribs,  its  motions  will  be  seen  and  felt  more  plainly 
than  usual  (drawing  in  the  intercostal  spaces  at  each  systole),  and 
there  will  *be  dullness  of  sound  on  percussion,  over  a  space  propor- 
tioned to  the  adhesion  and  the  size  of  the  heart,  during  every  stage 
of  respiration,  and  in  every  position  of  the  body.  A  projection  is 
strikingly  observable  about  the  ends  and  cartilages  of  the  middle 
ribs,  in  those  cases  in  which  an  enlargement  of  the  heart,  upwards 
and  downwards,  ensues,  in  consequence  of  its  general  adherence  to 
the  pericardium,  and  of  the  latter  to  the  diaphragm  and  walls  of  the 
thorax. 

Therapeutics.  When  lymph  has  been  effused,  and  become 
organized,  and  the  adhesions  formed  materially  interfere  with  the 
motions  of  the  heart,  the  case  is  beyond  the  reach  of  medicine. 
When  the  exudation  is  serous,  a  cure  may,  in  some  cases,  be  even- 
tually accomplished  by  means  of  such  remedies  as  Arsenicum,  Digitalis, 
Veratrum,  Cannabis,  Sulphur,  Pkosp/wrus,  Carlo  v.,  etc. 

ENDOCARDITIS. 

The  general  symptoms  of  inflammation  of  the  lining  membrane  of 
the  heart  are,  commonly,  still  more  uncertain  and  obscure  than  those 
of  pericarditis.  There  may  be  tumultuous  action  of  the  heart,  with 
fever,  irregular  action,  palpitation,  oppression,  anxiety,  faintness,  and 
some  degree  of  pain,  which  is  generally  referred  to  the  sternum  or 
epigastrium ;  but  these  symptoms  sometimes  exist  in  so  trivial  a 
degree  as  to  be  entirely  overlooked.  The  physical  signs  are,  conse- 
quently, to  be  chiefly  relied  on,  in  distinguishing  this  inflammation, 
as  well  as  in  pericarditis.  The  sounds  of  the  heart  are  louder  at 
first,  the  impulse  greater,  and  frequently  attended  with  a  vibration  or 
tremor,  but  the  pulsations  are  not  in  every  instance  more  frequent. 
Soon  afterwards  the  first  sound  seems  double,  and  is  prolonged,  or 
it  is  accompanied  by  a  slight  roughness,  which  ere  long  becomes 
converted  into  a  blowing  or  grating  noise,  forming  the  characteristic 
valvular  murmur,  produced  by  the  regurgitation  of  blood  through 
the  diseased  or  defectively-closed  valves.  By  paying  attention  to 
the   nature  of  the   sound,  and  the  situation  where  it  is  most  dis- 


ENDOCARDITIS.  385 

tinctly  heard,  we  may  generally  determine  with  considerable  certainty 
in  what  part  of  the  heart  it  occurs. 

The  left  side  of  the  heart  is  where  we  may  almost  invariably 
expect  to  meet  with  the  deranged  valves,  so  that  when  the  bellows- 
sound  or  murmur  is  perceived  we  have,  in  nearly  every  instance, 
simply  to  discriminate  whether  the  noise  is  produced  at  the  mitral  or 
aortic  valves.  The  mitral  valve,  or  inlet  of  the  left  ventricle,  is  more 
commonly  the  seat  of  the  disease  than  the  semilunar  valves  of  the 
aorta.  Whether  the  mitral  or  the  aortic  valves  form  the  seat  of  the 
murmur,  it  wrill  always  be  heard  over  the  left  side  of  the  heart, 
synchronous  with  the  first  sound.  If  it  is  heard  loudest  an  inch  or 
so  below,  and  a  little  to  the  inside  of  the  nipple,  wrhere  the  apex 
strikes,  becoming  more  indistinct  as  we  ascend  or  approach  be- 
yond the  upper  half  of  the  sternum,  it  is  occasioned  by  mitral 
regurgitation,  in  consequence  of  the  imperfect  closure  of  the  valve 
caused  by  the  exudation  of  serum  or  lymph  between  its  layers, 
and  the  irregular  spasmodic  action  of  the  columnae  carneae.  On  the 
other  hand,  if  the  murmur  be  heard  most  clearly  at  the  base  of 
the  heart,  along  the  upper  half  of  the  sternum,  particularly  on  a 
level  with  the  margin  of  the  third  rib,  and  even  in  the  carotid 
arteries,  where  it  usually  has  a  harsher,  more  grating  tone,  but 
decreases  in  intensity  as  we  approach  the  apex  of  the  heart,  we  may 
be  satisfied  that  it  is  generated  at  the  aortic  orifice,  and  is  caused 
by  tumefaction  of  the  semilunar  valves,  or  deposition  of  lymph 
between  their  surfaces.  The  second  sound  is  also  frequently  im- 
paired in  the  latter  instance,  or  it  is  accompanied  or  altogether 
supplanted  by  a  grating  noise.  The  pulse  varies  much  in  endocarditis, 
but  does  not  partake  of  the  violence  of  the  heart's  action.  It  is 
generally  small,  feeble,  irregular,  and  not  in  harmony  with  the 
impulse  of  the  heart,  when  the  mitral  valve  is  affected  ;  and  more 
or  less  full,  sharp,  jerking,  quick,  but  regular,  when  the  semilunar 
valves  are  the  seat  of  derangement. 

Causes.  These  may  in  general  be  considered  the  same  as  those 
of  pericarditis.  The  great  majority  of  cases  arise  from  the  metas- 
tasis of  rheumatism,  or  occur  during  the  course  of  pleuritis.  There 
are  few  instances  of  acute  rheumatism  in  which  some  of  the  signs  of 
obstruction  to  the  current  of  blood  through  the  mitral  or  semilunar 
valves  are  not  discoverable,  and  the  younger  the  patient  is,  the  greater 
is  the  probability  of  his  being  affected  with  rheumatic  endocarditis. 

25 


386  CIRCULATING  SYSTEM. 

Prognosis.  This  malady  may  be  held  as  rarely  fatal  during  its 
acute  stage.  If  the  valvular  murmur  be  not  removed  in  from  ten  to 
fourteen  days,  it  is  prone  to  remain  permanent,  and  the  patient  will 
eventually  sink  under  disease  of  the  heart,  although  the  fatal  issue  is 
not  unfrequently  delayed  for  from  five  to  ten,  or  twenty  years,  and 
even  somewhat  upwards.  It  is  consequently  of  the  utmost  import- 
ance to  detect  the  disease  early,  as  it  is  only  during  the  acute  stage 
that  we  may  entertain  any  confident  hope  of  preventing  it  from 
degenerating  into  a  chronic,  and  but  too  often  incurable  disease  of 
the  heart,  particularly  cartilaginous  or  osseous  disease  of  the  valves 
and  hypertrophy  of  the  ventricles. 

Therapeutics.  The  remedies  which  have  hitherto  been  prin- 
cipally recommended  in  the  treatment  of  endocarditis  are,  Aconitum, 
Arsenicum,  Lachesis,  Spigelia,  Bis?nuth,  Belladonna,  Digitalis,  Yeratrum, 
Nux  v.,  Pulsatilla,  Asparagus,  &c. 

Aconitum  is,  generally  speaking,  only  useful  in  acute  cases,  when 
the  pulse  is  full,  hard,  and  vibrating,  and  there  is  pain  of  a  sharp  or 
pricking  description  in  the  cardiac  region,  with  oppression,  anxiety, 
faintness,  and  tumultuous  action  of  the  heart.  We  have  found  it, 
together  with  Belladonna,  of  speedy  and  most  effectual  service  at  the 
commencement  of  endocarditis,  with  indications  of  affection  of  the 
aortic  orifice,  and  secondary  implication  of  the  brain  evinced  by 
delirium  and  occasional  stupor.  Arsenicum  is  one  of  the  most  im- 
portant of  our  remedies  in  diseases  of  the  heart,  and  we  should  say^ 
is  all  but  indispensable  in  endocarditis  with  disease  of  the  mitral 
valves.  It  may,  however,  be  of  fully  equal  service  when  the  outlet 
of  the  left  ventricle  is  affected ;  and  is,  moreover,  to  be  considered  as 
an  invaluable  remedy  in  complications  with  pericarditis.  Spigelia, 
Digitalis,  and  Lachesis,  are  also  deserving  of  notice  in  the  latter 
instance,  and  may  sometimes  be  of  great  service  after,  or  in  alterna- 
tion with  Arsenicum.  The  observations  of  Dr.  Clotar  Mueller^  jun., 
on  "  Endocarditis  Rheumatica,"  (which  is  by  far  the  most  frequent 
form  in  which  inflammation  of  the  lining  membrane  of  the  heart  is 
encountered,)  and  other  diseases  of  the  heart,  appear  to  us  to  be  of 
such  striking  interest,  that  we  gladly  avail  ourselves  of  Dr.  J.  C. 
Peters's  translation,*  to  introduce  an  extract  here  : 

*  Endocarditis  rheumatica,  by  Dr.  CI.  Miiller.      Translated,  with  notes,  by  John  C. 
Peters,  M.D.     Homoeopathic  Examiner,  Vol.  v.  No.  1. 


ENDOCARDITIS.  387 

"  It  is  our  intention  here  to  show  more  particularly  thaf  physical 
examinations  are  always  of  importance  in  the  selection  of  homoeo- 
pathic remedies,  and  that  a  continued  attention  to  this  point  must 
lead  to  the  most  important  results  in  the  cure  of  disease.  The  present 
condition  of  our  Materia  Medica,  at  the  first  glance,  would  seem  not 
to  favour  or  allow  of  such  an  attempt,  for  we  look  in  vain  in  it  for  even 
a  single  physical  sign,  which  is  as  subtle  and  exact  in  its  significa- 
tion as  e  bronchial  respiration/  or  '  bellows-murmur  with  the  second 
sound  of  the  heart/  &c.  It  could  not  and  perhaps  cannot  be  other- 
wise, for  the  greater  part  of  the  experiments  and  investigations  with 
drugs,  which  constitute  our  Materia  Medica,  were  made  at  a  time 
when  auscultation  and  percussion  were  but  little  known,  and  less 
practised ;  and  even  now  it  would  be  extremely  difficult  to  produce 
physical  signs  and  symptoms  in  previously  healthy  persons,  by 
means  of  drugs ;  experiments  with  drugs  on  the  healthy  must  be 
confined  to  certain,  and  those  very  narrow  limits,  whilst  natural 
disease  may  progress  to  total  disorganization,  and  often  acknowledges 
no  limits  short  of  death.  We  must  even  do,  in  the  treatment  of 
organic  diseases  of  the  heart  and  lungs,  what  has  been  done  in  the 
treatment  of  other  diseases,  viz.  conclude  from  slight  indications 
what  greater  results  might  have  followed,  if  the  experiments  with 
drugs  could  have  been  pushed  far  enough ;  if  one  attempt  to  produce 
in  the  healthy  subject,  with  Sulphur,  Baryta,  Calcarea,  &c,  the  extensive 
ulcers  and  scrofulous  derangements  which  have  been  cured  hundreds 
of  times  with  these  remedies,  he  will  probably  be  disappointed  ;  one 
will  certainly  wait  in  vain  to  see  Kali  card,  produce  purulent  expecto- 
ration, and  genuine  symptoms  of  phthisis ;  or  for  Site®  to  produce  the 
manifold  alterations,  and  new  formations  in  the  tendons,  bursae 
mucosae,  joints,  &c,  which  it  cures  with  wonderful  celerity,  &c.  But 
there  is  also  another  source  of  information  open  to  us,  which  was  not 
sufficiently  cultivated  during  the  early  career  of  Hahnemann,  viz. 
Pathological  Anatomy.  When  we  once  succeed  in  establishing  certain 
constant  organic  lesions  to  be  produced  by  drugs,  as  learned  by  post- 
mortem examinations  in  cases  of  poisoning  with  these  drugs,  then  we 
come  in  possession  of  strictly  homoeopathic  remedies  against  similar 
diseases ;  this  pathological  knowledge  of  the  effects  of  drugs,  is  of 
especial  importance  in  the  homoeopathic  treatment  of  endocarditis, 
for  this  disease,  as  it  progresses,  becomes  attended  with  almost  all 
the  symptoms  which  attend  diseases  of  the  heart  in  general. 

"Arsenicum  : — It  produces  anxiety  in  the  region  of  the  heart; 


388  CIRCULATING  SYSTEM. 

irritable  and  frequent  beating  of  the  heart,  with  great  feebleness  of 
the  pulse;  frequent,  violent,  irritable  beating  of  the  heart;  frightful 
and  very  troublesome  palpitations,  especially  at  night ;  nocturnal, 
irregular  and  violent  palpitations,  with  anxiety;  very  much  quickened, 
violent,  stormy,  irregular  and  painful  beating  of  the  heart;  loss  of 
contractility  of  the  heart ;  piercing,  burning,  and  soreness  in  the 
region  of  the  heart. 

"Pathological  Anatomy. — Very  much  relaxed  or  violently  contracted 
heart;  much  thickly-fluid,  tar-like  blood  in  the  right  auricle;  opa- 
lescent spots  upon  the  inner  surface  of  the  left  ventricle,  from  the  pre- 
sence of  false  membranes;  violet-red  spots  with  softening  of  the 
internal  coat  of  the  heart  (endocardium) ;  red-marbled  spots  in  the 
left  auricle  and  ventricle  ;  smaller  carmine-red  spots,  especially  on  the 
papillary  muscles,  and  penetrating  into  the  substance  of  the  heart ; 
much  darker  redness,  almost  blackness  of  the  right  cavities  of  the 
heart,  and  some  spots  on  the  papillary  muscles;  red  or  black  broad 
spots  in  the  left  ventricle  ;  inflammation  of  the  semi-lunar  valves  of 
the  aorta. 

"  If  we  recollect,  in  addition,  that  Arsenic  has  been  found  service- 
able in  palpitations,  carditis,  endocarditis,  rheumatic  and  organic 
diseases,  especially  of  the  left  side  of  the  heart ;  in  the  most  frightful 
paroxysms  occasioned  by  hypertrophy,  dilatation  or  valvular  diseases 
of  the  heart,  it  will  become  evident  that  Arsenic  possesses  the  most 
perfect  specific  and  homoeopathic  relation  to  endocarditis.  It  is  indi- 
cated not  only  in  the  commencement  of  the  disease,  but  also  when 
exudations  and  vegetations  have  formed  on  the  endocardium  and 
valves,*  especially  of  the  left  ventricle.  It  is  hence  the  main  remedy  in 
Bouillaud's  so-called  chronic  endocarditis.  It  is  indicated  when  the 
following  physical  signs  are  present :  dullness  over  a  greater  extent 
than  usual  in  the  cardiac  region,  especially  in  a  vertical  direction ; 
violent  and  irregular  action  of  the  heart,  with  feebleness  or  almost 
complete  extinction  of  the  pulse  ;  indistinctness,  or  roughness  of  both 
sounds  of  the  heart,  or  a  bellows-murmur  with  the  first  sound,  heard 
over  the  left  ventricle,  (and  along  the  aorta,  but  loudest  over  the 
aortic  valves,  viz.3  at  the  edge  of  the  third  rib,  near  the  left  edge  of 
the  sternum.) 

"Bismuth: — It  produces  violent  beating  of  the  heart;  violent 
palpitations,  visible  at  a  considerable  distance ;  a  symptom  which  is 
almost  peculiar  to  hypertrophy  of  both  ventricles. 

a  Pathological  Anatomy* — An  intensely  bright  inflammatory  redness 


ENDOCARDITIS.  389 

in  both  ventricles;  in  the  left  ventricle  several  cherry-red,  pretty- 
broad,  but  not  very  deep  spots.  This  evidently  must  prove  a  very 
important  remedy  in  diseases  of  the  heart,  especially  in  the  acutely 
inflammatory  stage,  although  it  may  also  prove  useful  in  valvular 
disease  and  hypertrophy.  It  is  indicated  when  the  following  physical 
signs  are  present :  dullness  on  percussion  over  a  great  extent  of 
surface;  violent  beating  of  the  heart,  distinctly  elevating  the  walls 
of  the  chest  (or  the  hand  or  head  of  the  auscultator  when  applied)  ; 
bellows-murmur  with  the  systole  of  the  heart,  and  heard  both  over 
the  right  and  left  ventricles. 

"  Colchicum  : — It  causes  rending  pain  in  the  region  of  the  heart ; 
very  violent  palpitations,  followed  by  very  weak  beating  of  the  heart. 

" Pathological  Anatomy : — Several  ecchymosed  spots  on  the  pericar- 
dium ;  effusion  of  serum  into  the  pericardium ;  heart  large  and  lax, 
its  external  surface  marked  by  dark,  violet  or  brownish  spots,  and 
with  large  circumscribed  patches  of  lymph.  It  would  seem  more 
homoeopathic  to  pericarditis*  than  to  endocarditis.  It  may  be  used 
when  the  following  physical  signs  are  present :  dullness  over  a  small, 
or  very  great  extent  of  surface  (when  there  is  effusion  into  the  peri- 
cardium the  dullness  mounts  higher  up  the  sternum,  in  the  direction 
of  the  great  vessels,  than  when  it  is  occasioned  by  mere  enlargement 
of  the  heart ;  distinct  bulging  of  the  ribs  over  the  heart) ;  action  of 
the  heart  violent  at  first,  and  attended  with  a  marked  friction-sound 
(a  vibratory  tremor,  generally  perceptible  to  the  hand  ;  Stokes  noticed 
this  tremor  in  five  cases  out  of  six ;  the  friction-sound  is  a  to-and-fro 
sound,  corresponding  with  the  movements  of  the  heart  backwards  and 
forwards ;  it  is  generally  more  or  less  rough,  sometimes  like  the  rasp- 
ing of  wood,  or  the  grating  of  a  nutmeg,  crackling  of  parchment, 
rustling  of  silk  ;  very  rarely  it  resembles  the  creaking  of  the  new  sole 
leather ;  when  the  quantity  of  effusion  increases,  these  sounds  may 
change  to  a  continuous  hollow  rumble,  owing  to  the  agitation  of  as 
large  a  quantity  of  fluid  as  is  compatible  with  the  production  of  a 
murmur).  When  the  quantity  of  serum  becomes  great,  the  heart  is 
pushed  back  from  the  walls  of  the  chest;  hence  its  impulse  can 
scarcely  be  felt,  all  friction  and  other  murmurs  cease,  and  the  natural 
sounds  of  the  heart  are  heard  very  indistinctly,  and  at  a  great 
distance. 

"Crgton: — It  causes  piercing  pain  in  the  region  of  the  heart; 

*  The  marked  amendment  which  speedily  followed  the  employment  of  Colchicum.  in  case 
No.  2,  article  Pericarditis,  inclines  me  to  corroborate  this. — J.  L. 


390  CIRCULATING  SYSTEM. 

loud  and  perceptible  pulsation  and  throbbing  of  the  heart,  especially 
when  lying  down ;  sudden  throbbing  in  the  region  of  the  aorta. 

"  Pathological  Anatomy. — Sixteen  ounces  of  dark  bloody  serum  in 
the  pericardium;  softening  of  the  heart;  actual  extravasations  of 
blood  into  the  substance  of  the  heart ;  dark  stripes  and  ecchymoses 
on  the  endocardium  of  both  ventricles  ;  inflammation  of  the  pulmonary 
arteries  and  veins ;  redness  of  the  valves. 

"This  is  evidently  one  of  the  most  important  homoeopathic  reme- 
dies in  diseases  of  the  heart  (and  perhaps  the  most  homoeopathic 
remedy  to  effusion  into  the  pericardium,  especially  the  haemorrhagic 
variety).  The  physical  signs  indicating  its  use  are  the  same  as  those 
requiring  the  use  of  Colchicum,  with  the  addition  that  there  may  be 
valvular  murmurs  heard  to  the  right  of  the  sternum,  over  the  right 
ventricle,  and  during  the  diastole  of  the  heart. 

"Aconite: — It  causes  pressing  together  of  the  chest  in  the 
region  of  the  heart ;  palpitation  in  young  plethoric  persons ;  palpita- 
tions with  great  anxiety,  oppression  of  the  chest,  general  heat, 
especially  in  the  face,  great  relaxation  of  the  limbs  ;  slow  throbs  in 
the  cardiac  region ;  aching  compressing  pain  below  the  sternum ; 
pain  in  the  left  side  of  the  chest,  between  the  fourth  and  sixth  ribs ; 
disproportion  between  the  heart  and  pulse  beats ;  for  the  pulse  beats 
three  times,  while  the  apex  of  the  heart  strikes  the  walls  of  the  chest 
once;  the  right  auricle,  however,  seeming  to  be  persistently  and 
convulsively  contracted. 

"  Pathological  Anatomy : — No  peculiar  and  characteristic  alterations 
are  found,  viz.,  no  signs  of  inflammation,  or  its  consequences,  but 
merely  signs  of  relaxation  and  debility  of  the  heart,  with  more  or 
less  of  venous  congestion :  the  heart  relaxed  and  dilated ;  the  left 
side  filled  with  fluid  red  blood,  and  the  right  with  fluid  or  coagulated 
black  blood,  or  in  general,  containing  much  black,  coagulated,  or 
brownish  blood.  Hence  the  pathological  appearances  afford  no 
warrant  for  the  use  of  Aconite  in  inflammatory  affections  of  the  heart ; 
still  it  is  advised  in  predominant  arteriality,  in  palpitations,  in  endo- 
carditis, with  or  without  articular  rheumatism ;  also  as  an  invaluable 
palliative  remedy  in  organic  affections  of  the  left  side  of  the  heart, 
and  large  vessels,  dilatation  of  the  left  ventricle,  &c. ;  in  endocarditis 
it  can  only  be  homoeopathic  in  the  very  commencement  of  the  disease, 
before  extensive  exudations  or  alterations  of  the  surface  of  the  endo- 
cardium and  valves  have  taken  place. 

"  Physical  Signs :— Judging  from  the  above,  Aconite  will  be  indi- 


ENDOCARDITIS.  391 

cated  when  there  is  dullness  on  percussion  over  the  heart,  when  the 
motions  of  the  heart  are  quick  and  violent,  but  do  not  evidently  and 
visibly  raise  the  walls  of  the  chest  at  each  impulse,  and  are  not 
synchronous  with  the  beats  of  the  radial  pulse ;  when  both  sounds 
of  the  heart  are  heard  louder,  clearer  [the  first  sound  being  almost 
as  clear  and  clacking  as  the  second,  which  is  the  most  characteristic 
sign  of  dilatation  of  the  left  ventricle],  and  heard  most  distinctly 
over  the  left  ventricle  [when  the  apex  of  the  heart  is  found  beating 
nearer  to  the  nipple  than  one  inch  below  and  within  it,  viz.  very 
near  the  nipple,  or  just  below  it,  or  outside  of  it,  or  even  above  it, 
for  the  larger  a  heart  becomes,  the  more  is  the  apex  carried  outwards 
and  upwards] . 

"Asparagus  : — It  causes :  An  indistinct  sensation  of  piercing  in 
th§  cardiac  region  ;  frequent  violent  palpitation  while  sitting ;  palpi- 
tation with  anxious  restlessness,  caused  by  motion  or  ascending  stairs  ; 
feelable  and  audible  throbbing  of  the  heart  from  moderate  exercise ; 
irregular,  quick,  double  beating  of  the  heart;  scarcely  perceptible 
action  of  the  heart.  It  is  less  homoeopathic  to  the  inflammatory 
stage,  than  to  the  consequences  of  endocarditis,  more  especially  to 
hypertrophy  of  both,  or  only  of  the  left  ventricle. 

"Physical  Signs: — Dullness  on  percussion  over  a  very  extensive 
surface ;  the  action  of  the  heart  violent,  elevating  at  each  beat,  the 
corresponding  portion  of  the  chest,  [so  that  when  the  hand  or  head 
of  the  examiner  is  placed  over  the  cardiac  region  it  will  evidently  be 
seen  to  rise  and  sink  with  every  contraction  and  dilatation  of  the 
heart ;  however  violent  the  palpitations  may  be  in  simple  nervous 
affections  of  the  heart,  no  permanent  bulging  of  the  ribs  over  the 
heart  is  noticed,  and  the  action  of  the  heart  never  lifts  the  hand  or 
head  of  the  auscultator]  ;  violent  pulsation  of  the  carotids ;  sounds 
of  the  heart  natural,  but  louder,  or  attended  with  murmurs  or  other 
abnormal  sounds  at  various  parts,  either  during  the  systole  alone,  or 
also  during  the  diastole. 

"  [Riecke  says  that  a  man  in  Paris,  suffering  with  palpitations, 
thought  he  felt  relief  every  time  he  ate  of  Asparagus;  hence  he  pre- 
pared a  syrup  in  order  to  have  some  when  it  was  out  of  season ; 
this  also  helped  him,  and  he  mentioned  it  to  his  physician,  who 
made  farther  and  satisfactory  experiments  and  communicated  their 
results  to  Bronpais,  who  wrote  a  short  article  about  it  in  1839 ;  then 
its  use  became  quite  fashionable,  but  lately  it  has  fallen  into  neglect. 
Bronpais  says,  like  Digitalis,  it  possesses  the  power  of  diminishing 


392  CIRCULATING  SYSTEM. 

the  action  of  the  heart,  and  of  increasing  the  urine,  without  irritating 
the  stomach;  hence  it  is  serviceable  in  hypertrophy  and  palpitations 
of  the  heart,  and  also  relieves  the  nervous  pains,  even  when  de- 
pendent upon  organic  disease.  Heyfelder  found  it  very  beneficial 
in  hypertrophy ;  Andral,  Fougier,  Serres,  &c,  saw  good  effects  from 
it  in  Cardiogmus,  even  Organicus,  while  Buchner,  in  his  experiments 
with  the  tincture,  often  felt  violent  palpitations  with  anxious  restless- 
ness, both  while  sitting  still  or  moving  about.] 

"Belladonna: — It  causes  aching  in  the  cardiac  region,  taking 
one's  breath  away,  and  causing  anxiety;  anxious  feeling  in  the 
region  of  the  heart,  with  occasional  intermittence  of  the  pulse ; 
irregular,  unequal  contractions  of  the  heart;  clucking  about  the 
heart,  when  going  up  stairs,  with  palpitation;  trembling  of  the 
heart ;  throbbing  pain  beneath  the  sternum,  near  the  epigastrium  ; 
very  feeble  beating  of  the  heart ;  violent  and  persistent  palpitations  : 
violent  heart-throbbing,  with  jarring  of  the  head  and  neck. 

"  Pathological  Anatomy : — Partly  fluid,  partly  coagulated  blood  in 
the  ventricles ;  blackish  coagula ;  lividity  and  great  softness  of  the 
heart  ;  blackish  and  very  thin  blood  in  the  arteries. 

"  From  the  above  it  is  evident  that  Belladonna  is  not  a  truly 
homoeopathic  remedy  for  endocarditis,  but  it  is  an  admirable  remedy 
in  congestion  of  the  chest,  preventing  the  occurrence  of  actual 
inflammation,  and  moderating  the  stormy  vascular  commotions  which 
attend  organic  diseases  of  the  heart,  and  cutting  short  the  frequent 
exacerbations  of  the  disease  which  threaten  to  light  up  inflammation 
anew. 

"  Physical  Signs  : — Percussion  sound  normal,  or  dull  over  a  rather 
large  extent  of  surface  ;  action  of  the  heart  alternately  violent,  then 
weak,  or  even  intermitting ;  sounds  of  the  heart  natural,  except 
clearer  than  usual,  of  irregular  rhythm,  first  stronger,  then  weaker, 
then  absent. 

"Veratrum  album: — It  causes  extreme  agony,  which  takes 
away  the  breath ;  palpitations,  with  anxiety  and  quick,  audible  respi- 
ration ;  paroxysms  of  agony  about  the  heart,  which  then  beats  very 
violently  and  feels  as  if  it  were  too  warm ;  violent  beating  of  the 
heart,  which  forces  up  the  ribs ;  the  heart  beats  up  very  high  and 
forcibly,  so  as  to  force  the  hand  away,  without  pain.  In  cases  of 
poisoning  of  dogs  with  it,  the  heart  beats  stronger,  quickly,  and 
irregularly,  in  strong  contrast  with  the  great  general  prostration  and 


ENDOCARDITIS.  393 

stupefaction  of  the  animal  ;  even  an  hour  after  death  the  heart  still 
moved  feebly. 

"  The  entire  absence  of  pain  about  the  hearty  while  this  organ  beats 
so  violently  as  to  shake  the  chesty  elevate  the  ribs,  and  lift  the  hand 
of  the  auscultatory  deserves  particular  attention,  for  this  almost  never 
occurs  except  in  hypertrophy  with  dilatation. 

"  Physical  Signs  : — The  percussion  sound  may  be  dull  over  a  very 
large  space ;  (the  apex  of  the  heart  may  beat  directly  beneath,  or 
outside  of,  or  above  the  nipple  ;  bulging  of  the  ribs  over  the  heart ;) 
action  of  the  heart  visibly  very  violent ;  sounds  of  the  heart  either 
very  loud  and  clear,  or  else  one  or  both  sounds  accompanied  with 
abnormal  murmurs. 

"  (From  the  well-known  action  of  Veratmm  on  the  stomach  and 
bowels,  it  deserves  particular  attention  in  those  affections  of  the 
heart  dependent  upon  or  attended  by  derangement  of  the  stomach ; 
6  in  some  forms  of  nervous  palpitation  there  is  an  increase  of  suffering 
after  meals,  or  when  the  stomach  is  deranged,  while  amelioration  is 
produced  by  dyspeptic  remedies ;  but,  as  the  stomach  produces  the 
same  effects  when  there  is  disease  of  the  heart,  these  signs  are  not 
pathognomonic  of  nervous  palpitation.  To  this  point  1  [Hope] 
would  particularly  direct  the  attention  of  physicians ;  because  many, 
in  forming  their  symptomatic  diagnosis  of  the  affections  in  question, 
regard  the  dyspeptic  signs  as  paramount  in  value  to  all  others,  and 
are  apt  to  refer  to  the  stomach  the  palpitation  which  may  really 
belong  to  organic  disease  of  the  heart/  It  is  easy  to  showr  that 
Veratmm  is  homoeopathic  to  both  these  varieties.  Hutchinson  re- 
marks that,  in  poisoning  with  Veratmm^  violent  palpitations,  inter- 
mittent pulse,  and  a  condition  of  things  which  presents  much 
similarity  to  organic  disease,  are  very  apt  to  ensue.  In  the  Med. 
Chir.  Rev.,  vol.  II,  page  196,  we  find  an  article  headed,  (  Veratmm 
album  used  for  producing  artificial  disease  of  the  heart?  A  man  by  the 
name  of  Chapman,  belonging  to  the  Marine  Artillery,  had  found  out 
the  secret  virtues  of  the  white  Hellebore,  and  turned  it  to  the 
advantage,  or  rather  disadvantage  of  himself  and  others,  to  whom 
he  sold  his  powders  at  a  high  price.  By  taking  the  Hellebore  every 
appearance  of  dyspepsia,  attended  with  great  nervous  irritability, 
and  violent  and  continued  palpitations,  were  produced.  This  Chap- 
man had  deserted,  and  was  taken  in  a  remote  part  of  the  country, 
where  he  completely  succeeded  in  deceiving  the  staff-surgeon,  who 


394  CIRCULATING  SYSTEM. 

examined  him,  and  reported  his  incapacity  for  military  service  in 
consequence  of  having  organic  disease  of  the  heart !  !  Dr.  Quavier 
states  that  this  practice  of  taking  Hellebore  was  productive  of  some 
alarming  consequences  for  a  considerable  period ;  some  were  perma- 
nently injured,  having  actually  produced  the  disease  which  they 
merely  intended  to  counterfeit.)" 

"  Digitalis  : — It  causes  in  the  healthy  subject,  slight  pain,  aching 
and  heaviness  about  the  heart ;  increased  activity  of  the  heart,  with, 
slowness  of  the  pulse ;  increased  throbbing  of  the  heart ;  palpitations 
which  arouse  one  from  sleep ;  palpitation,  and  commotion  of  the 
blood,  with  great  anxiety,  forcing  one  to  get  out  of  bed,  with  quick- 
ness of  the  pulse,  congestion  to  the  head,  noises  and  roaring  in  the 
ears  ;  diminished  action  of  the  heart;  scarcely  perceptible  beating  of 
the  heart ;  very  soft  and  weak  beating  of  the  heart ;  evident  throb- 
bing in  the  right  side  of  the  chest, 

"Pathological  Anatomy  .-—Several  blackish  and  quite  voluminous 
coagula  in  the  right  ventricle  ;  bright-red  and  fluid  blood  in  the  left 
ventricle  (in  a  vast  majority  of  instances  no  blood  is  found  in  the 
left  side  of  the  heart  after  death, — the  powerful  muscular  develop- 
ment of  the  left  ventricle  almost  always  seems  sufficient  to  empty 
that  cavity,  even  at  the  last  throb  which  marks  the  cessation  of  life ; 
hence,  whenever  blood  is  found  there  after  death,  it  denotes  an 
unusual  degree  of  relaxation,  debility,  and  utter  exhaustion  of  the 
muscular  structure  of  the  heart),  fluid,  dark-red  blood  in  the  heart ; 
extinguishing  of  the  irritability  of  the  heart. 

(Digitaline,  i.  e.,  the  active  principle  of  Digitalis,  according  to 
Bouchardat  and  Sandras,  in  doses  of  one-tenth  of  a  grain,  singularly 
modifies  the  circulation,  and  is  capable  of  irritating  the  digestive 
organs  in  a  high  degree ;  all  the  patients  to  whom  it  was  adminis- 
tered experienced  a  marked  slowness  of  the  pulse,  the  greatest 
depression  taking  place  in  general,  some  hours  after  the  exhibition 
of  the  drug ;  in  several  instances  it  was  diminished  in  frequency  to 
the  extent  of  nearly  one-half  of  the  normal  condition,  very  often 
only  one-third  or  one-fourth;  the  next  morning  it  became  rather 
more  frequent,  but  always  remained  from  ten  to  more  beats  below 
the  normal  pulse.  In  all  these  cases  the  pulse  was  also  irregular,  the 
irregularity  being  of  two  kinds— the  first  and  most  remarkable  irre- 
gularity was  that  the  intervals  between  the  pulsations  were  unequal ; 
sometimes  the  pulse  would  be  hard  and  very  quick,  then  hard  and 
slow  ;  at  others  it  would  be  soft  at  times,  then  hard  ;  again  it  would 


ENDOCARDITIS.  395 

remain  soft  persistently.  Some  patients  would  experience  light- 
headedness^ annoying  dreams  and  hallucinations,  soon  followed  by 
more  or  less  frequently  repeated  diarrhoea  or  bilious  vomiting,  which 
in  spite  of  all  precautions  sometimes  lasted  two  or  three  days  ;  the 
appetite  was  lost  at  the  same  time ;  whenever  it  induced  irritation  of 
the  digestive  organs,  the  pulse  again  becomes  frequent). 

"(The  marked  depressant  action  of  Digitalis  on  the  heart,  renders 
it  homoeopathic  to  dilatation,  with  thinning  of  that  organ,  which 
state,  according  to  Hope,  depends  upon  direct  debility,  or  deficient 
power.  In  this  effect  the  palpitations  are  of  a  feeble,  oppressed 
kind,  and  more  or  less  distressing,  frequent  and  prolonged,  according 
to  the  extent  of  the  dilatation  :  in  general  they  are  protracted ;  the 
pulse  is  soft  and  feeble,  and  if  the  debility  of  the  heart  be  great,  the 
pulse  is  small ;  irregularity  and  intermittence  are  common  during  the 
protracted  and  distressing  paroxysms  of  palpitation  and  dyspnoea; 
when  the  dilatation  is  attended  with  softening  of  the  substance  of 
the  heart,  the  pulse  is  apt  to  be  as  small,  weak,  intermittent,  irre- 
gular and  unequal,  as  in  the  worst  cases  of  disease  of  the  mitral 
valve ;  oedema  of  the  limbs  is  very  common  in  this  variety :  also 
lividity  of  the  face,  lips,  &c, ;  one  of  the  most  constant  and  charac- 
teristic of  the  equivocal  signs  of  dilatation  of  the  right  side  of  the 
heart,  is,  permanent  turgescence  of  the  external  jugular  veins,  with- 
out sensible  pulsation.  Among  the  physical  signs  of  dilatation  is  a 
change  in  the  character  of  the  first  sound  of  the  heart ;  this,  which 
is  naturally  dull  and  indistinct,  becomes  louder,  shorter  and  clearer, 
so  as  to  resemble  the  clear,  distinct  clacking  of  the  normal  second 
sound  ;  the  degree  of  the  dilatation  can  be  judged  of  by  observing 
how  far  the  first  sound  resembles  the  second.  The  greater  the 
shortness  and  clearness  of  the  first  sound,  the  thinner  will  the 
walls  of  the  heart  be  found.  The  dullness  on  percussion  is 
increased,  and  is  found  lower  down  than  natural ;  dullness 
over  the  inferior  part  of  the  sternum  denotes  dilatation  of  the 
right  ventricle  in  particular.  Although  the  heart  be  enlarged, 
the  impulse  is  diminished,  and  in  extreme  cases  absent,  even  during 
palpitation  ;  when  felt,  it  is  only  a  brief  percussion  of  the  chest,  not 
elevating  the  hand  or  ear  of  the  examiner ;  sometimes  several  beats 
of  the  heart  are  heard,  while  one  only  is  felt  (Hope).  There  is  old 
school  authority  for  the  use  of  Digitalis  in  this  disease  ;  Dr.  Holland 
says :  (  The  enlarged  and  flaccid  heart,  though  on  first  view  it  might 
seem  the  least  favorable  for  the  use  of  this  medicine,  is  perhaps 


396  CIRCULATING  SYSTEM. 

not  so ;  at  least  I  have  reason  to  believe,  that,  in  the  dropsical  affec- 
tions so  often  connected  with  this  state  of  the  heart,  the  action  of 
Digitalis  is  peculiarly  of  avail/  (See  Med.  Notes,  &c.  p.  574.)  Old 
school  physicians  also  say  that  it  helps  in  intermittent  and  otherwise 
irregular  pulse ;  Pereira  says :  6  In  patients  affected  with  an  inter- 
mittent and  otherwise  irregular  pulse,  I  have  several  times  observed 
this  medicine  produce  regularity  of  pulsation  ;'  a  circumstance  also 
noticed  by  Dr.  Holland.  Dilatation  of  the  heart  is  a  treacherous 
disease  to  those  who  auscultate  and  percuss  carelessly,  as  well  as  to 
the  mere  symptomatologist ;  for  the  heart  may  be  two  and  a  half 
times  its  natural  size,  and  yet  the  impulse  be  by  no  means  remark- 
ably strong ;  and  when  the  heart  is  much  loaded  and  oppressed  with 
blood,  the  sound  of  the  valves,  and  even  of  valvular  murmurs  may 
become  so  faint  that  they  cannot  be  heard,  without  the  patient  holds 
his  breath.  In  a  previous  article  we  have  referred  to  the  homceopa- 
thicity  of  Digitalis  to  diseases  of  the  mitral  valve). 

"Spigelia  : — It  causes  oppression  of  the  chest  and  palpitations; 
dull  stitches  occurring  synchronously  with  the  pulse,  and  felt  where 
the  apex  of  the  heart  strikes  the  chest ;  violent  and  audible  beating 
of  the  heart,  which  may  also  be  felt  through  the  clothes,  attended 
with  anxious  oppression  of  the  chest,  especially  in  the  morning,  soon 
after  rising,  also  w7hile  sitting  down ;  wave-like  motion  of  the  heart  - 
want  of  harmony  between  the  heart  and  pulse-beats ;  purring  sound 
in  the  chest,  especially  in  the  cardiac  region,  resembling  the  purring 
of  cats. 

cc  Spigelia  has  been  recommended  in  inflammations  and  organic 
diseases  of  the  heart,  but  we  have  as  yet  no  patholpgico-anatomical 
proof  that  it  is  really  homoeopathic  to  these  affections.  It  may 
prove  homoeopathic  to  pericardial  chorea  ;  Eberlee  says  that  it 
causes  spasmodic  twitching  of  the  face,  alternate  fits  of  laughing 
and  crying,  incessant  inclination  to  run  and  skip  about ;  Pereira 
says  it  often  causes  spasms  of  the  facial  muscles  and  even  gene- 
ral convulsions  ;  but  spasmodic  movements  of  the  eyelids  have 
been  observed  among  the  most  common  attendants  of  its  narcotic 
action.  It  is  not  generally  known  that  chorea  may  depend  upon  and 
mask  acute  pericarditis ;  Dr.  Bright  has  seen  cases  in  which  there 
were  peculiar  spasmodic  symptoms,  like  most  fully  developed  severe 
chorea,  except  the  convulsion  was  more  violent  than  is  -almost  ever 
seen  in  chorea ;  the  head  being  thrown  from  one  side  of  the  bed  to 
the  other ;  the  lips  closed  and  opened  with  a  smacking  sound  ;■  the 


ENDOCARDITIS.  397 

tongue  protruded  with  all  the  grimace  and  difficulty  as  in  chorea, 
and  yet  the  only  appearances  found  after  death  Mere  recent  and 
profuse  effusion  of  lymph  on  the  heart  and  pericardium,  and  recent 
vegetations  of  the  semilunar  and  mitral  valves.  Shigella  may  prove 
homoeopathic  and  curative  to  this  singular  form  of  disease ;  cantha- 
rides  also  produce  chorea,  and  may  light  up  inflammation  in  almost 
any  organ). 

"Physical  Signs  : — Spigelia  may  be  indicated  when  the  percussion- 
sound  is  normal  over  the  heart,  or  dull  over  a  very  large  surface ;  the 
impulse  of  the  heart  increased,  evidently  and  visibly  elevating  the 
walls  of  the  chest  at  each  beat ;  want  of  harmony  between  the  heart 
and  pulse-beats ;  (apex  of  the  heart  beating  nearer  the  nipple  than 
usual,  or  even  outside  of  it ;)  valvular  murmurs  at  various  parts  of 
the  heart,  as  well  as  with  the  systole  as  the  diastole,  or  with  both 
(friction  or  to-and-fro  sound  of  pericarditis). 

"Nux  vomica: — It  causes  palpitation  in  frequent  short  pa- 
roxysms, with  commotion  of  the  blood ;  pulsating  throbs  in  the 
direction  of  the  heart;  great  anxiety  wdth  severe  palpitation. 

"In  the  numerous  and  careful  post-mortem  examinations  which 
have  been  made  in  cases  of  poisoning  with  Nux,  no  organic  alterations 
about  the  heart  have  been  found ;  its  influence  upon  the  heart  must 
be  referred  to  the  nervous  system.  It  causes  increased  activity  and 
evident  irritation  of  the  ganglionic  system,  which  may  be  propagated 
to  the  mind  and  senses  ;  hence  the  above-mentioned  heart-symptoms 
may  arise  in  consequence  of  sympathy  with  the  ganglionic  and 
mental  affections.  For  this  reason  Hahnemann  laid  so  much 
stress  on  the  mental  symptoms  excited  hy  Nux,  and  mentioned  the 
presence  of  vexability  over  sensitiveness  to  all  impressions,  hypo- 
chondriacal humor,  passionate  irritability  and  sudden  choler,  great 
anxiousness,  starting  in  affright,  fearful  anxious  dreams,  &c,  as 
strong  indications  for  the  use  of  Nux  vomica.  Hence  Nux  cannot 
prove  homoeopathic  to  endocarditis,  or  any  other  heart  affection 
dependent  upon  any  organic  or  material  change  of  structure. 
From  the  above  it  becomes  evident  that  even  the  negative  results 
of  physical  examinations  are  of  importance  in  the  selection  of  a 
remedy. 

i€  (We  take  a  different  view  of  the  action  of  Nux ;  it  acts  predo- 
minantly and  specifically  upon  the  motion-side  of  the  spinal  marrow 
and  the  muscular  system  in  general,  and  tends  more  particularly  to 
cause  tetanic  spasms.     As  the  heart  is  a  very  muscular  organ,  it  is 


398  CIRCULATING  SYSTEM. 

very  probable  that  it  exerts  a  similar  action  upon  it ;  in  fact,  the 
spasm  of  the  heart  may  become  so  complete  and  persistent,  that  this 
organ  remains  tightly  contracted  for  some  time,  during  which  little 
or  no  impulse  is  felt,  the  respiration  being  difficult  and  the  pulse 
extinct ;  if  the  spasm  of  the  heart  be  less  complete  and  tonic,  i.  e., 
more  clonic,  then  violent  palpitation  may  ensue,  but  Nux  constantly 
tends  to  produce  long-continued  spasmodic  contraction  of  the  heart ; 
according  to  Sobernheim  it  often  causes  an  asphyxic  condition, 
dependent  upon  an  extremely  violent  contraction  of  the  respiratory 
muscles  and  heart.  Every  one  familiar  with  diseases  of  the  heart, 
must  be  familiar  with  this  state  of  things ;  a  patient  with  organic 
disease  of  the  heart  will  be  suddenly  taken  with  what  he  calls 
spasms:  he  sits  in  speechless  agony,  his  hands  clasped  over  the 
cardiac  region,  his  eyes  protruded,  his  face  livid,  &c. ;  the  physician 
attempts  to  feel  the  pulse,  and  can  scarcely  find  it,  he  places  his  hand 
or  ear  over  the  heart,  and  finds  everything  as  still  and  motionless  as 
death  itself:  after  a  while  the  spasm  relaxes  ;  more  or  less  palpitation 
follows,  and  the  patient  recovers  for  a  time.  Such  attacks  are  often 
mistaken  for  paralysis,  exhaustion,  or  debility  of  the  heart,  and  treated 
with  stimulants.  Hence  it  will  be  seen  that  the  action  of  Nux  is 
exactly  the  opposite  of  that  of  Digitalis  upon  the  heart ;  if  the  latter 
be  homoeopathic  to  dilatation  with  attenuation,  the  former  will  be  so 
to  contraction  with  thickening,  i.e.,  to  concentric  hypertrophy,  if 
any  such  disease  exist.  Iron,  Bark,  Nux  vomica,  Ignatia,  &c,  must 
prove  the  most  homoeopathic  remedies  to  simple  hypertrophy,  i.  e., 
where  the  walls  of  the  heart  are  thickened,  the  cavity  retaining  its 
natural  dimensions ;  also  in  that  variety  of  hypertrophy  in  which  the 
walls  are  considerably  thickened  and  the  cavity  dilated  ;  and  in  hyper- 
trophy with  contraction,  in  which  the  walls  are  thickened  and  the 
cayity  diminished  in  size). 

Pulsatilla  : — It  causes  stitches  and  anxious  aching  in  the 
cardiac  region,  with  difficulty  of  breathing,  relieved  by  walking; 
heaviness,  aching  and  burning  about  the  heart ;  palpitation  after 
slight  mental  emotions,  from  speaking,  and  after  eating :  palpitation 
with  anxiety,  forcing  one  to  throw  off  his  clothes ;  palpitation  in 
violent  paroxysms,  with  darkness  before  the  eyes,  want  of  breath, 
especially  while  lying  on  the  left  side. 

"  Hahnemann  has  taught  us  that  Pulsatilla  is  especially  suitable 
for  the  female  organism,  for  the  sluggish,  phlegmatic  temperament, 
for  gentle,  quiet,  and  lachrymose  individuals.     If  we  seek  for  a  reason 


ENDOCARDITIS.  399 

for  this,  we  will  find  it  in  a  consideration  of  the  general  action  and 
sphere  of  Pulsatilla ;  in  its  specific  relation  to  the  digestive  process 
it  exerts  a  marked  influence  upon  the  formation  of  blood,  and  upon 
the  venous  circulation ;  every  alteration  of  the  chyme  and  chylification 
must  produce  changes  in  the  blood ;  excessive  exaggeration  of  the 
digestive  process  must  produce  increased  formation  of  lymph  and 
blood,  and  predominant  venosity  (?).  As  women,  in  virtue  of  their 
sexual  formation,  require  and  use  a  greater  quantity  of  blood, 
they  are  more  subject  to  venous  derangement,  and  hence  Pulsatilla 
is  particularly  applicable  to  the  female  organism.  Among  the  venous 
symptoms  produced  by  Pulsatilla  are :  swelling  of  the  hemorrhoidal 
tumours,  enlargement  of  the  cutaneous  veins,  bleeding  from  the  nose, 
cough  with  expectoration  of  pieces  of  black  coagulated  blood ;  redness 
of  the  conjunctiva ;  the  presence  of  chills,  constant  internal  coldness, 
predominant  coldness  of  the  body,  all  point  to  a  marked  predomi- 
nance of  venosity  over  arteriality  ;  as  a  consequence  of  overfilling  of 
the  large  veins  of  the  chest,  and  of  the  right  side  of  the  heart,  we 
find  anxiety,  great  agony  with  palpitation  of  the  heart,  agony  in  the 
cardiac  or  praecordial  region,  driving  one  to  suicide;  trembling 
anxiety,  as  if  death  were  about  to  ensue,  with  fleeting  heat  of  the 
body,  coldness  of  the  hands,  paleness  of  the  face,  inclination  to 
weep,  &c. 

^At  the  bedside  it  has  been  found  useful  in  passive  congestion, 
with  distension  of  the  veins,  and  in  tedious  heart  affections;  it  acts 
principally  upon  the  venous,  i.  e.,  the  right  side  of  the  heart,  and 
hence  is  rarely  useful  in  the  inflammatory  stage  of  endocarditis ;  but 
when  insufficiency  of  the  mitral  valve  has  occurred,  causing,  as  it 
almost  always  does,  hypertrophy  with  dilatation  of  the  right  side  of 
the  heart,  and  consequent  excessive  accumulation  and  activity  of 
the  venous  blood  in  the  heart  and  chest,  then  Pulsatilla  comes  in 
play. 

"  Physical  Signs  : — Percussion  sound  dull,  over  a  large  extent  of  sur- 
face, especially  in  a  horizontal  direction  ;  the  impulse  of  the  heart  either 
increased  or  normal;  the  sounds  of  the  heart  increased  over  the 
right  ventricle,  or  a  bellows-murmur  in  the  same  place  ;  the  second 
sound  of  the  pulmonary  artery  distinctly  louder  than  the  second 
sound  of  the  aorta;  normal  sounds  of  the  heart  over  the  left  ventricle, 
or  a  murmur  with  the  systole ;  the  jugular  veins  distended,  and 
pulsating  evidently  (one  of  the  most  certain  signs  of  enlargement  of 
the  right  ventricle)  P 


400  CIRCULATING   SYSTEM. 

"Rhus  toxicodendron.*  Symptoms  which  it  is  capable  of  pro- 
ducing in  the  healthy  subject :  violent  throbbing  stitches  over  the 
region  of  the  heart,  whilst  in  a  sitting  posture,  so  as  to  cause  loud 
cries ;  stitches  in  the  region  of  the  heart,  with  painful  paralysis  and 
numbness  of  the  left  arm ;  palpitation  of  the  heart,  whilst  sitting  still, 
so  violent  that  the  whole  body  moves  at  each  pulsation ;  a  sensation 
of  weakness  and  trembling  in  the  heart;  excessive  anxiety,  with 
aching  in  the  region  of  the  heart,  and  tearing  in  the  region  of  the 
os  sacrum ;  excessive  anguish,  which  prevents  sleep  during  half  of 
the  night."  There  is,  in  addition  to  many  others,  one  circumstance 
in  particular  which  offers  considerable  difficulty  to  the  correct  selec- 
tion of  a  homoeopathic  medicine,  viz.  the  apparently  great  identity 
and  similarity  which  exists  between  the  individual  symptoms  of  many 
medicaments;  if  the  effects  of  the  various  remedies  differed  more 
distinctly  and  strikingly,  if  the  natural  boundaries  and  deviations 
were  more  prominent,  the  selection  of  the  proper  remedy  would  be 
materially  facilitated.  It  is  manifest  that  this  difficulty  arises  rather 
from  the  character  and  arrangement  of  our  Materia  Medica,  than  from 
the  nature  of  the  medicaments  themselves,  since  it  is  probable  that  no 
two  of  them  possess  pathogenetic  properties  which  entirely,  or  even 
only  partially  coincide  in  essential  and  particular  points,  excepting, 
perhaps,  different  preparations  and  combinations  of  one  and  the  same 
substance.  It  is,  therefore,  of  the  highest  importance  to  isolate  the 
effects  of  each  medicament  by  determining  and  establishing  its  essen- 
tial and  characteristic  qualities,  and  to  point  out  distinctly  its  distin- 
guishing and  differing  marks  and  peculiarities.  And  in  fact,  when 
reading  the  accounts  of  successful  homoeopathic  cures,  we  may  easily 
perceive  what  a  decided  influence  a  single  characteristic  symptom 
often  exercised  upon  the  correct  selection  of  the  remedy,  how  often, 
only  by  such  means  the  right  path  was  entered  upon,  and  that  a 
single  such  essential  and  peculiarly  characteristic  symptom  is  of 
much  greater  consideration,  than  many  unimportant  symptoms 
which  are  only  vaguely  or  not  at  all  connected  with  the  dis- 
ease. This  is  undoubtedly  the  reason  why,  when  two  remedies 
appear  to  be  equally  well  indicated,  according  to  the  similarity  of 
their  general  symptoms,  still  only  the  one  is  actually  suited  to  the 
case  under  treatment,  and  it  is  also  partly  owing  to  the  same  reason 

*  The  Nos.  of  the  "  Homoeopathic  Examiner,"  containing  the  remaining  remarks  on  this 
and  the  consecutive  medicines,  not  having  reached  us  as  yet,  we  have  attempted  to  supply 
the  deficiency  by  referring  to  and  translating  from  the  original  treatise. — J.  L. 


ENDOCARDITIS.  401 

that  the  thinking  physician  holds  an  advantage  over  the  layman,  who 
only  tries  to  accomplish  cures  by  opposing  symptom  against  symptom. 
Hahnemann  himself  often  directs  our  attention  to  this  point,  and 
ingeniously  points  out  such  characteristics  in  several  medicaments." 
Speaking  of  Rhus  tow.  he  mentions  as  its  peculiarity,  "that  it  pro- 
duces the  more  violent  paroxysms  and  sufferings,  whilst  the  body,  or 
the  affected  limb  is  kept  in  a  state  of  perfect  rest,  but  that,  on  the 
contrary,  a  remission  of  the  paroxysms  and  improvement  is  induced 
by  motion."  This  assertion  is  also  distinctly  suggested  and  fully 
borne  out  by  the  above-mentioned  symptoms  of  the  heart,  and  it 
deserves  here  the  greater  consideration,  from  the  fact  that  all  the 
remedies  hitherto  mentioned  yield  no  similarity  to  this,  but  quite  the 
contrary,  viz.,  increase  of  the  symptoms  on  movement.  cc  Now,  if  we 
apply  this  peculiarity  of  Rhus,  to  Endocarditis  and  to  diseases  of  the 
heart  in  general,  we  shall  unquestionably  find  that  it  greatly  limits  the 
field  of  operation  of  this  remedy  ;  for  although,  in  every  inflammation, 
an  increase  of  the  symptoms  generally  ensues  from  motion,  whereascon- 
siderable  remission  follows  if  the  body  or  the  seat  of  the  derangement 
is  kept  quiet,  still  this  is  more  especially  the  case  in  inflammations  and 
chronic  affections  of  the  heart.  For  in  these,  a  considerable  increase 
of  the  paroxysms  is  almost  invariably  created  by  any  degree  of  active 
corporal  exertion,  and  by  any  other  circumstance  which  is  capable  of 
producing  an  exciting  effect  upon  the  circulation  of  the  blood.  Never- 
theless, there  are  some  affections  of  the  heart  in  which  we  meet  with  a 
certain  analogy  with  this  peculiarity  of  Rhus;  viz.,  the  symptoms 
assume  absolutely  no  precarious  or  dangerous  violence,  in  consequence 
of  an  insufficiency  or  defective  state  of  the  valves  (usually  the  valves 
of  the  aorta),  as  long  as  the  heart  retains  its  contractile  power  in 
an  undiminished  ratio,  and  is  yet  strong  enough  to  overcome  and 
press  on  the  blood  in  its  impeded  current,  from  regurgitation  through 
the  deteriorated  and  imperfectly  closing  valves,  no  interruption  is 
given  to  the  circulation.  Everything  which,  in  such  cases,  exerts  a 
depressive  influence  upon  the  energetic  action  of  the  heart,  as  bleed- 
ing, large  doses  of  digitalis,  etc.,  superinduces  considerable  derange- 
ments and  dangerous  symptoms;  on  the  other  hand,  the  evil  is 
always  relieved,  if  we  succeed  in  strengthening  the  constitution  gene- 
rally, and  in  imparting  to  the  heart  that  amount  of  energy  which 
enables  it  to  keep  up  the  circulation  of  the  blood  in  its  normal  state; 
hence,  also,  it  happens  that  bodily  exercise,  judiciously  undertaken,  is 

26 


402  CIRCULATING  SYSTEM. 

sometimes  more  beneficial  to  persons  thus  affected  than  uninterrupted 
rest. 

"The  increase  of  the  symptoms  during  rest,  and  their  alleviation 
through  the  act  of  motion,  consequently  form  decidedly  characteristic 
and  striking  indications  for  the  employment  of  Rhus.  It  is  certainly 
not  adapted  to  the  pure  inflammatory  stadium,  but  will  be  found 
appropriate  to  the  subsequent  diseases  of  the  valves,  and  the  derange- 
ments ensuing  therefrom,  especially  in  the  case  of  insufficiency  of  the 
valves  and  constriction  of  the  ostia.  As  physical  signs,  we  may  point 
out  the  following  :  the  sound  on  percussion  is  normal,  or  dull  chiefly 
throughout  the  greater  part  of  the  longitudinal  direction  of  the  heart ; 
the  impulse  of  the  heart  is  mostly  increased,  and  that  to  such  a  degree 
as  to  shake  the  entire  thorax ;  in  place  of  the  second  sound,  a  pro- 
longed murmur  is  audible  over  the  whole  heart ;  during  the  systole, 
there  is  either  a  sound,  or  an  indistinct  one,  or  none  at  all. 

"Natrum  muriaticum.  It  produces  continual  pains,  violent 
stitches,  and  pain  in  the  heart  as  if  from  contusion ;  at  night  in  bed 
aching  beneath  the  heart,  as  if  ascending  from  the  abdomen,  with 
palpitation  of  the  heart,  which  is  increased  by  lying  on  the  left  side, 
and  lessened  by  changing  to  the  right ;  palpitation  of  the  heart  on 
the  slightest  movement,  whilst  in  the  erect  posture,  accompanied  by 
anxiety ;  fluttering  motion  of  the  heart ;  irregular  pulsation  of  the 
heart ;  intermittent  pulsations  of  the  heart ;  strong  pulsation  through- 
out the  whole  body. 

"  The  importance  of  these  symptoms  is  confirmed  and  increased  by 
experience  derived  from  the  practical  use  of  this  remedy ;  it  is  said 
to  be  of  great  advantage  particularly  in  organic  diseases  of  the  heart, 
chronic  palpitation  of  the  heart,  and  in  irregular  pulsation  of  the 
same.  Its  effects,  however,  do  not  correspond  as  closely  with  acute 
endocarditis,  but  rather  with  the  sequelae  of  that  inflammation. 
The  physical  symptoms  for  its  application  would  be  :  sound  on 
percussion  mostly  dull  throughout  the  greater  extent  of  surface  ;  the 
impulse  of  the  heart  violent,  irregular,  and  intermittent ;  the  sounds 
unequal,  louder,  or  supplanted  murmurs. 

"Natrum  carbonicum.  It  causes  aching  pain  in  the  region  of 
the  heart;  stitches  in  the  heart,  sometimes  increased  by  inspiration; 
pressive  aching  sensation,  as  if  some  hard  substance  were  placed 
in,  and  occupied  a  space  extending  from  the  region  of  the  heart 
to  the  scrobiculus,  with  a  sense  of  constriction   in   the  stomach; 


ENDOCARDITIS.  403 

painful  clucking  in  the  cardiac  region ;  palpitation  of  the  heart  on 
ascending  stairs ;  anxious  palpitation  of  the  heart  during  the  act 
of  stooping ;.  nocturnal  palpitation  of  the  heart,  awakening  from 
sleep  when  reclining  on  the  left  side  :  palpitation  of  the  heart,  which 
does  not  admit  of  rest  on  either  sidei 

"  The  symptoms  of  this  salt  bear  so  strong  a  resemblance  to  those 
of  the  foregoing  (they  are  almost  verbatim  the  same,  with  the  distinc- 
tion that,  amongst  those  which  appertain  to  Ntibrum  wiuriaticum,  we 
meet  with,  in  addition,  c  an  irregular  and  intermittent  pulsation  of 
the  heart/  a  symptom,  which,  as  has  already  been  mentioned,  is  not 
at  all  very  characteristic  or  of  any  importance  for  any  given  abnormal 
state)  that  we  cannot  discriminate  between  them  by  the  physical 
signs,  but,  at  the  utmost,  only  by  the  general  symptoms. 

"  Phosphorus  : — It  gives  rise  to  congestions  to  the  heart,  with 
palpitations,  which  become  very  violent  after  dinner ;  palpitation  of 
the  heart  accompanied  by  anxiety  in  the  evening,  and  in  the  morning 
in  bed  on  awaking ;  frequent  paroxysms  of  violent  palpitation  of  the 
heart ;  violent  palpitation  of  the  heart  in  the  afternoon  after  a  slight 
mental  emotion,  lasting  for  an  hour,  and  rendering  it  impossible  to 
remain  in  a  reclining  position :  recurrence  of  the  attack  on  going  to 
bed,  but  to  a  milder  extent ;  palpitation  of  the  heart,  early  in  the 
morning,  after  the  usual  breakfast ;  palpitation  of  the  heart,  some- 
times several  (two,  three,  six)  violent  pulsations  (when  walking  or 
sitting  after  dinner),  one  or  two  pulsations  during  the  night,  whilst 
lying  on  the  left  side ;  some  violent  paroxysms  of  palpitation  of  the 
heart,  after  a  slight  movement,  chiefly  of  the  left  arm,  on  sitting  up 
in  bed,  or  stretching,  &c,  which  disappeared  again,  when  at  rest ; 
violent  palpitation  of  the  heart  in  the  morning  in  bed  on  awaking, 
and  in  the  evening  after  lying  down ;  violent  nocturnal  palpitations 
of  the  heart ;  accelerated  circulation  of  the  blood ;  palpitation  of  the 
arteries  of  the  neck. 

"The  experiments  hitherto  made  by  Orfila  have  been  tried  with 
too  large  doses,  and  deiath  followed  too  quickly  (after  twenty  minutes 
to  a  few  hours)  to  allow  of  the  development  of  any  pathological 
alterations  in  those  organs  which  did  not  come  in  direct  contact 
with  the  poison.  It  was  only  observed  that  the  blood  contained  in  the 
left  ventricle  was  liquid  and  black,  like  that  contained  in  the  right. 

"  Phosphorus  has  been  chiefly  recommended  in  palpitations  of  the 
heart  with  abdominal  derangements  and  flatulence ;  also  when  many 
of  the  described  symptoms  of  the  heart  appear  or  become  exacer- 


404  CIRCULATING  SYSTEM. 

bated,  particularly  after  dinner.  When  we  consider  that  in  organic 
diseases  of  the  heart  (especially  in  hypertrophy)  the  paroxysms  are 
often  increased  soon  after  a  meal,  and  render  it  necessary  for  the 
patient  to  abstain  from  all  indigestible,  flatulent  food,  this  coin- 
cidence, taken  in  conjunction  with  the  other  confirmatory  symptoms, 
cannot  appear  unimportant.  In  pure,  acute  endocarditis,  Phosphorus 
can  only  rarely  be  indicated.  The  following  physical  signs  are  in  its 
favour :  the  sound  on  percussion  normal,  or  dull  over  a  considerable 
extent  of  surface  ;  the  impulse  of  the  heart  increased ;  the  sounds 
louder,  or  supplanted  by  murmur. 

"  Sepia  : — It  produces  stitches  in  the  heart ;  throbbing  in  the  pit 
of  the  stomach  early  in  the  morning,  then  undulating  or  fluttering 
sensations  in  the  chest,  similar  to  palpitation  of  the  heart,  followed 
by  burning  heat  in  the  face  and  body ;  throbbing  in  the  left  chest ; 
palpitation  of  the  heart  in  the  evening,  for  a  quarter  of  an  hour; 
palpitation  of  the  heart,  with  stitches  in  the  left  side  o#the  chest ;  the 
heart  beats  convulsively,  attended  with  great  anxiety,  and  trembling 
of  the  fingers  and  legs  ;  palpitation  of  the  heart,  lasting  for  several 
days,  accompanied  by  a  sensation  of  anguish,  and  rendering  it  neces- 
sary to  take  a  deep  inspiration,  but  unattended  with  any  moral  im- 
pression; intermittent  pulsation  of  the  heart,  with  anxiety;  inter- 
mittent pulsation  of  the  heart,  mostly  after  dinner ;  in  the  evening, 
when  in  bed,  violent  palpitation  of  the  heart,  and  beating  of  all  the 
pulses ;  waking  from  sleep  at  night,  in  consequence  of  violent  colic, 
with  an  unusually  perceptible  trembling  motion  of  the  heart  (without 
palpitation),  and  a  full  pulse. 

"  Notwithstanding  the  rather  numerous  symptoms  which  Sepia 
gives  rise  to  connected  with  the  heart,  it  has  been  but  little  employed 
against  diseases  of  that  organ,  and  indeed  none  of  its  symptoms  can 
be  considered  as  sufficiently  indicative  of  any  special  form  of  heart 
disease,  the  more  so,  as  those  very  symptoms  which  are  peculiar  to 
it,  viz.,  the  trembling  convulsive  action  and  intermitting  pulsation  of 
the  heart  are  no  fixed  diagnostic  signs  of  any  particular  disease,  but 
merely  an  irregularity  in  the  rhythmus,  which  may  take  place  in  the 
most  opposite  abnormal  states  of  the  heart,  and  even  in  an  apparently 
perfectly  normal  condition  of  the  same. 

"  It  appears  to  be  indicated  when,  on  auscultation,  the  following 
are  the  principal  results  :  sound  on  percussion  natural,  or  dull  over  a 
large  extent  of  surface ;  the  action  of  the  heart  violent,  unequal,  inter- 
mittent, convulsive  and  trembling ;    the   sounds  more  violent  and 


ENDOCARDITIS.  405 

louder  than  usual,  sometimes  intermitting ;  or  murmurs  instead  of 
the  natural  sounds. 

"Graphites': — It  produces  tightness  in  the  left  side  of  the 
thorax,  and  about  the  heart  early  in  the  morning,  for  several  hours, 
aching  in  the  region  of  the  heart  during  respiration ;  stitches  in  the 
cardiac  region ;  after  retiring  to  rest  for  the  night,  and  while  lying 
on  the  left  side,  throbbing  in  the  region  of  the  heart ;  the  paroxysm 
is  attended  with  anxiety,  and  is  of  so  violent  a  character  as  to  cause 
the  bedclothes  to  be  moved  by  it,  but  disappears  on  turning ;  violent 
throbbing  of  the  blood  at  the  heart,  and  in  the  rest  of  the  body  at  the 
slightest  motion ;  strong  pulsation  of  the  heart,  which  moves  the  arm 
and  the  hand,  and  is  productive  of  anxiety;  violent  palpitation  of  the 
heart ;  violent  palpitation  of  the  heart  several  times,  like  an  electric 
stroke  from  the  heart  towards  the  neck. 

"  Although  I  have  not  hitherto  heard  of  anything,  established  by 
experience,  concerning  the  use  and  effect  of  Graphites  in  diseases  of 
the  heart,  still  the  above-mentioned  symptoms  are  too  important,  and 
partly  too  characteristic,  as  to  have  admitted  of  its  having  been 
omitted  here.  The  action  or  efficacy  of  this  remedy  embraces  a  pretty 
extensive  sphere:  certain  symptoms  correspond  strikingly  with 
organic  lesions  of  the  hearty  which  have  already  attained  a  somewhat 
advanced  stage,  particularly  hypertrophy  and  dilatation.  The  follow- 
ing signs  may  be  considered  as  appropriate  indications  for  its  employ- 
ment :  dullness  on  percussion  over  a  considerable  surface ;  the  action 
of  the  heart  so  violent  as  to  shake  and  raise  the  thorax  and  the  head 
of  the  auscultatory  the  sounds  of  the  heart  loud  and  violent,  or 
supplanted  by  murmurs. 

"  Calcarea  carbonic  a  : — It  causes  painful  aching  in  the  region 
of  the  heart;  precordial  anxiety;  strong  pulsation  of  the  heart  after  a 
meal;  violent  palpitation  of  the  heart,  with  great  anguish  and  rest- 
lessness, oppression  at  the  chest,  and  pain  in  the  back ;  palpitation 
of  the  heart ;  violent  palpitation  of  the  heart ;  a  long-continued  spas- 
modic constriction  in  the  region  of  the  heart,  which  interrupts  the  act 
of  respiration,  with  subsequent  violent  shocks ;  great  anguish  and  pal- 
pitation of  the  heart;  stitches  in  the  heart,  obstructing  the  breath, 
and  leaving  behind  it  an  aching  pain  in  the  cardiac  region;  very 
violent  palpitation  of  the  heart,  with  an  unequal  pulse ;  pulsation  of 
the  large  vessels  in  the  chest. 

"'The  annals  of  homoeopathy  mention  several  cures  of  rheumatic, 
anomalous  gouty  affections  of  the  heart.     It  corresponds,  as  may  easily 


406 


CIRCULATING  SYSTEM. 


be  supposed,  not  with  the  pure  inflammatory  stadium,  but  with  the 
sequelae.  Physical  signs :  the  sound  on  percussionnormal,  or  dull  to 
the  greater  extent ;  the  impulse  of  the  heart  violent,  often  not 
synchronous  with  the  pulse  in  the  wrist ;  the  sounds  of  the  heart 
louder,  or  supplanted  by  murmurs. 

"In  conclusion  we  may  yet  venture  to  make  some  general  observa- 
tions on  the  occurrence  of  organic  diseases  of  the  heart,  and  on  the 
possibility  of  their  cure.     Doubts  have  repeatedly  been  raised,  and 
principally  in  homoeopathic  writings,  on  the  actual  existence  of  affec- 
tions of  the  heart  in  rheumatismus  acutus,  and  more  particularly  on 
the  safety  of  depending  on  auscultatory  phenomena  for  the  discovery 
of  organic  diseases*  of  the  heart,  as,  for  example,  copious  loss  of  blood, 
and  peculiar  chlorotic  and  gouty  dyscrasiae  are  in  themselves  sufficient 
to  produce  similar  consecutive  murmurs,  and  changes  in  the  sounds 
of  the  heart,  without  the  actual  coexistence  of  the  least  organic  meta- 
morphosis ;  many  are  inclined  to  consider  the  supposed  rheumatismus 
of  the  heart  as  nothing  else  than  a  consequence  of  copious  bleeding. 
Although  it  must  be  confessed  that  Bouillaud,  who  particularly  (and 
was  almost  the  first  who  did  so)  directed  our  attention  to  the  close 
relation  of  rheumatismus  to  the  heart,  has  given  occasion  to  this 
supposition  by  his  coup-  sur-coup  conducted  venesections,  and  that 
others  have  commited  exaggerations,  by  trying  to  discover  inflam- 
mation of  the  heart  in  every  case  of  rheumatismus,  still  innumerable 
cases  (which  had  run  their  course  without  the  employment  of  bleed- 
ing, and  in  which  the  correctness  of  the  auscultatory  diagnosis  could 
be  established  by  autopsy),  have  but  too  often  proved  the  existence 
of  structural  derangements  of  the  heart.     It  is  certainly  true  that  in 
chlorotic  persons,  and  under  particular  circumstances,  anomalies  are 
sometimes  observed  in  the  beating  of  the  heart,  which  disappear  too 
quickly  and,  in  most  cases,  spontaneously,  and  are  too  isolated  to 
warrant  us  in  determining  that  they  should  have  proceeded  from 
organic  metamorphosis,  still  this  identical  sudden  appearance  and 
vanishing,  when  taken  in  conjunction  with  the  other  general  symptoms, 
and  the  circumstance  that  such  inexplicable  cases  are  of  rare  occur- 
rence^  ought  to  facilitate  and  correct  the  diagnosis,  and  will  con- 
siderably diminish  the  weight  of  the  aforesaid  objection.     Another 
reason  which  gives  rise  to  the  doubts  which  many  entertain  of  the 
frequent  occurrence  of  organic  diseases  of  the  heart,  and  which  must 
necessarily   make   them,   at   the    same   time,  very   indifferent  and 
sceptical  to  the  possible  advantages  of  a  correct  diagnosis,  appear 


ENDOCARDITIS.  407 

to  be  the  exaggerated  and  partly  erroneous  view  which  they  harbour 
of  the  great  danger  and  unconditional  fatality  of  organic  diseases  of 
the  hearty  and  of  the  utter  fruitlessness  of  every  attempt  to  cure 
them.  And  yet  amongst  all  the  organic  diseases  and  derangements 
of  noble  organs,  perhaps  those  of  the  heart,  notwithstanding  the 
great  importance  of  this  organ,  are  the  least  accompanied  by  im- 
mediate or  direct  danger  ;  now  that  we  are  so  much  more  readily 
enabled  by  the  improvements  effected  in  medical  science  to  discover 
them  more  distinctly  and  more  correctly,  we  can  daily  convince 
ourselves  that  they  often  exist  for  many  years  and  even  without 
causing  any  serious  detriment  to  the  whole  organism,  that  they  have 
absolutely  not  always  been  the  causa  mortis,  yea,  that  many  have  only 
been  discovered  at  the  post-mortem  examination,  having  remained 
quite  unnoticed  during  the  existence  of  the  individuals,  and  conse- 
quently without  exerting  any  considerable  detrimental  influence  upon 
life.  Death  is,  comparatively  speaking,  seldom  directly  attributable 
to  them,  e.g.  by  the  bursting  of  the  heart,  but  for  the  most  part 
indirectly  by  the  derangement  of  other  organs  and  functions,  and  by 
increased  disposition  to  other  diseases,  such  as  hydrops,  apoplexy 
of  the  brain,  &c.  How  very  different,  in  this  respect,  is  the  case 
with  other  organic  diseases,  e.  g.  of  the  lungs,  which,  in  most 
instances,  produce  the  fatal  termination  in  a  more  direct,  progressive, 
and  irresistible  manner,  generally  leaving  but  little  prospect  to  the 
physician  of  averting  the  fatal  issue,  or  often  even  of  retarding  it 
for  any  considerable  time.  Although,  therefore,  medical  art  may 
very  rarely  and  perhaps  never  succeed  in  effecting  a  radical  cure  of 
advanced  organic  metamorphoses  of  the  heart,  nevertheless  there  is  a 
much  wider  scope  for  preventing  their  threatened  development,  or 
arresting  them  in  their  progress,  and  consequently  of  obviating, 
meliorating,  or  removing  the  secondary,  life-endangering,  but  not 
inevitable,  consecutive  symptoms  and  derangements  of  other  func- 
tions, and  of  the  system  in  general.  It  is  just  in  such  cases  and 
under  such  circumstances  that  homoeopathy  has  already  effected 
great  things ;  and  indeed  this  system  can  be  greatly  promoted  by, 
and  derive  much  advantage  from  the  further  cultivation  and  practical 
application  of  the  diagnostic  auxiliaries. 

If  it  appear  necessary  to  substantiate  this  assertion  by  practical 
examples,  I  appeal,  first  of  all,  to  the  testimony  of  many  practitioners, 
to  whom  such  cases  must  have  often  occurred,  if  they  have  ever 
made  their  observations  and  examinations  with  the  necessary  atten- 


408  CIRCULATING  SYSTEM. 

tion.  For  my  own  part,  I  shall  in  this  place  mention  only  two  cases, 
which  are  interesting  in  more  than  one  respect,  and  are  confirmatory 
of  what  has  been  asserted  above.  The  one  is  the  case  which  Dr. 
Goullon  has  fully  described,  (Neues  Archiv,  Vol.  I,  Heft  2,  p.  44,)  and 
which,  therefore,  I  must  content  myself  with  simply  referring  to. 
The  other  came  under  my  own  observation  two  years  ago  : — 

"  M.  Held,  the  daughter  of  healthy  parents,  was  from  her  earliest 
childhood  subject  to  frequent  attacks  of  violent  palpitation  of  the 
heart,  attended  with  anguish  and  swooning,  which  were  chiefly  called 
forth  by  bodily  exercise  and  exertions ;  the  evil  increased  every  year 
in  violence,  prevented  materially  the  growth  of  the  body,  and  w7as 
pronounced  by  several  physicians  to  be  hypertrophy  of  the  heart, 
and  treated  with  leeches,  cupping,  and  vesicatories.  When  she  had 
reached  her  eleventh  year,  Dr.  Noack  was  applied  to,  under  whose 
homoeopathic  treatment  the  paroxysms  became  more  scarce  and  less 
violent,  and  the  entire  constitution  of  the  patient  wras  at  the  same 
time  essentially  ameliorated  and  strengthened.  This  gentleman  left 
Leipsic  a  year  and  a  half  afterwards,  at  which  period  I  was  intro- 
duced by  my  father  to  the  patient  for  the  first  time.  She  was  then 
12^  years  old,  of  small  stature,  emaciated,  and  weakly;  the  left  side 
of  the  thorax  was  protruded  forwards  and  more  elevated  than  the 
right,  the  sternum  pressed  dextrad,  the  spine  also  bent  sideways, 
the  impulse  of  the  heart  exceedingly  violent,  strongest  between  the 
sixth  and  seventh  ribs,  both  to  the  sight  and  touch,  and  producing 
vibration  throughout  the  greater  part  of  the  epigastrium ;  the  sounds 
of  the  heart  were  strong,  loud,  quick,  irregular,  and  during  the 
systole  there  was  an  additional  murmur,  audible  particularly  over  the 
left  ventricle ;  the  palpitation  of  the  heart  was  frightfully  increased 
by  the  slightest  movement.  The  other  functions  of  the  body  were 
all  as  yet  pretty  regular ;  the  mental  capacities  were  somewhat  preco- 
cious, the  temper  mild,  easily  excitable  and  anxious.  After  the  lapse 
of  four  weeks,  considerable  deterioration  took  place,  in  consequence 
of  some  external,  noxious  influence,  the  dyspnoea,  the  anguish,  and 
the  palpitation  of  the  heart  became  almost  unbearable,  the  patient 
could  neither  walk,  nor  lie  down,  but  only  sit  in  a  half  erect  posture, 
violent  cough,  and  paroxysms  of  threatening  suffocation  appeared,  par- 
ticularly during  the  night,  accompanied  by  a  continuous  tormenting 
thirst;  the  feet,  and  subsequently  the  abdomen,  the  hands  and  arms  then 
became  in  the  highest  degree  cedematous;  the  urine  clouded,  dark  and 
somewhat  scanty ;  the  bowels  obstructed.      None  of  the  remedies  at 


CARDITIS.  409 

first  prescribed,  {Arsen.  Digit.  &c.)  succeeded  in  producing  the  slightest 
amendment,  or  in  stemming  the  progress  of  the  malady  in   this 
frightfully  aggravated  form ;  at  length,  when  death  appeared  almost 
unavoidable,  the  violence  of  the  most  distressing  symptoms  abated 
under  the  employment  of  Pmnus  spinosa  (second  dilution,  one  drop 
every  four  hours),  the  nights  became  more  tranquil,  the  paroxysms  of 
impending  suffocation  became  less  violent,  the  cedema  decreased,  and, 
in  short,  after  the  continued  use  of  this  remedy  for  a  period  of  three 
weeks,  the  patient  was  enabled  to  rise,  and  to  walk,  and  to  lie  down 
in  an  horizontal  position;  the  respiration  and  the  sleep  were  quiet, 
the  cedema  had  perfectly  disappeared,  with  the  exception  of  a  trivial 
degree  of  swelling  about  the  ankles ;  the  action  of  the  heart  became 
more  quiet,  the  sounds  more  regular  and  less  loud.     For  nine  months 
in  succession,  the  patient  enjoyed  such  a  state  of  health  as  she  had 
never  before  experienced,  she  became  stronger,  could  bear  a  much 
greater  amount  of  bodily  and  mental  exertion  without  inconvenience, 
and  the  repeated  physical  examinations  showed  that  the  anomalous 
states  of  the  heart  were  all  still  existing,  but  materially  lessened  in 
degree.     The  following  year,  in  consequence  of  violent  constitutional 
excitement  proceeding  from  the  first  appearance  of  the  menses,  the 
patient  suffered  a  relapse,  nevertheless  this  event  cannot  in  any  mea- 
sure be  considered  to  weaken  the  value  of  this  case  for  proving  our 
assertion ;  for  this  example  of  such  a  considerable,  and  in  all  proba- 
bility congenital  organic  malformation  of  the  heart,  being  borne  for 
a  period  of  thirteen  years,   notwithstanding   the  deformity  of  the 
thorax   superinduced   by  it,   cannot  otherwise  than  speak  forcibly 
against  the   generally  received  opinion  of  the   absolute   fatality  of 
organic  diseases  of  the  heart ;   it,   moreover,  proves   the   beneficial 
effects  which  homoeopathic  medicines  may  yet  exercise,  even  in  cases 
of  this  desperate  character." 


CARDITIS. 

Inflammation  of  the  substance  of  the  heart,  distinct  from  the 
membranous  affections,  is  a  rare  disease.  The  general  symptoms  of 
the  cases  on  record  present  similarity  to  those  of  pericarditis.  In  the 
event  of  inflammation  of  a  large  portion  of  the  heart,  a  fatal  termi- 
nation is,  in  all  probability,  unavoidable,  in  consequence  of  the  serious 
interruption  which,  in  such  a  case,  must  be  offered  to  its  function. 


410  CIRCULATING  SYSTEM. 

The  remedies  which  are  likely  to  be  the  most  effective,  in  cases  where 
there  is  any  prospect  of  performing  a  cure,  are  Aconitum,  Bryonia, 
Bachesis,  Arsenicum,  Pulsatilla,  Cocculus,  Spigelia,  Croton,  Digitalis, 
Carlo  v.,  Nalrum  m.,  &c.  The  cure  of  organic  diseases  of  the  heart, 
especially  when  they  are  of  some  standing,  or  of  a  complicated  nature, 
is,  unfortunately,  not  often  within  the  reach  of  art.  All  that  remains 
to  be  done,  in  the  majority  of  such  cases,  is  to  mitigate  the  general 
symptoms,  to  render  the  patient's  life  as  little  oppressive  yet  as  useful 
to  him  as  possible,  and  to  retard  the  onward  march  of  premature 
decay,  by  means  of  appropriate  medicines,  diet,  and  rules  of  conduct. 

In  Hypertrophy,  or  morbid  thickening,  or  increase  in  volume 
of  the  muscular  substance  of  the  heart,  indicated  chiefly  by  dyspnoea, 
increased  impulse,  diminished  natural  sounds,  dullness  on  percussion, 
and  full,  strong,  vibrating  pulse,  the  medicaments  which  have  been 
employed  with  more  or  less  success  are,  Ars.,  Spigel.,  Bism.,  Digit,, 
Rhus,  Phosph.,  Prunus  spin.,  Iod.,  Veratr.  ;  and  also  Graph.,  Ferr.,  China, 
Nux,  Ignatia,  Natr.m.,  Aeon,  (palliative),  Bella.,  Rhus. 

In  Dilatation  or  an  enlargement  of  the  capacity  of  one  or  more 
of  the  heart's  cavities,  characterized  by  palpitation  and  dyspnoea  on 
any  sudden  emotion,  diminished  impulse,  increased  and  more  ex- 
tensive sound,  and  soft,  feeble,  undulating  pulse,  &c,  or  hypertrophy 
and  dilatation,  with  combination  of  the  symptoms  and  signs  of  these 
two  states :  Spigel.,  Digit.,  Cannal.,  Ars.,  Bism.,  Asparag.,  Bachesis, 
Bycopod.,  Carlo  v.,  Puis.,  Rhus,  Spigel.,  Veratr.,  Nux,  Phosph.,  Am., 
Sep.,  Sulph.,  Calc.,  Aeon.,  Oleand.,  &c. 

In  Diseases  of  the  valves,  indicated  by  bellows-  or  rasp-sound, 
heard  most  distinctly  over  the  situation  of  the  diseased  valve,  persisting 
even  during  quietude,  and  occasionally  accompanied  by  a  purring 
tremor  or  vibration,  felt  on  placing  the  hand  on  the  region  of  the 
heart ;  palpitations  and  dyspnoea  aggravated  by  exercise  or  by  mental 
emotions ;  weak,  small,  and  sometimes  intermittent  pulse ;  swelling 
of  the  feet  towards  evening ;  and,  as  the  disorganization  advances, 
discoloration  of  the  face  and  extremities,  extension  of  oedema  to  the 
legs,  dropsical  infiltration  into  the  different  cavities  of  the  body : 
Ars.,  Phosph.,  Argentum,  Aurum,  Coco.,  Natr.  m.,  Croton,  Digit.,  Spigel. ; 
and  Rhus,  Puis.,  Bella.,  Bach.,  Assa.,  By  cop.,  Veratr.,  Sep.,  Graph.,  ho. 
(See  Dr.  G.  Mueller's   observations,   page  383,  where  general  and 


CARDITIS.  411 

physical  indications  for    most   of   the  foregoing  medicaments  are 
enumerated.) 

In  Aneurism  of  the  ascending  portion  and  arch  of  the  aorta, 
which  is  frequently  indicated  by  the  following  signs  :  loud  whizzing  or 
rushing  at  the  superior  extremity  of  the  sternum,  perceived  on  the 
application  of  the  hand  to  that  region ;  rattling  in  the  throat ;  op- 
pression at  the  chest ;  dissimilarity  of  the  pulse  at  the  wrists ;  dull 
sound,  and  perceptible  impulse  under  the  sternum  or  below  the  right 
clavicle  when  the  tumour  is  large;  single  or  simple  pulsation,  with 
increased  impulse  and  louder  sound,  in  contradistinction  to  the 
double  pulsation  and  the  normal  sound  of  the  heart;  bellows-sound 
attending  the  single  pulsation.  The  general  symptoms  differ  con- 
siderably according  to  the  situation,  shape,  and  size  of  the  aneurism. 
Thus,  when  it  may  happen  to  be  so  formed  or  placed  as  to  press 
against  the  gullet,  it  will  cause  impeded  deglutition,  and  sometimes 
a  constant  clucking  noise ;  it  may  press  upon  the  spine  and  give  rise 
to  severe  dorsal  pains,  with  nervous  symptoms  of  various  kinds, 
and  great  debility ;  or  it  may  compress  one  of  the  larger  bronchial 
tubes,  or  produce  absorption  of  a  part  of  the  lungs,  and  create 
difficulty  of  breathing,  cough,  &c.) :  Carlo  v.,  Lachesis,  Lycopodium, 
Ars.,  Sulph.  ;  or  Spigel.,  Rims,  Graph.,  Cole,  Puis.,  Digit,  Natrum  m., 
Zincum,  &c,  are  the  remedies  which  are  likely  to  prove  most  useful. 

The  most  useful  remedies,  generally  speaking,  for  removing  attacks 
of  congestion,  in  diseases  of  the  heart,  are  Aconitum,  Belladonna, 
Lachesis,  Nux  v.,  Opium,  Aurum  ;  or  Cocculus,  Coffea,  Phosphorus,  Ferrum, 
Ars.,  Digit.,  Plumb. 

Affections  of  the  heart  induced  by  the  injudicious  employment  of 
Mercury,  are  commonly  remediable  by  means  of  those  medicines  which 
are  the  more  powerful  antidotes  to  the  multifarious,  injurious  effects 
wThich  arise  from  the  abuse  of  that  mineral,  but  especially  such  as : 
Hepar  sulphur  is,  Acidum  nitricum,  Aurum,  Pulsatilla,  Cinchona,  Lachesis, 
Lycopodium,  etc. 

Those  which  are  manifested  in  a  gouty  habit,  require  the  em- 
ployment of  the  remedies  which  correspond  to  that  diathesis,  as  well 
as  to  diseases  of  the  heart  in  general. 

In  acute  rheumatism  of  the  ^heart :  Aconitum,  Lachesis,  Belladonna, 
Bryonia,  Arsenicum,  Pulsatilla,  Spigelia,  Colch.,  and  Nux  v.,  form  the 
principal  remedies. 


412  CIRCULATING  SYSTEM. 

Against  arterial  inflammation,  in  consequence  of  a  wound,  etc., 
Rhus  has  chiefly  been  recommended.  If,  at  the  same  time,  there 
has  been  considerable  contusion  of  the  adjacent  parts,  Arnica  will 
be  necessary.  When  the  inflammation  is  intense  and  accompanied 
by  great  constitutional  disturbance,  or  when  it  threatens  to  extend 
rapidly  towards  the  heart,  Aconitum  must  be  employed.  Pulsatilla 
and  Arsenicum  may  be  useful  in  certain  cases,  the  latter  more  parti- 
cularly in  advanced  stages  of  the  affection.  The  same  remedies  are 
equally  applicable  in  Phlebitis,  arising  from  external  injury.  When 
inflammatory  action  is  manifested,  in  the  vena  porta,  with  burning  pain 
in  the  seat  and  course  of  that  important  vessel,  and  the  commencement 
of  its  incipient  and  terminal  ramifications,  pain  and  distension  in  the 
right  hypochondrium,  bitter  taste,  whity-brown,  or  yellowish  tongue, 
vomiting,  yellowness  of  the  white  of  the  eye,  and  of  the  face,  Nux  v. 
is  an  important  medicament.  Lachesis,  Pulsatilla,  and  Sulphur  may 
answer  better  in  other  cases  ;  or  Arsenicum  when  symptoms  of  extreme 
prostration,  with  dryness  of  the  tongue,  and  delirium,  supervene.  In 
chronic  phlebitis,  Lycopodium,  Plumbum,  Carlo  v.,  Calc,  Arnica,  etc., 
may  prove  of  efficacy.    (See  also  Varices.) 


CUTANEOUS  DISEASES. 


ST.  ANTHONY'S  FIRE.    ROSE. 
Erysipelas* 

Diagnosis.  The  first  local  symptoms  are  heat,  tingling  or  prick- 
ing pains,  with  diffused  swelling,  tension,  and  deep  shining  redness 
of  the  affected  part.  This  is,  ere  long,  followed  by  pungent,  burning 
and  sometimes  tearing  or  shooting  pain,  which  is  aggravated  by 
motion  or  pressure.  On  pressure,  the  redness  disappears  for  a  mo- 
ment, but  immediately  returns  on  removing  the  finger.  The  consti- 
tutional symptoms  vary  according  to  the  severity  of  the  case  ;  they 
generally  consist  of  shiverings,  succeeded  by  flushes  of  heat ;  sleepiness 
wandering  pains,  dry  tongue,  nausea,  oppression  at  the  stomach,  and 
headache ;  vesications  frequently  arise  on  the  affected  parts,  attended 
with  increase  of  fever.  (Erysipelas  hullosum.)  In  a  few  days  the  red- 
ness changes  into  a  yellowish  hue.  When  the  face  is  attacked,  the 
features  become  much  disfigured  by  the  swellings,  and  delirium 
supervenes.  The  disease  assumes  a  very  serious  aspect  when  it 
affects  the  face  and  scalp,  and  accordingly  requires  the  utmost  atten- 
tion and  discrimination  in  the  treatment  pursued. 

The  hair  often  falls  off  after  a  severe  attack  of  erysipelas  of  the 
face. 

Causes.  Derangement  of  the  digestive  functions,  exposure  to 
cold  or  powerful  mental  emotions ;  occasionally  it  appears  during 
menstruation ;  certain  kinds  of  food  also  provoke  it  in  some  idiosyn- 
crasies ;  for  example,  lobsters,  oysters  or  other  shell-fish. 

Therapeutics.  The  principal  remedies  in  the  treatment  of  the 
ordinary  forms  of  erysipelas  are  Aconite,  Belladonna,  Bryonia,  Bul- 
mtilla,  Rhus  toxicodendron,  Arsenicum,  and  Lachesis. 

Aconite,  only  in  case  there  be  much  fever  or  hot  dry  skin  at  the 


414  CUTANEOUS  DISEASES. 

commencement,   or  even  during  the  course  of  the  disease,  if  re- 
quired. 

Belladonna,  chiefly  in  Erysipelas  phlegmonodes,  but  also  in 
cedematodes  and  erraticum,  when  the  redness  expands  in  rays,  and  an 
acute  shooting  pain  with  heat  and  tingling,  is  experienced  in  the 
affected  part,  which  is  aggravated  by  movement.  Facial  erysipelas, 
with  burning  heat,  excessive  swelling,  so  that  the  eyes  are  almost 
closed,  violent  headache,  thirst,  dry,  hot  skin,  restlessness,  disturbed 
sleep,  delirium. 

In  such  instances,  Belladonna  is  generally  alone  sufficient  to  effect 
a  cure  ;  but  sometimes  it  will  be  found  necessary  to  have  recourse  to 
Lachesis  or  Rhus  toxicodendron,  after,  or  in  alternation  with  Belladonna, 
particularly  when  vesications  are  evolved ;  or  to  Hepar  s.  when  the  skin 
is  smooth,  looks  less  glassy  and  inflamed  after  the  employment  of 
Belladonna,  but  the  heat,  pain  and  swelling  remain  unaltered.  (See 
Rhus.) 

Bryonia  is  frequently  useful  when  the  disorder  affects  the  joints, 
and  when  the  pain  is  exacerbated  by  the  slightest  movement.  Bella- 
donna, however,  is  equally  appropriate  in  most  affections  of  this 
nature.  (Sulphur  is  sometimes  required  to  complete  the  cure  after 
Bryonia?) 

Pulsatilla,  when  the  hue  of  the  skin  is  less  intense,  or  of  a 
blueish  red,  and  the  morbid  spots  frequently  disappear  from  one 
place  to  reappear  in  another  (Erysipelas  erraticum).  It  is  further  indi- 
cated when  the  disease  affects  the  internal  and  external  ear,  par- 
ticularly in  vesicular  erysipelas,  after  Rhus  toxicodendron,  (Belladonna 
and  Rhus,  and,  in  some  instances,  Graphites,  are  also  frequently  called 
for  in  fugitive  or  wandering  erysipelas.) 

Rhus  toxicodendron  is  our  best  remedy  in  vesicular  erysipelas, 
and  also  appropriate  in  erysipelas  with  gradual  but  very  extensive 
oedema  (Erysipelas  oedematodes),  particularly  when  the  disease  has  a 
tendency  to  extend  itself  to  the  brain  and  membranes,  and  the  symp- 
toms closely  resemble  those  developed  in  Encephalitis.  In  some 
instances  it  is  necessary  to  have  recourse  to  Belladonna  and  Hepar 
sulphuris  to  complete  the  cure  (see  the  indications  for  these  remedies 
p.  311) — or  to  Belladonna  and  Rhus  alternately, — or  to  Lachesis, 
which,  next  to  Rhus,  is  perhaps  the  more  generally  useful  remedy  in 
Erysipelas  vesicularis.  (Graphites  is  also  useful  in  some  obstinate  cases 
of  vesicular  erysipelas.) 

It  may  be  likewise  remarked  that  Rhus  is  especially  suitable  to  ery- 


st.  Anthony's  fire.  415 

sipelas  arising  from  particular  kinds  of  food  in  certain  idiosyncrasies ; 
in  other  cases  of  this  kind,  however,  Pulsatilla  or  Bryonia  will  be 
found  equally  serviceable,  according  to  the  symptoms  and  the  tem- 
perament of  the  patient. 

Nux  v.  In  erysipelas  of  the  knee  or  foot  with  extremely  painful 
bright  red  swelling,  this  remedy  is  considered  by  Reissig  to  be  as 
preferable  to  other  remedies  as  Rhus  generally  is  in  vesicular  erysi- 
pelas. He  found  it  more  especially  successful  in  pseudo-erysipelas 
occurring  in  irritable  subjects,  particularly  females,  and  even  in  morti- 
fication of  the  subcutaneous  cellular  tissue.* 

Arsenicum,  when  vesicles  of  a  blackish  hue,  with  a  tendency  to 
degenerate  into  gangrene,  present  themselves  {Erysipelas gangrenosum), 
still  more  clearly  pointed  out  if  great  prostration  of  strength  be 
present.  This  medicine  may  also  be  advantageously  alternated  with 
Carbo  vegetabilis  or  with  Lachesis  in  such  cases.  {Lachesis  and  Rhus  are 
occasionally  of  great  service  after,  or  in  alternation  with  Arsenicum.) 

Cuprum  aceticum.  The  value  of  this  remedy,  upon  the  testi- 
mony of  Dr.  Schmid,  of  Vienna,  has  been  already  noticed  in  reper- 
cussed  eruptions,  when  a  marked  metastasis  to  the  brain  has  taken 
place,  under  Scarlet  Fever  (which  see). 

Sulphur  and  Arsenicum  are  important  remedies  when  erysipelas  has 
terminated  in  ulceration.  In  some  chronic  forms  of  the  complaint, 
Acidum  nitricum,  Euphorbium,  Sulphur,  Graphites,  Silicea  [pseudo-ery- 
sipelas), and  Hepar  s.  have  been  found  serviceable.  The  alternate  use 
of  Bella.,  Rhus,  and  sometimes  Lachesis,  or  Crotalus,  has  succeeded  in 
removing  permanently  a  disposition  to  erysipelas  of  the  face.*  In 
Erysipelas  Scroti  {Chimney-sweeper's  Cancer) ,  Arsenicum  is  the  most 
important  remedy ;  Rhus,  Clematis,  and  Lachesis  have  also  been  recom- 
mended. 

The  greatest  care  must  be  observed  to  avoid  the  risk  of  taking 
cold  even  during  convalescence ;  such  an  accident  occurring  during 
the  disease  is,  as  is  well  known,  frequently  attended  with  the  most 
dangerous  results.  The  troublesome  itching  so  frequently  attendant 
upon  erysipelas,  is  often  materially  relieved  by  the  application  of 
wheaten  starch,  or  the  flour  of  maize. 

In  conclusion,  I  may  be  allowed  to  remark,  that  by  the  fortunate 
discovery  of  remedies,  perfectly  homoeopathic  to  most  of  the  forms  of 


*  Allg.  Horn.  Zeit.  xxi,  88.  ■$  Ibid,  xxii,  20. 


416  CUTANEOUS  DISEASES. 

erysipelas,  we  are  now  enabled  to  subdue  this  affection  with  the  same 
facility  and  certainty,  as  we  treat  other  diseases  curable  by  well- 
known  specifics. 


BOIL. 

Furunculus.     Abscessus  nucleatus. 

Diagnosis.  Round,  or  rather  cone-shaped,  hard  elevations,  of 
different  sizes,  slowly  inflaming  and  suppurating,  discharging  matter, 
generally  at  first,  tinged  with  blood,  but  still  retaining  a  portion  of 
morbidly-altered  cellular  tissue,  which  may  form  the  nucleus  of  other 
elevations  after  those  which  appeared  first  have  healed. 

Gauses.  A  peculiar  constitutional  tendency.  Boils  are^  however, 
frequently  critical,  as  in  gout,  following  acute  fevers  or  eruptive  dis- 
eases, and  sometimes  forming  the  termination  of  chronic  exanthemata 
such  as  itch,  &c. 

Therapeutics.  The  following  are  the  remedies  most  serviceable 
in  this  troublesome  affection:  Arnica  montana,  Sulphur,  Belladonna,  Mer- 
curius,  Aconitum,  and  Hepar  sulphuris. 

Arnica  is  the  best  remedy  in  most  cases  of  boils,  and  will  fre- 
quently prevent  their  return  ;  but,  in  the  majority  of  cases,  Sulphur 
is  necessary  to  eradicate  the  affection.  This  desirable  result,  how- 
ever, is  best  accomplished  by  the  use  of  these  two  remedies  on  each 
attack,  for  two  or  three  successive  times,  the  employment  of  Sulphur 
being  invariably  had  recourse  to  as  soon  as  cicatrization  seems  about 
to  commence.  It  sometimes  happens,  however,  that  the  pain  and 
constitutional  disturbance  are  so  great  that  it  becomes  necessary  to 
have  recourse  to  one  or  more  of  the  subjoined  remedies. 

Aconitum,  when  the  boil  presents  an  extremely  inflammatory 
appearance  and  the  affection  is  accompanied  with  considerable  fever 
and  restlessness,  is  promptly  efficacious  in  subduing  these  symptoms, 
and  may  precede  a  more  specific  remedy  for  those  which  remain. 

Belladonna,  should  the  boil  have  an  inflamed,  fiery,  or  erysipe- 
latous red  appearance ;  or,  moreover,  should  it,  if  situated  upon  the 
extremities,  be  associated  with  swelling  and  tenderness  of  the  glands 
under  the  armpit,  or  upon  the  groin ;  dry,  hot  skin,  thirst,  head- 
ache. 


CARBUNCLE.  417 

Mercurius,  should  the  swelling  refuse  to  yield  to  the  preceding 
remedy,  after  the  inflammatory  redness  has  been  subdued. 

When  matter  has  formed,  Hepar  sulphuris  will  be  found 
conducive  to  bringing  the  tumour  to  a  head,  and  thereby  curtailing 
suffering. 

A  tendency  to  frequent  returns  of  this  affection  is,  as  already  stated, 
often  obviated  by  the  repeated  exhibition  of  Arnica  and  Sulphur;  but 
when,  from  some  innate  taint,  these  remedies  are  not  found  sufficient, 
the  same  result  may  be  attained  by  the  employment  of  Lycopodium, 
Nux  vomica,  Phosphorus,  or  Acichim  nitricum. 


CARBUNCLE. 

Anthrax.     Funmculus  malignans.     Pustula  nigra. 

Diagnosis.  A  livid,  blueish,  or  black  spot,  upon  an  extended 
surface,  extremely  painful,  readily  running  to  gangrene,  and  proving 
fatal  from  the  extension  of  mortification.  The  disease  is  attended  by 
headache,  thirst,  foul  tongue,  sickness,  loathing  of  food,  languor, 
jactitation,  and  sleeplessness. 

Therapeutics.  The  best  remedies  in  this  affection  are  Lachesis, 
Silicea,  and  Arsenicum  album. 

Si  lice  a  : — When  administered  at  the  commencement,  in  simple 
non-contagious  carbuncle,  is  frequently  found  sufficient  to  effect  a 
perfect  cure. 

Lac  he  sis  : — When  the  anthrax  presents  a  livid  appearance,  and 
seems  disposed  to  extend  rapidly  or  to  ^burrow. 

Arsenicum  : — When  the  carbuncle  threatens  to  terminate  in 
gangrene ;  it  is  also  the  most  efficacious  remedy  when  the  disease  has 
arisen  from  contagion. 

In  some  cases  Cinchona,  Rhus  toxicodendron,  Pulsatilla,  and  SiUcea 
may  be  found  serviceable  in  completing  the  cure  after  Arsenicum. 


CHILBLAINS. 

Perniones. 

This  affection  is  too  well  known  to  require  any  particular  description. 
The  exciting  cause  is  exposure  to  transitions  of  temperature,  from 

27 


418  CUTANEOUS  DISEASES. 

cold  to  heat,  and  vice  versa,  but  the  origin  of  chilblains  is  more  deeply 
seated ;  the  feet  are  the  part  most  generally  attacked,  although  fre- 
quently the  hands  also  suffer.  When  the  chilblains  bursty  and 
become  ulcerated,  they  constitute  an  exceedingly  painful  affection. 

Severe  suffering  from  chilblains  is  an  indication  of  constitutional 
taint  not  to  be  neglected,  and  individuals  so  afflicted  should  place 
themselves  under  a  proper  course  of  treatment ;  for,  until  the  system 
is  completely  renovated,  they  are  continually  subject  to  a  recurrence 
of  this  troublesome  affection. 

Therapeutics.  The  following  are  the  most  useful  medicines  in 
ordinary  cases : — 

Nux  vomica,  Pulsatilla,  Belladonna,  Arnica,  Chamomilla,  Arsenicum, 
and  Sulphur. 

Nux  vomica  is  particularly  indicated  when  the  inflammation  is  of 
a  bright  red  colour,  with  swelling,  attended  with  itching,  increased  by 
warmth,  and  when  the  chilblains  evince  a  tendency  to  burst. 

Pulsatilla,  when  the  inflammation  is  of  a  livid  hue,  with  itching 
and  beating  in  the  part  affected,  and  when  the  suffering  comes  on,  or 
is  exacerbated,  in  the  evening  or  towards  midnight.  [Sulphur  is  often 
very  useful  after  Pulsatilla,  and  Thuja  is  often  serviceable  when  the 
indications  we  have  given  for  the  latter  do  not  yield  to  its  employ- 
ment.) 

Belladonna,  when  the  inflammation  is  of  a  blueish  red  (but 
lighter  than  that  indicating  Pulsatilla),  and  very  considerable,  attended 
with  a  creeping,  tingling  sensation. 

Arnica,  when  the  swelling  is  hard,  shining,  and  painful,  attended 
with  itching. 

Chamomilla,  when  with  the  inflammation  and  itching  a  burning 
sensation  is  present ;  followed  by 

Arsenicum,  when  the  pains  are  excessively  violent,  attended  with 
severe  burning,  or  when  the  chilblain  bursts,  and  becomes  converted 
into  an  irritable  spreading  sore.  Arsenicttm  may  in  some  such  cases 
be  advantageously  alternated  with  Carlo  vegetabilis. 

Sulphur  is  a  valuable  remedy  when  the  inflammation  and  itching 
are  very  severe,  and  the  affection  has  failed  to  yield  to  the  foregoing 
medicines. 

In  the  instance  of  Arnica  we  may  also  apply  a  lotion  in  the  pro- 
portion of  one  part  of  the  mother-tincture  to  five  of  water. #      The 

*  The  external  application  of  the  other  remedies  also,  is  frequently  very  serviceable ;  in 


ABSCESS,  ETC.  419 

following  remedies  may  also  be  consulted  in  certain  cases :  Agaricus 
muscarius,  Acidum  nitricum,  Petroleum,  Rhus  toxicodendron,  Bryonia, 
Ledum,  Mercurms,  Cinchona,  and  Secale  comutum. 


CORNS. 

Clavi  Pedis, 

That  these  troublesome  excrescences  not  unfrequently  arise  from 
an  inherent  vice  of  constitution,  is  evident  from  the  fact  of  many  indi- 
viduals who  wear  tight  boots  and  shoes  (unquestionably  the  principal 
exciting  cause)  escaping  them,  while  others,  with  every  precaution, 
suffer  severely  :  such  being  the  case,  the  main  object  must  be,  by  a 
course  of  properly-selected  internal  remedies,  to  eradicate  the  pre- 
disposing cause.  Among  these,  Antimonium  crudum  (externally  as  well 
as  internally,  as  described  under  the  head  of  Chilblains),  Phos- 
phorus, Rhus,  Bryonia,  and  Ammonium  carbonicum,  Zycopodium,  Petroleum, 
Sepia,  Acidum  phosphoricum  and  Sulphur  will  be  found  useful.  Great 
alleviation  of  suffering  has,  however,  been  found  to  result  from 
bathing  the  feet  in  warm  water,  and  then  applying  a  very  weak  Arnica 
lotion  (a  drop  or  two  of  the  tincture  to  an  ounce  of  water)  after 
having  previously  had  the  corn  pared  down  carefully. 

While  upon  this  subject  it  may  be  remarked  that  Nux  vomica 
has  been  found  serviceable  in  cases  of  swelling  and  redness  of  the 
heel,  resembling  chilblains,  attended  with  acute,  burning,  shooting 
pains,  materially  increased  by  the  pressure  of  the  boot  or  shoe,  or  by 
walking. 

Arnica  may  be  recommended  for  the  same  symptoms,  should  Nux 
vomica  be  found  insufficient  to  relieve. 


ABSCESS.    LYMPHATIC  TUMOURS.    DISEASE  OF  THE  CONGLOBATE 

GLANDS. 

Abscess.     By  this  term  is  meant  a  collection  of  purulent  matter, 
resulting   from  morbid  action,   contained  in  a  sac  or  cyst   of  or- 

which  case  we  may  dissolve  a  drop  or  two  of  the  tincture  of  the  same  remedy  that  we 
are  administering  internally,  in  about  ah  ounce  or  so  of  water,  and  bathe  the  chilblains 
with  the  lotion  twice  a  day :  in  addition  to  this,  it  is  sometimes  advantageous  to  envelop 
the  affected  parts  in  a  piece  of  linen  which  has  been  dipped  in  the  lotion. 


420  CUTANEOUS  DISEASES. 

ganized  coagulating  lymph,  furnished  with  absorbent  and  secreting 
vessels. 

Abscesses  are  divided  into  acute  and  chronic.  The  acute  species 
is  preceded  by  sensible  inflammation  in  the  affected  part,  which  is 
soon  followed  by  suppuration.  The  commencement  of  the  sup- 
purative process  is  evinced  by  a  change  in  the  description  of  pain, 
which  becomes  more  obtuse  and  throbbing,  by  an  increase  of  the 
swelling,  and,  when  matter  is  formed,  by  the  perceptible  fluctuation 
of  the  part,  when  the  abscess  is  not  too  deeply  seated ;  lastly,  par- 
ticularly in  idiopathic  cases,  when  the  formation  of  pus  is  in  con- 
siderable quantity,  the  fever  which  attended  the  previous  inflamma- 
tion is  lessened,  and  irregular  chills  or  rigors  supervene,  succeeded 
in  turn  by  heat  and  increase  of  fever. 

When  the  abscess  is  mature,  the  tumour  becomes  pointed,  or  pre- 
sents a  sort  of  conical  shape,  generally  near  the  centre  of  the  cuta- 
neous surface ;  over  this  spot  the  skin  assumes  a  reddish  hue,  becomes 
thin,  and  ere  long  gives  way,  and  allows  the  contents  of  the  cavity  to 
escape. 

The  signs  of  the  formation  or  existence  of  a  chronic  abscess,  on  the 
other  hand,  are  in  the  generality  of  instances  devoid  of  any  apparent 
disorder,  either  local  or  constitutional,  until  it  begins  to  approach  the 
surface  and  form  an  external  swelling.  The  secreted  matter  is  un- 
healthy, thin,  and  serous,  and  contains  substances  resembling  curds 
or  flakes.  When  the  pus  is  evacuated,  and  the  air  admitted  into  the 
cavity,  inflammation  of  the  cyst  arises,  and  is  productive  of  a  salu- 
tary effect,  if  the  abscess  be  small;  but  if  it  be  large,  great  constitutional 
disturbance  ensues,  the  cavity,  instead  of  contracting  and  filling  up 
under  the  process  of  healthy  granulation  or  incarnation,  goes  on  dis- 
charging copiously,  and  hectic  fever  is  produced. 

Therapeutics.  In  acute  abscesses  we  may  apply  poultices  and 
warm  unmedicated  fomentations,  and  forward  the  suppurative  process 
by  the  administration  of  Hepar  sulph.  3,  gr.  ss,  in  repeated  doses.* 
The  lancet  is  never  necessary,  except  when  the  pus,  by  its  extensive 
diffusion  or  pressure  (especially  when  seated  under  ligamentous  or 
tendinous  expansions),  is  liable  to  injure  important  parts  ;  or  when, 


*  WThen  there  is  much  constitutional  disturbance,  with  intense  pain  and  extensive  inflam- 
mation, before  the  formation  of  pus,  the  employment  of  Aconitum  and  Belladonna,  in  alter- 
nation, is  sometimes  requisite  ;  antiphlogistic  regimen  must  at  the  same  time  be  observed. 


ABSCESS,  ETC.  421 

from  its  situation,  there  is  reason  to  apprehend  its  discharge  into  any 
of  the  cavities  of  the  body. 

When  it  is  necessary  to  effect  an  artificial  opening  by  means  of  the 
lancet^  the  incision  ought  to  be  made  at  the  most  dependent  pointy 
where  this  can  be  safely  and  readily  accomplished ;  but  when  this  is 
impracticable,  in  consequence  of  the  great  thickness  of  the  parts 
between  the  purulent  matter  and  skin,  the  most  prominent  or  pointed 
part  ought  to  be  selected.  When,  on  the  other  hand,  this  latter  point 
happens  to  be  at  the  upper  part  of  the  abscess,  the  lancet  must  be  laid 
aside,  and  the  abscess  allowed  to  open  spontaneously,  or,  still  better, 
through  the  instrumentality,  or  at  all  events  the  important  aid,  of 
Hepar  sulphuris,  Silicea,  and  Lachesis.  The  two  former  may  frequently 
be  administered  in  alternation  with  advantage;  the  third  is  more 
particularly  to  be  preferred,  when  a  considerable  portion  of  the  skin 
has  been  much  distended,  and  presents  a  deep  red  or  blueish  appear- 
ance, or  where  its  structure  has  been  destroyed  by  the  magnitude  of 
the  abscess.  Mercurius  is  occasionally  useful  when  there  is  indura- 
tion.* The  subsequent  treatment  is  generally  more  easily  conducted, 
and  the  healing  of  the  cavity  more  speedily  effected,  when  the  matter 
has  been  evacuated  by  the  aid  of  appropriate  medicine,  instead  of  the 
lancet. 

In  chronic  abscesses,  it  has  usually  been  found  most  beneficial  to 
make  an  outlet  for  the  matter  as  early  as  possible,  to  prevent  its  large 
accumulation,  and  thereby  avoid  the  consequent  frightful  constitu- 
tional disturbance,  which  is  so  prone  to  occur  in  such  cases,  from  the 
extent  of  the  inflammation  after  the  bursting  of  the  abscess.  The 
opening  should  be  made  near  the  base  of  the  abscess,  and  merely  large 
enough  to  admit  of  the  exit  of  the  matter. 

When  the  collection  of  matter  is  very  extensive,  it  frequently  accu- 
mulates again  after  having  been  evacuated ;  hence  it  has  been  recom- 
mended to  heal  up  the  opening  immediately,  and  to  make  a  new  one 
again  when  necessary,  but  before  the  pus  has  accumulated  in  any 
considerable  quantity. 

When  the  matter  has  been  withdrawn,  a  dose  or  two  of  Mercurius 
should  be  administered,  followed  by  Hepar  sulph.,  Silicea,  and  some- 
times also  by  Calcarea  and  Phosphorus.     Silicea  and  Phosphorus  have 

*  Carbo  a.  is  equally  serviceable  here,  and  may  follow  Mercurius,  when  that  remedy  fails 
to  answer  our  expectations.  Baryta  is  also  useful  in  such  cases,  particularly  when  there  is 
considerable   surrounding  swelling  as  well  as  induration,  even  after  the  opening  of  the 


422  CUTANEOUS  DISEASES. 

been  described  as  being  useful  when  atrophy  or  consumption  results 
in  consequence  of  chronic  suppuration. 

It  may  here  be  mentioned  that,  in  Lymphatic  Tumours,  Sulphur 
chiefly,  but  also  Mercurms  or  Silicea,  and  in  Encysted  (whether 
steatomatous  or  otherwise),  Calcarea,  have  been  found  very  efficacious.* 
Further,  that  in  the  state  of  enlargement  and  induration  of  the  Con- 
globate Glands,  situated  in  the  neck,  under  the  chin,  and  behind 
the  ears,  such  as  is  usually  met  with  in  scrofulous  habits, — Mercurms 
and  Dulcamara  are  two  of  the  most  important  remedies.  When  the 
glands  have  become  indurated,  Conium  is  one  of  the  most  efficacious 
remedies ;  or,  in  inveterate  cases,  Silic,  Carl,  a.,  Stilph.,  Calc,  Baryta, 
&c;  and  when  suppuration  or  ulceration  ensues,  Hepar  sulphuris, 
Lachesis,  and  Silicea  are  more  useful.  These  latter,  particularly  Hepar 
sul.  and  Silicea,  together  with  Calendula  officin.,  StilpJmr  and  Calcarea,  in 
some  cases,  are  moreover  extremely  useful  in  materially  obliterating 
the  unsightly  scars,  which  are  so  frequently  met  with  in  glandular 
swellings,  that  have  been  neglected  or  improperly  treated  by  means 
of  stimulating  embrocations,  caustics,  &c.f      (See  Scrofula.) 


itch. 

Scabies.    Psora. 

This  contagious,  inflammatory  affection  of  the  skin  is  characterized 
by  an  eruption  of  pointed  vesicles,  transparent  at  the  summit,  and 
filled  with  a  viscid  and  serous  fluid.  These  are  subsequently  inter- 
mixed with,  or  terminate  in  pustules.  With  the  exception  of  the 
face,  they  appear  on  every  part  of  the  body,  but  much  more  fre- 
quently and  abundantly  about  the  thumb,  wrist,  between  the  fingers, 
and  at  the  bend  of  the  joints,  &c,  and  are  accompanied  by  incessant 
and  almost  insupportable  itching,  without  fever.  There  are  several 
varieties  of  the  disorder,  but  it  is  often  very  difficult  to  distinguish 
their  characteristic  differences. 

■■*  Graphites,  Silicea,  Hepar  s.,  and  Sulphur,  Causticum,  Baryta  c,  Carlo  v.,  Acidum 
nitricum,  Lachesis,  or  Phosphorus,  &c,  may  be  required  in  some  cases. 

f  In  old-standing  or  obstinate  cases  of  glandular  enlargement  and  induration  or  ulcera- 
tion, Baryta  c,  Staphysagria,  Carlo,  a.  et  v.,  Hepar  s.,  Sulphur,  Calcarea,  Calendula,  and 
Silicea,  as  also,  Kali  c,  Lycopodium,  Iodium,  Acidum  nitricum,  Bovista,  Belladonna,  &c,  are 
remedies  of  great  utility,  and  must  be  selected  according  to  the  general  features  of  the  case, 
when  Mercurius,  Dulcamara,  and  Silicea  are  found  insufficient  to  discuss  the  swelling,  &c. 


itch.  423 

Therapeutics.  Sulphur  is  unquestionably  one  of  the  most  im- 
portant remedies  in  this  disorder,  particularly  at  the  commencement. 
In  the  milder,  uncomplicated  forms  of  the  malady,  and  in  the  purulent 
variety,  especially  when  confined  to  the  fingers  and  wrists,  it  is  indeed 
specific. 

A  dose  of  the  said  remedy,  at  a  low  potency,  may,  in  such  instances, 
be  administered  night  and  morning  for  a  week  or  ten  days,  but  dis- 
continued as  soon  as  signs  of  improvement  set  in.  In  some  rather 
obstinate  acute  cases,  that  is,  when,  after  ten  days  to  a  fortnight  or 
three  weeks,  but  little  improvement  has  been  effected,  we  shall  find 
the  treatment  facilitated  by  the  simultaneous  employment  of  the 
remedy  externally,  applying  the  Tinctura  sulphuris  as  a  lotion 
night  and  morning.  A  very  speedy  or  a  sudden  suppression  of  the 
eruption  is,  on  the  other  hand,  not  to  be  regarded  as  a  cure,  but  on 
the  contrary,  as  a  driving  in  or  repercussion  of  the  eruption. 

Against  other  varieties  of  the  disorder,  and  in  neglected  cases,  Sul- 
phur  is  not  a  sufficient  remedy;  therefore  it  becomes  necessary  to 
have  recourse  to  Mercurius,  Carlo  v.,  Hepar  s.,  Sepia,  Feratrum,  Lycopod., 
&c.  as  follows :  Mercurius,  when  the  eruption  is  accompanied  by  in_ 
tolerable  itching,  especially  on  becoming  warm  in  bed ;  looks  dry  and 
cracking,  but  consists  of  minute  vesicles  resembling  papillae,  when 
not  narrowly  examined,  which  are  slightly  inflamed,  and  bleed  easily 
when  scratched  [scabies  papuliformis).  These  little  elevations  or  vesicles 
are  sometimes  intermixed  with  pustules,  which,  on  breaking,  form 
scabs.  It  is  sometimes  necessary  to  administer  Sulphur  or  Acidum 
sulphuricum  in  alternation  with  Mercurius,  in  this  form  of  the  com- 
plaint, at  intervals  of  four  or  five  days,  until  an  improvement  or 
change  in  the  symptoms  result. 

In  the  event  of  an  amelioration,  it  is  found  useful  to  cease  to  ad- 
minister the  medicine  as  long  as  it  continues ;  but  if  the  improvement 
soon  comes  to  a  close,  or  a  change  occurs  in  the  character  of  the 
eruption,  another  remedy  must  be  prescribed.  If  the  affection  has 
retained  the  papular-looking  form,  and  Mercurius  alone  has  previously 
been  administered,  Hepar  s.  may  be  selected  ;  but  if  both  Sulphur  and 
Mercurius  have  been  employed,  Carlo  v.  may  be  advantageously  alter- 
nated with  Hepar ;  and  should  any  symptom  remain  thereafter,  Sepia 
or  Feratrum  will  generally  speedily  remove  them. 

In  other  cases  of  scabies  papuliformis,  and  particularly  where  the 
papular  appearance  is  more  strongly  marked  than  in  the  preceding, 
Mezereum  and  Silicea  are  very  serviceable. 


424  CUTANEOUS  DISEASES. 

In  the  pustular  or  humid  variety  {scabies  purulenta),  distinguished 
by  distinct^  prominent,  yellow  pustules,  having  a  moderately 
inflamed  base,  which  are  usually  met  with  on  the  hands ,  and  feet, 
and  subsequently,  if  unchecked,  on  the  back,  shoulders,  arms, 
and  thighs,  about  the  axillae,  and  near  the  knee  and  elbow-joints, — 
Stilphur,  as  has  been  already  stated,  is  the  principal  remedy ;  in  inve- 
terate or  neglected  cases,  considerable  benefit  will  nevertheless  be  fre- 
quently obtained  by  giving  Lycopodium  in  alternation  with  it.  Should 
improvement  ensue,  and  the  eruption  assume  a  drier  aspect,  Mercurius 
and  Carlo  v.  will,  in  most  instances,  serve  to  complete  the  cure.  But 
if  no  beneficial  effect  is  produced  after  two  or  three  repetitions  of  these 
remedies,  at  intervals  of  four  or  five  days,  Graphites  may  be  exhibited 
at  short  intervals  for  three  or  four  successive  times,  lengthening  the 
intervals  at  each  repetition  of  the  dose ;  and  if  no  favorable  alteration 
be  brought  about  soon  thereafter,  Mercurius  may  be  administered  in 
the  same  manner.  Should  extensive  incrustation  ensue  on  the 
breaking  and  discharging  of  pustules,  &c,  Acid,  sulphuricum  is  gene- 
rally of  great  service. 

When  the  pustules  are  large,  they  coalesce  and  form  irregular 
blotches,  which  sometimes  ulcerate  to  a  greater  or  less  extent;  in 
such  cases  Clematis  and  Rhus  will  be  found  serviceable.  When,  on 
the  other  hand,  the  pustules  assume  a  prominent  and  globular  form, 
of  a  yellowish  or  blueish  colour,  Lachesis  has  been  found  to  be  the 
most  appropriate  remedy. 

In  Scabies  lymphatica,  or  watery  itch,  characterized  by  transparent 
vesicles  of  considerable  size,  without  an  inflamed  base,  much  the 
same  treatment  may  be  pursued  as  has  been  described  for  the  dry  or 
papuliform  variety ;  but  in  some  cases  the  alternate  use  of  Sulphur, 
Rhus,  and  Arsenicum  is  requisite.  When  Scabies  has  been  materially 
altered  in  its  character  by  the  abuse  of  Stclphur  in  allopathic  practice, 
Mercurius,  Sepia,  Rhus,  and  Staphysagria,  or  Acid,  nitricum,  Dulcamara, 
Calcarea,  and  Pulsatilla,  etc.  have  been  used  with  success.  Kreosote 
externally  {largely  diluted)  and  internally,  has  been  recommended  in 
some  obstinate  cases  of  Scabies,  and  Sulphur,  Arsenicum,  and  Carbov.  in 
cases  which  have  been  suppressed  or  repercussed  by  powerful  ex- 
ternal applications.  When  furunculi  make  their  appearance  during 
the  course  of,  or  on  the  disappearance"  of  scabies,  Silicea  generally 
removes  them  very  speedily  and  effectually. 

*  Boeninghausen's  Manual  of  Homoeopathic  Therapeutics. 


whitlow,  4:2o 

WHITLOW. 

Paronychia.     Panaris. 

By  this  term  is  understood  an  abscess  more  or  less  deeply  seated, 
fbrme<2  near  the  end  of  the  finger,  attended  with  severe  pain  and 
considerable  swelling;  it  has  a  great  disposition  to  reappear  in 
individuals  who  have  once  suffered  frjom  its  attacks,  which  clearly 
demonstrates  the  advantage  of  treating  it  as  a  constitutional,  and 
not  as  a  merely  local  affection  ;  in  so  doing  we  may  have  recourse 
to  the  following  medicines  :  Mercurms,  Hepar  sulphuris,  Rhus,  Sul/phur, 
and  Silicea. 

Therapeutics.  We  may  generally  commence  the  treatment  by 
Mercurius.  But  should  the  swelling  not  decrease  after  a  few 
doses  of  Mercurius,  or  the  pain  become  intense,  recourse  must  be 
had  to  the  alternate  administration  of  Silicea  and  Hepar  s.* 

Rhus  is  more  particularly  indicated,  where  there  is  a  considerable 
degree  of  erysipelatous  inflammation. 

Lachesis  : — In  cases  where  the  affected  part  is  of  a  dark  red  or 
blueish  hue,  and  the  pains  extremely  violent,  this  remedy  may  be 
administered,  followed  by  Arsenicum  and  Carlo  v.,  if  an  angry-looking, 
black,  and  painfully-burning  sore  form  on  the  affected  finger,  f 

But  we  must  have  recourse  to  the  alternate  administration  of 
Sulphur  and  Silicea  at  intervals  of  about  eight  days,  or  so,  in 
cases  where  a  constant  tendency  to  a  recurrence  of  the  complaint 
exists.  These  remedies,  particularly  the  latter,  are  the  most  appro- 
priate in  those  severe  cases  in  which  the  matter  forms  between  the 
periosteum  and  bone,  and  when  the  latter  has  become  diseased  in 
consequence. 

Magnetis  Polus  Arcticus.  The  application  of  the  north  pole 
of  the  magnet,  for  a  minute  or  two,  to  the  finger,  will  often  afford 
speedy  relief,  when  the  pain  is  so  intense  as  to  be  almost  insup- 
portable. A  poultice  is  also  somewhat  soothing  under  such  circum- 
stances. 

*  These  two  remedies  are,  moreover,  exceedingly  serviceable  in  forwarding  suppuration, 
and  are  therefore  equally  useful  in  bringing  the  abscess  speedily  to  maturity,  and  causing 
the  discharge  of  the  pus,  when  there  is  no  longer  any  possibility  of  effecting  resolution ;  but 
when  the  matter  is  deeply  seated,  and  evacuation  is  not  speedily  obtained,  the  lancet  must 
be  employed. 

f  Hering's  Hausartz. 


42(>  CUTANEOUS  DISEASES. 


IRRITATION  OR  ITCHING  OF  THE  SKIN. 

go. 

This  affection  is  usually  an  accompaniment  of  other  diseases,  and 
is  to  be  treated  accordingly ;  however,  in  some  cases,  it  declares  itself 
in  an  idiopathic  form,  and  is  generally  caused  by  scarcely  perceptible 
colourless  elevations  under  the  cuticle, — which,  however,  are  some- 
times of  a  considerable  size,  soft  and  smooth,  but  without  desquama- 
tion, or  any  peculiar  eruptive  appearance. 

Therapeutics.  Against  this  extremely  distressing  irritation, 
Sulphur  is  frequently  the  specific  remedy,  particularly  when  exacer- 
bation ensues  in  the  evening,  or  when  the  body  is  warm  in  bed ;  but 
in  other  and  more  ordinary  cases,  the  following  remedies  will  be  found 
serviceable :  Ignatia  amara,  Pulsatilla,  Mercurius,  Rhus  toxicodendron, 
Hepar  sulphuris,  Nux  vomica,  or  Arsenicum  album. 

Ignatia  amara: — When  the  irritation  is  most  severe,  after  going 
to  bed,  and  resembles  flea-bites  all  over  the  body ;  and  after  scratching, 
which  relieves,  shifts  readily  from  one  part  to  another, 

Pulsatilla  when  the  irritation  comes  on  in  the  warmth  of  the 
bed,  and  is  aggravated  by  scratching. 

Mercurius  when  the  irritation  continues  through  the  whole  night, 
and  Pulsatilla  proves  insufficient ;  also  in  cases  when  the  parts  affected 
bleed  readily  after  scratching.  {Sulphur  is  sometimes  useful,  every 
four  or  five  days,  in  alternation  with  Mercurius  in  such  cases.) 

Rhus  toxicodendron,  when  itching  is  accompanied  by  a  violent 
burning  sensation,  followed  by 

Hepar  sulphuris,  if  necessary  to  complete  the  cure. 

Nux  vomica  alternately  wdth  Arsenicum,  when  the  irritation  or 
itching  appears  on  undressing. 

In  obstinate  cases  of  almost  all  kinds,  Sulphur,  followed  by  Carlo  v., 
will  be  found  serviceable.  Lycopodmm,  Graphites,  Silicea,  &c,  may  be 
called  for  in  particular  cases.  Opium  is  often  useful  in  the  case  of  old 
people. 

In  Prurigo  scroti,  Sulphur,  Acidum  nitricum,  Dulcamara,  and  Rhodo- 
dendron have  chiefly  been  recommended.  Prurigo  pudendi :  Sulphur, 
Sepia,  Conium,  Calcarea,  Natrum  m.,  and  Sulphur.  Prurigo  ani :  Sepia, 
Acidum  nitricum,  Thuja,  Mercurius,  Sulphur,  as  also  Kali  c,  Baryta  c, 
and  Zincum. 


RINGWORM.  427 


RINGWORM  (HERPETIC  OR  VESICULAR). 

Herpes  circinnatus.     Herpes  serpigo. 

This  affection  generally  occurs  in  children.  It  has  been  considered 
contagious  from  the  circumstance  of  several  children  of  one  family,  or 
at  the  same  school,  being  sometimes  attacked  at  the  same  time; 
but  there  is  every  reason  to  believe  that  this  opinion  is  erroneous, 
from  the  fact  of  none  of  the  other  species  of  herpes  being  communi- 
cable by  contact.  When  not  complicated  with  another  disease  it  is 
not  attended  with  any  general  constitutional  derangement.  The  dis- 
order is  characterized  by  an  eruption  of  small  rings  or  circular  bands, 
the  vesicles  only  occupying  the  circumference  ;  these  are  small,  and 
have  a  red-coloured  base  of  greater  or  less  intensity.  About  the  third 
or  fifth  day  the  vesicles  become  turbid,  and  then  discharge,  when 
little  brownish  scabs  form  over  them.  The  portions  of  skin  within  the 
circlets  are  usually  healthy  at  first ;  but  for  the  most  part  subsequently 
become  rough,  of  a  reddish  hue,  and  scale  off  as  the  vesicular 
eruption  dies  away.  The  duration  of  the  eruption  frequently  does 
not  extend  beyond  a  week  or  two,  but  when  there  is  a  series  of  con- 
secutive rings  on  the  face,  neck,  arms,  and  shoulders,  as  frequently 
happens  in  warm  climates  (where  the  affection  moreover  assumes  a 
more  serious  and  obstinate  character),  or  during  hot  weather  in  this 
country,  it  is  necessarily  protracted  considerably  beyond  this  period. 

Therapeutics.  In  the  majority  of  cases  the  affection  yields 
readily  under  the  action  of  Sepia,  of  which  from  two  to  three  globules 
may  be  given  in  a  little  water,  and  the  dose  repeated  on  the  fourth 
day,  if  required  by  any  appearance  of  tardiness  in  the  subsidence  of 
the  eruption,  or  should  there  be  any  indications  of  the  formation  of 
fresh  rings. 

In  some  obstinate  cases  the  alternate  use  of  Rhus  and  Sulp/i.  every 
four  or  five  days  is  found  necessary.  Calcarea,  Natr.,  Nair.  m.> 
Clem.,  and  Magn.,  have  been  recommended  in  others.*  All  kinds  of 
outward  applications  must  be  avoided. 


*  Bceiiinghaiisen's  Manual  of  Homoeopathic  Therapeutics. 


428  CUTANEOUS  DISEASES. 

RINGWORM  OF  THE  SCALP.     PUSTULAR  RINGWORM. 

Porrigo  scutulata.     Tinea  capitis.     Tinea  annularis.     Favus  confertus. 

This  disease  is  still  more  popularly  known,  than  the  above  by  the 
term  of  ringworm  (or  ringworm  of  the  scalp).  It  is  unquestionably  of  a 
highly  contagious  nature,  being  readily  communicated  among  children 
who  make  use  of  the  same  comb  and  brush,  or  even  towel,  and 
is  of  long  and  uncertain  continuance, — indeed  there  are  few  cutaneous 
affections  which  have  more  frequently  baffled  the  unwearied  efforts 
of  practitioners  than  this;  and  it  would  have  been  well  had  less 
been  attempted  by  those  of  the  old  school  in  the  way  of  treatment ; 
for  in  but  too  many  instances  the  so-called  cure  has  proved  worse 
than  the  disease. 

Pustular  ringworm  commonly  attacks  children  from  the  age  of 
two  years  to  the  period  of  puberty ;  it  is  not  confined  to  the  scalp, 
but  also  appears  on  the  neck,  trunk,  and  extremities ;  when  confined 
to  the  trunk,  it  proves  by  no  means  so  obstinate  and  rebellious  a 
disease  as  when  located  in  the  hairy  scalp. 

Diagnosis.  The  affection  is  characterized  at  the  commencement, 
by  the  appearance  of  isolated,  red-coloured,  irregular,  circular  patches, 
on  which  appear  numerous  small  yellowish  points  or  pustules,  which 
do  not  rise  above  the  level  of  the  skin,  and  are  generally  traversed 
in  the  centre  by  a  hair.  These  pustules,  which  are  much  more 
thickly  studded  in  the  circumference,  than  the  centre  of  the  circular 
patches,  soon  break  and  form  thin  scabs,*  which  frequently  unite 
with  the  adjacent  patches,  and  assume  a  regular  and  extensive  and 
irregular  appearance,  but  commonly  retain  a  somewhat  circular  shape. 
The  incrustations  become  thick  and  hard  by  accumulation,  and  are 
detached  from  time  to  time  in  small  pieces,  which  bear  a  close 
resemblance  to  crumbling  mortar.  When  the  scabs  have  been 
removed  or  torn  off,  the  surface  which  they  had  occupied  looks  red 
and  glossy,  but  is  studded  with  slightly  elevated  pimples,  in  some 
of  which  minute  globules  of  matter  subsequently  become  apparent. 

By  these  repeated  evolutions  of  the  eruption,  the  incrustations 
become  thicker,  the  areas  of  the  primary  patches  extend,  and  new 

*  Sometimes  cup-shaped  or  concave  (characteristic  of  favus),  and  at  first  of  a  tawny,  but 
subsequently  of  a  light  yellow  or  whitish  colour ;  when  they  crack  and  break  up,  they  be- 
come reduced  to  a  powder,  which  looks  like  pulverized  sulphur. 


RINGWORM.  429 

ones  are  formed,  so  that  the  corresponding  edges  become  blended, 
and  frequently  the  whole  head  thus  becomes  affected.  The  circular 
character  of  the  original  groups  is  still  indicated,  however,  by  the 
appearance  of  partially-formed  arcs  in  the  circumference  of  the  larger 
incrustations.  As  the  patches  or  clusters  extend,  the  hair  covering 
them  usually  becomes  lighter  in  colour,  breaks  off  short,  and  as  the 
process  of  scabbing  is  repeated,  it  is  thrown  out  by  the  roots,  and 
finally,  there  remains  only  a  narrow  chaplet  of  hair  round  the  head. 
If  the  hair-follicles  are  destroyed,  the  baldness  remains  permanent. 

Causes.  The  disease  is  chiefly  propagated  by  contagion,  but 
appears  to  originate  spontaneously  in  children  of  scrofulous,  flabby, 
or  feeble  and  emaciated  habit,  if  they  be  ill-fed,  ill-lodged,  uncleanly, 
and  deprived  of  a  wholesome  degree  of  exercise. 

Therapeutics.  It  cannot  be  denied  that,  even  under  homoeo- 
pathic treatment,  the  disease  frequently  proves  extremely  obstinate ; 
but  in  many  cases  the  difficulty  experienced  in  effecting  a  cure, 
arises  from  the  previous  treatment  which  the  patient  has  undergone, 
or  from  culpable  conduct  on  the  part  of  the  parents,  or  others,  in 
allowing  the  disorder  to  pursue  its  course  for  a  lengthened  period, 
unchecked  and  utterly  neglected,  ere  proper  assistance  is  sought. 

The  following  are  the  principal  remedies  employed  in  the  homoeo- 
pathic treatment : 

Rhus,  Arsenicum,  Staphysagria,  Hepar  s.,  Lycopodium,  Dulcamara, 
Bryonia,  Phosphorus,  Graphites,  Baryta  c,  Calcarea,  Oleander,  Sulphur, 
&c. 

The  medicines  must  be  selected  according  to  the  various  changes 
which  take  place  during  the  continuance  of  the  disease;  but  as  it 
would  be  wholly  impossible,  in  so  general  a  work,  to  give  appropriate 
directions  for  the  treatment  of  every  case,  we  can  merely  enumerate 
a  few  of  the  leading  indications  for  some  of  the  more  important 
remedies,  referring,  at  the  same  time,  to  others,  as  being  worthy  of 
attention  in  cases  which  do  not  yield  to  the  ordinary  remedies. 

While  the  patches  exhibit  an  irritable  and  inflammatory  aspect, 
Rhus  will  usually  be  found  the  most  appropriate  remedy  :  the  head 
should  at  the  same  time  be  regularly  and  gently  sponged  with  tepid 
water  twdce  a  day.  Should  a  dry  exfoliation  and  scabbing  then  ensue, 
Sulphur  may  be  had  recourse  to;  but  if,  on  the  other  hand,  an 
offensive  discharge  break  out,  attended  by  violent  itching,  without 


430  CUTANEOUS  DISEASES. 

much  redness,  Staphysagria  may  be  administered,  and  then  again 
Rhus.  If,  notwithstanding  the  administration  of  these  remedies,  very 
little  favorable  progress  be  made,  or  if,  on  the  contrary,  the  affection 
become  rather  worse,  and  the  exudation  take  on  an  acrimonious 
character,  and  productive  of  an  extension  of  the  disorder,  or  of  the 
formation  of  ulcers,  Arsenicum  should  be  exhibited :  after  the  action 
of  which,  Rhus  will  frequently  produce  a  satisfactory  effect.  These 
remedies  may  also  be  occasionally  administered  externally  with  good 
effect,  by  dissolving  a  few  globules  of  the  remedy  selected  in  a  little 
water,  and  applying  the  liquid  once  or  twice  a  day  to  the  affected  parts. 

When  the  foregoing  means  are  insufficient  to  effect  a  cure,  which 
is  unfortunately  not  a  rare  circumstance,  particularly  when  strumous 
or  debilitated  subjects  are  afflicted  with  the  disease,  the  following 
remedies  must  be  used : 

Hepar  s.,  when  the  eruption  is  not  confined  to  the  head,  but  also 
appears  upon  the  forehead,  face,  and  neck ;  when,  moreover,  the 
eyes  and  eyelids  become  inflamed  and  weakened,  and  soreness  or 
ulceration  breaks  out  on  or  behind  the  ears.  In  the  latter  case 
Baryta  c,  Graphites,  and  Oleander  are  also  useful. 

Dulcamara,  when  the  glands  of  the  throat  and  neck  are  enlarged 
and  indurated  (or  Bryonia,  when  there  is  inflammation  and  tenderness 
of  these  glands) ;  after  which  Staphysagria  may  be  administered, 
and  then  one  or  more  of  the  remedies  mentioned  at  the  commence- 
ment, followed  by  Baryta  c. 

If  these  medicines  prove  ineffectual,  Sulphur,  Graphites,  Calcarea, 
Lycopodium,  Phosphorus,  or  Oleander  may  answer  the  purpose  required, 
and  must  be  selected  according  to  circumstances.  In  some  cases 
the  alternate  use  of  two  or  more  -medicaments  will  be  found 
advantageous,  such  as  Sulphur  and  Calcarea, — Sulphur,  Rhus,  and 
Graphites, — Graphites  and  Lycopodium — Graphites  and  Phosphorus,  and 
so  on.  A  dry,  inert,  and  scaly  appearance  of  the  eruption  chiefly 
requires  Calcarea,  or  Sepia,  Silicea,  and  Sulphur,  but  also  Hepar  s., 
Phosphorus,  Rfais,  Arsenicum,  or  Oleander.  A  humid  or  moist-looking 
eruption :  Lycopodium,  Graphites,  and  Rhus,  or  Staphysagria,  Arsenicum, 
Sulphur,  Sepia ;  and  also  Baryta  c,  Calcarea  c,  dcuta  virosa,  and 
Oleander,  &c. 

In  the  other  varieties  of  scald-head,  such  as  the  Porrigo  lupinosa,* 

*  Characterized  by  small,  dry,  circular  scabs,  of  a  yellowish-white  colour,  having  raised 
margins,  and  a  central  depression,  like  that  on  the  seeds  of  the  lupine.  The  incrustations 
are  deeply  set  in  the  skin,  to  which  their  edges  are  firmly  adherent. 


RINGWORM.  431 

Porrigo  furfurans*  Porrigo  favosa^  &c,  the  same  class  of  remedies 
are  required  as  above  prescribed;  whilst  against  Porrigo  decalvans 
(characterized  chiefly  by  patches  of  baldness),  Graphites,  Phosphorus, 
Baryta,  Lycopodmm,  and  Zincum  have  been  found  the  most  serviceable ; 
but  Sulphur,  Calcarea,  Silicea,  &c,  and  most  of  the  other  aforesaid 
remedies  may  be  found  indicated  in  particular  cases.  With  regard 
to  the  administration  of  the  medicines,  it  may  be  stated,  that  at  the 
commencement  of  the  disorder,  a  dose  may  be  given  daily,  or  every 
second  day,  until  symptoms  of  improvement  make  their  appearance, 
the  medicine  must  then  be  discontinued,  whilst  the  case  progresses 
favorably,  and  only  renewed,  when  the  amelioration  ceases,  or  the 
disorder  threatens  to  extend  itself.  When  no  signs  of  improvement 
become  perceptible,  or  when,  on  the  contrary,  the  malady  evidently 
seems  to  be  getting  gradually  worse,  notwithstanding  the  exhibition 
of  two  or  three  doses  of  a  particular  remedy,  another  must  be  selected 
according  to  the  indications. 

In  cases  of  old  standing,  the  intervals  between  the  exhibitions  of 
the  medicine  must  generally  be  lengthened,  or  a  dose  may  be  given 
daily  for  a  week,  and  then  a  period  of  ten  to  twelve  days,  and  even 
upwards,  allowed  to  elapse  before  the  medicine  is  repeated,  or  another 
remedy  substituted. 

Undeviating  attention  to  cleanliness  must  be  observed  throughout 
the  entire  course  of  the  complaint,  and  the  homoeopathic  diet  rules 
must  be  strictly  adhered  to  in  the  majority  of  cases.J  The  hair 
ought  generally  to  be  removed  early  in  the  disease. 

*  This  variety  commences  with  the  eruption  of  small  pustules,  containing  a  straw-coloured 
fluid,  which  soon  discharge,  dry,  and  form  thin  laminated  crusts,  with  scale-like  exfolia- 
tions. The  affection  is  confined  to  the  scalp,  and  is  attended  with  considerable  itching  and 
soreness,  although  there  is  but  slight  excoriation ;  the  hair  partially  falls  off,  and,  occa- 
sionally, becomes  subsequently  somewhat  lighter  in  colour. 

f  Distinguished  by  the  eruption  of  large,  soft,  straw-coloured  pustules,  generally  somewhat 
flattened,  possessing  an  irregular  margin,  and  surrounded  by  a  slight  inflammatory  redness. 
They  are  met  with  on  other  parts  of  the  body  as  well  as  the  scalp,  and  are  accompanied 
by  much  itching.  On  breaking,  these  pustules  discharge  a  viscid  matter,  which  hardens 
into  semitransparent,  greenish-yellow  scales.  The  disease  extends  to  the  face,  and  even- 
tually the  ulceration  spreads  over  the  entire  head,  and,  from  the  continued  discharge,  the 
hair  and  moist  scabs  become  matted  together.  Pediculi  are  generated  in  large  numbers, 
and  aggravate  the  excessive  irritation.  The  incrustations  thicken  into  irregular  masses, 
bearing  some  resemblance  to  a  honeycomb.  The  acrid  exudation  from  the  ulcerated  patches 
on  the  scalp  exhales  an  offensive  and  pungent  vapour. 

t  Adults,  affected  with  this  disorder,  or  indeed  with  any  other  cutaneous  disease,  ought 
wholly  to  abstain  from  fish  and  salt  meat.  Children  ought  to  be  placed  under  similar 
restrictions,  and  should  not  be  allowed  to  partake  of  heating  farinaceous  food,  such  as  oat- 
meal (in  the  form  of  porridge  or  stirabout,  gruel),  maize,  &c. 


432  CUTANEOUS  DISEASES. 


INTERTRIGO. 

This  affection  consists  of  a  galling  or  excoriation  of  the  skin, 
accompanied  with  inflammatory  redness  and  moisture,  around  the 
anus,  between  the  nates,  at  the  inner  and  upper  part  of  the  thighs, 
the  groin,  or  other  parts  of  the  body,  such  as  the  axillae,  &c.  Riding, 
much  walking  in  the  heat  of  summer,  and  the  irritation  of  the  urine, 
are  the  most  frequent  exciting  causes.  It  is,  very  frequently,  readily 
relieved  by  Graphites  or  Lycopodium,  externally  and  internally,  at 
low  potencies.  Arnica,  and  also  Nux  v.,  Pulsatilla,  Sepia,  Sulphur, 
Arsenicum,  and  Chamomilla  have  also  been  recommended  in  particular 
cases :  the  selection  being  made  according  to  the  temperament  and 
complexion  of  the  patient,  as  also  the  state  of  the  digestion,  sexual 
functions,  &c.     (See  also  Excoriations  in  Children.) 


PSORIASIS. 

This  cutaneous  disorder  is  distinguished  by  a  rough  and  scaly 
condition  of  the  epidermis,  sometimes  in  isolated  spots  or  patches  of 
an  irregular  form,  at  other  times  continuous,  but  almost  always 
attended  with  clefts  or  fissures  in  the  skin.  It  is  usually  accom- 
panied by  constitutional  derangement,  and  recedes  or  recurs  at 
particular  seasons  of  the  year. 

The  cure  of  this  disorder  is  generally  difficult  and  tedious,  espe- 
cially when  it  occurs  in  the  inveterate  form  {psoriasis  inveterata), 
characterized  by  nearly  universal  scaliness,  with  a  harsh,  dry,  thick- 
ened and  rigid  state  of  the  skin,  which  is  at  the  same  time  red  and 
deeply  cracked),  or  when  it  is  chiefly  confined  to  the  palm  of  the 
hand  {psoriasis  palmaris).  In  the  simple  form  (psoriasis  simplex), 
Lycopodium  at  a  low  potency,  in  repeated  doses,  frequently  effects  a 
cure  in  from  four  to  eight  weeks,  even  when  the  disorder  is  of  lopg 
standing ;  Rhus  and  Bryonia  are  also  of  considerable  value  in  this 
variety.  In  other  cases,  Sulph.,  Sepia,  Calc,  Graphites,  Clematis,  and 
Ledum  may  be  called  for  by  the  nature  of  the  case.  In  Psoriasis 
inveterata,  Arsenicum  is  of  more  or  less  utility,  as  also  JRhus  and  Sepia; 


PEMPHIGUS.  433 

but  it  is  often  requisite  to  have  recourse  to  Sulphur,  Antim.  c,  Amman,  c, 
Graphites,  or  Calc,  etc.,  to  complete  the  cure. 

Against  Psoriasis  palmaris,  Sulphur,  Sepia,  and  Acid,  muriaticum,  or 
Zincum  have  hitherto  been  principally  employed.  When  there  is  a 
discharge  from  the  rhagades  of  an  offensive  smell,  Rhus,  Graphites, 
Lycopod.,  Mercurius,  or  Hepar,  &c,  are  often  of  important  service.  And 
in  Psoriasis  facialis, — Sulph.,  Calc.,  Aurum,  Graph.,  Lycopod.  ;  or  Sepia, 
Cicuta,  Ledum,  Oleander,  &c,  claim  a  preference. 

The  diet,  in  this  affection,  as,  indeed,  in  all  other  cutaneous 
maladies,  should  be  simple  and  unstimulating.  Fruits,  and  also 
vegetables,  are  often  hurtful  when  the  eruption  is  in  an  aggravated 
form,  and  ought,  therefore,  to  be  avoided  under  such  circum- 
stances. 


PEMPHIGUS. 
Febris  bullosa,  Pompholyx. 

Pemphigus  consists  of  an  eruption  of  yellowish  and  transparent 
bullae  or  blebs  on  various  parts  of  the  body,  varying  in  size  from  a 
lentil,  or  a  split  pea,  to  a  walnut,  commonly  presenting  an  inflamed 
base,  and  generally  assuming  the  shape  of  an  almond.  Fever  is  a 
frequent  accompanying  symptom ;  but  some  authors  maintain  that 
the  disorder  occurs  in  two  different  forms,  viz.,  the  acute  and  chronic, 
and  that  fever  is  only  peculiar  to  the  former,  and  invariably  absent 
from  the  latter ;  whilst  others,  again,  create  a  further  distinction  by 
giving  the  name  of  Pemphigus  to  the  affection,  when  the  vesicles 
exhibit  an  inflammatory  base,  and  are  preceded  or  accompanied  by 
fever,  and  denominating  it  Pompholyx  when  exempt  from  these 
additional  symptoms. 

The  disease  occasionally  comes  on  without  precursory  signs ;  but 
may  also  be  ushered  in  by  sickness,  general  uneasiness,  precordial 
oppression,  headache,  lassitude,  painful  stiffness  in  the  joints,  and 
violent  itching  of  the  skin ;  or  otherwise  it  commences  with  irregular 
chills,  followed  by  dryness  and  burning  heat  of  the  skin,  as  also  thirst, 
anorexia,  and  great  rapidity  of  pulse.  The  eruption  generally  declares 
itself  at  first  by  one  or  more  circular  or  oval  red  spots  or  patches, 
which  are  slightly  prominent,  and  frequently  bear  a  close  similitude 
to  the  first  signs  of  smallpox.  These  patches  soon  take  on  a  dusky 
hue,  and  are  preceded  or  attended  by  some  degree  of  pain  and  heat 

28 


434  CUTANEOUS  DISEASES. 

in  the  affected  parts.  From  the  effusion  of  transparent  serum 
beneath  the  epidermis,  it  becomes  raised  in  the  form  of  vesications 
presenting  the  appearance  of  blisters  arising  from  a  scald,  or  pro- 
duced by  the  application  of  cantharides  to  the  skin.  The  develop- 
ment of  these  blebs  sometimes  ensues  so  speedily  after  the  evolution 
of  the  erythematous  patches,  that  some  authors  have  been  induced  to 
conclude  that  pemphigus  was  never  preceded  by  any  redness  of 
the  cutaneous  surface.  The  eruption  gradually  extends  over  the 
greater  part  of  the  body,  but  rarely  affects  the  hairy  scalp  or  the 
genital  organs.  The  vesicles  increase  rapidly  in  size,  and  in  some 
places  become  confluent.  The  skin  between  the  bullae  presents  a  natu- 
ral appearance,  except  when  the  latter  approximate  closely,  in  which 
case  a  more  or  less  marked  erythematous  blush  pervades  the  interstices. 
When  the  vesicles  have  attained  their  maturity,  and  burst  of  them- 
selves, they  form  incrustations  of  a  whitish,  or  a  pale  brown  colour ; 
but  if  the  epidermis  be  detached  by  friction  soon  after  the  bullae 
have  broken  up,  painful  excoriations  generally  result.  The  duration 
of  pemphigus  with  fever  (acute  pemphigus)  varies  from  one  to  four 
weeks,  according  as  the  eruption  may  have  been  simultaneous  or  con- 
secutive. Pemphigus  without  fever,  again  (or  chronic  pemphigus), 
in  which  the  development  of  the  bullae  is  always  successive,  generally 
occupies  a  period  of  several  months,  and  even  much  longer,  if 
unchecked,  in  some  cases.  When  accompanied  by  nervous  fever  the 
disorder  is  to  be  regarded  as  of  serious  character ;  as  also  when  it  is 
very  extensive,  frequently  renewed,  and  associated  with  inflammation 
of  the  bladder,  &c. 

Therapeutics.  When  the  eruption  is  preceded  or  accompanied  by 
inflammatory  fever,  the  employment  of  Aconitum  becomes  more  or  less 
requisite ;  but  as  soon  as  the  fever  and  restlessness  have  been  consi- 
derably allayed  Cantharides  (3 — 6)  or  Rhus  (3 — 6)  must  be  selected. 
The  former  is  more  especially  useful  when  the  bullae  present  a  close 
analogy  to  the  vesication  produced  by  a  blistering  plaster,  when  the 
irritation  is  intense  and  consists  of  a  violent  burning  itching,  or  when 
the  disorder  is  attended  with  dysuria,  haematuria,  cystitis  or,  in  the 
case  of  females,  with  inflammation  of  the  vagina.  This  remedy  may 
at  the  same  time  be  advantageously  applied" externally  by  means  of  a 
camel's  hair  brush.  Rhus  is  an  invaluable  remedy  in  the  majority  of 
cases  of  Pemphigus,  although  it  occasionally  fails  to  relieve  the 
troublesome  pruritus  so  readily  as  Cantharides.     Should  nervous  fever 


SHINGLES.  435 

be  associated  with  the  eruption,  Rhus  will  be  rendered  still  more 
requisite.  When  the  blebs  are  copiously  developed  on  the  face,  and 
there  is  severe  headache,  thirst,  synochal  fever  with  dry  hot  skin, 
tossing  about,  disturbed  sleep,  and  even  delirium,  as  is  prone  to  be 
the  case  in  young  subjects,  Belladonna  should  be  prescribed.  (See  also 
Heat-spots  in  children.)  After  the  employment  of  Belladonna, 
Lachesis  or  Rhus  are  generally  required  to  complete  the  cure  in 
pemphigus  febrilis. 


SHINGLES. 

Zona.     Herpes  zoster.     Cingulum.     Ignis  sacer5  fyc. 

The  term  Zona  or  Herpes  zoster,  has  been  given  to  a  cutaneous 
disorder  characterized  by  the  formation  of  several  clusters  of  vesicles, 
which  usually  appear  on  one  side  of  the  body  in  the  shape  of  a  semi- 
circular band  or  belt,  most  commonly  at  the  waist,  but  sometimes 
across  the  shoulder,  and  occasionally  on  the  neck,  face,  and  scalp, 
or  other  parts  of  the  body.  The  eruption  is  occasionally  preceded, 
for  a  few  days,  by  languor,  thirst,  and  loss  of  appetite,  fits  of  shiver- 
ing, headache,  sickness,  restlessness,  brownish  or  whitish  coating  on 
the  tongue,  accelerated  pulse,  heat  and  tingling  in  the  skin.  More 
commonly,  however,  the  disorder  appears  without  any  precursory 
symptoms,  and  the  attention  of  the  affected  party  is  primarily  drawn 
to  the  region  where  the  eruption  is  about  to  be  developed  by  a  sense 
of  pricking  and  smarting,  or  burning  heat  and  sharp  pain.  On 
examining  the  parts  several  bright  red,  irregular  blotches,  more  or  less 
widely  separated,  are  observed,  and  upon  each  of  which,  numbers  of 
minute  white  silvery-looking  vesicles  show  themselves,  and  ere  long 
increase  to  the  size  of  a  lentil  or  pea.  The  vesicles  are  at  first  trans- 
parent, being  filled  with  a  clear  limpid  fluid,  but  about  the  fourth 
day  they  assume  a  milky,  or  yellowish,  or  sanguinolent  colour,  and 
the  fluid  contained  becomes  sero-purulent,  or  even  converted  into 
true  pus.  Soon  after  this,  they  often  become  somewhat  confluent, 
and  flatten  or  subside,  leaving  a  very  faint  outline  behind  them,  or 
what  is  still  more  frequently  the  case,  they  dry  up  and  form  small 
yellowish  or  brownish  scabs. 

Some  of  the  vesicles,  again,  burst  on  the  second,  or  between 
that  and  the  fourth  day,  and  discharge  a  small  quantity  of  limpid 
serum ;  the  epidermis  being  detached,  suppuration  of  the  vascular  rete 


436  CUTANEOUS  DISEASES. 

of  the  corion  takes  place  for  a  few  days  in  consequence  of  the  expo- 
sure. While  the  vesicles  of  the  first  groups  are  acquiring  an 
opalescent  aspect,  new  clusters  begin  to  appear  in  succession  for 
three  or  four  days,  and  pursue  the  same  course.  From  the  eighth  or 
twelfth,  to  about  the  twenty-first  day,  all  the  incrustations  of  zona 
are  detached,  leaving  the  surface  of  the  skin  in  a  tender  state,  and 
covered  with  marks  of  a  deep-red  colour,  which  gradually  disappear. 
Where  the  vesicles  have  been  confluent,  and  the  inflammation  severe, 
the  eruption  is  frequently  of  longer  duration  than  above  stated,  and 
the  skin,  from  occasionally  becoming  ulcerated  below  the  incrusta- 
tions, which  in  such  cases  are  rendered  very  adherent,  heals  slowly, 
and  presents  numerous  pits  or  cicatrices  for  a  considerable  time 
afterwards. 

The  causes  of  herpes  zoster  are  obscure.  It  is  most  common  in 
summer  and  autumn.  It  is  not  contagious,  and  does  not  appear  to 
have  ever  been  seen  as  an  epidemic.  The  disorder  is,  on  an  average, 
not  of  a  serious  character,  especially  when  occurring  in  children  and 
adults,  but  in  the  aged,  it  is  liable  to  be  followed  by  sloughing  and 
gangrenous  ulceration,  and  is  always  distressing  from  the  pains 
which  accompany  it. 

Therapeutics.  When  the  disease  is  preceded  by  considerable 
constitutional  disturbance,  with  severe  pain,  restlessness,  deep-seated 
darting  pains  in  the  chest,  heat  of  skin  and  quickness  of  pulse,  a 
dose  or  two  of  Aconitum  afford  speedy  relief.  Spare  diet  must  at  the 
same  time  be  enjoined.  Should  the  febrile  symptoms,  pain,  and 
restlessness  not  completely  yield  to  Aconitum,  Sulphur  may  be  pre- 
scribed, succeeded  by  a  repetition  of  Aconitum,  or  by  Aconittim  and 
Cqffea  in  alternation  if  there  be  less  pain  but  continued  restlessness. 
When  the  primary  symptoms  have  been  removed,  or  when  the  attack 
has  commenced  without  any  precursory  symptoms,  Rhus  toxicodendron 
generally  forms  the  most  useful  remedy,  and  is,  in  most  cases,  suffi- 
cient to  conduct  the  disease  to  a  happy  issue— even  in  those  occurring 
in  individuals  of  an  advanced  age ;  it  is  sometimes  requisite,  how- 
ever, to  exhibit  Sulphur  or  Graphites  after,  or  in  alternation  with  Rhus. 
The  patients  should,  in  all  cases,  be  cautioned  against  lying  on  the 
affected  side,  as  gangrene  is  liable  to  be  induced  by  so  doing,  parti- 
cularly in  bad  habits  and  elderly  subjects.  If  sloughing  and  gan- 
grenous ulceration  supervene,  notwithstanding  all  our  precautions, 
Arsenicum  must  be  had  recourse  to,  succeeded  or  alternated  with 


ULCERS.  437 

Lachesis  and  Cinchona,  should  a  favorable  reaction  not  follow  the 
employment  of  Arsenicum  alone.  Sulphur,  and  sometimes  Acidum 
nitricum  usually  form  the  most  appropriate  remedies  to  forward  the 
process  of  healthy  granulation  and  cicatrization.  The  parts  may  be 
dressed  with  dry  lint.  Nourishing  and  easily  digestible  food  must 
be  allowed  in  such  cases,  and  even  wine  and  water,  or  a  little  pure 
wine  if  required,  as  is  sometimes  the  case  in  old  and  debilitated 
patients.  Mercurius  has  been  recommended  as  likely  to  be  useful  in 
zona,  and  may  occasionally,  along  with  Hepar,  prove  serviceable  when 
the  inflammation  has  run  high,  and  the  fluid  contained  in  the  vesicles 
has  become  converted  into  true  pus  :  Antimonium  tartaricum  when  at 
the  very  commencement  there  is  considerable  gastric  disturbance 
with  nausea  and  vomiting ;  and  Arsenicum  when  the  cutaneous  pains 
consist  of  a  severe  burning,  and  are  accompanied  by  uncontrollable 
restlessness,  dry  heat  of  skin,  and  great  thirst. 


ULCERS. 

Ulcera. 

An  ulcer,  or  sore  of  continuance,  may  be  the  result  of  a  wound, 
bruise,  burn,  or  abscess  ;  it  may  also  arise  from  a  bad  condition  of 
body,  particularly  when  combined  with  sedentary  habits,  and  gross 
or  otherwise  unwholesome  living.  In  the  latter  case,  its  formation 
is  preceded  by  a  greater  or  less  degree  of  pain,  heat,  redness,  and 
swelling  of  the  part.  In  many  instances  a  little  vesicle  or  pustule 
appears,  which,  on  bursting,  exposes  a  gap  or  breach  in  the  skin. 
Sometimes  there  is  at  the  commencement  a  single  small  excavation ; 
in  other  cases,  several  contiguous  ulcerated  spots  are  observed,  which 
speedily  become  blended  together,  and  form  a  sore  of  considerable 
magnitude. 

When  no  effort  at  cicatrization  or  healing  is  taking  place,  the  ulcer 
always  presents  an  excavation  or  hollow,  the  margins  of  which  are 
red,  sharp,  sometimes  thick,  prominent,  rounded,  or  callous,  and  often 
jagged  and  irregular.  The  surface  of  the  ulcer,  at  the  same  time, 
presents  a  dirty  white  or  yellowish  colour,  and  is  usually  covered 
with,  and  discharges  a  thin  watery  humour  or  sanies,  frequently 
tinged  with  blood,  and  sometimes  so  acrid  as  to  inflame  and  corrode 
the  skin.  While  the  process  of  ulceration  is  extending,  the  edge  of 
the  adjacent  skin  is  inflamed  and  painful ;  but  as  soon  as  a  tendency 


438  CUTANEOUS  DISEASES. 

to  heal  sets  in,  this  ceases,  and  healthy  granulations  form,  which 
present  a  florid  colour,  are  of  a  firm  consistence,  and  have  a  pointed 
shape,  resembling  minute  cones.  The  matter  secreted  is  altered  to  a 
bland,  thick,  and  whitish  or  cream-like  fluid  (healthy  pus)  not 
adherent  to  the  granulating  surface.  These  granulations  do  not  rise 
higher  than  the  surrounding  skin,  and  when  they  have  risen  to  the 
level  of  it,  those  at  the  margin  of  the  ulcer  become  covered  with  a 
smooth,  thin,  blueish  film,  which  is  at  first  semi-transparent,  but 
soon  changes  to  opaque  on  being  converted  into  new  skin. 

Therapeutics.  In  the  treatment  of  ulcers  in  general,  the  follow- 
ing are  some  of  the  most  important  remedies :  Arsenicum,  Carlo  v., 
Lachesis,  Mercurius,  Sulphur,  SiUcea,  Sepia,  Lgcojoodium. 

Arsenicum  is  chiefly  useful  when  the  ulcer  presents  a  livid  aspect, 
or  looks  bloody,  and  bleeds  at  the  slightest  touch,  and,  instead  of 
healthy  pus,  secretes  an  ichorous  discharge  mixed  with  blood ;  the 
edges  of  the  sore  are  at  the  same  time  hard  and  irregular,  and  the 
patient  complains  of  great  pain,  particularly  of  an  intense  burning 
description. 

Garbo  v.  is  indicated  under  similar  circumstances,  and  is  there- 
fore very  useful  in  alternation  with  the  former  remedy,  especially 
when  the  discharge  from  the  ulcer  is  of  a  very  offensive  nature,  and 
the  burning  pains  are  much  exacerbated  towards  evening  and  during 
the  night.  When  the  ulcer  is  large,  or  seems  disposed  to  extend 
rapidly,  or  when  it  is  surrounded  by  numerous  small  ulcerations  or 
pustules ;  further,  when  there  is  considerable  swelling  and  discolora- 
tion of  the  surrounding  parts,  the  leg  presenting  a  mottled,  dark- 
blue  or  purple  appearance, — Lachesis  forms  a  most  important  and 
eminently  useful  remedy. 

Mercurius  will  usually  be  found  very  serviceable  when  the  ulcer 
is  deep,  and  secretes  a  thin  and  offensive  discharge;  but  should 
healthy  granulation  not  supervene  on  the  filling  up  of  the  cavity 
under  the  action  of  Mercurius,  Sulphur  or  Silicea  may  be  prescribed, 
or  both  these  remedies  alternately.  When  the  discharge  continues 
thin  and  offensive,  notwithstanding  the  employment  of  Mercurius, 
Assqfcetida  may  be  administered,  provided  Arsenicum,  or  some  other 
remedy  does  not  merit  a  preference. 

Sulphur  is  almost  indispensable  in  nearly  every  case  of  long 
standing,  and  is  sufficient  of  itself  to  effect  a  cure  in  many  chronic 
cases.     It  is  more  particularly  indicated,  however,  when  excessive 


ulcees.  439 

itching,  burning,  or  gnawing  and  smarting  pains  are  experienced  in 
the  sore,  which  bleeds  much  when  dressed,  presents  no  distinct 
appearance  of  granulation,  secretes  a  thick,  yellow,  unhealthy  pus,  or 
a  fetid  sanies,  and  has  its  irregular,  elevated  margins  frequently  sur- 
rounded by  groups  of  pimples,  w7hich  add  to  the  irritation  created  by 
the  sore ;  further,  where  there  is  cedematous  swelling,  and  a  reddish- 
brown  discoloration  of  the  limb,  wThen  the  ulcer  is  seated  in  the 
inferior  extremities. 

Silicea  is  of  nearly  equal  importance  wTith  Sulphir,  in  the  treat- 
ment of  chronic  ulcers.  It  is  accordingly  of  the  utmost  service  in 
many  cases,  when  administered  in  alternation  w<ith  that  remedy,  and, 
in  those  of  a  very  obstinate  character,  with  Sepia  and  Acidum  mtricum. 
The  secretion  of  a  thick  and  discoloured  pus  is  a  useful  indication 
for  Silicea;  at  the  same  time,  when  the  discharge  consists  of  a  thin, 
acrid,  and  offensive  sanies,  this  remedy  is  of  like  utility,  particularly 
in  sores  with  imperfect  granulation,  or  the  repeated  formation  of 
large  and  flabby  vegetations.  When  the  pus  is  of  a  citron-yellow 
colour,  the  margins  of  the  ulcer  callous  or  inverted,  and  an  intoler- 
able itching,  sometimes  with  a  pain  of  a  burning  description,  is 
experienced  at  night  in  bed, — Lycopodium  may  be  given  with 
advantage.  In  superficial  chronic  ulcers,  Lycopodiwm,  is,  moreover,  one 
of  the  most  useful  medicaments. 

In  administering  the  remedies,  it  is  frequently  sufficient  to  give  a 
dose  every  eight  or  ten  days  ;  in  other  cases,  it  is  found  necessary  to 
dissolve  a  few  globules,  or  a  drop  or  twro  of  the  tincture  in  a  pint  or 
so  of  pure  water,  to  which  a  tablespoonful  of  spirits  of  wine  has 
been  added,  and  order  a  tablespoonful  to  be  taken  daily. 

When  the  ulcer  is  inflamed  or  extremely  painful,  a  soothing  effect 
is  often  derived  from  the  application  of  linen  dipped  in  warm  water ; 
and  if  the  ulcer  be  seated  in  the  leg,  the  affected  limb  should  be  kept 
at  rest,  and  not  allowed  to  remain  in  a  depending  position.  The 
application  of  lint  dipped  in,  and  kept  constantly  wet  with  cold 
water,  is  another  simple,  but  highly  useful  form  of  dressing,  and  is 
frequently  of  greater  efficacy  than  the  preceding,  especially  when  the 
ulcer  presents  a  sharp,  jagged,  and  undermined  appearance,  with  no 
distinct  formation  of  granulations,  but  exhibits  a  surface  consisting 
of  a  whitish  spongy  substance,  covered  with  a  thin  and  acrid  dis- 
charge, and  bleeds  on  being  dressed. 

When,  on  the  other  hand,  the  granulations  are  sufficiently  developed, 
but  of  a  pale  colour,  and  often  large  and  flabby,  with  a  smooth  and 


440  CUTANEOUS  DISEASES. 

glossy  surface,  the  edges  of  the  surrounding  skin  being  at  the  same 
time  thick,  prominent,  and  rounded,  the  pus  thin  and  watery,  inter- 
mixed with  flakes  of  coagulating  lymph,  which  adheres  closely  to  the 
surface  of  the  sore,  but  the  pain  is  trifling,  and  the  sore  comparatively 
insensible, — considerable  assistance  will  generally  be  derived  from  the 
employment  of  a  moderately  tight  and  properly  applied  bandage.  The 
promotion  of  healthy  granulation  and  cicatrization  is  further  mate- 
rially forwarded  by  the  external  employment  of  the  same  remedy  which 
we  are  prescribing  internally  (in  the  same  manner  as  described  under 
the  heading  of  Chilblains)  ;  but  in  other  cases  it  will  be  found  suffi- 
cient to  keep  the  dressings  constantly  wet  with  cold  water :  wre  must, 
however,  never  omit  the  internal  administration  of  the  appropriate 
remedy ;  as,  otherwise,  the  sore  will  be  liable  to  break  out  again  and 
again,  at  longer  or  shorter  intervals,  though  apparently  healed  up  in  a 
satisfactory  manner,  under  the  employment  of  the  unmedicated  cold 
dressing  alone.*  In  the  treatment  of  healthy  or  healing  ulcers,  dry  lint 
may  be  applied  to  the  wound,  and  the  dressing  changed  only  once 
in  forty-eight  hours,  when  the  secretion  of  pus  is  scanty  and  insuffi- 
cient to  moisten  the  lint  in  a  shorter  period. 

Ulcers  attended  with  or  arising  from  a  varicose  state  of  the  veins, 
are  usually  very  obstinate  and  difficult  to  heal,  particularly  when  it  is 
inconvenient  or  impossible  for  the  patient  to  be  kept  at  rest.  Under 
such  circumstances,  it  is  essential  that  a  properly  fitting  bandage  or 
laced  stocking  should  be  worn.  The  best  remedies  calculated  to  effect 
a  permanent  cure  are,  Arnica,  Pulsatilla,  Lachesis,  Sulphur,  and  Silicea; 
also  Arsenicum,  Carlo  v.,  and  Acid,  pkospkoricum.  The  two  first-named, 
when  given  alternately  about  once  a  week,  early  in  the  disorder,  are 
occasionally  sufficient  to  effect  a  cure,  but  for  the  most  part  it  is 
necessary  to  have  recourse  to  the  others,  either  to  complete  the  cure 
or  to  prevent  a  relapse.  The  indications  for  their  selection  are,  in 
this  form  of  ulcer,  much  the  same  as  already  given  in  the  treatment 
of  ulcers  in  general.  Acidum  phosphoricum  is  extremely  useful  in  cases 
of  more  or  less  lymphatic  ulceration,  particularly  when  the  patient 
has  previously  been  injuriously  affected  by  the  employment  of  Mercury 
under  allopathic  treatment. 

Acidum  nitricum  will  prove  of  essential  service  after  Acid,  jokos.  if 
required. 

*  In  chronic,  indolent  ulcers  on  the  inferior  extremities,  such  as  are  frequently  met  with 
in  elderly  persons,  the  treatment  ought  to  be  solely  internal  at  the  commencement,  and  the 
doses  administered  at  intervals  of  a  week  and  upwards. 


ULCERS.  441 

Sepia,  Arsenicum,  Petroleum,  Silicea,  and  Sulphur  are  most  serviceable^ 
when  proud  flesh  forms  on  the  ulcers. 

Against  the  following  varieties  of  ulcers  most  of  the  subjoined 
medicines  have  been  found  of  the  greatest  utility  :* 

Phagedenic  :  Arsenicum,  Silicea,  Mezereum,  Hepar  s.,  Sulphur ; 
also  Conium,  Acid,  nitricum,  and  Ranunculus. 

Scrofulous:  Sulphur,  Silicea,  Calcarea,  Lycopod.,  Carlo  v.,  Arseni- 
cum, Acid,  muriaticum,  Baryta  acetica,  and  Belladonna. 

Putrid  ulcers,  or  those  occurring  in  Cachectic,  Scorbutic  subjects: 
Sulphur,  Silicea,  Arsenicum,  Carlo  v.,  Hepar  s.,  Acidum  muriaticum,  Pul- 
satilla, and,  in  some  instances,  Ammon.  c.  et  m. 

Gangrenous  :  Arsenicum,  Lachesis,  Cinchona,  Silicea,  Belladonna, 
and  Conium ;  also  Rhus  toxicodendron,  Secale  cornutum,  and  Squilla. 

Carcinomatous  :  Arsenicum,  Lachesis,  Conium,  Sulphur,  Silicea., 
Diadema  aranea,  Mercurins  ;  also  Aurum,  Staphysagria,  and  Hepar  s. 

Fistulous:  Sulplmr,  Silicea,  Calcarea,  Lycopodium,  Pulsatilla,  and 
Antiwmiium.  In  fungous  ulcers  :  Sulphur,  Silicea,  Calcarea,  Graphites* 
Sepia,  Staphysagria,  Petroleum,  Antimonium,  lodium,  Thuja,  and  Acid, 
nitric. ;  and  in  Fungus  Jmmatodes :  Phosphorus,  Thuja,  and  Acid.  nitr. 

Mercurial:  Hepar  s.,  Acidum  nitricum,,  Acidum  phosphoricum,  Aurum, 
Carlo  vegetalilis,  Sulphur,  Silicea,  Belladonna,  Thuja,  Sarsaparilla,  and 
Acid,  fluoricum  (especially  about  the  ankle,  with  more  or  less  impli- 
cation of  the  bones.) 

Syphilitic  :  Mercurius  chiefly,  but  also  Acid,  nitricum,  to  promote 
healthy  granulation,  when  the  former  is  insufficient,  or  to  combat 
mercurial  complication,  when  the  patient  has  previously  been  sub- 
jected to  injurious  doses  of  that  remedy.  In  other  cases  Lachesis, 
Sulphur,  and  Thuja,  &c,  are  requisite  to  establish  the  cure.  (See 
Syphilis.) 

Indolent  (with  thick,  smooth,  prominent,  and  rounded  margins, 
a  flat  bottom,  smooth,  shining  granulations,  which  are  liable  to  be 
repeatedly  and  suddenly  absorbed  soon  after  their  formation,  leaving 
the  sore  as  much  increased  in  size  as  it  had  previously  diminished. 
The  pus  is  thin  and  aqueous,  and  contains  flakes  of  lymph  which 
adhere  tenaciously  to  the  surface  of  the  sore) :  Sepia,  Ac.  phosph., 
Lye,  Carlo  v.,  Ars.,  Lack,  Sulph.,  Silic,  chiefly. 

*  Characteristic  indications  for  many  of  the  remedies  quoted  will  be  found  in  Boening- 
hausen's  Manual  of  Homoeopathic  Therapeutics. 


442  CUTANEOUS  DISEASES. 

Inflamed  :  Aeon.,  Ars.,  Merc,  Hep.,  Sil.,  and  also,  Mez.,  Puis.,  Ant., 
Bella.,  or  Silic,  Sulph. 

Insensible:  Euphorbium,  Ars. 

Irritable  (painful,  bleeding  readily,  with  thin  ichorous  discharge, 
and  imperfect  or  indistinct  granulations) :  Ars.,  Assa.,  Lye.,  Hepar, 
Carlo  v.,  Merc.,  Phosph.,  Silic.,  Mez.,  Acid,  m.,  Lack.,  Puis.,  Acid,  nitr., 
Con.,  Sulph.,  Bella.,  Thuja,  Staph. 

Itching:  Sulph.,  Silic,  Ac.  phosph.,  chiefly,  but  also  Bye,  Sep., 
Graph.,  Ars.,  Alum.,  Puis.,  Staph.,  Bov.,  Ban. 

Itching  at  the  edges  only  :  Tart. 

—  at  night  only  or  chiefly :  Bye,  Staph. 

Burning  :  Ars.,  Carlo  v.,  or  Bye,  Sep.,  Sil.,  Clem.,  Graph.,  Mez., 
Hep.,  Acid.  %.,  Acid,  m.,  Bhus,  Puis.,  Nux,  Bov.,  Cham.,  Canth.,  Plumb., 
Ban.,  Lam. 

Burning  pain  during  the  night  only:  Bye,  Bhus,  Staph.,  Hepar. 

—  pain  or  heat  at  the  edges  :  Acid.  m. 

—  pain  when  touched  :  Bach.,  Lye 

Creeping  or  crawling  sensations  in  the  ulcers:  Bhus,  Clem., 
Cham.,  Con. 

Excoriation,  with  pains  resembling  a  recent :  Mez.,  Bhus,  Hep., 
Puis.,  Bella.,  &c. 

Gnawing  pain,  with:  Staph.,  Mere,  Phosph.,  Bye,  Bar.,  Kali, 
Bui.,  Sulph.,  &c. 

Jerking  pains,  with:  Staph.,  Cham.,  Clem.,  Ac.  m.,  Ac.  s.,  Am., 
Buta,  &c. 

Piercing  or  boring  pain,  with :  Sulph.,  Silic,  China. 

Throbbing  pain,  with :  Sulph.,  Clem.,  Hep.,  Merc,  China,  Bryon.,  &c. 

Shooting,  darting,  pricking  pains,  with  :  Ac.  nitr.,  Merc,  Silic, 
Hep.,  Pills.,  Sulph.,  Mix,  chiefly ;  but  also  Staph.,  Sep.,  Bye,  Ars.,  Mez., 
Clem.,  Graph.,  China,  Petr.,  Bam.,  Ban. 

Shooting  pain  at  night  only  or  principally :  Bhus. 

—  pains  at  the  edges,  and  only  when  touched :  Clem. 

—  or  pricking  pains  as  if  from  splinters :  Acid.  nitr. 
Smarting  :  Silic,  Graph.,  Staph.,  Bam.,  Bhus,  Puis.,  Cham.,  Bry. 

—  or  soreness  at  night  only  :  Bhus. 

Tearing,  rending  pain  in  the  ulcers:  Bye,  Sulph.,  Sep.,  Graph., 
Staph.,  Canth. 

Tearing,  during  the  night  only  or  chiefly :  Lycopodium. 
Tensive  pain  in  the  ulcers  :  Sulph.,  Con. 


ULCERS.  443 

Ulcers  which  present  a  blueish  or  livid  appearance :  Ars.,  Lack., 
Silicea,  chiefly ;  but  also  Con.,  Sulph.,  Here,  Assa.,  Aur. 
Ulcers  with  blueish  margins  :  Assa. 

—  which  have  a  greenish  aspect :  Ars. 

Ulceus  which  have  a  whitish  appearance :  Mere.,  Sabin.,  Ars. 

—  smooth  :  Ac.  phosph.,  Lach.,  Sil.,  San. 

—  superficial :  Ac.  ph.,  Ac.  nitr.,  Merc. 

—  tumid :  Lycop.,  Con.,  Bella. 

—  with  indurated  edges  :  Ars.,  Sil.  ;  and  also  Merc.,  Sulph.,  Sep., 
Assa.,  Thuja,  Puis.,  Petr.,  Lye,  Bryon.,  Sec. 

Ulcers  with  inverted  edges:  Lycopodium,  Ars. 

—  with  pale  edges :  Nux  v. 

—  with  elevated  edges :   Ars.,  Sil.,  Sulph.,  chiefly ;   but  also 
Merc,  Lye,  Sep.,  Puis.,  Thuja,  Assa.,  Petr.,  &c. 

Ulcers  wdth  jagged  edges  :  Mere,  Thuja,  Staph.,  Hep.,  Acid,  ph., 
Sulph.,  Sil.,  Lach. 

Ulcers  surrounded  by  papilla:  Sulph.,  Lach.,  Sep.,  Ars.,  Puis.,  Rhus, 
Sil.,  Lye,  &c« 

Ulcers  with  unhealthy  pus. 

Pus,  serous,  aqueous,  sanious:  Mere,  Acid,  nitr.,  Sulph.,  Sil.,  Ars., 
Carlo  v.,  Lye,  Graph.,  Clem.,  Ruta,  Assa.,  Rhus,  Ran.,  &c. 

Pus,  albuminous :  Ars.,  Amm.,  Sulph.,  Sil.,  Sep.,  Cale,  Lye,  Puis., 
chiefly. 

Pus,  brownish :  Ars.,  Carb.  v.,  Sil.,  Bry.,  Sec. 

—  excessive  secretion  of:  Sep.,  Puis.,  Sil.,  Ac. ph.,  Lye,  Chin.,  Arg., 
Canth.,  Staph.,  Calen.,  Scill.,  Mere,  Phosph.,  Sec. 

Pus,  gelatinous :  Arg.,  Mere,  Sep.,  Sil.,  chiefly. 

—  gray :  Ambr.,  Lye,  Mere,  Sil.,  &c. 

—  yellow :  Puis.,  Lye,  Ars.,  Kreos.,  Natr.,  Nitr.,  Thuja,  JDule,  Aur., 
Sep.,  Sil.,  Clem.,  &c. 

Pus,  acrid,  ichorous :  Ars.,  Mere,  Sil.,  Rhus,  Staph.,  Sep.,  Sulph., 
Graph.,  Clem.,  Kreos.,  Acid,  nitr.,  Natr.,  Ac.  sulph.,  Hep.,  Lye,  Ran.,  &c* 

Pus,  sanguineous :  Ars.,  Assa.,  Hep.,  Merc.  ;  and  Sulph.,  Sep.,  Lach., 
Sil.,  Lye,  Rhus,  Kali,  Car  bo  v.,  Sec. 

Pus,  scanty  secretion,  or  suppression  of:  Lach.,  Mere,  Sil.,  Cale; 
and  Carbo  v.,  Clem.,  Sassa.,  Phosph.,  Petr.,  Staph.,  Magn.,  Led.,  Bar., 
Graph.,  &c. 

Pus,  fefyd:  Sulph.,  Ac.  phosph.,  Hep.;  and  Carbo  v.,  Ac.  nitr.,  Aur., 
Ac.  m.,  Kreos.,  Staph.,  See  com.,  Con.,  Sil.,  Sec. 


DISEASES  OF  THE  URINARY  AND  GENITAL  ORGANS. 


INFLAMMATION  OF  THE  KIDNEYS. 
NepJmtis. 

Diagnosis.  Pressing,  pungent  pain  in  the  renal  region,  shooting 
along  the  urethra  to  the  bladder,  dysuria,  strangury,  and  ischuria 
(when  both  kidneys  are  affected),  hot  and  high-coloured  or  red  urine  ; 
drawing  up,  swelling,  and  pain  of  the  testis  on  the  affected  side ; 
numbness  and  spasms  of  the  foot  on  the  same  side ;  nausea,  vomit- 
ing, colic,  and  tenesmus :  lying  on  the  part  affected  and  motion 
aggravate  the  pains. 

Causes.  Excessive  use  of  stimulants ;  shocks  of  the  body,  falls, 
or  strains,  external  injuries ;  long  lying  on  the  back,  abuse  of  diu- 
retics or  cantharides,  suppressed  hemorrhoids  or  menstruation, 
metastases  or  calculi. 

Therapeutics.  The  principal  remedies  in  this  affection  are, 
Aconitum,  Cantharides ',  Nux  vomica,  Pulsatilla,  Belladonna,  ffepar  sul- 
jphuris,  Cannabis,  Merctirius,  Arnica  montana. 

Aconite.  In  the  inflammatory  stage  of  this  affection,  this  re- 
medy should  be  administered  in  repeated  doses,  in  the  same  manner 
as  in  Inflammatory  Fever ;  after  which,  in  the  majority  of  cases,-— 

Cantharides  will  be  found  most  efficacious  in  prosecuting  the 
treatment,  and  may  indeed  be  had  recourse  to  at  the  very  commence- 
ment of  the  attack,  even  when  the  accompanying  fever  is  consider- 
able, particularly  when  the  urine  passes  off  in  drops,  or  is  tinged 
with  blood,  or  when  micturition  is  exceedingly  painful,  with  burning 
pain  in  the  urethra,  and  when  there  are  the  general  symptoms  of 


INFLAMMATION  OF  THE  KIDNEYS.  445 

shooting,  cutting,  and  tearing  pains  in  the  loins  and  region  of  the 
kidneys,  or  even  in  cases  of  complete  strangury. 

R  Canth.  Tinct.  6,  gtt.  iv. 
Aq.  pur.  Jiv. 
Dosis.    3SS  ter  quaterve  vel  ssepius  quotidie,  pro  re  nata. 

The  proved  value  of  this  medicine,  when  used  homceopathically, 
in  the  cure  of  this  painful  disorder,  is  another  of  the  many  exempli- 
fications of  the  truth  of  the  homoeopathic  law :  its  power  of  causing 
diseases  of  the  urinary  organs,  even  when  applied  in  the  form  of 
blister,  being  so  well  known,  that,  in  all  medical  works,  it  has  been 
noted  as  an  exciting  cause  of  this  affection. 

Cannabis  is  of  nearly  equal  importance  to  Cantharides  in  ne- 
phritis. It  is  especially  called  for  when  a  dragging  pain,  or  an  obtuse 
aching  or  pressive  pain,  or  a  sensation  as  if  from  excoriation  is  expe- 
rienced, extending  from  the  region  of  the  kidneys  down  towards  the 
groin,  accompanied  by  painful  and  difficult  urination. 

Form  of  prescription,  the  same  as  Cantharides. 

Nux  vomica  :  —When  the  affection  can  be  traced  to  a  suppression 
of  a  hemorrhoidal  discharge,  determination  of  blood  to  the  abdomen, 
excess  of  wine  or  stimulants,  and  sedentary  habits,  and  where  we 
find  constipation,  feeling  of  faintness,  nausea,  vomiting,  distension  of 
the  abdomen,  and  drawing  up  of  the  testis  and  of  the  spermatic  cord. 
(Cocculus  and  Arsenicum  are  sometimes  required  after  Nux  v.) 

Pulsatilla,  In  females  of  phlegmatic  temperament,  when  the 
complaint  is  connected  with  irregular  or  suppressed  menstruation. 

The  dose  of  the  two  latter  remedies  may  consist  of  a  few  globules 
or  a  drop,  (sixth  dilution  or  potency),  repeated  every  twelve  hours, 
while  necessary. 

Belladonna  :  When  shooting  pains  are  experienced  in  the 
kidneys,  extending  to  the  bladder, — and  further,  when  nephritis  is 
accompanied  with  colic  and  cardialgia,  heat  and  distension  in  the 
region  of  the  kidneys,  scanty  micturition,  the  urine  presenting  an 
orange  yellow,  or  sometimes  a  bright  red  colour,  and  depositing  red 
or  whitish  thick  sediment ;  anxiety,  restlessness,  and  periodical 
aggravation — constipation. 

Form  of  prescription,  same  as  Cantharides. 

Hepar  sulphuris  is  useful,  when  we  have  reason  to  apprehend 
the  formation  of  an  abscess  or  the  commencement  of  suppuration : 
here  the  diagnosis  is  difficult,  and  the  professional  student  must  be 


446  URINARY  AND  GENITAL  ORGANS. 

careful  not  to  mistake  the  apparent  alleviation  of  suffering  for  the 
subjugation  of  the  disease.  The  following  symptoms  may  serve  as 
a  guide  in  these  cases :  cessation  of  the  acute  pain,  a  sensation  of 
throbbing  and  a  feeling  of  weight  in  the  region  of  the  kidneys ; 
alternate  chills  and  slight  flushes  of  heat,  and  copious  perspiration. 

R  Pulv.  Hep.  Sulph.  3,  gr.  iv. 
Divide  in  partes  sequal.  octo,  quarum  sumat  unam  tertiis  horis. 

Mercurius  is  also  valuable  in  this  stage,  but  more  particularly 
when  diarrhoea  and  tenesmus  are  present. 

Colchicum.  When,  in  addition  to  the  usual  symptoms  of  this 
disease,  there  is  excessive  nausea  with  tympanitic  distension  of  the  abdo- 
men, and  painful  and  scanty  emission  of  bright  red  urine. 

Form  of  prescription,  same  as  Cantharides. 

When  the  disease  has  assumed  a  chronic  form,  and  induration  of 
the  kidneys  has  taken  place,  Mercurius  will  often  be  found  useful, 
followed  by  Aurum,  unless  some  marked  indication  calls  for  the 
employment  of  another  medicine. 

In  Nephritis  arising  from  contusions  or  violent  concussions  of  the 
body,  Arnica  is  the  principal  remedy. 

In  cases  arising  from  the  abuse  of  Cantharides  in  blistering  we  may 
exhibit  a  drop  or  two  of  the  saturated  solution  of  Camphor,  and  every 
hour  rub  the  inside  of  the  thighs  with  the  same  preparation,  twice 
a  day,  until  relief  is  attained. 

Observation.  This  disease  sometimes  arises  from  the  presence 
of  calculi  in  the  kidneys ;  in  which  case  the  symptoms  of  fever  do 
not  occur,  until  a  considerable  time  after  severe  pain  has  been  expe- 
rienced;— further  a  numbness  of  the  thigh,  and  a  retraction  of  the 
testicle  of  the  affected  side,  are  considered  as  distinguishing  marks  of 
the  existence  of  a  calculus  in  the  kidney  or  ureter :— here  the  use  of 
Nociatiana  rustica  has  repeatedly  been  found  a  useful  palliative,  admi- 
nistered every  half  hour.  But  one  or  more  of  the  subjoined  medica- 
ments may  be  found  more  appropriate,  and  of  a  more  permanent  be- 
nefit: Zycop.,  Sassa.,  Cannah.,  Mez.,  Bella.,  Calc.  In  conclusion,  the  fol- 
lowing remedies  (the  utility  of  which  in  various  forms  of  nephritis  or 
nephralgia,  either  chronic  or  otherwise,  clinical  observation  has  con^ 
firmed)  may  be  pointed  out,  as  meriting  the  attention  of  the  profes- 
sional student :  Calcarea  Carhonica,  Lycopodium,  Capsicum,  Colchicum, 
Phosphorus,  Sepia,  Uva  ursi,  Kali  carbonicum  et  nitricum,  wad  Graphites. 

Patients  suffering  from  Nephritis  should  strictly  avoid  wine,  malt 
liquor,  and  spirits. 


INFLAMMATION  OF  THE  BLADDER.  447 

In  the  event  of  suppuration,  the  following,  in  addition  to  Hepar  s-., 
have  been  recommended :  Arsenicum,  Sulphur,  Silicea,  Kali  nitrimim, 
and  Sarsaparilla. 


INFLAMMATION  OF  THE  BLADDER. 


Burning  pain  in  the  region  of  the  vesica,  with  tension,  heat,  pain 
when  touched,  and  external  tumefaction;  frequent  and  painful  dis- 
charge of  urine,  or  suppression,  and  generally  tenesmus ;  fever,  and 
sometimes  vomiting,  as  in  Nephritis.  The  causes  of  this  complaint 
closely  resemble  those  of  Nephritis,  but  it  occurs  more  frequently  in 
parturition  than  the  latter  affection. 

Therapeutics.  We  should  have  recourse  to  Aconitum,  as  in 
Nephritis,  when  a  considerable  degree  of  inflammatory  fever  is  pre- 
sent, followed  by — 

Cantharides,  which  here,  as  in  the  above-mentioned  disease,  is 
the  leading  remedy. 

Nux  vomica  :  When  the  affection  is  attributable  to  habitual 
indulgence  in  wine  or  spirituous  liquors,  this  remedy,  timely  admi- 
nistered, will,  in  many  instances,  check  its  further  progress ;  and 
also,  when  it  results  from  suppressed  hemorrhoids,  or  other  habitual 
discharges,  or  from  dyspeptic  derangements.  It  may  be  followed,  if 
required,  by  Sulphur  and  Calcarea.  The  two  last-named  remedies  are 
well  adapted  to  the  treatment  of  the  chronic  form  of  the  complaint. 

Pulsatilla,  is  valuable  in  checking  the  development  of  the 
affection,  when  arising  from  suppressed  menstruation  ;  and  is,  more- 
over, serviceable  in  all  cases,  from  whatever  cause  arising,  when 
occurring  in  individuals  of  phlegmatic  temperament,  with  the  follow- 
ing symptoms:  frequent  desire  to  urinate,  painful  and  scanty 
emission  of  slimy  or  sanguinolent  urine,  which  deposits  a  purulent- 
looking  sediment ;  burning  and  cutting  pains  in  the  hypogastrium, 
with  external  heat  and  tumefaction  ;  suppression  of  urine. 

Hyoscyamus  : — When  there  is  difficult  urination,  but  the  disease 
is  not  far  advanced,  particularly  when  we  have  reason  to  suspect, 
that  this  symptom  arises  from  spasmodic  constriction  of  the  neck 
of  the  bladder,  or  when  in  fact  it  is  more  of  a  spasmodic  than  inflam- 
matory character.     Digitalis  is  serviceable  when,  in  addition  to  the 


448  URINARY  AND  GENITAL  ORGANS. 

ischuria,  a  constrictive  pain  is  felt  in  the  bladder ;  and  Arsenicum  and 
Carlo  v.  have  been  found  very  efficacious  in  allaying  the  burning  in 
the  urethra  during  urination,  when  Sulphur,  Calcarea,  or  any  of  the 
foregoing  remedies  have  not  succeeded  in  arresting  it.  Arsenicum  is, 
further,  of  great  service  when*  there  is  intense  thirst,  and  a  distress- 
ing degree  of  anxiety  and  restlessness. 

Form  of  prescription  of  the  first-named  remedies,  the  same  as  in 
Nephritis  :  of  Hyoscyamus,  Digitalis ',  Sulphur,  Calcarea,  Arsenicum 
and  Carlo  v.,  the  same  as  Nux  v.  and  Pulsatilla.  Hellelorus  niger,  as 
also  Veratrum  and  Capsicum^  have  been  favorably  spoken  of  in  cases 
which  come  on  gradually,  but  subsequently  become  very  severe, 
attended  with  frequent  urging  to  urinate,  and  spasmodic  pains, 
during  which  only  a  small  quantity  of  wrater  is  passed ;  to  these 
symptoms  are  added,  continual  inclination  to  vomit,  aversion  to  all 
kinds  of  food,  excessive  distension  of  the  abdomen.  When  the 
disease  has  arisen  from  the  application  of  Cantharides  as  a  blister  in 
allopathic  practice.  Camphor  must  be  resorted  to  as  described  under 
Nephritis.  And  when  it  arises  from  the  presence  of  stone  or 
gravel,  the  same  remedies  as  those  mentioned  at  the  termination  of 
the  preceding  chapter,  are  the  most  useful.  Arsenicum  all.,  Nux  v., 
Sulph.,  Sepia,  Silicea,  and  Kali  nitricum  are  the  remedies  on  which  our 
chief  reliance  may  be  placed  when  suppuration  sets  in.  And  Helle- 
horus  niger,  Capsicum,  Staphysagria,  Lycopodium,  or  Baryta,  when 
BlenorrJma  supervenes. 

Chronic  Inflammation  of  the  Bladder  is  accompanied  by  an  extremely 
irritable  state  of  that  organ,  together  with  a  profuse  secretion  of 
mucus  which  is  discharged  along  with  the  urine.  From  the  latter 
circumstance  the  designation  of  Catarrhus  vesicae  has  been  given  to 
this  form  of  the  disease.  The  remedies  which  are  most  serviceable 
in  the  treatment  of  chronic  cystitis  are,.  Dulcamara,  Pulsatilla,  Sulphur  ; 
or  Merc,  Calc,  Nux,  Phosph.,  Can,,  Kali,  Antimon.  c,  etc. 


RETENTION  OF  URINE.  449 


RETENTION  OF  URINE. 

Ischuria. 

When  an  obstruction  to  the  flow  of  urine  takes  place,  the  fluid 
accumulates  and  distends  the  bladder  to  such  an  extent,  that  it  rises 
up  above  the  pubis,  and  forms  a  perceptible  swelling  in  the  hypo- 
gastric region;  the  entire  abdomen  becomes  tumid  and  tender  to  the 
touch,  and  a  considerable  degree  of  fever  is  present ;  the  inclination 
to  pass  water  is  frequent  and  urging,  but  utterly  ineffectual,  and 
accompanied  by  intense  pain . 

Ischury  is  always  to  be  held  as  a  dangerous  affection  when  it  con- 
tinues for  any  length  of  time,  for  if  relief  be  not  administered,  inflam- 
mation and  consequent  mortification  ensues,  the  urine  finds  an  outlet 
into  the  abdomen,  and  death  soon  follows. 

The  causes  of  retention  of  urine  are,  usually,  inflammation  or 
stricture  of  the  urethra,  enlargement  of  the  hemorrhoidal  veins; 
suddenly  suppressed  hemorrhoids,  either  by  extirpation  or  other- 
wise ;  over-distension,  spasm  of  the  neck  of  the  bladder,  inflammation 
or  hernia  of  the  bladder,  paralysis  of  the  bladder,  absorption  of  can- 
tharides  applied  externally,  or  taken  internally,  excess  in  vinous  or 
spirituous  liquors,  the  pressure  of  the  rectum,  from  a  lodgement  of 
indurated  faeces,  or  of  the  uterus,  tumours,  etc.  on  the  neck  of  the 
bladder;  swelling  or  ulcer  of  the  prostate  gland,  calculi,  or  particles  of 
gravel  lodging  at  the  neck  of  the  bladder,  or  in  the  urethra. 

Therapeutics.  The  following  remedies  may  be  quoted  as  those 
which  are  best  adapted  to  overcome  all  ordinary  cases  of  ischury : 

Aconitum,  Carnphora,  Cdntharides,  Sulphury  Calc.  c,  Nux  v.,  Carl.  v.?  and 


Aconitum  is  peculiarly  efficacious  when  there  is  considerable  fever, 
with  burning  heat  in  the  region  of  the  bladder,  outwardly  percep- 
tible to  the  touch.  In  the  case  of  children,  where,  in  addition  to  the 
foregoing  symptoms,  there  is  also  distension  of  the  abdomen,  with 
suppression  both  of  faeces  and  urine,  this  medicine  is,  moreover,  one 
of  our  most  important  remedies.  In  urgent  cases,  a  dose  of  this 
remedy  may  be  exhibited  every  half  hour  or  so,  until  the  symptoms 
yield. 

29 


450  URINARY  A^D  GENITAL  ORGANS. 

Camphora  forms  a  valuable  general  remedy  where  no  occasional 
cause  of  the  disorder  can  be  detected,  but  it  is  also  of  great  service 
where  the  complaint  ef idently  arises  from  spasmodic  action,,  Burning 
heat  in  the  abdomen  and  urethra,  with  shivering  coldness  of  the  sur- 
face, and  shivering  succeeded  by  a  hot  fit,  do  not  contraindicate  the 
employment  of  Camphora,  but  as  soon  as  the  incipient  symptoms  of 
fever  become  more  developed,  Aconitum  must  be  had  recourse  to.  In 
administering  Camphora,  we  shall  frequently  find  it  sufficient,  particu- 
larly with  children  or  very  sensitive  subjects,  to  make  the  patient 
smell  the  camphorated  spirit;  in  other  cases  a  drop  or  two  of  the  first 
attenuation,  or  of  the  common  spirits  of  camphor,  may  be  given  on  a 
piece  of  sugar,  and  repeated  twice  or  thrice  in  a  space  of  a  quarter  of 
an  hour.  The  attempted  cure  of  hemorrhoids  by  the  knife  or  ligature 
forms  a  not  unfrequent  source  of  urinary  complaints,  and  of  ischuria 
amongst  others.  When  retention  of  urine  has  arisen  from  such  a  cause, 
or  from  excessive  enlargement  of  the  hemorrhoidal  veins,  the  urine 
should  be  drawn  off  by  the  catheter,  and  the  pain  relieved  by  the 
administration  of  Sulphtr,  in  alternation  with  Aconite.  Should  these 
not  permanently  relieve,  and  the  pain  consist  of  a  severe  burning 
description,  Carho  v.  and  Arsenicum  must  be  prescribed.  Nux  v.  is 
extremely  useful  when  the  patient  has  been  addicted  to  the  habitual 
use  of  spirituous  liquors  ;  and  is,  moreover,  one  of  the  most  service- 
able medicaments,  in  conjunction  with  Sulphur,  Pulsatilla,  Carb.  v., 
Arsenicum,  etc.,  according  to  the  characteristic  features  of  the  case,  in 
effecting  a  radical  cure  where  that  is  practicable.  When  ischury  has 
been  caused  by  over-distension,  from  want  of  opportunity  of  empty- 
ing the  bladder  while  travelling,  etc.,  the  catheter  should  be  intro- 
duced to  draw  off  the  accumulated  urine,  and  the  contractility  of  the 
bladder  restored  by  means  of  Kyoscyamus,  Arnica,  Dulcamara,  or  Arseni- 
cum. The  repeated  application  of  cold  water  to  the  hypogastric  region 
may  also  prove  beneficial  in  this  respect.  When  surgical  assistance 
is  not  at  hand,  or  wThen,  particularly  in  the  case  of  females,  the  intro- 
duction of  the  catheter  is  objected  to  from  feelings  of  delicacy,  Aconi- 
tum or  Camphora  ought  to  be  tried  first,  and  will  very  frequently 
supersede  the  necessity  of  resorting  to  mechanical  interference,  and, 
moreover,  materially  tend  to  ward  off  any  evil  effects  which  might 
otherwise  arise  in  consequence  of  the  prolonged  retention.  The 
application  of  hot  fomentations  to  the  pubic  region,  and  the  use  of  the 
hip-bath,  or  large  injections  of  tepid  water  are  sometimes  sufficient  to 
promote  the  expulsion  of  the  urine.     Retention  of  urine  depending 


DYSURIA.  451 

upon  spasm  of  the  neck  of  the  bladder  frequently  yields  to  the  use  of 
Camphora,  but  other  remedies,  such  as  Aconitum,  etc.  may  be  required 
in  particular  cases.  When  the  disorder  is  occasioned  by  distension 
of  the  rectum  from  alvine  concretions,  or  flatus  pressing  upon  the 
neck  of  the  bladder,  the  effectual  removal  of  the  primary  disorder 
must  be  obtained  by  means  of  Opium,  Nux  v.,  Pulsatilla,  Plumb,  c, 
Sulphur,  and,  where  required,  Aconitum.  The  employment  of  unmedi- 
cated  enemata,  and  of  the  catheter,  may  frequently  be  found  requisite 
as  auxiliary  means  of  relief. 

If  ischuria  arise  from  distension  of  the  uterus  in  consequence  of  an 
accumulation  of  the  menstrual  fluid,  or  from  gas  or  flatus,  retroversio 
uteriy  tumours  (polypi),  etc.,  pressing  against  the  neck  of  the  bladder  or 
the  urethra, — Sepia,  Puis.,  Bella.,  Nux  v.,  Sulph.,  Phosphorus,  Lycopodium, 
— Staphysagria,  Calcarea,  Belladonna,  Cantharides,  etc.,  are  the  remedies 
by  which  a  radical  cure  is  most  likely  to  be  accomplished.  In  the 
instance  of  retention  of  urine  from  hernia  of  the  bladder,  the  urine 
should  be  taken  away  by  means  of  the  catheter,  the  protruded  bladder 
reduced,  and  a  truss  applied ;  if  the  hernia  be  irreducible,  the  swelling 
should  be  supported  by  a  suspensory  bandage,  but  we  may  frequently 
succeed  in  effecting  the  reduction,  and  of  materially  guarding  against 
relapses  by  the  aid  of  such  remedies  as  Nux  v.,  Aconitum,  Opium,  Sul- 
phur, Plumbum,  etc.     (See  Hernia.) 

If  inflammation  or  enlargement  of  the  prostate  be  the  evident 
cause,  Aconitum,  Pulsatilla,  and  Thuja  will  be  found  useful.  If  para- 
lysis of  the  bladder,  Hyoscyamus,  Arsenicum,  Dulcamara,  or  other 
remedies,  according  to  the  original  disorder  which  has  been  produc- 
tive of  the  paralytic  affection.  And  when  inflammation  of  the  bladder 
or  kidneys,  or  inflammation  or  stricture  of  the  urethra,  have  given  rise 
to  the  retention,  see  Cystitis,  Gonorrhcea,  and  Stricture. 

Calculi  lodging  in  the  urethra,  and  occasioning  obstructed  micturi- 
tion, require  to  be  extracted  or  cut  out. 


DIFFICULTY  IN  DISCHARGING  THE  URINE. 
Dysuria.     Stranguria. 

Dysury,  or  difficulty  in  discharging  water,  may  arise  from  various 
causes,  such  as  inflammation  of  the  urethra  arising  from  gonorrhcea, 
or  the  employment  of  acrid  injections,  inflammation  of  the  kidneys 
or  bladder,  spasm  in  the  neck  of  the  bladder,  enlargement  of  the 


452  URINARY  AND  GENITAL  ORGANS. 

hemorrhoidal  veins,  a  collection  of  hardened  faeces  in  the  rectum ; 
excess  in  drinking  intoxicating  beverages,  tumour  or  other  diseases  of 
the  prostate  gland,  the  suppression  of  an  eruption  or  of  some  habitual 
discharge,  or  the  prolonged  application  of  cold,  particularly  in  gouty 
habits,  the  lodgement  of  particles  of  gravel  at  the  neck  of  the  bladder 
or  in  the  urethra,  and  the  abuse  of  cantharides,  either  externally  or 
internally,  etc.  etc. 

Dysury  is  commonly  attended  with  frequent  inclination  to  urinate, 
smarting  pain,  heat  and  difficulty  in  voiding  the  water,  and  a  sense 
of  fulness  in  the  region  of  the  bladder.  When  there  are  painful  or 
uneasy  urgings,  and  the  urine  passes  off  only  in  drops  or  in  minute 
quantities,  the  disorder  is  usually  termed  strangury.  When  the 
disease  is  induced  by  the  presence  of  a  calculus  in  the  kidney  or 
urethra,— nausea  or  vomiting,  and  a  sharp  pain  in  the  lumbar  region, 
as  also  in  that  of  the  kidney  or  urethra,  accompany  the  before-men- 
tioned symptoms.  When  from  a  similar  cause,  having  its  seat  in  the 
bladder,  or  when  produced  by  gravel  lodged  in  the  urethra,  an  acute 
pain  is  experienced  at  the  extremity  of  the  penis,  especially  during 
the  emission  of  the  last  drops  of  urine,  and  the  stream  of  urine  is  either 
spiral  or  bifurcated.  Should  scirrhous  enlargement  of  the  prostate 
have  given  rise  to  the  complaint,  a  hard,  painless  tumour  may  be 
detected  by  the  introduction  of  the  finger  into  the  rectum,  or  it  may 
even  be  felt  on  pressing  the  hand  against  the  perinaeum. 

Therapeutics.  As  this  disease  is  almost  always  symptomatic, 
the  treatment  must  be  directed  against  the  primary  affection.  We 
shall  accordingly  confine  ourselves  in  this  place  to  a  brief  description 
of  the  indications  of  the  remedies  which  have  been  employed  with 
the  greatest  success  in  ordinary  cases.  When  there  is  frequent 
inclination  to  make  water,  with  great  pain  and  difficulty  in  voiding 
it,  the  discharge  being,  at  the  same  time,  very  small  in  quantity, 
often  passed  only  in  drops,  and  presenting  a  dark-red,  muddy  ap- 
pearance, the  symptoms  will  generally  yield,  or  at  all  events  become 
materially  relieved  by  the  employment  of  Acomtv/m*  When  a  sense 
of  fulness  in  the  hypogastric  region  is  complained  of,  together  with 
a  cutting,  burning,  or  aching  pain,  Pulsatilla  may  be  prescribed  with 
advantage ;  and  Belladonna  when  a  darting  or  pricking  pain  extend- 
ing from  the  lumbar  region  to  the  bladder,  agitation  and  colic 
are  encountered.  Hepar  s.  has  been  found  productive  of  permanent 
benefit  when  Bella,  gave  but  temporary  relief.     If  the  calls  to  make 


DYSURIA.  453 

water  be  extremely  urgent,  and  the  urine  is  passed  in  a  very  small 
stream,  is  acrid,  dark-coloured,  soon  becomes  cloudy,  and  exhales 
an  offensive  odour,  Mercurius  may  be  prescribed.  Eepar  s.  is  frequently 
useful  after,  or  in  alternation  with  Mere.  For  dysuria,  with  almost  in- 
cessant inclination  to  make  water,  Petroselinum  is  often  very  serviceable ; 
and  when  the  performance  of  the  act  of  urination  is  at  the  same 
time  extremely  difficult,  the  urine  invariably  passing  only  in  single 
drops,  attended  with  severe  burning  pain  in  the  region  of  the  bladder 
and  in  the  urethra,  Cantharides  can,  with  difficulty,  be  dispensed  with. 
The  several  causes  of  the  disorder  must  always  be  attended  to,  and  will, 
where  known,  prove  of  great  assistance  in  selecting  the  homoeopathic 
remedy.  We  shall  accordingly  find  that  when  excess  in  drinking 
(either  vinous  or  spirituous  liquors)  has  given  rise  to  it :  Nuxv.,  Opium, 
or  Sulphur  and  Pulsatilla  are  the  most  applicable.  When  disease 
of  the  prostate  gland,  and  when  enlargement  of  the  hemorrhoidal 
veins,  or  suppressed  hemorrhoids:  Nux  v.,  Pulsatilla,  Sulphur,  or 
Aconitum,  Carbo  v.,  Lachesis,  Arsenicum,  Lycopodium,  Calcarea,  Mer- 
curius. (See  art.  Hemorrhoids.)  Again,  when  the  disease  has 
been  excited  by  a  fall  or  a  blow  on  the  back  or  region  of  the  bladder, 
Arnica,  and  when  it  has  arisen  in  consequence  of  a  fright,  Aconitum, 
are,  for  the  most  part,  the  most  serviceable  remedies.  The  abuse  of 
Cantharides  applied  externally  or  taken  internally  is  not  an  unfrequent 
source  of  the  complaint,  and  is  chiefly  to  be  removed  by  Spirits  of 
Camphor,  which  is,  moreover,  the  principal  remedy,  particularly  at 
the  commencement  of  the  cure,  when  other  poisons  have  occasioned 
an  attack  of  dysuria.  Aconitum  and  Pulsatilla  are  sometimes  required 
after  Camphor.  When  a  chill  or  the  prolonged  application  of  cold 
has  induced  the  disease,  a  preference  must  be  given  to  Aconite,  Bella- 
donna, or  Dulcamara,  or  to  Nux  v.,  Pulsatilla,  Mercurius,  Sulphur,  Cal- 
carea,  or  Sarsaparilla.  And  when  inflammation  of  the  prostate  gland* 
forms  the  primary  cause,  Pulsatilla  and  Thuja  often  prove  of  essential 
service.  The  age  and  sex  of  the  patient  is  also  a  frequent  guide  to 
the  selection  of  particular  remedies.     Thus,  in  old  men,  Lycopodium 

*  At  the  commencement  of  Prostatitis,  Belladonna  may  be  prescribed  with  advantage, 
when  the  pain  is  increased  by  the  slightest  pressure  over  the  seat  of  the  gland,  and  when 
there  is  considerable  fulness  or  swelling  in  the  region  of  the  neck  of  the  bladder.  Cannabis 
is  also  worthy  of  attention  under  similar  circumstances.  If  the  pains  are  less  severe,  con- 
sisting more  of  an  obtuse  aching  description,  Mercurius  is  useful.  WThen  prostatitis  occurs 
as  a  sequela  of  suppressed  gonorrhoea,  Pulsatilla  and  Lycopodium  have  been  particularly 
recommended.  In  chronic  inflammation  of  the  prostate,  and  consecutive  induration,  Thuja h 
Merc,  Carbo  v.,  Calc.  c,  and  Conium  form  the  principal  remedies. 


454  URINARY  AND  GENITAL  ORGANS. 

and  Opium  are  almost  always  called  for  at  one  period  or  other  of  the 
treatment.  In  ataxic  females  or  pregnant  women,  Pulsatilla,  Cal- 
carea,  Acid,  jokosp/wricum,  or  Sulphur,  Conium,  Ntccc  v.  ;  and  in  children, 
Aconitwm,  Belladonna,  Nux  v.,  Pulsatilla  are  the  medicaments  which 
have  hitherto  been  most  frequently  used  with  the  best  results.  In 
acute  cases  the  diet  must  be  sparing,  and  sometimes  consist  ex- 
clusively of  demulcent  drinks,  such  as  gruel,  &c,  especially  if  the 
pain  is  very  severe.  Warm  fomentations  and  injections  of  tepid 
water  sometimes  give  considerable  relief.  In  all  cases  salt  should 
be  partaken  of  in  great  moderation,  and  acids  altogether  eschewed. 
In  chronic  cases  considerable  relief  is  often  obtained  from  drinking 
copiously  of  cold  water  throughout  the  day.  Exposure  to  currents 
of  air  ought  always  to  be  avoided  by  those  who  are  subject  to  urinary 
complaints.  (See  Nephritis,  Cystitis,  and  also  the  indications 
which  have  been  given  for  the  remedies  employed  in  Hematuria.) 


SUPPRESSION  OF  URINE. 

A  partial  and  occasionally  even  a  complete  suppression  of  urine  fre- 
quently takes  place  in  fever.  It  also  occurs  in  dropsy,  and  in  inflamma- 
tion of  various  organs,  such  as  the  kidneys,  &c. ;  and  finally,  it  may  arise 
from  loss  of  secreting  power  in  the  kidneys.  The  term  is  now,  for 
the  most  part,  confined  to  the  latter  form  of  the  complaint ;  and  it  is 
our  intention  in  this  place  to  restrict  ourselves  to  that  variety.  The 
disease  commonly  takes  place  in  individuals  beyond  the  meridian  of 
life  ;  but  it  is  occasionally  met  with  at  a  less  mature  age,  and  is  some- 
times encountered  even  in  children.  Gouty  habits  appear  to  be  most 
liable  to  be  seized  with  it,  and  particularly  after  being  much  exposed 
to  cold  and  wet,  or  on  the  suppression  of  an  eruption,  or  some  accus- 
tomed discharge,  such  as  hemorrhoids,  &c.  Generally  speaking^ 
there  is  no  desire  to  make  water,  nor  is  there  pain  or  tumefaction 
above  the  pubes  indicating  an  accumulation  of  urine,  the  defective 
secretion  of  which  will  be  farther  confirmed  by  the  introduction  of 
the  catheter.  Nausea,  constipation,  and  an  occasional  sense  of  sink- 
ing, usually  accompany  the  disorder.  Sometimes  a  series  of  other 
distressing  symptoms,  such  as  frequent  and  severe  fits  of  vomiting, 
hiccough,  pain  in  the  back,  intense  headache  and  restlessness  are 
present  from  the   commencement.     The  pulse  continues   for   some 


SUPPRESSION  OP  URINE.  455 

time  normal  $  when  it  becomes  slower  it  indicates  danger.  The  skin 
is  generally  natural,  but  profuse  sweating  sometimes  supervenes,  and 
the  perspiration  has,  in  some  instances,  been  found  to  exhale  a  strong 
urinous  odour. 

Suppression  of  urine  leads  sooner  or  later  to  serious  consequences, 
if  the  secretion  be  not  restored,  and  is  frequently  very  speedily  fatal, 
in  consequence,  apparently,  of  inducing  cerebral  disease,  and  termi- 
nating in  coma. 

Therapeutics.  The  homoeopathic  remedies  which,  in  most 
instances,  may  be  employed  with  success  in  restoring  the  func- 
tions of  the  kidneys  are :  Aconitum,  Camphora,  Cantharides,  Nux  v., 
Puk.y  Belladonna,  Opium,  Lycopodium,  Sulphur >  &c.  Their  leading 
indications  in  suppression,  or  diminished  secretion  of  urine,  are 
similar  to  those  which  have  been  given  under  the  heads  of  Dysuria 
and  Ischuria.  Attention  should  in  every  case  be  directed  to  the 
causes  which  have  apparently  been  the  means  of  developing  the 
disorder,  and  the  selection  of  the  remedies  made  in  accordance  there- 
with. Thus,  when  the  suppression  or  retropulsion  of  an  eruption 
has  called  forth  the  disorder,  Sulphur  will  form  an  almost  indispens- 
able remedy.  The  same  remedy,  together  with  Nux  v.,  Pulsatilla, 
Calcarea  or  Sepia,  is  equally  useful  where  some  habitual  discharge, 
such  as  the  hemorrhoidal,  menstrual,  &c,  has  been  checked.  The 
affection,  as  already  observed,  is  prone  to  occur  in  gouty  habits, 
conjoined  with  free  living,  or  excessive  indulgence  in  spirituous 
liquors.  In  these  cases  Nux  v.  will  prove  of  great  service,  especially 
when  we  meet  with  nausea,  or  frequent  and  violent  vomiting,  head- 
ache, or  heat  in  the  face  and  head  after  meals,  constipation,  nocturnal 
restlessness,  or  unrefreshing  sleep  with  frightful  dreams.  Opium,  Lyco- 
podium, Lachesis,  or  Sulphur  may,  in  some  cases,  be  found  necessary, 
when  Nux  v.  is  inadequate  to  effect  a  radical  cure.  When  exposure  to 
cold  and  wet  has  given  rise  to  the  disorder  Dulcamara  may  be  found 
useful  at  the  commencement,  particularly  when  there  is  a  copious 
and  offensive  secretion  from  the  skin.  Acidum  nitricum  and  Colocynth 
may  be  of  some  utility  where  the  perspiration  is  profuse  and  exhales 
an  urinous  odour.  In  all  cases,  any  signs  of  an  approach  of  cerebral 
disease  ought  to  be  studiously  watched,  and,  when  detected,  imme- 
diately combated  by  the  appropriate  remedies.  (See  Phrenitis.) 
The  following  remedies  may  also  be  enumerated  as  worthy  of  atten- 
tion in  this  disease :    Cannabis,  Alumina,  Kreosotum,  Bryonia,   Carlo  v., 


456  URINARY  AND  GENITAL  ORGANS. 

Evphorlium,  Staphysagria,  Clematis,  Digitalis,  Squilla,  Colchicum, 
Graphites,  Rhus,  &c  For  the  treatment  of  suppression  of  urine  in 
consequence  of  Nephritis,  Cystitis,  or  Hydrops,  see  those  diseases. 


STRICTURE  OF  THE  URETHRA. 

A  stricture  of  the  urethra  may  be  defined  to  be  a  diminution,  or 
such  an  alteration  of  a  portion  of  the  tube  as  renders  it,  at  the 
affected  part,  much  narrower  than  what  it  is  in  the  normal  state,  or 
even  completely  obstructed.  The  formation  of  the  disease  appears, 
m  most  instances,  to  depend  upon  a  thickening  of  parts  of  the  canal, 
the  result  of  inflammatory  action.  The  first,  or  at  all  events  one  of 
the  earliest  signs  of  stricture  of  the  urethra  is  the  retention  of  a  few 
drops  of  urine  in  the  passage  after  the  patient  has  performed  the  act 
of  micturition;  but  these  drops  are  soon  involuntarily  emitted; 
while  another  small  quantity,  accumulated  between  the  cervix  of  the 
bladder  and  the  stricture,  may  be  expelled  by  the  effect  of  pressure 
below  the  urethra.  The  next,  and  sometimes  the  first  derangement 
observed  is,  that  there  is  a  frequent  inclination  to  void  water,  the 
patient  being  under  the  necessity  of  emptying  the  bladder  repeatedly 
m  the  course  of  the  night.  As  the  obstruction  increases,  the  urine 
cannot  be  passed  without  pain  and  effort,  and  the  stream  becomes 
forked,  spiral,  or  scattered.  In  the  advanced  stage  of  the  disease  the 
urine  comes  away  by  drops,  and  is  sometimes  mixed  with  purulent 
matter  or  glairy  mucus.  In  addition  to  these  symptoms,  the  patient 
is  distressed  with  pain  about  the  glans  penis,  and  occasionally  in  the 
loins,  and  is,  moreover,  often  attacked  with  severe  paroxysms  of 
intermittent  fever.  Exposure  to  cold,  violent  exercise,  excess  in 
venery,  and  the  pleasures  of  the  table  aggravate  all  the  symptoms, 
and  cause  entire  stoppage  of  urine,  The  thin,  glairy,  or  gleety  dis- 
charge, which  commonly  attends,  has  frequently  led  to  the  mistake 
that  the  case  is  one  of  gonorrhoea  secondaria,  or  gleet ;  but  the 
existence  of  the  symptoms  we  have  above  enumerated,  together  with 
the  unequivocal  proof  which  is  to  be  derived  from  the  introduction 
of  an  appropriate  bougie,  remove  all  uncertainty.  The  most  common 
seat  of  the  stricture  is  just  behind  the  bulb  ;  and  that  which  is  per- 
haps next  in  frequency  is  about  four  and  a  half  inches  within  the 
canal;  then  three  and  a  half;  and  sometimes  close  to  the  external 
orifice  of  the  urethra. 

The  evils  which  are  liable  to  result  from  old  and  aggravated  cases 


STRICTURE  OF  THE  URETHRA.  457 

of  stricture  are  thickening  of  the  bladder,  with  deprivation  of  its 
usual  power  of  expansion,  or  inflammation  accompanied  with  dis- 
charge of  a  sort  of  viscid  secretion,  bearing  a  resemblance  to  pus ; 
retention  of  urine,  and  dilatation  and  ulceration  of  the  urethra 
between  the  bladder  and  the  first  and  principal  stricture.  When  the 
urethra  ulcerates,  and  abscesses  form  and  burst,  channels  are  pro- 
duced, through  which  the  urine  escapes  into  the  surrounding  cellular 
membrane,  nxA  fistula  in  joerinteo  are  constituted. 

Therapeutics.  In  the  incipient  stage  of  stricture  of  the  urethra 
a  cure  may  often  be  effected  by  appropriate  medicines ;  even  in  a 
more  advanced  stage  a  cure  is  sometimes  practicable,  or  at  all  events 
such  a  degree  of  improvement  capable  of  being  brought  about 
that  the  after  treatment  by  mechanical  means,  where  requisite,  is 
thereby  materially  facilitated.  The  following  are  the  principal 
medicines,  from  the  employment  of  which  results  of  a  satisfactory 
nature  are  frequently  to  be  obtained:  Cannabis,  Petroselinum,  Can- 
tharides,  Camphora,  Mercurius,  Aconitum,  Sulphur;  and,  in  some 
instances,  with  induration,  and  more  or  less  contraction  and  thick- 
ening of  the  urethra:  Clematis,  Dulc,  Digit.,  Petr.,  Sulph.,  or, 
Acid,  nitr,,  Silicea,  Calcarea,  Lycopodium,  Pulsatilla,  &c.  A  few  of  the 
leading  indications  for  the  selection  of  some  of  these  remedies  will 
be  found  in  the  chapters  on  Dysuria,  Hematuria,  Gonorrhoea.  If 
the  symptoms  are  invariably  exacerbated  by  exposure  to  cold,  Dulca- 
mara may  be  prescribed  with  advantage  ;  and  when  excess  in  wine  or 
spirituous  liquors  causes  serious  aggravation,  and  occasionally  com- 
plete retention  of  urine,  Nux  v.  is  a  useful  palliative.  (See  Reten- 
tion of  Urine.) 

In  old  inveterate  cases,  and  particularly  in  permanent  bad  cartila- 
ginous strictures,  recourse  must  be  had  to  the  ordinary  mechanical 
means.  In  cases  where  it  seems  requisite  from  the  commencement 
to  conduct  the  treatment  on  the  principle  of  mechanically  dilating 
the  contracted  part  of  the  urethra  by  means  of  bougies  or  elastic 
gum-catheters,  but  where  the  urethra  is  so  irritable  that  the  patient 
cannot  bear  the  introduction  of  the  instrument,  or  where  copious 
hemorrhage  follows  its  employment,  Aconitum  or  Arnica  may  be  pre- 
scribed with  advantage.  These  remedies  are,  moreover,  often  of  great 
utility  in  warding  off  inflammatory  action  in  the  testes  from  the  use 
of  bougies. 

Where  the   medical  treatment    no  longer   offers   any  reasonable 


458  URINARY  AND  GENITAL  ORGANS. 

prospect  of  success,  and  the  stricture  is  so  complete  or  extensive  as 
entirely  to  arrest  the  introduction  of  the  bougie,  a  surgical  operation 
becomes  necessary,  which  consists  in  the  perforation  of  the  stricture, 
with  a  stilet;  or  the  plan  of  cutting  down  to  the  stricture,  and  then 
cutting  through  the  diseased  part  of  the  tube  must  be  resorted  to. 


URINARY  ABSCESS  AND  FISTULA. 

Fistula  injoerinceo. 

Fistulae  in  perinaeo  are  ulcerated  openings  in  the  perinaeum,  which 
not  unfrequently  take  place  in  consequence  of  the  natural  passage 
for  the  urine  becoming  completely  impervious  from  stricture.  The 
urethra  becomes  ulcerated  immediately  behind  the  seat  of  the 
obstruction,  and  the  urine  escapes  into  the  cellular  membrane ;  the 
injected  parts  swell  and  inflame ;  suppuration  speedily  supervenes ; 
the  abscess  bursts,  and  the  fistulous  opening,  forming  an  outlet  for 
the  urine,  is  produced.  In  some  instances  no  urine  is  discharged 
from  the  aperture  until  two  or  three  days  have  elapsed,  but  in  others, 
it  flows  from  the  first,  intermixed  with  fetid  pus.  The  secretion  of 
pus  then  diminishes,  and  the  urine  passes  out  of  the  new  channel  in 
large  quantities.  Several  external  openings  are  occasionally  formed, 
in  place  of  one.  Fistulae,  of  a  similar  nature  to  the  foregoing,  may 
be  produced  in  the  groin,  scrotum,  and  even  at  the  base  of  the  penis 
near  the  pubis ;  and  in  some  rare  cases  they  form  a  communication 
between  the  rectum  and  the  part  of  the  urethra  behind  the  obstruc- 
tion. Retention  of  urine  is  no  longer  prone  to  occur  when  fistulae 
in  perinaeo  are  established. 

Therapeutics.  It  is  recommended  by  most  surgeons  to  open 
the  abscess  which  forms  the  swelling  in  the  perinseum  early.  The 
cure  of  the  fistula  necessarily  depends  upon  that  which  has  given 
rise  to  it,  viz.,  the  strictures  themselves  :  when  these  are  removed, 
either  by  the  ulcerative  process  which  preceded  the  production  of 
the  fistulae,  or  by  other  means,  the  urine  resumes  its  natural  course, 
and  the  fistulous  aperture  closes.  If  it  should  not  do  so,  we  must 
seek  to  effect  this  object  by  the  employment  of  homoeopathic  medi- 
cines ;  and  of  these  the  following  will  generally  answer  best :  Silicea, 
Sulphur,  Calcarea,  and,  sometimes  Mercurius,  Arsenicum,  Lachesis,  or 
Cantharides.      The  introduction  of  a  gum-catheter  into  the  bladder, 


INCONTINENCE  OF  URINE.  459 

and  the  confinement  of  the  patient  to  bed  for  a  few  days,  is  in  some 
eases  sufficient ;  but  where  this  is  impracticable  from  the  stricture 
remaining  entire,  and  refusing  to  yield  to  the  usual  remedial  agents, 
a  staff  may  be  passed  down  the  urethra  as  far  as  the  stricture,  the 
canal  laid  open,  a  catheter  conveyed  into  the  bladder,  and  kept  there 
until  cicatrization  is  accomplished. 


INCONTINENCE  OF  URINE. 

Involuntary  flow  of  urine  usually  proceeds  from  relaxation,  or  a 
paralytic  affection  of  the  bladder ;  or  from  irritation  or  compression 
of  the  bladder,  in  consequence  of  the  secretion  of  acrid  urine,  the  pre- 
sence of  gravel,  or  a  diseased  state  of  the  organ  itself. 

Therapeutics.  When  the  incontinence  proceeds  from  relaxation 
brought  on  by  a  too  free  use  of  vinous  or  spirituous  liquors,  consider- 
able relief,  if  not  a  radical  cure,  will,  in  most  instances,  be  effected  by 
the  employment  of  Nux  v.  In  other  cases  having  a  similar  origin, 
Opium,  Lachesis,  Sulphur,  Calcarea,  and  sometimes  Acid,  muriaticum, 
must  be  had  recourse  to  subsequent  to,  or  in  alternation  with  Nux  #. 
If  masturbation  or  excess  of  venery  have  induced  a  relaxed  condition 
of  the  sphincter  of  the  bladder,  Nux  v.,  followed  by  Sulphur  and  Cal- 
carea, will  generally  be  found  the  more  efficacious  remedies ;  but  the 
auxiliation  of  Acid,  muriaticum,  China,  and  Acidum  phosphoricum  will 
often  be  required.  The  use  of  the  flesh -brush  and  frequent  sponging 
writh  cold  water  is  also  of  some  service  in  such  cases.  The  inconti- 
nence of  urine  which  proceeds  from  paralysis  of  the  vesica,  or  is 
attendant  on  more  general  paralytic  derangement,  has  been  cured  by 
Cicuta  and  Magn.  aust.  The  aid  of  one  or  more  of  the  following  medi- 
caments, Aconitum,  Belladonna,  Hyoscyamus,  Cocculus,  Nux  v.,  Opium, 
Natrum  m.,  Arsenicum,  Sulphur,  Bryonia,  Dulcamara,  Bauroceracus,  Sepia 
.or  Silicea,  etc.,  will,  however,  be  necessary  in  many  cases.  The 
employment  of  electro-magnetism,  cold  bathing,  and  of  friction  at  the 
upper  part  of  the  sacrum  should  not  be  neglected  in  inveterate  cases 
of  paralytic  enuresis.  Against  spasmodic  incontinency,  Camphor  a, 
Belladonna,  Hyoscyamus,  Ignatia,  Natrum  m.,  Nux,  Pulsatilla,  Conium, 
Cina,  and  Rhus  ;  or  Bycopod.,  Sulph.,  Bach.,  Baryt.  c,  Ruta,  etc.  should 
claim  most  attention,  and  be  selected  according  to  the  peculiarities 
of  the  case,  and  with  due  regard  to  the  collateral  symptoms.     If 


460  URINARY  AND  GENITAL  ORGANS. 

inflammation  about  the  neck  of  the  bladder  and  urethra  give  rise  to 
the  disease,  Aconitum  and  Cantharides  should  chiefly  be  employed.  (See 
also  Cystitis  and  Gonorrhoea.)  When  the  secretion  of  acrid  or 
highly  acidulated  urine  produces  an  involuntary  flow  of  urine,  con- 
siderable relief  will  be  obtained  by  drinking  freely  of  cold  water,  or 
of  barley-water  or  linseed-tea.  Amongst  the  homoeopathic  remedies 
from  wThich  the  most  appropriate  selection  may  be  made,  to  effect  a 
radical  cure  of  such  cases,  the  following  may  be  quoted.  Mercurius, 
Hepar  s.,  Kreosotum,  Lauroceracus,  Arsenicum,  Graphites,  Iodium,  Vera- 
trum,  or  Tartarus  emet.,  etc.  If  the  presence  of  gravel  or  sand  create 
irritation  and  consequent  involuntary  expulsion  of  urine  as  soon  as  it 
is  secreted,  the  exhibition  of  Calcarea,  Nux  v.,  Cannabis,  Uva,  Phospho- 
rus, or  Petroleum  is  often  attended  with  the  most  satisfactory  results. 
In  all  cases  where  there  is  much  pain  and  irritation,  recourse  may  be 
had  to  the  simple  diluents  above  alluded  to,  together  with  the 
employment  of  Aconitum  and  Sulphur  in  alternation,  and  the  injection 
of  tepid  water  into  the  bladder. 

Against  nocturnal  enuresis,  Ammonium  carbonicum  is  often  efficacious ; 
as  likewise  Belladonna,  especially  when  the  weakness  proceeds  from  cere- 
bral irritation ;  Kreosotum  when  the  emission  takes  place  only  during 
deep,  almost  comatose  sleep,  and  Cina  when  the  existence  of  worms  in 
the  alimentary  canal  appears  to  be  the  irritating  cause.  (See  the 
other  remedies  given  under  the  article  Invermination.)  In  other 
instances  of  this  frequently  most  troublesome  form  of  the  complaint, 
Pulsatilla,  Sepia,  Sulphur,  Silicea,  Carl,  v.,  Arsenicum,  or  Hepar,  Graph., 
Cole.  Am.,  China,  Con.,  Petrol.,  Natr.,  Rut.,  or  Mags,  oust.,  etc.,  may  be 
indicated. 

In  the  case  of  children,  if  the  emission  of  urine  take  place  only  at 
an  early  hour  in  the  morning,  the  nurse  ought  to  be  ordered  to  get 
into  the  habit  of  raising  the  child  from  bed  before  the  time  of  the 
usual  occurrence  of  the  mishap. 


DIABETES. 

By  this  term  is  understood  an  immoderate  secretion  of  urine,  con- 
taining a  large  proportion  of  saccharine  matter.  Sometimes,  however, 
the  quality  of  sweetness  is  absent,  and  the  usual  urinary  taste  alone 
perceived.  The  complaint  has,  consequently,  been  divided  into  two 
species,  of  which  the  former  has  received  the  appellation  of  Diabetes 


DIABETES.  461 

mellitus,  and  the  latter  that  of  Diabetes  insipidus.  The  mellitic  variety- 
is  by  far  the  more  dangerous  and  fatal.  Diabetes,  for  the  most  part, 
comes  on  slowly  and  insidiously,  insatiable  thirst  and  voracious  appe- 
tite, the  usual  attendant  symptoms  throughout  the  disorder,  being 
frequently  the  only  striking  symptoms  at  the  commencement.  In 
other  cases,  the  patient  complains  of  great  lassitude,  and  a  tendency 
to  perspire  after  any  trivial  exertion ;  the  appetite,  although  keen,  is 
generally  accompanied  by  deranged  digestion.  Pain,  sometimes  of  a 
very  severe  disposition,  is  often  complained  of  in  the  lumbar  region, 
and  a  sense  of  distressing  weakness  is  generally  experienced  in  the 
said  part  of  the  body.  As  the  disease  progresses,  especially  in  the 
diabetes  mellitus,  rapid  emaciation  of  the  whole  body  ensues ;  the 
thirst  continues  excessive,  but  the  quantity  of  urine  voided  exceeds 
in  quantity  that  of  the  fluid  and  aliment  introduced ;  there  is  a  feeling 
of  complete  prostration;  the  pulse  becomes  quick  and  weak;  the 
breathing  exceedingly  laborious,  and  dropsical  infiltration  takes  place 
in  the  inferior  extremities.  The  disease  affects  men  more  frequently 
than  women,  and  it  frequently  attends  sympathetically  in  a  milder 
form  on  hysteria,  hypochondriasis,  dyspepsia,  and  asthma.  Those 
who  are  in  the  decline  of  life,  or  have  a  shattered  constitution  arising 
from  intemperance,  as  hard  drinking,  excessive  venery,  or  from  the 
prolonged  abuse  of  diuretics  or  aperients,  or  other  powerful  depleting 
measures,  such  as  repeated  venesections,  etc.,  seem  to  be  most  subject 
to  its  attacks.  Many  instances,  however,  have  occurred  in  which  no 
obvious  cause  could  be  assigned.  The  duration  of  the  disease  has 
varied  from  five  or  six  weeks  to  many  months,  and  even  several  years 
before  terminating  fatally. 

Therapeutics.  The  very  different  opinions  as  to  the  proximate 
cause  of  the  disorder,  and  the  contradictory  pathological  conclusions, 
which  have  been  drawn  by  allopathic  writers,  have  led  them  to 
promulgate  and  adopt  the  most  opposite  and  conflicting  varieties 
of  treatment.  In  homoeopathic  writings,  again,  we  meet  with  com- 
paratively fewT  detailed  descriptions  of  treatment,  and  authentic 
radical  cures,  particularly  of  the  mellitic  form  of  the  complaint. 
This  is,  undoubtedly,  in  a  great  measure  to  be  attributed  to  the 
rarity  of  the  disease,  for  the  very  minute  attention  which  is  necessarily 
paid  to  symptoms  by  the  homoeopathic  practitioner,  in  order  to 
enable  him  to  reap  the  peculiar  advantages  of  his  materia  medica 
without,  at  the  same  time,  neglecting  to  pay  due  attention  to  every 


462  URINARY  AND  GENITAL  ORGANS. 

additional  circumstance  which  may  facilitate  his  choice  of  the  appro- 
priate remedy,  such  as  the  history  of  the  case,  and  a  careful  discrimina- 
tion between  cause  and  effect, — must  materially  tend  to  overcome  the 
difficulties  which  surround  the  allopathist,  and  render  the  disease  in 
his  hands  one  of  so  intractable  a  nature.  The  medicines  which  have 
been  chiefly  recommended  by  the  limited  number  of  homoeopathic 
authors  who,  hitherto,  have  casually  written  on  or  referred  to 
Diabetes  mellitus,  are  Acidum  phosphorictim,  Mercurius,  Sulphor, 
Natrum  m.,  Carlo  vegetabilis,  Ledum;  and,  further,  Acid,  muriatictcm, 
Asclepias  vincetoocicum,  Ammon.  c,  Arsenicum,  Alumina,  Graphites,  Ambra, 
Baryta  c,  Bella.,  Con.,  Magn.,  Terebinth.,  and  Meph.,  &c.  Of  these  the 
following  have,  as  yet,  been  principally  employed :  Mercurius  solubilis, 
Veratrum,  Kali  carbonieum,  and  Acidum  mtiriaticum.  Their  indications 
are  mainly  as  follows  :* 

"  Merc.  sol.  is  indicated  when  there  is  a  constant  desire  to  urinate, 
night  and  day,  swollen  moist  prepuce  and  glans  penis,  both  of  them 
painful;  drawing,  squeezing  sensation  in  the  testicles,  a  cutting, 
tearing  pain  in  the  left  kidney,  painful  swelling  of  the  gums,  white 
coated  tongue,  constant  dryness  in  the  mouth,  a  bad  fetid  breath, 
constant  hunger,  insatiable  thirst,  burning,  acrid,  scraping  eructations, 
burning  pain  in  the  epigastric  region,  wakefulness,  owing  to  the 
desire  to  urinate ;  slow,  languid  pulse,  sunken  countenance,  general 
weakness  and  debility,  swelling  of  glands,  &c. 

"Veratrum: — Great  alteration  of  the  countenance  as  of  a  dead 
person ;  swelling  of  the  gums,  looseness  of  the  teeth,  sticky  dryness 
of  the  mouth  and  fauces,  which  cannot  be  removed  by  any  liquids, 
great  nausea  and  thirst,  painful  hunger,  drawing  pain  in  the  umbilical 
region,  excessive  flow  of  urine,  even  involuntary,  soreness  of  prepuce, 
extreme  general  prostration  and  weakness,  especially  of  the  extremi- 
ties, trembling  of  the  whole  body,  inclination  to  faint,  weak,  almost 
imperceptible  pulse. 

"  Kali  carb. : — Jerking  pains  in  both  renal  regions,  especially  on 
sitting  down,  and  protracted  ;  dull  stitches  in  the  left ;  frequent  and 
violent  desire  to  urinate,  especially  troublesome  at  night,  the  urine 
of  a  pale  green  colour;  burning  sensation  in  the  urethra  during 
evacuations  ;  sharp  drawing  pains  through  the  penis;  pains  on  motion 
in  the  inguinal  region ;  feeling  of  cold  in  the  intestines,  as  if  water 
were  being  dropped   upon   them;    burning  heat  in   the   stomach, 

■*  Homoeop.  Exam,  vol  iv.  No,  12,  p.  525. 


H/EMATURIA.  463 

languor,  swollen  and  ulcerated  gums,  dry  mouth,  fetid  breath,  violent 
thirst,  especially  in  the  evening  and  at  night,  very  pale  and  sunken 
countenance,  sunken  eyes,  irritable  surly  state  of  mind,  easily  alarmed, 
uneasiness  and  wakefulness,  great  prostration,  feeling  of  emptiness 
in  the  whole  body,  drawing  pains  in  the  back,  frequently  proceeding 
from  the  sacrum. 

"Acidum  muriaticum  is  preferable  to  all  other  remedies  in  cases 
where  there  is  an  entire  absence  of  thirst,  and  where  the  urine  has 
a  milky  appearance  ;  also  in  cases  of  drunkards,  where  it  has  proved 
very  efficacious." 

When  diabetes  is  symptomatic  of  dyspepsia,  asthma,  hysteria,  &c, 
see  the  remedies  which  have  been  enumerated  under  these  different 
heads. 

The  diet  in  diabetes  ought  to  be  wholesome,  and  contain  the 
greatest  amount  of  nutriment  in  a  small  bulk ;  animal  food  ought 
to  be  preferred ;  vegetables,  especially  potatoes,  and  fruits  are  to  be 
inhibited.  All  kinds  of  liquids  wrhich  exert  a  specific  or  direct  effect 
upon  the  kidneys  should  be  strictly  avoided.  Milk  should,  in  gene- 
ral, be  also  abstained  from. 


HEMATURIA. 
Mictus  cruentus. 

The  passing  of  blood  with  urine  may  arise  from  various  causes, 
amongst  which  the  following  are  the  most  frequent :  falls,  bruises, 
blows,  violent  exertion,  such  as  leaping  and  hard  riding, — the  lodge- 
ment of  a  small  stone  in  the  kidney  or  ureter,  or  by  inflammation  of 
the  kidney ;  it  may  also  be  occasioned  by  irregular  menstruation, 
hemorrhoidal  disturbances,  habitual  and  excessive  indulgence  in 
spirituous  drinks,  the  frequent  use  of  certain  vegetables,  such  as 
asparagus  &c,  excess  in  venery,  and  by  the  frequent  external  and 
internal  employment  of  Cantharides.  The  blood  voided  is,  in  most 
instances,  intermixed  with  the  urine,  but  when  it  originates  from  the 
lacerating  effects  of  an  irregular  stone,  it  is  generally  discharged  in 
streaks  and  coaguli,  and  deposits  a  dark  brown-coloured  sediment, 
bearing  a  resemblance  to  coffee-grounds.  The  act  of  urination  is 
generally  performed  with  some  difficulty,  and  accompanied  with 
tenesmus.  When  the  blood  proceeds  from  the  kidney,  the  urine  first 
expelled  looks  muddy  and  high-coloured,  is  usually  very  copious,  and 


464  URINARY   AND  GENITAL  ORGANS. 

attended  with  acute  pain  in  the  back,  anxiety,  numbness  in  the 
thighs,  drawing  up  of  the  testes,  constipation,  and  other  abdominal 
derangements.  When  from  the  ureter,  the  symptoms  are  nearly 
the  same  as  the  foregoing,  with  the  exception  that  the  pains  extend 
from  the  lumbar  region  along  the  course  of  the  ureter  down  into  the 
pelvis,  with  strangury,  and  perhaps  also  nausea  and  vomiting.  In 
hemorrhage  coming  from  the  vesica  urinaria,  we  commonly  meet 
with  spasm,  dysury,  occasionally  severe  burning  and  other  pains  in 
the  hypogastrium  perinaeum,  penis,  and  anus,  during  and  subsequent 
to  the  act  of  micturition.  To  these  are  added,  especially  when  the 
difficulty  of  making  water  is  considerable,  great  anxiety,  cold  sweats, 
shivering  chills,  debility,  and  fits  of  syncope.  The  blood  is  not  so 
intimately  combined  with  the  urine  as  in  the  immediately  preceding 
cases,  generally  deposits  a  coherent  sediment,  and  is  sometimes  emit- 
ted in  a  free  state. 

The  voiding  of  sanguineous  urine  is  always  to  be  regarded  in  a 
serious  light,  especially  when  it  is  commingled  with  purulent  matter. 
The  prognosis  must,  however,  be  regulated  by  a  variety  of  circum- 
stances, such  as  the  active  or  passive  nature  of  the  discharge,  the 
age  and  constitution  of  the  patient,  the  duration  and  recurrences  of 
the  affection,  the  collateral  symptoms,  and  the  occasional  causes,  &c. 

Therapeutics.  Cantharis  forms  one  of  the  more  generally  use- 
ful remedies  in  this  disease.  It  may  be  had  recourse  to  in  almost  all 
cases  where  we  are  uncertain  as  to  the  exciting  cause  of  the  disorder, 
and  especially  where  there  is  considerable  difficulty  in  making  water, 
with  scalding  in  the  urethra  during  the  act  of  micturition,  or  violent 
cutting  and  spasmodic  pains  in  the  hypogastric  region,  the  blood 
discharged  being  either  pure  and  passed  in  drops,  or  copiously  inter- 
mixed with  the  urine,  or  in  streaks  or  coagulated.  Even  when  the 
existence  of  purulent  matter  is  detected  in  the  sanguinolent  urine,  the 
employment  of  Cantharides  may  be  attended  with  beneficial  results. 
But  the  assistance  of  such  remedies  as  Pulsatilla,  Clematis,  Mercurius, 
Hepar  s.,  Cannabis,  Sdbina,  or  Uva  %rsi  is  commonly  essential  in  the 
latter  case. 

When,  on  the  other  hand,  the  disorder  has  evidently  originated  in 
the  employment  of  Spanish  fly  itself,  in  the  form  of  a  blister,  in  allo- 
pathic practice,  or  in  large  doses  internally,  a  drop  or  two  of  Spirits  of 
Camphor  must  be  given,  and  repeated  every  two  or  three  hours  until 
relief  is  afforded.  Should  any  sequelae,  such  as  burning  in  the  urethra, 


HEMATURIA.  465 

etc.  etc.,  remain  after  the  employment  of  Camphor,  Carlo  v.  and  Arseni- 
cum will  usually  cause  them  to  yield.  Next  to  Cantharides,  Mezereum 
has  been  recommended  as  one  of  the  principal  remedies  in  the  homoeo- 
pathic treatment  of  hasmaturia,  more  particularly  where  the  blood 
passed  does  not  appear  to  be  in  large  quantity,  and  the  accompanying 
pains  not  very  severe;  further,  when  the  blood  is  rarely  or  never 
coagulated. 

When  the  disorder  has  resulted  from  external  violence,  it  usually 
gives  way  readily  under  the  use  of  Arnica  ;  but  if  the  patient  be  of  a 
plethoric  habit,  it  will  be  found  highly  advantageous,  if  not  impera- 
tive, to  exhibit  Aconitum  in  alternation  with  Arnica. 

To  pursue  the  description  of  treatment  required  in  those  cases 
where  the  occasional  or  predisposing  cause  is  known,  we  shall  find 
that  Nux  vomica  forms  an  eminently  useful  remedy,  when  the  habitual 
over-indulgence  in  spirituous  or  vinous  liquors,  or  suddenly  suppressed 
or  checked  hemorrhoids  have  given  rise  to  it,  and  painful  aching 
in  the  back  with  smarting  in  the  urethra  are  complained  of.  After 
Nux  v.,  Sulphur  may  generally  be  prescribed  with  much  benefit ; 
and  this  remedy,  again,  may  in  turn  be  succeeded  by  Calcarea  with 
advantage,  particularly  when  the  blood  is  discharged  in  small  clots. 
Pulsatilla  is  very  serviceable  in  females  affected  with  ataxic  menstrua- 
tion, but  it  has  been  found  of  equal  value  in  the  male  subject  when 
the  disease  was  attended  with  a  constrictive  and  cutting  pain  around 
the  umbilicus,  extending  with  great  violence  to  the  lumbar  region ; 
or,  where  spasmodic  pains  were  experienced  in  the  inferior  extre- 
mities, particularly  the  right  knee,  and  from  thence  upwards  to  the 
groin,  with  spasmodic  retraction  of  the  scrotum  and  penis,  and 
burning  pain  at  the  orifice  of  the  urethra.  Sulphur  and  Calcarea  may 
often^  as  in  the  case  of  Nux  v.,  follow  Pulsatilla  wdth  good  effect. 

Cases  apparently  arising  from  venereal  excesses  usually  require 
Cinchona  in  the  first  instance,  and  subsequently  Nux,  Sulphur,  Calcarea9 
or  Phosphorus.  Mercurius,  also,  is  sometimes  of  much  value  here^  par- 
ticularly when  the  blood  is  often  discharged  during  sleep,  along  with 
seminal  emissions.  Hepar  s.  may  succeed  Mercurius,  should  the  latter 
produce  merely  temporary  melioration.  At  other  times  Ledum, 
or  Mezereum,  may  be  found  better  indicated.  When  the  voiding  of 
bloody  urine  arises  from  the  presence  of  calculi,  Nux  v.,  Cannab.,  Calc, 
Petrol,,  Phosph.,  Canth.,  Lycopod.,  Sass.,  Canth.,  Ac.  nitr.,  Nux  m.,  and 
Zincum  have  chiefly  been  recommended.  When  the  pain  is  excessive, 
Aconitum,  and  in  some  cases  Arnica,  may  exert  a  soothing  influence. 

30 


466  URINARY  AND  GENITAL  ORGANS. 

Squilla,  Zincum,  Conium,  and  Millefolium  have  also  been  favorably- 
spoken  of,  as  being  useful  in  particular  cases  of  this  affection.  Water 
or  barley-water  should,  in  most  cases,  be  drunk  in  considerable  quan- 
tities. When  hematuria  occurs  merely  as  a  secondary  disorder,  in 
connexion  with  Nephritis  or  Cystitis,  see  these  diseases. 


DISCHARGE  OF  BLOOD  FROM  THE  URETHRA. 

Urethrorrhagia*     Hamorrhagia  methm.     Styrnatosis. 

This  complaint,  like  the  preceding,  is  frequently  met  with  in  con- 
nexion with  other  disorders.  It  may,  however,  exist  in  an  idiopathic 
form  either  in  consequence  of  mechanical  injury,  or  venereal  excess,  in 
either  of  which  cases  the  same  remedies  must  be  had  recourse  to  as 
those  given  for  the  treatment  of  hematuria  arising  from  similar 
causes.  When  it  occurs  as  a  secondary  malady,  in  connexion  with 
hemorrhoids,  menstrual  irregularity,  etc.,  Nux  v.,  Pulsatilla,  Sulphur, 
etc.,  are  the  most  appropriate  medicaments,  and  may  be  selected 
according  to  the  indications  described  above.  Should  the  affection 
be  encountered  as  a  secondary  symptom  of  gonorrhoea,  it  will  com- 
monly yield  to  Cantharides,  but  Cannabis  or  Sulphur  may  sometimes  be 
required  to  complete  the  cure. 


INFLAMMATION  OF  THE  URETHRA,     CLAP. 
Urethretis.     Gonorrhoea.    Blenorrhcea. 

Under  the  above  heads  we  purpose  to  treat  of  inflammation  of  the 
mucous  membrane  of  the  urethra  resulting  from  impure  connexion, 
attended  with  a  discharge  of  puriform  matter.  The  affection  com- 
monly commences  a  week  or  ten  days  after  the  risk  of  taking  it  has 
been  incurred ;  but  in  some  cases  it  begins  in  two  or  three  days, 
and  in  others  no  perceptible  symptoms  become  developed  for  two 
or  three  weeks.  The  disease  varies  in  severity  according  to  the  extent 
and  intensity  of  the  inflammation.  In  ordinary  cases  the  latter 
only  extends  an  inch  and  a  half  along  the  urethra,  or  two  inches 
from  its  orifice ;  but  in  severe  forms  it  occupies  the  entire  course 
of  the  canal,  and  even  affects  the  mucous  membrane  of  the  bladder. 
The  earliest  symptom  of  a  clap  consists  of  a  sense  of  titillation  or 


INFLAMMATION  OF  THE  URETHRA.  467 

itching  at  the  orifice  of  the  urethra,  which  sometimes  extends  over 
the  whole  of  the  glans  penis,  and  is  accompanied  by  a  frequent 
inclination  to  make  water.  In  a  short  time  some  uneasiness  is 
experienced  on  passing  the  urine,  and  the  orifice  of  the  urethra  is 
observed  to  be  red  and  swollen,  and  perhaps  a  small  quantity  of 
discharge  is  observed.  The  act  of  urination  now  becomes  more 
and  more  painful,  sometimes  almost  insupportable,  while  the  stream 
becomes  diminished  and  broken,  notwithstanding  the  increased  ex- 
pulsive efforts  exerted  by  the  patient.  A  somewhat  copious  dis- 
charge of  thick,  white,  or  yellowish  puriform  matter  soon  takes  place 
from  the  urethra.  As  the  inflammation  advances,  or  when  it  has 
been  intense  from  the  commencement,  the  discharge  becomes  greenish, 
acrid,  and  sometimes  mixed  with  blood.  The  glans  and  prepuce 
frequently  become  red  and  tumefied ;  involuntary  and  painful  erections 
often  occur,  particularly  during  the  night,  and  there  is  sometimes 
considerable  restlessness,  headache,  and  other  symptoms  of  fever. 
This,  the  acute,  stage  of  the  disease  generally  goes  on  increasing, 
or  at  least  continues  with  unaltered  violence  for  eight  or  ten  days, 
but  is  sometimes  prolonged  to  three  weeks  and  even  upwards,  if 
unchecked,  or  aggravated  by  the  thoughtlessness  of  the  patient,  in 
committing  errors  in  diet,  indulging  in  the  use  of  ardent  spirits, 
exposing  himself  to  cold  or  the  excitement  of  sexual  intercourse. 
When  the  acute  stage  begins  to  subside,  its  decline  is  marked  by  a 
diminution  of  the  pain  and  scalding  sensation  in  making  water,  and 
in  a  month  or  six  weeks  none  of  the  symptoms  may  remain.  It 
very  often  happens,  however,  that  instead  of  undergoing  a  spontaneous 
cure  of  this  description,  the  acute  symptoms  disappear,  but  a  dis- 
charge of  puriform  fluid  continues  for  a  considerable  period,  the 
affection  assuming  the  form  of  chronic  inflammation. 

The  above  are  the  symptoms  of  gonorrhoea  as  it  is  usually  met 
with.  But  it  occasionally  appears  in  a  much  more  serious  and  dis- 
tressing form,  in  which  not  only  the  whole  course  of  the  urethra,  but 
even  the  bladder  itself,  becomes  implicated  in  the  inflammation. 
When  this  happens,  the  sufferings  of  the  patient  become  materially 
aggravated ;  the  calibre  of  the  tube  is  much  contracted,  in  conse- 
quence of  the  tumefied  state  of  the  mucous  membrane,  and  the  urine 
is  passed  with  the  greatest  difficulty  and  only  in  drops,  accompanied 
by  excruciating  pain  in  the  urethra,  hips,  loins,  and  hypogastrium  ; 
the  involuntary  erections  are  frequent  and  attended  with  excessive 
sufferings,  especially  when  combined  with  distortion  of  the  penis 


468  URINARY  AND  GENITAL  ORGANS. 

(chordee)  from  the  effusion  of  coagulated  lymph  into  the  corpus 
spongiosum  urethrae.  In  the  worst  cases,  small  indurations  may 
often  be  felt  in  the  course  of  the  urethra,  and  sometimes  Cowper's 
glands  and  the  prostate  partake  of  the  inflammation,  in  which  event 
a  sense  of  heat,  weight,  and  fulness  is  experienced  in  the  perinseum, 
with  pain  in  the  hypogastrium,  dysuria,  and  tenesmus,  particularly 
when  the  disease  has  spread  to  the  bladder  or  its  cervix.  Abscess, 
fistula,  and  permanent  disease  of  the  prostate,  or  stricture  of  the 
urethra  are  the  occasional  results  of  the  last-mentioned  state  of 
matters.  Phimosis,  orchitis,  bubo,  not  unfrequently  take  place, 
from  the  extension  of  the  inflammation  to  the  prepuce,  testes,  and 
glands  of  the  groin  during  the  course  of  gonorrhoea.  Gleet,  or  the 
existence  of  a  serous  or  muco-purulent,  pale  green,  or  colourless 
discharge  from  the  urethra,  is  not  an  unfrequent  occurrence  after  an 
attack  of  acute  inflammation.  It  is  commonly  attributed  to  chronic 
inflammatory  action.  The  most  trifling  error  in  diet,  and  particularly 
the  use  of  spirits,  wines,  and  pungent  condiments,  is  generally 
followed  by  frequent  inclination  to  void  water,  a  degree  of  ardor 
urinae,  and  increased  oozing  of  matter.  This  state  often  continues 
for  years,  and  grows  more  and  more  aggravated,  until  at  length  a 
permanent  stricture  is  formed,  or  thickening  of  the  bladder,  disease 
of  the  prostate,  or  even  of  the  kidneys,  becomes  established. 

In  women  the  symptoms  are,  generally  speaking,  not  so  distressing 
as  in  men.  Sometimes,  however,  the  inflammatory  action  affects  the 
mucous  membrane  of  the  vagina,  and  even  that  of  the  uterus  itself. 
The  discharge  takes  place  from  the  secreting  surfaces  of  the  labia* 
nymphae,  and  clitoris,  as  well  as  from  the  lining  of  the  meatus 
urinarius  and  vagina  in  severe  cases. 

Treatment  of  Gonorrhoea.  The  disease  sometimes  proves 
very  intractable  even  in  homoeopathic  practice ;  but  if  the  treatment 
is  commenced  sufficiently  early  it  terminates  much  less  frequently 
in  the  secondary  form  of  the  malady,  and  the  other  serious  conse- 
quences we  have  detailed,  than  it  does  under  allopathic  treatment. 
The  remedies  which  have  hitherto  been  chiefly  employed  by  homceo- 
pathists  are  Copaiba,  Petroselinum,  Cannabis,  Aconitum,  Sulphur,  Can- 
iharides,  Capsicum,  Silicea,  Z^cqpodium,  Acidum  mtricum,  Sepia,  &c. 

In  the  milder  forms  of  the  affection,  or  in  cases  occurring  in 
healthy  subjects,  a  cure  is  generally  very  easily  and  speedily  accom- 
plished when  the  patient  applies  before  the  second  stage  has  set  in. 


INFLAMMATION  OF  THE  URETHRA.  469 

We  have  repeatedly  succeeded  in  arresting  the  disease  at  its  outset 
(i.  e.  when  the  orifice  of  the  urethra  looks  fuller  and  redder,  and  a 
disagreeable  itching  is  felt  in  the  tube,  together  with  frequent  desire 
to  make  water,  and  some  pain  on  voiding  it)  by  means  of  the  alternate 
employment  of  Aconite  and  Cannabis,  at  intervals  of  at  first  six,  and 
subsequently  twelve  to  twenty-four  hours.  So  soon,  however,  as  the 
discharge  begins,  and  ardor  urinae  is  experienced,  Copaiba  3 — 6  often 
proves  a  very  useful  if  not  a  specific  remedy  ;  but  should  there  be 
a  perpetual  urgency  to  make  water,  Petroselinum  0  may  be  prescribed 
in  preference  to  Copaiba.  Cannabis  is  preferable  to  either  Copaiba  or 
Petroselinum,  when  the  inflammation  runs  somewhat  higher,  and  the 
pain  and  difficulty  in  passing  water  are  consequently  more  intense. 
A  drop  of  the  first,  second,  or  third  dilution  may  be  taken  every 
six  or  eight  hours.  In  gonorrhoea  with  phimosis,  or  extension  of  the 
inflammation  to  the  prepuce,  Mercurius  is  the  most  important  remedy ; 
but  it  is  sometimes  necessary  to  prescribe  a  dose  or  two  of  Aconitum,, 
in  the  first  place,  when  the  inflammatory  action  is  excessive,  and  the 
glans,  as  well  as  the  preputium  very  much  tumefied.  (See  Phimosis.) 
Mercurius  is,  further,  of  considerable  efficacy  at  the  commencement 
of  the  second  stage  of  the  disease,  when  there  remains  a  muco- 
purulent discharge,  of  a  white  or  greenish  yellow  colour,  and  some 
degree  of  pain  in  passing  the  last  drops  of  water ;  or  when  there  is 
swelling  and  induration  of  the  lymphatic  glands  of  the  penis.  SiUcea 
or  Hepar  s.  is  sometimes  required  after  Merc,  in  the  latter  case ;  and 
Capsicum  is  often  useful  in  removing  any  ardor  urinae  that  may  remain. 
Sulphur  is  still  more  frequently  required  than  Mercurius  after  the 
inflammatory  stage  is  over,  and  particularly  when  the  discharge  has 
become  serous,  and  a  feeling  of  uneasiness  alone  remains  in  the 
urethra  when  voiding  urine.  In  painless  gonorrhoea  accompanied 
wdth  swelling  we  have  generally  given  Merc,  Sulphur,  or  Silicea, 
at  the  sixth  potency :  a  few  globules  night  and  morning  for  four 
successive  days.  We  now  come  to  the  treatment  of  the  severer 
forms  of  gonorrhoea.  Here  the  employment  of  Aconitum,  Cannabis, 
and  Cantharides  is  especially  called  for.  The  curative  power  of  these 
remedies  in  such  cases  is  frequently  very  striking,  and  the  rapidity 
with  wThich  they  afford  relief  highly  satisfactory.  Aconitum  is  more 
or  less  useful  in  most  cases  of  gonorrhoea  occurring  in  young  and 
vigorous  subjects,  and  attended  with  headache,  restlessness,  and 
other  febrile  symptoms ;  but  it  is  almost  indispensable  where  the 
inflammation  is  severe  and  extensive,  the  pain  during  micturition 


470  URINARY  AND  GENITAL  ORGANS. 

excruciating,  the  glans,  or  indeed  the  entire  penis,  much  swollen, 
and  the  sufferings  greatly  exacerbated  by  frequent  or  almost  constant 
erections  (priapismus).  In  such  cases  a  drop  or  two  of  Aconitum 
at  the  third  or  sixth  dilution  may  be  added  to  an  ounce  of  water, 
and  a  dessert-spoonful  given  every  six  hours.  Relief  is  generally 
obtained  after  the  first  dose,  and  it  is  rarely  necessary  to  continue 
the  medicine  after  it  has  been  taken  for  the  third  time.  Cantharides 
is  generally  required  after  Aconitum.  It  may  be  given  from  six  to 
eight  hours  after  the  second  or  third  dose  of  the  latter,  when  the 
intensity  of  the  pain  and  any  febrile  irritation  which  may  have 
been  present  have  yielded,  but  the  dysuria,  ardor  urinse,  and  chordee 
still  continue  distressing,  Cantharides  may  be  exhibited  without  the 
previous  employment  of  Aconite,  when  there  is  no  marked  degree  of 
constitutional  disturbance,  but  the  scalding  during  micturition  and 
the  chordee  are  very  severe,  and  the  discharge  is  greenish  and  tinged 
with  blood.  It  may  be  prescribed  at  the  sixth  dilution,  and  the 
dose  repeated  in  from  six  to  twelve  hours  according  to  circumstances. 
Cannabis  is  sometimes  required  after  Cantharides,  especially  when  the 
dysury  proves  obstinate;  and  when  Cannabis  effects  little  or  no 
improvement,  Petroselinum  may  be  administered.  We  have  occasionally 
found  the  alternate  employment  of  Petrosel.,  CantL,  and  Cannabis 
requisite  before  the  continuous  urging  inclination  to  pass  water  and  the 
torture  during  micturition  could  be  subdued.  Mercurius  or  Sulphur 
are  not  unfrequently  useful  in  completing  the  cure,  when  the  before- 
mentioned  remedies  have  removed  the  active  inflammatory  symptoms. 

Treatment  of  the  Second  Stage  op  Gonorrhoea.  When 
the  disorder  has  reached  the  chronic  stage  before  the  patient  seeks 
advice,  we  must  generally  expect  to  encounter  more  difficulty  in 
effecting  a  cure,  than  during  the  first  or  inflammatory  stage ;  the 
more  so,  if  the  patient  has  previously  drugged  himself  with  large  and 
long-continued  doses  of  cubebs  or  of  balsam  of  copaiba,  or  has  fruit- 
lessly persevered  for  some  length  of  time  in  the  employment  of 
astringent  injections.  In  a  number  of  cases,  early  benefit  has  been 
derived  from  the  use  of  Capsicum,  Mercurius,  Sulphur,  and  Acid.  nitr. 
Capsicum  has  chiefly  been  recommended  when  the  discharge  is  whitish 
and  purulent,  and  ardor  urinae  is  still  experienced  when  making  water. 
Ferrum,  Pulsatilla,  and  also  Nux  v.  have  been  stated  to  be  useful  when 
Capsicum  failed  to  remove  the  symptoms  quoted.  Sulph.  and  Merc. 
are  considered  the  most  useful,  in  general  cases,  when  the  patient 


INFLAMMATION  OF  THE  URETHRA.  473 

has  previously  been  under  a  course  of  copaiba  or  cubebs.  Acid,  nitric. 
is  often  very  serviceable  in  gonorrhoea  as  soon  as  the  inflammatory 
stage  is  over ;  but  generally  requires  to  be  followed  by  Sulph.  if  the 
pain  has  subsided,  but  the  discharge  continues.  When  the  inflam- 
mation had  evidently  extended  far  down  the  urethra,  we  have  found 
much  advantage  in  the  use  of  Cantharides  and  Cannabis,  and  in  some 
cases  from  Nux  v.,  when  the  discharge  wras  serous  and  scanty  the 
desire  to  pass  water  frequent  and  urgent,  the  act  of  urination 
painful  and  difficult,  the  stream  of  urine  broken  or  forked;  in 
short,  when  the  symptoms  presented  the  appearance  of  the  formation 
of  stricture  or  a  tendency  thereto.  In  addition  to  the  above 
medicines,  Acid,  nitricum  may  be  mentioned  as  a  useful  remedy  in 
gonorrhoea  secundaria  or  gleet;  also  Sepia,  Zycqpodium,  Cubeba,  SiUcea, 
Calcarea,  Thuja,  Natrum  m.,  and  Dulcamara.  When,  in  consequence 
of  errors  in  diet,  the  use  of  wines,  spirits,  acids,  &c.,  an  increased 
discharge  takes  place,  accompanied  by  frequent  desire  to  urinate,  and 
some  scalding  pain,  Nux  v.,  or  one  or  more  of  the  other  remedies 
enumerated  above,  as  Cannabis,  Sec,  must  be  resorted  to.  Tussilago 
petasites  (in  the  dose  of  two  teaspoonfuls  of  the  expressed  juice  of  the 
plant,  or  of  the  water  containing  the  plant  in  a  macerated  condition) 
has  recently  been  recommended  as  a  most  efficacious  remedy  in  recent 
as  well  as  chronic  gonorrhoeas.  If  aggravation  follows  the  first  dose 
or  two  of  the  medicine,  it  must  be  given  in  a  weaker  or  more  diluted 
form.  A  case  of  ophthalmia  which  had  existed  for  two  years,  and  had 
made  its  appearance  after  a  suddenly  suppressed  clap,  was  cured  by 
the  employment  of  this  remedy.* 

When  there  is  a  complication  of  gonorrhoea  and  chancre,  or  when 
the  discharge  from  the  urethra  is  found  to  proceed  from  chancres 
within  the  tube,  Mercurius  should  be  prescribed.  (See  also  Syphilis.) 
And  when  there  are  condylomata  on  or  in  the  vicinity  of  the  genital 
organs,  or  there  is  reason  to  suppose  that  1>he  discharge  from  the 
urethra  is  of  sycosic  origin,  Thuja  and  Acidum  nitric,  or  Cinnab., 
Merc,  and  Sulph,  are  the  principal  remedies  with  which  the  cure  is 
to  be  accomplished.  (See  Sycosis.)  Against  symptomatic  buboes 
Carbo  animalis  is  considered  as  one  of  the  most  efficacious  remedies. 
Silicea  and  Mercurius  may  also  be  named  as  likely  to  be  useful  in 
some  cases.  (See  art.  Bubo.) 

If  cystitis  ensue  in  consequence  of  the  extension  of  the  inflam- 
mation to  the  mucous  membrane  of  the  bladder,  Cantharides  and 
*  Rosenberg,  Gr.  u.  st.  N.  Arch.,  1— -2.  80. 


472  URINARY    AND    GENITAL    ORGANS. 

Cannabis  will  claim  the  principal  attention.  (See  Cystitis.)  %  When 
swelled  testicle  results  from  the  sudden  suppression  of  a  clap,  Clematis, 
Sulphur,  and  Pulsatilla  form  the  most  appropriate  remedies.  (See 
Orchitis.)  And  when  rheumatism  or  ophthalmia  are  produced,  the 
medicaments  enumerated  in  the  respective  chapters  on  these  affec- 
tions must  be  employed.  It  sometimes  happens  that  pains  in  the 
region  of  the  prostate  are  complained  of  for  a  considerable  length  of 
time  after  an  attack  of  gonorrhoea,  which  prove  particularly  trouble- 
some during  erections,  and  occasionally  incapacitate  the  individual 
affected  for  riding  on  horseback.  Their  removal  is,  in  general,  ac- 
complished without  difficulty  by  means  of  Pulsatilla,  Thuja,  Sulphur, 
Lgcopodium,  or  Capsicum.  (See  Prostatitis.) 

During  the  treatment  of  gonorrhoea,  wine,  spirits,  and  malt  liquors 
ought  to  be  abstained  from.  Pure  cold  water  is  the  best  diluent, 
and  may  be  freely  partaken  of.  Active  exercise  should  be  shunned 
during  the  inflammatory  stage ;  when  it  cannot  be  wholly  avoided  a 
suspensory  bandage  should  be  worn.  If  the  inflammation  be  extensive 
or  the  parts  much  swollen,  confinement  to  the  recumbent  posture 
becomes  requisite. 


INFLAMMATION  OF  THE  GLANS  PENIS. 

Balanitis.     Balano-blenorrhcea. 

Inflammation  of  the  glans  penis  may  either  occur  simultaneously 
with  inflammation  of  the  urethra  after  impure  connexion ;  or  it  may 
arise  from  mechanical  injury,  or  from  the  inadvertent  application  of 
poison  to  the  part,  as  sometimes  happens  when  the  patient  has  been 
occupied  in  handling  poisonous  plants. 

When  the  disorder  takes  its  rise  from  extension  of  the  inflam- 
mation of  the  urethra  over  the  whole  of  the  glans,  and  also  the 
prepuce,  Mercurius  is,  in  general,  the  most  appropriate  remedy. 
Sometimes  it  may  be  found  necessary  to  give  a  dose  or  two  of 
Aconitum  before  Mercurius ;  and  in  other  cases  Cannabis  may  be  more 
prominently  indicated  than  either  of  the  said  remedies.  (See 
Inflammation  of  the  Urethra,  and  also  Phimosis.)  Acidmm 
nitricum  is  useful  when  small,  superficial  ulcerations  form  on  the 
glans  in  neglected  or  protracted  cases.  If  the  affection  has  been 
caused  by  a  bruise,  or  has  arisen  from  friction  during  coitus,  Ar- 
nica should  be  administered,  and  alternated  every  eight  hours  with 


INFLAMMATION  OF  THE  TESTIS.  473 

Aconitum,  should  the  inflammation  and  swelling  be  excessive.  In 
the  event  of  these  remedies  failing  to  relieve  the  symptoms,  Rhus 
toxicodendron  must  be  employed.  Belladonna  and  Bryonia,  sometimes 
in  alternation  with  Aconitum,  have  been  recommended  as  the  best 
adapted  to  the  treatment  of  those  cases  which  have  originated  in  the 
accidental  application  of  poison.  Cannabis,  Cantharides,  Cuprum,  or 
Ledum  are  considered  by  some  homoeopathists  as  the  most  deserving 
of  attention,  when  no  cause  can  be  traced  or  assigned  as  having 
given  rise  to  this  inflammation.  If  the  disorder  be  of  syphilitic  or 
sycosic  origin,  the  remedies  which  we  have  mentioned  in  the 
chapters  on  these  two  diseases  must  be  resorted  to. 


INFLAMMATION  OF  THE  TESTIS. 

Swelled  Testicle.     Orchitis.     Hernia  humeralis 

This  affection  is  liable  to  arise  from  external  injury ;  but  it  is 
much  more  frequently  encountered  as  a  sympathetic  disease  from 
irritation  of  the^urethra.  The  inflammation  and  swelling  come  on 
suddenly,  and  as  abruptly  subside,  or  pass  from  one  testis  to  the 
other.  At  the  commencement  of  the  attack,  the  testicle  is  tumefied, 
soft,  and  sensitive  to  the  touch  ;  after  a  short  period  it  becomes  hard 
and  excessively  painful.  The  spermatic  cord  is  also  rendered  very 
tender,  and  thickened,  whilst  its  veins  are  occasionally  found  in  a 
varicose  state.  Pain  in  the  loins,  colic,  sickness,  more  or  less  fever, 
depression  of  spirits,  and  occasionally  a  difficulty  of  making  water, 
are  other  not  unfrequent  concomitants  of  the  disorder. 

Therapeutics.  If  the  accompanying  fever  run  high,  a  few 
doses  of  Aconitum  must  be  exhibited.  On  the  reduction  of  the  fever, 
and  diminution  of  local  heat,  Pulsatilla  is  one  of  the  most  efficacious 
remedies  when  irritation  of  the  urethra,  and  especially  that  arising 
from  suppressed  gonorrhoea,  has  given  rise  to  the  affection.  Sulphur 
and  Clematis  erecta  are  sometimes  required  to  complete  the  cure  after 
the  employment  of  Pulsatilla  ;  in  many  cases,  indeed,  these  remedies 
are  preferable  to  Pulsatilla,  even  at  the  beginning  of  the  disease. 
When  the  swelling  has  resulted  from  external  injury  Arnica,  externally 
and  internally,  rarely  fails  to  afford  speedy  relief.  It  may  be  preceded 
by  Aconite  if  called  for,  and  succeeded  by  Pulsatilla  or  by  Conium  if 
the  pain  and  swelling  do  not  readily  diminish  under  the  action  of 


474  URINARY  AND  GENITAL  ORGANS. 

Arnica.*  In  those  cases  where  Aconite  has  been  found  necessary,  the 
application  of  lint  dipped  in  cold  water  and  kept  constantly  moist,  is 
frequently  productive  of  great  relief.  Should  induration  in  the 
epididymis  remain,  Aurum,  Clematis,  and  Sulphur  will  be  found  the 
more  generally  useful.  In  other  instances,  and  especially  in  indura- 
tions of  long  standing,  we  may,  in  addition  to  the  above,  bear  the 
following  remedies  in  mind :  Rhododendron  crysanthum,  Merc,  Graph., 
Lycopod.,  Agnus  castus,  Staph.,  Spong.,  or  Zincwm.  Against  orchitis  as 
a  metastasis  of  Parotitis,  Pulsatilla,  Merc,  and  Nux  v.  have  been 
strongly  recommended ;  and  in  that  from  the  abuse  of  Mercury, 
Cinchona,  Aurum,  Acidum  nitr.,  and  Sulphur  have  proved  of  great 
efficacy. 

SARCOCELE. 


This  is  an  affection  of  the  body  of  the  testis,  in  which  its  sub- 
stance is,  for  the  most  part,  converted  into  a  hard  fleshy  substance, 
hence  the  name.  In  the  mild  form  of  the  complaint  the  tumour  is 
smoother,  and  produces  little  or  no  pain  or  uneasiness  beyond  what 
is  occasioned  by  its  weight.  This  benign  condition  of  matters  some- 
times goes  on  without  material  alteration  for  a  considerable  period ; 
but  in  other  cases  it  very  speedily  acquires  a  more  serious  character, 
by  becoming  unequal  and  knotty,  increased  in  bulk,  and  attended 
with  acute  shooting  pains  extending  up  the  loins  and  back.  When 
it  assumes  a  malignant  character,  it  ulcerates  and  forms  a  large,  foul, 
offensive  phagedenic  ulcer  with  indurated  edges  ;  or  extremely  pain- 
ful fungi  burst  forth  from  the  ulcerated  surface,  subject  to  repeated 
occurrences  of  hemorrhage.  Occasionally  an  accumulation  of  fluid 
in  the  tunica  vaginalis  takes  place  coeval  with  the  enlargement  and 
induration  of  the  testis,  producing  that  mixed  variety  of  the  disorder 
denominated  hydro-sarcocele. 

Sometimes  the  disease  appears  to  be  merely  local,  particularly 
when  an  external  injury  has  given  rise  to  its  formation,  and  the 
patient  is  of  a  good  habit  of  body.  But  when  it  proceeds  from,  or 
happens  to  become  developed  in  a  tainted  constitution,  the  abdomi- 
nal viscera  and  system  at  large  become  implicated,  severe  constitu- 
tional irritation  supervenes,  and  a  termination  is  sooner  or  later  put 
to  the  patient's  existence. 

*  See  art.  Contusions. 


VARICOCELE.  475 

Therapeutics.  In  the  mild  form  of  the  complaint,  of  in  the 
first  stage,  resolution  may  be  effected  by  means  of  one  or  more,  of 
the  following  remedies  :  Aurum,  Clematis,  Lycopod/ium,  Agnus  castus, 
Graphites,  Rhododendron,  and  Sulphur.  When  the  scrotum  presents  a 
livid  colour,  and  its  veins  are  varicose,  Lachesis  will  be  found  very 
useful.  In  more  advanced  stages,  or  when  the  tumour  acquires  a 
malignant  character,  Arsenicum,  Lachesis,  Clematis,  Arenia  diadema, 
Carl,  v.,  or  Thuja  may,  in  some  instances,  enable  us  to  arrest  the  fatal 
progress  of  the  disorder,  but  in  the  majority  of  such  cases  extir- 
pation is  the  only  resource. 


VARICOCELE. 

Varicocele,  Cirsocele,  or  varicose  enlargement  of  the  sper- 
matic veins,  usually  commences  close  to  the  testis,  and  extends 
upwards  to  the  abdominal  ring.  The  tumefaction  of  the  vessels  is 
commonly  greater  the  nearer  they  approach  the  testis.  The  swelling 
is  knotty  and  unequal,  bearing  some  resemblance  to  coiled-up  earth- 
worms ;  it  is  sensitive  to  the  touch,  creates  a  feeling  of  weight  in  the 
scrotum,  also  in  the  loins,  and  often  a  degree  of  numbness  in  the 
thigh.  Prolonged  retainment  of  the  erect  posture,  exercise  or  over- 
exertion of  any  kind  produce  an  aggravation  of  symptoms.  Cirsocele 
is  to  be  distinguished  from  hernia  as  follows :  after  placing  the 
patient  in  the  horizontal  posture  proceed  to  reduce  the  swelling  by 
compression  of  the  scrotum ;  then  press  the  fingers  against  the 
upper  part  of  the  abdominal  ring,  and  request  the  patient  to  get  on 
his  legs ;  if  it  be  a  cirsocele,  the  swelling  will  reappear  with  increased 
size,  from  the  obstruction  which  is  offered  to  the  return  of  blood 
into  the  abdomen  by  the  pressure ;  but  if  a  hernia,  the  recurrence  of 
the  tumour  cannot  take  place  as  long  as  the  pressure  at  the  ring  is 
continued.  Blows  upon  the  groin,  the  violent  pressure  of  a  hernial 
truss  over  the  spermatic  cord  tumours  resting  on  and  interrupting 
the  circulation  in  the  vena  cava  inferior,  excesses,  &c,  are  considered 
as  the  most  common  exciting  causes  of  the  malady. 

Therapeutics.  The  radical  cure  of  cirsocele  is  frequently 
attended  wTith  great  difficulty ;  and  in  many  cases  it  is  only  prac- 
ticable to  give  palliative  relief.  Pulsatilla,  Lachesis,  and  Arnica  are 
the  more  generally  useful  remedies.     In  most  cases  we  may  com- 


476  URINARY  AND  GENITAL  ORGANS. 

mence  with  Pulsatilla,  and  desire  the  patient  to  support  the  testis 
with  a  suspensory  bandage.  Lachesis  is  frequently  of  considerable 
service  after  the  previous  employment  of  Pulsatilla,  but  particularly 
when  the  vessels  present  an  extremely  livid  appearance.  When 
external  injury,  such  as  a  blow,  or  the  pressure  arising  from  the  pad 
of  a  truss,  has  given  rise  to  the  affection,  Arnica,  in  the  form  of 
lotion  (one  part  of  the  tincture  to  ten  of  water),  should  be  applied. 

If,  from  long  standing,  or  violent  exercise,  the  vessels  have  become 
more  than  usually  tumid  and  painful,  a  dose  of  Aconitum  may  be  pre- 
scribed, the  part  frequently  bathed  with  cold  water,  and  the  patient 
confined  to  the  recumbent  posture.  Nux  v.  is  of  service  where  there 
is  constipation,  and  neither  Pulsatilla  nor  Lachesis  correspond  to  this 
particular  symptom.  (See  art.  Constipation.)  Sulphur  will  often 
prove  useful  after  Nux*  Arsenicum  and  Carlo  v.  may  be  selected 
when  severe,  burning  pains  are  complained  of  in  the  tumour.  And 
in  inveterate  cases:  Sulphur,  Graphites,  Lycqpodium,  Carlo  v.,  Sepia,  &c. 
are  the  remedies  from  which  we  can  expect  to  derive  the  most 
assistance ;  but  where  the  symptoms  do  not  yield  to  any  of  these  or 
others  which  may  have  appeared  better  indicated,  and  the  tumour  is 
large,  extremely  painful,  and  threatens  to  waste  away  the  testis  by 
its  pressure,  the  varicose  veins  should  be  removed,  and  inflammation 
subdued  by  the  antiphlogistic  measures  given  under  the  head  of 
Wounds. 


HYDROCELE. 

By  the  term  hydrocele  is  meant  a  tumour  arising  from  a  preter- 
natural accumulation  of  serous  fluid,  having  its  seat  in  the  mem- 
branes of  the  scrotum  [Anasarca  integumentorum),  or  the  coats  of  the 
testis  and  its  vessels  {Hydrocele  tunica  vaginalis).  The  former  is  com- 
mon to  the  whole  bag  and  enveloping  cellular  tissue  ;  it  is  generally 
accompanied  with  anasarca  in  other  parts,  or  ascites,  and  when 
pressed  upon  retains  the  impression  of  the  finger.  The  latter  is  a 
purely  local  affection,  and  is  that  to  which  the  name  of  hydrocele  is 
by  many  writers  restricted.  It  presents  the  appearance  of  a  pyriform 
swelling  of  the  scrotum ;  is  elastic,  free  from  pain,  and  rarely  occurs 
on  both  sides,  but  more  commonly  on  the  left  than  the  right.  The 
tumour  is  primarily  manifested  at  the  inferior  part  of  the  testis,  and 
gradually  ascends  towards  the  abdominal  ring.     In  some  cases  the 


HYDROCELE.  477 

accession  of  the  disorder  is  sudden,  and  the  swelling  increases  to  a 
painful  degree  of  distension ;  but  more  frequently  it  takes  place  very 
slowly,  and  occasionally  continues  for  many  years  with  little  disturb- 
ance. The  tumour  is  usually  hard  at  its  posterior  surface,  where  the 
testis  is  for  the  most  part  situated.  As  it  enlarges,  and  particularly 
in  its  early  stage,  it  is  transparent,  so  that  a  shade  of  light  pervades 
the  whole  tumour  when  a  candle  is  held  on  the  opposite  side  ;  and 
on  compressing  it  with  the  fingers  fluctuation  is  perceptible,— 
by  which  circumstance,  together  with  the  absence  of  pain  and  the 
smoothness  of  the  surface,  it  is  distinguishable  from  hernia  of  the 
omentum  or  intestines,  sarcocele,  fungus  haematodes,  or  schirrus  of 
the  testis. 

Therapeutics.  As  anasarcous  swelling  of  the  scrotum  is  gene- 
rally met  with  in  conjunction  with  anasarca  or  ascites,  we  refer  the 
reader  to  these  different  headings  for  particulars,  and  shall  merely 
add  that  when  there  appears  to  be  no  marked  participation  of  the 
whole  habit  in  the  disorder,  it  will  frequently  yield  readily  to  the 
employment  of  Hetteborus,  Arsenicum.,  or  China,  &c.  The  radical  cure 
of  hydrocele  of  the  tunica  vaginalis  is  in  many  cases  attended  with 
considerable  difficulty.  In  those  of  recent  origin,  or  occurring  in 
very  young  subjects,  Pulsatilla  will  often  be  found  an  effectual 
remedy.  In  more  inveterate  cases,  Hepar  sulphuris,  Graphites,  Sulphur, 
Nux  v.,  Arnica,  Conium,  &c,  externally  as  well  as  internally,  become 
requisite,  the  latter  two  especially  when  a  contusion  has  given  rise 
to  the  affection.  Mercurius,  Cinchona,  and  Digitalis  have  been  em- 
ployed with  success  in  several  cases.  And  in  strumous  habits, 
Silicea  has  been  stated  to  be  of  greater  efficacy  than  almost  any  other 
remedy.  In  all  cases  it  ought  to  be  the  earnest  and  untiring  aim  of 
the  practitioner  to  effect  a  cure  by  means  of  appropriate  medicine,  in 
place  of  resorting  to  the  hazardous  experiment  of  effecting  a  cure  by 
the  operation  of  injection.  When  the  tumour,  from  its  great  bulk, 
has  become  of  painful  annoyance  to  the  patient,  palliative  relief  may, 
if  absolutely  necessary,  be  afforded  by  the  evacuation  of  the  accu- 
mulated fluid  by  means  of  a  trocar.  After  which  process,  the  parts 
may  be  dressed  with  lint  dipped  in  cold  water,  and  a  dose  or  two  of 
Arnica  given  internally,  prior  to  the  selection  of  any  other  remedy, 
according  to  the  nature  of  the  case,  the  constitution  and  tempera- 
ment of  the  patient. 


478  URINARY  AND  GENITAL  ORGANS. 

Diffused  Hydrocele  of  the  Spermatic  Cord  {Hydrocele 
funiculi  spermatid)  consists  of  a  collection  of  watery  fluid  in  or  about 
the  cellular  membrane  surrounding  the  spermatic  cord.  The  tumour 
occupies  the  course  of  the  cord,  is  soft,  colourless,  and  unaccom- 
panied by  pain.  It  seems  to  diminish  on  the  application  of  pressure, 
but  speedily  resumes  its  usual  size,  either  in  the  recumbent  or  erect 
posture,  as  soon  as  the  pressure  is  discontinued.  It  is  often  no 
longer  than  the  portion  of  the  cord  which  occupies  the  groin,  but 
sometimes  it  extends  as  far  as  the  testis,  and  produces  excessive 
distension  of  the  scrotum.  When  the  swelling  attains  a  large  size, 
it  is  productive  of  great  inconvenience,  and  the  patient  complains  of 
uneasiness  in  the  lumbar  region. 

The  treatment  of  this  form  of  hydrocele  is  closely  analogous  to  the 
preceding.  When  the  swelling  is  small,  a  suspensory  bandage  should 
be  worn ;  and  if  it  appears  to  have  originated  from  the  pressure  of 
an  ill-made  or  badly-fitting  truss  applied  to  obviate  hernia,  the  occa- 
sional cause  \inust  necessarily  be  remedied,  otherwise  all  attempts  at 
a  cure  will  prove  abortive.  When  the  disease  is  associated  with 
anasarca  in  other  parts,  or  when  morbid  states  of  the  abdominal 
viscera,  such  as  indurations,  &c,  become  manifest,  remedies  must  be 
selected  to  embrace  the  whole  deranged  habit.  (See  Anasarca, 
Enteritis,  &c.)  In  some  desperate  cases,  it  may  be  found  neces- 
sary to  lay  open  the  tumour  by  an  incision  extending  from  the  abdo- 
minal ring  to  the  testis. 

Encysted  Hydrocele  of  the  Spermatic  cord.  {Hydrocele 
cystata  funiculi  spermatid.)  In  this  variety  of  the  complaint  the  fluid 
is  contained  in  one  (rarely  two)  distinct  cell  or  cyst.  The  tumour  is 
of  an  oblong  shape,  and  is  placed  between  the  abdominal  ring  and 
testis.  It  is  always  free  from  pain,  possesses  a  good  deal  of  trans- 
parency, and  is  commonly  very  tense.  Itt  differs  from  hydrocele  of 
the  tunica  vaginalis,  by  not  extending  below  the  testis,  feeling  like  a 
distended  bladder,  and  throughout  exempt  from  hardness.  The 
testis  is,  however,  always  to  be  felt  below  or  behind  it ;  whereas  in 
hydrocele  of  the  vaginal  tunic,  when  of  considerable  magnitude,  the 
testicle  cannot  be  discovered.  It  is  distinguished  from  hernia  by  its  size 
and  form  remaining  unaltered  in  the  horizontal  posture,  and  by  not 
becoming  enlarged  or  receiving  any  impulse  from  sneezing  or  cough- 
ing ;  further,  by  its  incapability  of  being  returned  into  the  cavity  of 
the  abdomen,  and  its  being  unattended  with  any  derangement  of  the 


VENEREAL  DISEASE.  479 

intestinal  tract.  A  perceptible  fluctuation  and  the  absence  of  pitting 
on  pressure  determine  its  features  from  those  of  anasarcous  hydrocele. 
The  homoeopathic  treatment  required  is  the  same  as  that  described 
for  hydrocele  of  the  vaginal  coat. 


VENEREAL  DISEASE. 
Syphilis,    Lues  Venerea. 

The  symptoms  produced  by  the  venereal  disease  are.  generally 
divided  into  primary  and  secondary  ;  by  the  term  primary  is  under- 
stood the  ulceration,  sometimes  followed  by  a  swelling  of  the  ab- 
sorbent glands,  which  results  from  the  direct  application  of  a  peculiar 
virus  to  the  parts. 

When  the  ulceration  is  situated  on  the  organs  of  generation  it  is 
denominated  a  chancre,  and  the  glandular  swelling  receives  the  appel- 
lation of  bubo.  The  ulcer  may  be  on  the  prepuce,  the  glans  penis,  at 
the  angle  formed  by  the  junction  of  the  two  former,  at  the  fraenum, 
the  orifice  of  the  urethra,  the  body  of  the  penis,  or  even  on  the 
scrotum  or  perinaeum.  In  the  female,  the  ulcers  are  commonly 
formed  about  the  labia,  nymphae,  clitoris,  and  sometimes  within  the 
orifice  of  the  urethra  or  the  vagina.  The  first  symptoms  of  a  chancre 
generally  set  in  from  three  to  six  days  after  coition,  and  are  commonly 
announced  by  a  feeling  of  itching,  which  upon  examination  is  found 
to  proceed  from  a  small  pimple  or  pustule  having  an  inflamed  base, 
which  feels  hard  to  the  touch ;  soon  afterwards,  an  elevated  point  is 
observed  on  the  minute  cone,  from  an  opening  in  which  a  limpid  fluid 
is  discharged,  and  succeeded  by  a  more  or  less  rapid  development  of 
ulceration.  The  primary  venereal  sore  varies  much,  however,  both  in 
appearance  and  intensity  in  different  individuals,  these  several  forms 
seeming  in  a  great  measure  to  depend  on  the  habit  of  body,  age,  and 
temperament  of  the  patient.  The  most  common  varieties  are  the 
Hunterian  chancre,  the  superficial  ulcer  with  raised edges,the  phagedenic,  and 
the  sloughing  ulcer.  The  Hunterian  chancre  commences  in  the  manner 
we  have  already  described.  As  soon  as  this  sore  is  formed,  it  exhibits 
a  tendency  to  assume  the  circular  form,  becomes  deep  and  spreading, 
is  covered  with  a  tenacious  and  adherent  matter,  and  has  a  hard, 
cartilaginous  base  and  margin ;  it  is  met  with  on  all  the  parts  of  the 
genital  and  urinary  organs  we  have  alluded  to.     When  on  the  glans 


480  URINARY  AND  GENITAL  ORGANS. 

it  is  usually  less  painful,  and  less  inflamed  than  when  it  is  on  the 
prepuce  or  fraenum,  but  more  inclined  to  hemorrhage.  The  super- 
ficial ulcer  has  its  margins  considerably  elevated,  and  sometimes 
spongy,  but  is  not  attended  with  induration  ;  it  is  sometimes 
accompanied  by  two  or  three  sores  of  the  same  character,  and  has 
its  seat  very  often  on  the  outside  of  the  prepuce,  but  is  as  frequently 
met  with,  attended  by  its  superficial  satellites,  on  the  corona 
glandis,  under  the  prepuce,  or  around  its  orifice.  When  located  at 
the  side  of  the  fraenum  it  usually  destroys  that  fold  of  reflected 
integument. 

The  phagedenic  sore  is  destitute  of  any  marked  degree  of  sur- 
rounding hardness,  has  no  granulations,  but  presents  a  livid-coloured 
circumference,  and  is  liable  to  spread  most  rapidly  and  alarmingly, 
particularly  when  injudiciously  treated  by  irritating  external  appli- 
cations, or  by  excessive  doses  of  Mercury.  Lastly,  the  sloughing  ulcer 
is  distinguished  by  displaying  itself,  at  the  commencement,  as  a  black 
spot,  which  extends,  then  casts  off,  and  discloses  a  phagedenic  or 
corroded  surface.  The  ulcer  which  remains  after  the  slough  has 
come  away  is  of  a  painful  character,  and  has  a  dark  blue  or  livid 
crimson  margin.  A  bad  habit  of  body,  combined  with  intemperance, 
insufficient  or  unwholesome  diet,  and  a  residence  in  an  unhealthy 
neighbourhood,  or  the  effects  of  improper  treatment,  and  particularly 
the  abuse  of  Mercury r,  or  the  employment  of  powerful  and  irritating 
local  applications,  are  apparently  the  principal  causes  which  give  rise 
to  the  formation  of  this  serious  description  of  sore,  which,  if  not 
checked,  or  if  perse veringly  maltreated,  will  frequently  go  on  slough- 
ing and  ulcerating  until  nearly  the  whole  of  the  external  sexual 
organs  are  destroyed. 

The  cleft  of  the  nates,  the  groin,  the  perinaeum  and  the  labia 
pudendi  are  frequent  seats  of  the  sloughing  ulcer. 

Secondary  Symptoms.  These  most  frequently  consist  in  an 
ulcerated  state  of  the  fauces,  mouth,  and  Schneiderian  membrane.  In 
bad  constitutions,*  and  especially  where  improper  treatment  has  been 
employed,  such  as  excessive  doses  of  Mercury  (one  of  the  most  fruit- 
ful sources  of  many  of  the  so-called  secondary  symptoms  in  general), 
considerable  portions  of  the  velum  palati  and  tonsils,  as  also  the 
epiglottis,  the  cartilages  of  the  larynx,  and  eventually  even  the  bones 

*  Ricord  is  of  the  opinion  that  secondary  symptoms  never  arise  from  contagion,  but  are 
derived  from  hereditary  taint.     (Traite  Pratique  des  Maladies  Veneriennes.) 


SYPHILIS.  481 

of  the  nose  become  affected,  and  are  sometimes  destroyed ;  affections 
of  the  skin  (syphilida)  of  various  kinds,  assuming  the  form  of  papulae, 
pustulae,  squamae,  tuberculae,  etc.,  also  occur,  sometimes  preceded  by 
febrile  symptoms.  The  syphilitic  eruptions  chiefly  shew  themselves 
upon  the  external  organs  of  generation,  about  the  verge  of  the  anus, 
on  the  face,  especially  the  forehead  and  angles  of  the  mouth ;  but 
sometimes  also  on  the  back,  and  indeed  the  whole  body.  They  have 
very  often  a  peculiar  hue,  varying  in  shade  from  a  violet  red  to  an 
earthy  yellow,  but  commonly  distinguished  by  the  denomination 
"  coppery,"  and  have  usually  a  tendency  to  ulcerate.  Other  symptoms 
of  constitutional  infection  almost  constantly  accompany  the  syphilitic 
eruptions,  such  as  pains  in  the  bones,  ulcers  in  the  throat,  etc. 

Constitutional  lues  often  affects  the  iris,  producing  inflammation  and 
ulceration.  The  periosteum  and  bones  are  frequently  the  principal 
seat  of  the  constitutional  symptoms,  particularly  the  bones  of  the 
cranium,  the  inferior  maxillary,  the  clavicle,  sternum,  distal  end  of 
the  radius,  and  the  tibia,  in  addition  to  those  of  the  nose,  as  already 
observed.  When  the  disease  settles  in  the  bones,  or  when  the  bones 
have  become  involved  by  the  employment  of  Mercury  in  large  doses, 
the  patient  is  tormented  with  nocturnal  pains  of  a  more  or  less  excru- 
ciating character. 

Treatment  of  the  Primary  Symptoms  of  Lues. 

Bicord,*  in  opposition  to  Hahnemann,  considers  a  chancre,  at  its 
commencement,  as  a  purely  local  disease,  and  therefore  recommends 
that  it  should  be  treated  as  such,  and  destroyed  by  the  application  of 
a  cautery  within  three  to  five  days  after  the  contraction  of  the  infec- 
tion. He  states  that  he  never  knew  of  a  case,  so  treated,  which  ter- 
minated in  the  absorption  of  the  virus  into  the  system,  followed  by 
symptoms  of  general  poisoning.  We  have  not,  as  yet,  been  so  fortu- 
nate as  to  have  had  any  cases  submitted  to  our  observation  at  so  early 
a  period  of  their  career,  and  cannot  therefore  offer  any  testimony  in 
favour  of  the  latter  part  of  M.  Ricord^s  assertion,  if  that  were  needed, 
seeing  that  it  is  founded  on  extensive  practical  experience.  We  have, 
however,  had  opportunity  of  treating  a  considerable  number  of  cases 
at  a  somewhat  more  advanced  stage,  and  propose  to  give  the  following, 
brief  outline  of  the  treatment  we  pursued  : — 

*  Traite  Pratique  des  Maladies  Veneriennes. 

31 


482  URINARY  AND  GENITAL  ORGANS. 

The  remedies  we  employed  were  Mercurius  vivus,  Merc,  corrosivus, 
Acidum  nitricum,  Hepar  s.,  Acid,  phosph.,  Zycqpodium,  Sulphur,  Silicea, 
Arsenicum,  Carlo  v.,  Lachesis,  Thuja,  and  Sepia.  In  the  selection  of 
these  we  were  guided  by  the  state  and  appearance  of  the  sore,  and 
varied  the  potencies  according  to  the  habit  of  body  of  the  patient. 
Where  Mercury  had  not  been  previously  employed,  we  prescribed  it 
for  all  sores  which  presented  an  indurated  base  and  margin,  whether 
they  secreted  and  were  covered  with  a  tenacious  or  a  thin  offensive 
matter,  and  we  should  certainly  most  unwillingly  dispense  with  this 
valuable  remedy  in  such  cases,  notwithstanding  the  bad  repute  it  has 
acquired,  from  the  frightful  effects  which  have  so  frequently  arisen 
from  its  abuse  in  the  hands  of  our  allopathic  brethren.  Such  results 
can  never  take  place  in  homoeopathic  practice,  assuredly  not,  in  the 
hands  of  any  one  at  all  deserving  of  the  name  of  a  homoeopathic 
practitioner.  Where  the  health  of  the  patient  was  remarkably  good, 
and  the  sore  neither  of  long  duration,  nor  had  in  any  way  been  aggra- 
vated by  previous  treatment,  we  have  repeatedly  succeeded  in  effecting 
a  cure  in  from  ten  to  fourteen  days,  by  means  of  Mercurius 
vivus  6.*  A  few  globules  (about  a  dozen)  night  and  morning,  for 
five  or  six  days,  and  subsequently,  on  the  ulcer  assuming  a  healing 
aspect,  every  second  or  third  day.  In  other  cases,  especially  in  torpid 
constitutions,  it  was  found  requisite  to  have  recourse  to  the  third, 
second  and  first  triturations,  and  to  the  second  and  third  of  Mercu- 
rius corrosivus,  giving  J  to  \  a  grain  daily  until  a  copious  discharge 
of  healthy  pus  supervened,  or  the  excavation  began  to  be  filled 
up  with  healthy  granulations.  As  soon  as  either  the  one  or  the  other 
of  these  changes  took  place,  a  pause  of  three  or  four  days  was  made. 
At  the  expiration  of  that  period,  a  few  more  doses  were  generally  suffi- 
cient to  effect  a  cure  in  the  last-named  instance;  but  in  the  former, 
if  no  signs  of  granulation  made  their  appearance,  (which  however, 
was  rarely  the  case),  a  dose  or  two  of  Sulphur  6  produced  a  favor- 
able effect.  If,  on  the  other  hand,  granulations  appeared,  but  instead 
of  being  firm  and  florid,  they  were  pale,  flabby,  and  prominent, 
Acidum  nitr.  3  answered  better.  Again,  when,  after  the  previous 
employment  of \  Mercury,  the  sore  improved  somewhat,  became  less 
cartilaginous  at  the  base,  and  finally  filled  up  with  florid  but  too 
elevated  granulations,  and  remained  hard  at  the  edges,  was  very 
painful  and  irritable,  bleeding  rather  freely  at  the  slightest  touch,  and 

*  The  highest  potencies  of  Mercurius  (200  and  upwards),  are  said  to  have  recently  been 
employed  in  Germany,  with  unequivocal  benefit  in  the  treatment  of  chancre. 


SYPHILIS.  483 

secreting  a  thin,  acrid,  offensive  discharge,  Arsenicum  brought  about 
a  healthy  and  otherwise  favorable  action.  Nevertheless,  a  few  doses 
of  Sulphur  or  Acid,  niir.  were  sometimes  required  to  complete  the  cure, 
after  the  employment  of  Arsenicum,  especially  when  the  ulcer  had  spread 
rapidly,  and  attained  a  large  size  at  the  commencement.  From  four  to 
six  or  eight  weeks  generally  elapsed  before  a  cure  was  established  in 
these  cases. 

When  there  was  excessive  pain,  swelling,  and  inflammation,  and 
these  symptoms  did  not  yield  to  the  employment  of  Mercurius,— Sulphur 
and  Aconitum,  in  alternation,  every  twelve  hours,  gave  relief.  In  other 
cases,  the  exposure  of  the  part  to  the  vapour  of  hot  water,  together 
with  spare  diet  and  the  recumbent  position,  were  sufficient  to  allay 
the  excessive  irritation.  The  dressing,  when  the  ulcer  was  neither 
very  irritable  nor  extremely  painful,  consisted  of  a  small  piece  of  lint. 
Great  cleanliness  is  requisite  in  all  kinds  of  sores ;  and  when  the 
chancre  is  located  under  the  prepuce,  and  the  latter  is  much  swollen 
and  inflamed,  water  should  be  throwTn  up  between  the  prepuce  and 
glans  by  means  of  an  appropriate  syringe. 

The  remedies  which  we  employed  against  the  ulcer  with  raised 
edges  were  Acid,  nitricum,  Hepar  s.,  Sulphur,  Arsenicum,  Silicea,  Carlo  v., 
Lycopodium,  Acid,  phosph.,  Sepia  and  Mercurius.  Most  of  the  cases 
treated  had  already  existed  from  six  to  eight  weeks,  and  upwards, 
and  had  been  subjected  to  a  smart  Mercurial  course,  both  outwardly 
and  inwardly.  Acid,  nitricum  and  Hepar  s.  were  consequently 
very  generally  required.  To  the  former  the  preference  was  given 
when  the  gums  were  severely  affected,  and  when  aching  pains  were 
complained  of  in  the  bones  ;  the  sore  itself  not  painful,  yet  disposed 
to  bleed  easily  and  profusely,  presenting  no  signs  of  central  granu- 
lation, and  having  the  margins  elevated  and  spongy-looking ;  or 
when  there  was  a  tendency  to  the  production  of  condylomata  (sycosic 
complication),  with  secretion  of  a  thin  sanious  discharge.  The 
dose  consisted  of  one  drop  of  the  third  dilution,  at  first,  night  and 
morning,  then  daily,  and  subsequently  every  other  day,  according  to 
the  results.  Sulphur  6  and  Thuja  were  sometimes  required  after 
Acid.  nitr.  had  effected  all  the  benefit  it  seemed  capable  of.  The 
former  when  cicatrization  proceeded  slowly  and  imperfectly;  and 
the  latter  (both  outwardly  and  inwardly),  when  excrescences  continued 
to  form  and  to  discharge  profusely.  Hepar  sulphuris  proved 
particularly  useful  wrhen  the  mouth  and  gums  exhibited  unequivocal 
signs  of  mercurial  action,  and  when  the  sore  was  painful,  irritable, 


484  URINARY  AND  GENITAL  ORGANS. 

and  had  assumed  a  disposition  to  spread  rapidly.  A  quarter  of  a 
grain  of  the  third  or  second,  and  in  some  instances  the  first,  tritura- 
tion, were  given  night  and  morning,  at  the  commencement  of  the 
course,  for  four  days ;  then  daily,  for  a  like  period,  and  subsequently 
every  second  or  third  day.  Silicea,  and  at  other  times  Acid,  nitric, 
were  sometimes  called  for  to  complete  the  cure,  after  Repar  s.  had 
subdued  the  more  prominent  symptoms  of  mercurial  aggravation, 
and  given  a  healthy  character  to  the  sore.  Sulphur,  as  has  already  been 
observed,  is  sometimes  of  much  utility  in  promoting  healthy  granulation 
in  the  Hunterian  chancre,  and  is  also  of  great  service  in  sores  which 
present  a  red  or  bluish  margin,  and  display  a  tendency  to  take  on  a  bad 
character ;  but  it  is  especially  in  the  treatment  of  the  superficial  ulcer 
with  raised  margins  that  we  have  derived  the  most  satisfactory  results 
from  its  employment.  When  a  sore  of  that  character  occurred  in  a 
strumous  habit,  or  in  persons  of  lymphatic  or  bilious  temperament, 
who  were  subject  to  hemorrhoidal  attacks  and  obstinate  constipa- 
tion— when,  moreover,  the  edges  of  the  sore  were  spongy,  very 
sensitive,  and  prone  to  bleed  rather  copiously,  however  gently  the 
prepuce  might  be  drawn  back — and,  finally,  when  the  secretion  from 
the  ulcer  was  thin  and  ichorous,  or  thick,  yellow,  and  rather  copious, 
but  the  centre  of  the  ulcer  flat  and  presenting  no  signs  of  incarnation, 
we  never  failed  to  derive  the  most  satisfactory  results  from  the 
employment  of  Sulphur  6,  ten  or  twelve  globules  daily  for  from  six 
to  eight  days,  and  then  at  longer  intervals,  if  we  perceived  that  the 
medicine  had  made  a  favorable  alteration  in  the  appearance  of  the 
sore.  It  was  rarely  that  any  other  remedy  was  required  to  complete 
the  cure  when  Sulphur  was  indicated  as  above.  Arsenicum,  Carlo  v., 
and  Silicea  were  found  very  useful  when  the  ulcers  had  been  ren- 
dered irritable  by  a  free  use  of  stimulating  applications  under 
allopathic  treatment.  Arsen.  or  Carlo  was  equally  beneficial  when 
the  margins  of  the  sore  were  jagged,  sharp,  and  undermined ;  the 
discharge  thin,  acrid,  and  offensive ;  the  ulcer  painful  and  liable  to 
bleed  somewhat  copiously  when  slightly  touched.  Carlo  v.  received 
a  preference  to  Arsenicum  when  the  patient  bore  evidence  of  having 
been  under  a  cpurse  of  Mercury,  the  breath  emitting  the  peculiar  fetor, 
and  the  gums  looking  inflamed,  spongy,  and  ulcerated.  Silicea  was 
sometimes  requisite  after  the  two  preceding  medicines,  when  they 
had  produced  great  improvement,  but  seemed  inadequate  to  effect 
cicatrization.  When  the  sore  was  inflamed  as  well  as  painful  and 
irritable,  and   the   discharge   discoloured,  or  thin  and  bloody,  the 


SYPHILIS.  485 

granulations  indistinct  or  altogether  absent,  Silicea  was  of  vast  service. 
These  medicines  were  prescribed  at  the  sixth  potency,  and  in  the 
same  manner  as  Sulphur.  Nux  v.  and  Pulsatilla  were  occasionally  em- 
ployed with  advantage  when  the  appearance  of  the  sore  was  altered 
by  intemperance  in  eating  and  drinking.  Mercurins,  from  the  reasons 
already  specified,  was  rarely  an  available  remedy  in  this  form  of  chancre; 
but  in  two  instances  in  which  it  had  not  previously  been  employed, 
or  at  all  events  in  unusual  moderation,  it  was  productive  of  unequi- 
vocal benefit  at  the  sixth  potency.  The  sores  in  the  cases  in  question 
occurred  in  subjects  of  lymphatic  temperament  and  of  plethoric 
habit,  and  displayed  an  active,  spreading  character ;  the  secretion 
being  at  the  same  time  acrid,  ichorous,  and  rather  copious. 

In  some  very  obstinate  cases  of  superficial  chancre,  where  the 
sore  assumed  all  the  characteristics  of  an  indolent  ulcer,  the  margins 
being  thick,  rounded,  and  prominent,  without  the  slightest  ap- 
pearance of  granulation,  or  if  any  granulations  formed,  they  presented 
a  pale  and  flabby  appearance,  Lycopodium  and  Phosphoric  acid  proved 
very  serviceable.  The  former  particularly  in  persons  of  lymphatic 
temperament  and  mild  disposition,  with  tendency  to  habitual  con- 
stipation ;  the  latter  in  spare,  debilitated  subjects,  who  had  been 
addicted  to  excessive  indulgence  in  venery.  When  neither  of  these 
were  sufficient  to  establish  a  cure,  Sepia  and  Sulphur  brought  about 
the  desired  result.  These,  then,  were  the  principal  remedies  which 
we  employed  with  unequivocal  benefit  in  the  treatment  of  the 
Hunterian  and  superficial  chancres ;  and  in  not  one  instance  did  the 
slightest  appearance  of  constitutional  or  secondary  symptoms  super- 
vene. Considerable  advantage  accrued  from  the  simultaneous  ex- 
ternal employment  of  the  appropriate  remedy  in  some  cases,  when 
the  sores  were  of  a  very  indolent  character.  As  regards  the  treatment 
of  the  two  other  kinds  of  primary  sores,  viz.  the  phagedenic  and  the 
sloughing,  we  cannot  say  much,  having  had  only  three  cases  of  the 
former,  and  none  of  the  latter  under  our  observation ;  but  we  have 
every  reason  to  conclude  that  the  homoeopathic  remedies  would, 
when  timely  resorted  to,  readily  succeed  in  arresting  the  progress  of 
the  disease.  In  the  three  cases  of  phagedenic  sores  above  alluded 
to,  two  of  them  had  previously  been  injudiciously  treated  by  over- 
doses of  Mercury,  and  had  been  further  aggravated  by  the  employment 
of  irritating  external  applications.  Hepar  s.  3,  Lachesis  6,  and  Acid, 
nitr.  3,  soon  brought  on  a  healthy  action  in  these,  and  effected  a 
cure.     The  remaining  case,  which  bordered  closely  on  the  sloughing 


486  URINARY  AND  GENITAL  ORGANS. 

ulcer,  yielded  to  Arsenicum  6  and  Silicea  6.  We  found  a  striking 
change  for  the  better  in  the  appearance  of  the  sores,  from  the  internal 
use  of  Arsenicum  and  Lachesis, — the  livid  red  or  blueish  margins  soon 
assuming  a  healthier  colour  after  their  employment.  The  other 
remedies  exerted  perhaps  a  more  favorable  influence  over  the  process 
of  granulation.  Against  the  true  sloughing  ulcer,  Arsenicum  must, 
doubtless,  be  an]  efficient  remedy;  it  corresponds,  both  in  its 
pathogenetic  properties  and  those  which  have  been  derived  from 
clinical  observation,  so  closely  to  the  local  and  constitutional  symp- 
toms of  the  disease.  Lachesis, — and  Silicea,  Bella.,  China,  Mezereum, 
Hepar,  or  Acid,  nitr.,  might  also  be  found  useful,  if  not  indispensable, 
in  many  instances. 

Simple  excoriations  on  the  glans,  resulting  from  coitus,  will  gene- 
rally heal  readily  without  any  treatment  whatever,  if  attention  be 
paid  to  cleanliness.  A  weak  lotion  of  Arnica  (one  part  in  sixteen  or 
twenty)  will  frequently  hasten  recovery.  Cases  which  from  neglect, 
and  particularly  want  of  cleanliness,  have  become  converted  into 
small,  flat,  superficial  sores,  require  Acidum  nitricum  or  Acid,  phosph.  ; 
the  latter  we  found  more  useful  when  the  spots  or  sores  were  of 
larger  size.  The  diet,  in  all  primary  sores,  must  be  regulated  by 
circumstances.  In  young  plethoric  subjects  affected  either  with  the 
Hunterian  or  with  the  superficial  chancre  with  raised  margins,  the  diet 
must  be  low,  and  if  the  sore  be  very  painful  and  inflamed,  the  reclin- 
ing posture  is  often  necessary.  The  drink  must  consist  of  nothing 
but  water,  toast-,  barley-,  or  rice-water,  weak  black  tea,  and  cocoa. 
In  somewhat  debilitated  subjects,  or  in  all  cases  where  the  sore  is 
neither  in  an  inflamed  state  nor  very  painful,  the  diet  need  not  be 
sparing;  but  stimulants,  such  as  wine,  or  spirits,  are  rarely,  if  ever, 
called  for,  and  are  often,  if  not  always,  objectionable  under  homoeopa- 
thic treatment.  In  the  phagedenic  sore,  absolute  rest  in  the  recum- 
bent posture  is  imperative.  If  there  be  great  prostration  of  strength, 
the  diet  should  not  be  too  sparing,  and  yet  not  more  generous  than 
the  state  of  the  digestive  functions  will  admit  of.  Wine  may  be 
called  for,  where  the  patient  has  been  long  accustomed  to  the  daily 
use  of  spirituous  liquors,  or  where  the  constitution  is  extremely 
debilitated,  and  no  reaction  is  found  to  take  place  from  the  employ- 
ment of  the  appropriate,  or  homoeopathic  remedy. 

Btiho.  This  term  was  formerly  exclusively  employed,  as  its  name 
implies,  to  denote  a  swelling  in  the  groin,  arising  from  the  passage  of 


SYPHILIS.  487 

venereal  matter  or  poison  through  the  inguinal  glands;  and  yet  if 
the  patient  have  a  primary  venereal  sore  on  one  of  his  fingers,  he 
may  have  a  bubo  immediately  above  the  elbow,  or  in  the  axilla. 
Buboes  have  been  divided  into  venereal,  sympathetic^  and- constitutional. 
The  venereal  bubo  is  supposed  to  arise,  as  above  observed,  from  the 
direct  irritation  which  the  venereal  poison  offers  to  the  lymphatic 
gland  or  glands  as  it  passes  through  this  portion  of  the  absorbent 
system  into  the  blood.  But  the  matter  of  syphilis  may  be  taken  up 
into  the  circulation  without  exciting  any  inflammation  in  the  glands 
of  the  groin,  or  similar  glands  in  other  parts  of  the  body.  The 
occurrence  of  a  bubo  in  consequence  of  ulcers  on  the  external  parts 
is,  in  reality,  comparatively  rare  in  healthy  subjects,  particularly 
when  the  primary  sore  is  properly  treated ;  and  we  are  confident 
that,  in  many  cases,  the  injudicious  and  too  free  use  of  irritating 
local  applications,  such  as  sulphate  of  copper,  nitrate  of  silver,  and 
the  red  precipitate,  in  allopathic  practice,  is  a  frequent  source  of 
this  glandular  implication.  The  purely  sympathetic,  or  non-venereal 
bubo  is  generally  preceded  and  accompanied  by  some  degree  of 
derangement  of  the  health.  At  times  it  may  be  induced  by  causes 
apparently  the  most  trivial,  such  as  the  wearing  of  a  tight  boot,  the 
effects  of  a  sprain  or  bruise,  &c.  A  boil  or  sore  on  the  foot,  leg, 
thigh,  or  nates,  an  inflamed  or  painful  corn,  a  bunion  on  the  great 
toe,  are  frequent  causes  of  inflammation  and  enlargement  of  the 
inguinal  glands.  By  the  constitutional  bubo,  we  here  allude  to 
scrofulous  swelling  of  the  lymphatic  glands  of  the  axilla,  or  of  the 
groin,  especially  the  latter.  Getting  the  feet  wet,  or  sitting  on  a 
damp  seat,  in  a  gig,  or  on  the  top  of  a  coach,  frequently  develops 
this  form  of  bubo. 

Therapeutics.  It  is  sometimes  difficult  if  not  impossible  to 
arrive  at  the  true  character  of  a  bubo  ;  the  patient,  from  false  deli- 
cacy, often  refusing  to  admit  that  he  has  previously  been  affected 
writh  chancre.  In  homoeopathic  practice,  this  is  of  no  material 
consequence ;  the  appearance  and  condition  of  the  swelling,  and  the 
state  of  the  general  health  forming  a  sufficient  group  of  symptoms 
to  enable  us,  in  doubtful  cases,  to  select  the  appropriate  remedies. 
The  correct  history  of  the  case  is,  however,  by  no  means  unimportant, 
as  it  facilitates  the  choice  of  the  remedy.  If  a  bubo  be  a  venereal 
one,  and  the  chancre  is  in  existence  with  it,  we  should  not  deviate 
from  the  treatment  called  for  by  the  aspect  of  the  primary  sore. 


488  TJRTNARY  AND  GENITAL  ORGANS. 

But  if  the  sore  assumes  a  somewhat  improved  appearance,  or  remains 
perfectly  unaltered,  and  the  bubo,  on  the  other  hand,  becomes  con- 
siderably aggravated,  we  ought  to  give  the  latter  our  chief  attention, 
and  prescribe  according  to  the  features  which  it  presents.  The 
following  is  the  mode  of  treatment  we  have  ourselves  pursued. 
Whenever  the  swellings  were  either  small,  or  of  considerable  size, 
but  neither  excessively  inflamed  nor  particularly  painful,  we  pre- 
scribed Mercurius  at  the  third  trituration,  quarter  of  a  grain  night 
and  morning,  until  signs  of  improvement  made  their  appearance. 
In  those  cases  again  in  which  the  swelling  was  large  and  painful, 
and  accompanied  by  intense  inflammation,  the  integuments  pre- 
senting a  deep  red  hue  extending  over  a  considerable  surface,  the 
redness  disappearing  on  pressure,  but  returning  immediately  after 
the  finger  was  removed,  Belladonna  6,  every  six  to  twTelve  hours,  was 
found  to  be  of  the  greatest  efficacy.  When  suppuration  threatened, 
or  became  established,  Silicea  6,  every  twelve  hours,  formed  an  ad- 
mirable remedy,  having  either  the  effect  of  producing  absorption  of 
the  matter,  and  causing  the  tumour  to  subside,  or  of  quickly  for- 
warding the  suppurative  process  and  the  discharge  of  the  pus  from 
the  cellular  membrane  surrounding  the  gland.  The  former  more 
desirable  result  generally  took  place  when  the  preceding  inflamma- 
tion had  not  been  intense.  Hepar  <?.,  third  trituration,  we  preferred 
to  Silicea,  if  the  patient  had  previously  been  subjected  to  a  course  of 
Mercury,  Staphysagria  6  was  substituted  for  Hepar  $.,  when  the  mouth 
and  gums  were  much  inflamed  or  ulcerated.  When  the  bubo  took 
on  an  indolent  and  indurated  condition,  or  had  remained  in  that 
state  for  several  months  prior  to  the  adoption  of  the  homoeopathic 
treatment,  Card.  v.  was  often  very  serviceable,  having  frequently  the 
effect  either  of  dispersing  the  tumour,  or  of  causing  it  to  suppurate. 
Silicea  was,  however,  of  nearly  equal  efficacy  in  such  cases,  and  at  all 
events  rarely  failed  to  do  good,  when  Carlo  v.  or  a.  produced  only  a 
slight  degree  of  amendment.  A  swollen,  spongy,  or  ulcerated  state 
of  the  gums  was  an  additional  indication  for  Carlo  v.  Sulphur,  or  Aurum, 
and  Acid,  nitricum  proved  useful  in  some  obstinate  cases.  Should  the 
matter  of  a  suppurated  bubo  exhibit  a  decided  tendency  to  spread, 
before  advice  has  been  sought  it  may  sometimes  be  necessary  to  have 
the  swelling  opened  by  the  lancet.  After  the  pus  has  been  discharged, 
and  the  bubo  has  become  converted  into  a  sore,  the  treatment  must 
be  conducted  according  to  the  character  and  appearance  of  the  ulcer. 
(See  Ulcers,  as  also  the  treatment  described  for  primary  sores  on 


SYPHILIS.  489 

the  glans,  &c.)  Silicea  and  Sulphur  are  two  of  the  most  valuable 
remedies  in  all  cases  where  the  parts  do  not  show  a  disposition 
to  heal ;  but  Acid,  nitr.,  Aurum,  Carl,  v.,  Assafcetida,  or  Staphysagria 
will  sometimes  be  called  for,  particularly  in  cases  which  have  evi- 
dently been  aggravated  by  the  previous  use  of  Mercury  in  excessive 
quantities. 

Against  sympathetic  lulo,  Belladonna,  Hepar,  Silicea,  Sulphur, 
Carlo  a.,  &c,  are  the  more  important  medicaments.  The  indica- 
tions for  Belladonna  have  already  been  given  above.  Hepar  s. 
may  follow  Belladonna  if  suppuration  threatens ;  or  if,  after  the 
removal  of  the  excessive  inflammation,  the  gland  remains  in  a 
tumefied  state.  Silicea  is  one  of  the  most  useful  remedies  in 
sympathetic  bubo,  either  at  the  very  commencement,  even  when 
there  is  a  considerable  degree  of  inflammation,  or  at  a  more  advanced 
stage  of  the  affection,  when  suppuration  threatens  or  is  already 
established.  When  a  bunion  on  the  great  toe,  or  an  inflamed  bursa 
in  any  other  part  has  given  rise  to  the  bubo,  there  will  be  additional 
reason  for  prescribing  Silicea,  as  that  remedy  wdll  in  such  a  case  be 
homoeopathic  to  the  originating  cause  as  well  as  its  sequel.  In 
bubo  arising  from  suddenly  suppressed  perspiration  in  the  feet,  this 
medicine  is,  moreover,  a  most  important  medicament.  Sulphur  is 
also  an  efficient  remedy  in  sympathetic  buboes,  particularly  when 
they  occur  in  individuals  wTho  are  subject  to  hemorrhoids,  or  to  boils 
on  the  lower  extremities  or  nates ;  or  when  the  inflammation  and 
enlargement  of  the  inguinal  gland  or  glands  has  arisen  after  the 
suppression  of  an  old  sore  on  the  foot,  leg,  or  thigh.  Carlo  a,  has 
been  recommended  as  an  effective  remedy  in  sympathetic  bubo, 
from  the  circumstance  that  even  when  suppuration  seems  unavoid- 
able, it  has  generally  either  the  effect  of  causing  the  tumour  to 
subside,  or  quickly  suppurate  and  discharge.  We  have  found  Silicea 
to  answer  the  purpose  better. 

In  the  treatment  of  scrofulous  bubo,  Mercurius  and  Dulcamara  are 
very  serviceable  when  the  swelling  is  of  recent  origin,  and  has  become 
developed  after  getting  the  feet  wet,*  or  after  sitting  on  a  damp  seat. 
A  dose  or  two  of  Belladonna  will  sometimes  be  required,  especially  if 
the  inflammation  runs  high.  In  cases  of  longer  standing  Silicea  and 
Sulphur  are  generally  of  greater  efficacy.  Silicea,  as  has  already  been 
remarked,  is  a  valuable  remedy  in  suppurated  buboes;  in  chronic 

*  Silicea  is,  however,  to  be  preferred  to  either  of  these  remedies  when  checked  perspira- 
tion occurs  in  persons  who  have  long  been  affected  with  sweating  of  the  feet. 


490  URINARY  AND  GENITAL  ORGANS. 

cases  it  is  particularly  required  where  the  swelling  is  indurated  and 
painless.  Sulphur  is  frequently  of  much  utility  when  the  tumour  is 
hard,  but  painful  to  the  touch,  and  the  integuments  somewhat 
inflamed,  or  very  liable  to  become  so  after  any  slight  exertion. 
Calc.  c,  Clematis,  and  Carlo  v.  et  a.  are  also  deserving  of  notice  in 
scrofulous  buboes.  [Calc,  after  the  previous  employment  of  Sulph.  ; 
and  Clematis,  Carlo  v.  or  a.  after  Silicea,  in  obstinate,  indolent,  and 
indurated  swellings.)  Iodium,  Acid,  nitr.,  Arsenic.,  Aurum,  Staph.,  or 
Spongia,  &c,  have  likewise  been  recommended  in  scrofulous  buboes. 
Silicea  and  Sulphur  are  two  of  the  principal  remedies  to  promote 
granulation  and  cicatrization  when  these  buboes  have  become  con- 
verted into  ulcers.      (See  Venereal  Buboes,  and  also  Scrofula.) 


Treatment  of  Secondary  Symptoms. 

Sore  Throat.  This  form  of  secondary  symptoms,  so-called,  arises 
in  most  cases,  as  a  sequel  of  the  abuse  of  Mercury,  either  internally 
or  locally,  in  the  treatment  of  a  primary  sore.  It,  consequently, 
for  the  most  part,  yields  most  readily  to  the  use  of  anti-mercurial 
remedies,  such  as  Hepar  s.,  Acid.  nitr. :  Bella.,  Lach.,  Sulph.,  Silic, 
Thuja,  Staph. — Arsenic,  Alumina,  Lycopodium.  When  the  mouth  and 
gums  likewise  are  inflamed  or  ulcerated,  one  or  more  of  the  same 
remedies,  together  with  Carlo  vegetalilis,  Aurum,  Natrum  m.,  Iod.,  and 
China  must  be  had  recourse  to,  according  to  circumstances.  We  are 
generally  in  the  habit  of  commencing  with  Hepar  s.,  third  trituration, 
when  the  patient  complains  chiefly  of  pain,  dryness,  and  scraping  in 
the  throat,  writh  some  degree  of  inflammation  and  swelling  of  the 
tonsils,  but  little  or  no  true  ulceration.  When,  on  the  other  hand, 
on  examining  the  throat,  the  tonsils  are  observed  to  be  somewhat 
enlarged,  the  fauces  considerably  inflamed  and  ulcerated,  the  ulcer 
or  ulcers,  superficial,  and  of  a  gray  colour,  we  commence  with  Acid, 
nitr.  3 — 6  in  preference.  Belladonna  and  Lachesis  are  very  useful 
when  the  inflammation  and  swelling  are  more  severe,  and  the  ulcers 
extremely  painful  and  irritable.  After  these  remedies  have  subdued 
the  excessive  inflammation,  Acidum  nitr.  and  Sulphur  are  generally  of 
great  value,  and  often  sufficient  to  complete  the  cure.  In  other 
cases  Carl,  v.,  Aurum,  Silicea,  or  Arsenicum,  &c,  are  required.  (See 
also  the  treatment  of  Primary  Ulcers.)  In  those  cases  where  we 
have  no  reason  to  suspect  that  Mercury  has  not  given  rise  to,  or 


SYPHILIS.  491 

aggravated  the  symptoms,  Mercurms  is  an  important  remedy,*  parti- 
cularly when  the  ulcer  or  ulcers  are  covered  with  a  tenacious  and 
adherent  matter,  and  the  surface  considerably  excavated.  Acid, 
nitricum  and  Thuja  have  been  recommended  after  Mercurius  or  Sulphir. 
Silicea,  or  Arsenicum,  Lachesis,  or  Carlo  v.,  may  sometimes  be  found  better 
indicated  than  either  of  the  preceding  remedies.  Lycopodium  6 — 9  is 
considered  by  Rummelt  to  be  a  remedy  which  can  with  difficulty  be 
dispensed  with  in  secondary  syphilis.  He  gave  it  with,  striking 
advantage  in  a  case  of  sore  throat,  which  had  long  resisted  various 
kinds  of  treatment  (not  homoeopathic) ;  the  tonsils  were  covered  with 
ulcers,  having  a  gray-coloured  base.  He  also  found  it  of  great 
efficacy  in  several  cases  where  the  fauces  and  tongue  were  covered 
writh  an  herpetic-looking  eruption,  bearing  some  resemblance  to  the 
wrinkled  skin  on  the  hands  of  washerwomen,  and  attended  with  a 
burning  sensation  on  partaking  of  warm  food,  or  after  smoking. 

Against  aching  pains  in  the  bones,  Acid,  nitr.,  Aurum,  and  Lachesis, 
are  of  great  service;  and  in  venereal  nodes  or  other  diseases  of  the 
bones,  the  same  remedies,  together  with  Acid,  phosph.,  Assafmt,  Sulph., 
Calc,  Silic,  Dulc,  or  Mercurius,  when  the  affection  has  not  actually 
been  produced  or  materially  aggravated,  as  is  but  too  often  the  case, 
by  the  abuse  of  that  mineral.  (See  Oz^ena,  and  Diseases  of  the 
Bones.) 

Against  syphilitic  Ophthalmia  {Iritis)  Acidum  nitric,  is  often  a  most 
effective  remedy,  particularly  when  severe  nocturnal  pains  in  the 
bones  are  complained  of  at  the  same  time,  and  the  patient  has  pre- 
viously undergone  a  course  of  Mercury.  (See  Iritis.) 

The  treatment  of  secondary  symptoms  in  the  form  of  eruptions 
must  be  regulated  according  to  the  different  species  of  cutaneous 
disease  to  which  they  bear  the  greatest  resemblance,  together  with 
the  character  of  the  other  constitutional  symptoms  which  usually 
attend.  When  the  eruption  partakes  of  the  papular  form  (Lichen, 
Strophulus,  Prurigo),  Aconitum,  Sulphur,  Acid,  nitr.,  Hepar  s., 

*  Hartmann  recommends  the  Mercurius  prmcipitatus  ruber  in  syphilitic  ulceration  of  the 
throat,  one  grain  of  the  first  trituration  night  and  morning,  for  from  six  to  eight  days  ;  at 
the  expiration  of  which  period,  or  sooner,  if  signs  of  medicinal  action  become  earlier 
developed,  he  discontinues  the  prescription,  and  only  repeats,  as  before,  in  the  event  of  a 
cessation  taking  place  in  the  improvement  which  may  have  resulted  from  the  employment  of 
this  preparation.— Ueber  die  Anwrendungsder  Homceop.  Arzn.,  Aeon.,  Bryon.,  Merc,  p.  109. 
f  Allg.  Horn.  Zeit.  vol.  vii,  p.  117. 


492  URINARY  AND  GENITAL  ORGANS. 

Sepia,  JDulc,  Con.,  Thuja,  Cicuta,  Lycopod.,  Ac.  muriat.,  Bryonia,  Puis. 
The  two  last  named,  together  with  Lycopod.  and  Sulphur,  particularly 
when  there  is  considerable  derangement  of  the  digestive  function. 
When  the  secondary  symptoms  are  associated  with  the  tubercular  or 
with  the  pustular  form  (Sycosis,  Acne  rosacea,  Impetigo,  Favus, 
Ecthyma),  Acid,  nitr.,  Thuja,  Aurum,  Lachesis,  Carlo  v.  et  a.,  Sulph., 
Lycopod.,  Calc,  Cic,  Arsenic,  Rhus,  Staph.,  &c.  And  when  they  have 
taken  on  the  form  of  squama  (Scaly  Syphilis,  Lepra,  Psoriasis, 
Pityriasis,  Pellagra,  Acrodynia),  Sulphur,  Lycopod.,  Lachesis, 
Thuja,  Arsenic, —  Calc,  Cicuta,  Led.,  Graph.,  Sep.,  Natr.  Carbo  a.  etv., 
Clem.,  Petr.,  Phosph.,  Olean.,  Ahim.,  Zinc,  &c.  Secondary  venereal 
ulceration  of  the  skin  is  frequently  preceded  by  an  eruption,  possessing 
one  of  the  before-mentioned  characters,  and  sometimes  in  the  form 
of  bulla  (venereal  rupia).  These  ulcers  present  no  uniform  or  con- 
stant aspect,  sometimes  assuming  a  circular  shape,  with  an  irregular, 
foul,  ash-coloured  surface;  at  others  displaying  the  peculiarity  of 
healing  in  the  centre  and  extending  at  the  circumference,  the  edges 
being  sharp,  and  the  unhealed  part  presenting  the  same  colour  and 
appearance  as  in  the  before-mentioned  instance.  The  tawny  hue,  and 
the  shape  and  situation  of  the  ulcers  are  considered  as  the  cha- 
racteristic signs  of  their  venereal  origin.  In  syphilitic  eruptions  of 
most  kinds  Mercurius  is  more  or  less  useful,  but  as  it  so  very  frequently 
happens  that  that  remedy  has  been  most  injudiciously  and  abusively 
employed  before  the  patient  seeks  the  aid  of  homoeopathic  treat- 
ment, it  is  seldom  that  we  can  desire  that  benefit  from  its  use 
which  might  otherwise  be  the  case.  The  remedies  which  have 
principally  been  recommended  against  the  venereal  ulceration  of  the 
skin,  whether  complicated  or  not  with  mercurial  erythema,  or  eczema, 
or  other  symptoms  of  mercurial  poisoning,  are,  Acid,  nitr.,  Sulph., 
Silicea,  Hepar  s.,  Laches.,  Thuja,  Aurum,  Carbo  v.,  Acidumfuor.,  and  also 
Aconitum  and  Belladonna,  chiefly  as  intermediate  remedies  when  there 
is  excessive  febrile  irritation.  The  treatment  of  phagedenic  ulcera- 
tions, such  as  occur  in  the  advanced  stages  of  syphilis  wTill  chiefly 
consist  in  the  employment  of  the  same  remedies  as  those  we  have 
named  as  the  most  suitable  for  primary  phagedenic  sores.  When 
secondary  symptoms  exhibit  themselves,  especially  in  the  form  of 
venereal  whitlow,  with  formation  of  a  very  offensive  matter  under  the 
nails,  and  exfoliation  of  the  latter,  Mercurius,  Carbo  v.,  and  Silicea  are 
the  most  useful  medicaments.  (See  Whitlow.)    And  when  rhagades, 


SYPHILIS.  493 

or  ragged  ulcerated  fissures,  are  the  more  prominent  features  of  the 
affection,  the  medicines  to  be  employed  are  Merc,  Sulph.,  Lycopod., 
Acid,  nitr.,  Hepar  <?.,  Calc,  Agnus  <?.,  and  Graphites. 


\ilis  in  Infants,  The  venereal  poison  is  not  unfrequently  com- 
municated to  the  foetus  in  utero  through  the  medium  of  the  blood  of 
the  mother.  The  child  is  also  said  occasionally  to  contract  the 
disease  at  the  time  of  birth  from  the  direct  application  of  the  virus  of 
a  chancre  with  which  the  mother  happens  to  be  affected.  In  the 
former  instance  the  child  is  born  with  the  disease.  The  symptoms  of 
syphilis  in  the  new-born  child,  or  soon  after  birth,  are  copper-coloured 
blotches,  and  scaly  eruption  over  the  greater  portion  of  the  body, 
pustules  and  superficial  ulcerations  about  the  anus  and  nates,  and 
sometimes  on  the  organs  of  generation,  rhagades,  warts,  hard  and 
soft  swellings  about  the  head;  also  ulcerations  and  fissures  at  the 
corners  of  the  mouth,  and  in  the  lining  membrane  of  the  fauces,  and 
in  some  instances  on  the  eyelids.  In  addition  to  these  symptoms 
there  is  often  an  obstruction  of  the  nostrils  with  a  thick,  yellow 
secretion,  so  that  the  child  cannot  breathe  freely ;  the  cuticle  peels  off 
extensively ;  the  child  becomes  excessively  emaciated,  and  if  not 
speedily  relieved  it  becomes  hectic  and  soon  perishes. 

Therapeutics.  The  disease  has  been  found  to  yield  readily  to 
Mercurius  v.  6 ;  but  the  homoeopathic  practitioner  is  often  prevented 
from  having  recourse  to  this  remedy  by  discovering  unequivocal 
indications  that  the  child  has  previously  been  subjected  to  a  course 
of  some  mercurial  preparations,  under  allopathic  treatment.  Under 
such  circumstances  it  is  generally  requisite,  particularly  when  the 
mouth,  gums,  and  throat  are  severely  affected,  to  prescribe  Hepar  s. 
or  Acidum  nitr.  When  the  mischief  done  is  more  extensive,  and  the 
hard  as  well  as  the  soft  parts  have  become  implicated,  Aurum  may  be 
prescribed  in  the  first  place,  and  subsequently  Hepar  s.  and  Acid.  nitr. 
in  alternation.  Should  there  be  great  difficulty  in  swallowing,  Bella- 
donna will  generally  afford  relief,  should  Acid.  nitr.  fail  to  do  so. 
If  the  mercurial  affection  does  not  form  a  prominent  feature,  as  is 
frequently  the  case  when  the  preparation  employed  has  been  Calomel 
in  comparatively  small  doses,  we  may  then  administer  either  Mer- 
curius sol.  or  Merc,  corros.  at  the  sixth  or  twelfth  potency,  one  globule 
daily  or  every  other  day,  for  four  to  six  days,  carefully  watching  the 
effect  produced,  and  discontinuing  the  medicine  as  soon  as  we  perceive 


494  URINARY  AND  GENITAL  ORGANS. 

traces  of  its  action  on  the  local  symptoms  or  on  the  system  generally. 
When  the  child  exhibits  great  sensibility  to  external  impressions,  or 
when  it  is  frequently  seized  with  spasms  or  tremors,  is  very  restless 
and  sleepless,  and  averse  to  take  nourishment,  the  extremities  being,  at 
the  same  time  cold,  the  countenance  earth-like,  and  the  nose  pointed ; 
when,  moreover,  there  is  a  lingering,  debilitating  fever,  with  excessive 
thirst,  and  small,  hard,  accelerated  pulse,  China  should  be  prescribed. 
After  the  employment  of  China,  Ferrum  has  been  found  beneficial, 
when  administered  at  a  low  potency.  In  other  cases  Acid.phosph, 
will  claim  a  preference  to  Ferrum,  particularly  if  the  tendency  to 
colliquative  sweats  does  not  subside  under  the  employment  of  China, 
Sulphur,  Silicea,  and  also  Calcarea,  Lycopodium,  and  Lachesis  are  also 
deserving  of  notice  in  such  circumstances.  If  the  eyes  and  eyelids 
are  principally  affected,  or  subsequently  become  so,  Mercurius  corros. 
should  form  the  principal  remedy,  unless  Mercury  in  some  form  or 
other  has  already  been  used,  in  which  case  one  or  more  of  the  followT- 
ing  must  be  selected  :  Belladonna,  Acid,  nitr,,  Hepar  s,,  Sulphur,  Calc, 
Aurum,  Graphites,  Thuja,  Cannabis,  (See  Ophthalmia.) 

Against  affections  of  the  periosteum,  nodes,  or  other  diseases  of 
the  bones,  Assafatida  is  one  of  the  most  useful  medicaments ;  and  the 
next  in  importance  are  perhaps  Mezereum  and  Acidum  phosphoricum ; 
but  Silicea,  Sulphur,  and  Calcarea  must  also  be  borne  in  mind.  (See 
Diseases  of  the  Bones,  and  Secondary  Symptoms.)  When 
phagedenic  sores  appear  on  the  genital  organs  or  other  parts  of  the 
body :  Lachesis,  Arsenicum,  Silicea,  or  Mezereum,  &c,  will  be  required. 
(See  Primary  Sores.)  The  mother  or  nurse  of  the  affected  child 
should  simultaneously  be  placed  under  treatment.  It  is  by  some 
thought  sufficient  to  operate  on  the  child  through  the  milk  of  the 
nurse,  but  we  are  in  favour  of  the  preceding  plan,  with  the  observance 
of  due  caution  in  the  exhibition  of  medicine  to  the  child. 


phimosis. 

'Phimosis  is  understood  to  signify  that  contracted  state  of  the  extre- 
mity of  the  prepuce  which  prevents  its  being  retracted  so  as  to 
expose  the  glans  penis.  It  is  most  commonly  produced  by  inflam- 
mation and  swelling,  or  thickening  of  the  prepuce.  Sometimes  it 
occurs  as  a  congenital  affection.      The  treatment  must  be  conducted 


PARAPHIMOSIS.  495 

according  to  the  nature  of  the  exciting  cause.  If  friction,  or  any- 
other  mechanical  injury  has  given  rise  to  it,  Arnica  should  be  em- 
ployed. In  other  cases,  originating  in  a  similar  cause,  Calen&ala 
officin.,  R7ms,  or  Pulsatilla  may  be  required. 

If  from  syphilis,  Mercurms,  Acid.  nitr.3  and  Thuja  chiefly.  Division 
of  the  prepuce  may  sometimes  be  rendered  necessary  in  syphilitic 
phimosis,  when  the  escape  of  the  pus  is  entirely  prevented  by  the 
extent  and  severity  of  the  inflammatory  swelling.  When  it  proceeds 
from  uncleanliness,  Aconitum  may  first  be  prescribed,  if  there  be  much 
inflammation,  and  then  Mercurius.  Tepid  water  should  at  the  same 
time  be  injected  between  the  prepuce  and  glans  by  means  of  a  small 
syringe.  Should  the  prepuce  present  a  puffy  or  bladder-like  appear- 
ance, Rhus  may  be  employed  with  advantage.  Circumcision  is  gene- 
rally employed  in  surgical  practice  against  congenital  phimosis, 
When  phimosis  arises  from  the  irritation  caused  by  excrescences, 
\  and  Acid.  nitr.  must  be  resorted  to.   (See  Sycosis.) 


PARAPHIMOSIS. 

What  is  denominated  paraphimosis  is  that  state  of  the  prepuce  in 
which  it  is  drawn  behind  the  corona  glandis,  and  is  incapable  of 
being  again  brought  forward.  In  young  subjects  it  is  rarely  attended 
with  serious  results,  but  when  it  takes  place  in  adults,  the  prepuce 
often  becomes  intensely  inflamed  and  ulcerated,  and  the  glans  penis 
destroyed  by  mortification. 

In  recent  cases,  the  reduction  is  often  affected  by  compressing  the 
glans,  and  simultaneously  drawing  the  prepuce  forward.  When 
requisite,  the  process  may  be  facilitated  by  previously  immersing  the 
penis  in  cold  water,  or  applying  it  to  the  part.  In  more  advanced 
cases,  when  the  prepuce  is  considerably  swollen,  if  will  "be  necessary 
to  administer  a  dose  or  two  of  Aconitum^  and  sometimes  Mercurius,  in 
order  to  subdue  the  inflammation,  before  the  parts  can  be  handled. 
Warm  fomentations  are  also  useful.  The  division  of  the  stricture  is 
necessary  if  all  other  means  fail.  When  suppuration  ensues,  either 
prior  or  subsequent  to  the  reduction,  Mercurius,  Eepar  $.,  and  Cap- 
sicum  have  been  recommended.  And  when  induration  remains, 
Lachesis,  Should  mortification  threaten,  the  employment  of  Arseni- 
cum or  Lachesis  may  avert  its  development. 


496  URINARY  AND  GENITAL  ORGANS. 


HERPES  PREPUTIALS. 


Herpes  preputialis.  This  disease  is  occasionally  confounded 
with  syphilis,  from  the  close  resemblance  which  it  sometimes  bears 
to  that  affection.  It  consists  of  an  eruption  of  vesicles  which  appears 
on  various  parts  of  the  body,  and  not  unfrequently  on  the  penis, 
especially  at  the  prepuce,  and  has  therefore  received  the  appellation 
of  Herpes  preputialis.  When  the  foreskin  is  the  seat  of  the  disorder 
a  sensation  of  heat  and  itching  is  ascertained  on  the  outer  or  inner, 
or  even  on  both  surfaces  of  the  said  part,  and  in  the  space  of  a  day 
or  two  one  or  more  small  patches  of  a  vivid  red  colour  make  their 
appearance,  on  each  of  which  five  or  six  small  globular  vesicles  arise, 
containing  a  serous  and  transparent  fluid.  The  heat  and  itching 
now  increase,  and  on  the  third  or  fourth  day  the  fluid  grows  turbid, 
and  is  converted  into  pus.  The  vesicles  then  burst,  and  the  dis- 
charged fluid  dries  and  forms  small,  thin,  scaly  incrustations.  When 
the  eruptions  break  out  on  the  inner  surface  of  the  prepuce,  the  epithe- 
lium becomes  detached  after  the  rupture  of  the  vesicles,  and  exposes 
the  inflamed  vascular  rete  of  the  chorion.  It  is  the  superficial  sore 
thus  produced  which  is  sometimes  mistaken  for  a  primary  venereal 
ulcer.  The  absence  of  the  raised  or  of  the  indurated  edges,  and  of 
the  small,  gray-coloured  secretion,  covering  the  base  of  the  venereal 
sores,  forms  the  leading  determination.  In  the  early  stage  of  herpes 
preputialis  the  disease  is  distinguished  by  the  evolution  of  a  cluster 
of  small  vesicles.  When  the  vesicles  are  developed  on  the  outer 
surface  of  the  prepuce,  the  fluid  they  contain  is  either  reabsorbed,  or 
desiccates  on  the  fifth  or  sixth  day ;  in  the  latter  event  it  is  altered 
into  minute  dry  scabs,  which,  provided  the  parts  have  not  been 
irritated  by  friction,  are  thrown  off  about  the  eighth  or  tenth  day, 
and  the  cure  is  then,  for  the  time  being,  complete.  It  is  not  a 
contagious  complaint,  but  is  prone  to  occur  repeatedly  in  the  same 
individual.  The  friction  of  the  clothes  during  prolonged  exercise, 
and  the  contact  of  deranged  vaginal  secretions  aggravate  and 
often  develop  the  affection  in  those  who  are  predisposed  to  it.  The 
use  of  mercurial  preparations  in  a  deranged  state  of  the  digestive 
functions,  and  the  previous  occurrence  of  one  or  more  syphilitic 
attacks,  have  all  been  considered  as  predisposing  causes. 


sycosis.  497 

Therapeutics.  In  most  cases  the  disease  may  be  left  to  itself, 
particularly  when  the  vesicles  are  situated  on  the  exterior  of  the  fore- 
skin. But  it  is  always  necessary  to  protect  the  part  from  friction, 
as  the  cure  is  invariably  delayed  when  the  drying  up  of  the  vesicles 
is  retarded.  When  the  inner  surface  of  the  prepuce  forms  the  seat 
of  the  disease,  the  vesicles  or  excoriations  ought  to  be  protected  by 
the  introduction  of  a  small  portion  of  lint  between  the  glans  penis 
and  the  prepuce.  Cold  water  may  also  be  freely  employed.  When 
the  affection  proves  unusually  obstinate,  or  is  reproduced  again  and 
again,  Acid.  p/wspL,  Aumm,  Hepar  s.,  and  Mtmmhave  been  strongly 
recommended.  The  state  of  the  digestion  ought  to  be  attended  to 
at  the  same  time.  When  a  chronic  inflammation  of  the  urethra 
exists  simultaneously,  Canth.,  Petrol.,  Petroselinwm,  Dulc,  SuVph,  Gale, 
Silk.,  Sep.,  or  Lycqpod.  will  chiefly  claim  attention. 


SYCOSIS. 

By  the  above  term  we  allude  to  the  disease  described  by  Hahne- 
mann *  as  having  occurred  very  extensively  during  the  last  war, 
from  1809  to  1814,  and  which  manifests  itself  externally  in  the  form 
of  excrescences  on  the  genital  organs  a  few  days,  or  even  weeks,  after 
impure  connexion.  "  These  excrescences  are  occasionally  dry, 
resembling  warts,  but  much  more  frequently  soft,  spongy,  secreting  a 
fetid  fluid,  bleeding  easily,  and  similar  to  cockscombs  or  cauliflowers; 
they  appear  in  men  upon  the  glans  penis,  at  the  margin  and  the 
inner  surface  of  the  prepuce,  also  on  the  scrotum,  perineum  and 
nates  ;  in  women,  on  the  vulva  and  adjacent  parts.  They  are  often 
accompanied  by  a  gonorrhoeal  discharge,  which  is  thick  and  purulent 
from  the  commencement,  with  little  pain  during  urination,  but  with 
hard  tumefaction  of  the  penis,  or  lymphatic  swellings  on  the  dorsum 
penis,  very  sensitive  to  the  touch.  The  disease  was  considered  by 
the  majority  of  allopathic  practitioners,  as  simply  a  symptom  or 
modification  of  syphilis,  and  was  accordingly  treated  by  them  with 
Mercury,  and  by  violent  external  application,  cautery,  excision,  liga- 
tures, &c.  The  immediate  and  natural  sequel  of  this  method  was, 
that,  generally,  the  condylomata  reappeared  after  the  expiration  of  a 

*  Die  chronischen  Krankheiten,  ihre  eigentliche  Natur  und  homoeopatische  Heilung. 
lster  Th.,  2te  viel  vermehrte  Auflage,  p.  104. 

32 


498  URINARY  AND  GENITAL  ORGANS. 

longer  or  shorter  time,  and  were  again  subjected  to  the  same  treat- 
ment ;  or  if  the  means  employed,  succeeded  in  destroying  them,  the 
sycosis  deprived  of  its  local  or  vicarious  symptom,  showed  itself  in 
another  and  more  aggravated  manner,  in  the  form  of  secondary 
symptoms;  the  external  means  employed,  and  the  Mercury  (which  is 
unappropriate  to  the  disease),  given  internally,  being  inadequate  to 
destroy,  in  the  slightest  degree,  the  sycosic  miasm  with  which  the 
system  was  impregnated.  In  addition  to  the  injurious  constitutional 
disturbance  produced  by  the  Mercury,  particularly  when  given  in 
large  doses,  and  in  the  shape  of  the  most  acrid  and  irritating  pre- 
parations—analogous excrescences  broke  out  upon  other  parts  of  the 
body ;  in  some  cases  -consisting  of  spongy  elevations,  whitish, 
sensible,  and  flat,  having  their  seat  in  the  mouth,  on  the  lips,  tongue, 
and  fauces ;  in  others,  large,  prominent,  brownish-looking  tubercles, 
situated  in  the  armpits,  on  the  neck  and  scalp,  &c. ;  or,  again,  other 
symptoms  were  developed,  of  which  I  need  only  mention  here, 
retraction  of  the  flexor  tendons,  particularly  those  of  the  fingers." 

Therapeutics.  Hahnemann  was  the  first  who  recommended 
and  employed  Thuja  occidentalis  in  sycosis.  When  the  disease  is  in 
its  primary  form,  accompanied  or  not  by  a  gonorrhceal  discharge,  and 
not  complicated  with  syphilis,  or  occurring  in  a  strumous  habit,  a 
few  drops  of  a  low  potency,  or  a  few  globules  of  the  third  or  sixth 
dilution,  speedily  succeed  in  effecting  a  radical  cure ;  in  obstinate 
cases,  in  addition  to  internal  administration,  the  condylomata  may  be 
touched  daily  with  the  diluted  tincture  of  Thuja. 

In  some  cases  the  cure  is  materially  facilitated  by  the  use  of  Acid, 
nvtricum.  in  alternation  with  Thuja.*  Where  there  is  a  complication 
of  syphilis  with  sycosis,  Mercurius  and  Sulphur  in  alternation,  at  low 
potencies  (third  trituration),  are  very  efficacious. 

Against  the  secondary  symptoms  of  sycosis,  Thuja  and  Acidum 
nitricum  are  still  to  be  held  as  the  most  important  remedies ;  but 
when  they  are  found  inadequate  to  destroy  the  disease,  either  in  con- 
sequence of  complications  with  secondary  syphilis,  or  some  other 
dyscrasia,  Sulphur,  Ac.  phosph.,  Euphrasia,  Cinnab.,  Sabina,  Staph.,  or 
Lycopodium.     Of  these,  Sulphur  has  commonly  been  found  the  most 


*  The  aid  of  Acid,  nitric,  is  almost,  indispensable  in  all  cases  in  which  the  patient  has 
formerly  been  placed  under  a  course  of  Mercury  during  one  or  more  syphilitic  attacks,  or 
some  other  affection. 


sycosis.  499 

appropriate  to  administer  when  the  constitutional  symptoms,  such  as 
sore  throat,  with  enlargement  of  the  tonsils  and  ulceration,  hoarse- 
ness, stains  on  the  skin,  scaly  spots,  or  eruptions  assuming  the 
character  of  psoriasis  or  lepra,  have  undergone  little  or  no  improve- 
ment under  the  employment  of  Thuja  and  Acid.  nitr. ;  it  will,  further, 
claim  a  preference  when  there  is,  at  the  same  time,  general  derange- 
ment of  the  system,  and  especially  when  the  patient  is  affected  with" 
symptoms  of  abdominal  plethora,  with  hemorrhoids,  and  constipa- 
tion ;  or  when  shooting  pains  are  experienced  in  the  joints,  and  the 
flexor  tendons  of  the  fingers  are  in  a  state  of  contraction ;  tongue 
dry,  red,  rough,  and  fissured,  lips  much  tumefied.  Zycqpodium  may 
follow  Sulphur  with  advantage,  when  there  is  superficial,  wThite  ulcer- 
ation of  the  tonsils ;  and  the  tongue  is  fissured,  or  is,  together  with 
the  inner  surface  of  the  lips  and  the  fauces,  covered  with  a  scaly, 
herpetic-looking  eruption.  Siaphysagria,  when  the  gums  are  much 
affected,  somewhat  ulcerated,  swollen,  soft,  or  spongy,  and  the  glans 
penis  covered  with  soft,  moist  excrescences.  Sabina  has  been  of 
great  service  when  the  condylomata  were  large,  moist,  and  painful 
even  when  not  touched.  Acid,  johosphoricum  will  deserve  attention 
when  the  sycosic  excrescences  are  of  long  standing,  or  when  the 
patient  has  previously  been  treated  with  Mercury  in  large  doses,  and 
Acid,  nitr.,  Thuja,  Sulphur,  and  Staphysagria  have  either  failed  to  do 
good,  or  have  only  effected  partial  improvement.  Cinnabar  has  been 
strongly  recommended  as  a  valuable  remedy  in  inveterate  or  second- 
ary sycosis.  Hahnemann  considered  Mercury  as  inappropriate  to 
sycosis,  and  as  peculiarly  hurtful  when  given  in  over-doses.  When 
administered  in  the  small  doses  employed  by  homceopathists,  it 
appears  to  be  of  great  efficacy  in  some  obstinate  cases.  A  compli- 
cation with  syphilis,  or  secondary  symptoms,  in  the  form  of  enlarge- 
ment of  the  tongue,  swelling  and  ulceration  of  the  tonsils  (provided 
these  latter  symptoms  have  not  arisen  from  the  abuse  of  Mercury), 
condylomata,  &c,  will  justify  us  in  anticipating  a  beneficial  action 
from  the  use  of  Cinnabar.  Sometimes  the  sore  throat  arising 
from  sycosis  may  bear  so  close  a  resemblance  to  that  of  secondary 
syphilis,  that  it  will  be  difficult  to  found  a  diagnosis  thereupon ;  but 
the  history  of  the  commencement  of  the  disorder,  along  with  the 
existence  of  tubercular  or  wart-like  excrescences  in  the  vicinity  of 
the  anus,  genital  organs,  or  other  parts  of  the  body,  will  enable  us  to 
discriminate  the  sycosic  from  the  syphilitic  origin.  In  sycosic  bu- 
boes, Thuja  and  Acid,  nitricum  are  the  principal  remedies,  but  cases 


500  URINARY  AND  GENITAL  ORGANS. 

may  often  occur  in  which  Staphgsagria,  Sulphur,  or  Mercurius  will  be 
required.     (See  Bubo,) 

We  shall  conclude  this  portion  of  the  work  by  giving  a  short 
statement  of  Dr.  Goullon^s  mode  of  treating  Syphilis,*  together 
with  an  extract  from  the  more  extensive  and  interesting  observations 
of  Dr.  Attomyr,t  on  the  treatment  of  Venereal  Diseases. 

Dr.  Goullon  employed  Mercurius  solub.  and  Merc,  sublim.  corros. 
chiefly*  in  the  treatment  of  chancres  in  general.  The  former  in  the 
dose  of  T\,  |  of  a  grain,  twice  a  day ;  and  the  latter,  to  which  he 
gave  the  preference,  as  follows  ; 

&  Merc,  corros.  gr.  ss — j ;   Aq.  unc.  viij ;   Spir.  vin.  q.  s. 

A  tablespoonful  morning  ancLevening,  (diminishing  the  quantity  when 
vomiting  followed  the  first  dose  or  two). 

When  the  sores  were  foul  and  confluent,  attended  with  fetid 
discharge,  also  local  application  of  the  same  remedy.  The  greater 
the  degree  of  improvement  effected,  the  less  frequently  was  the 
medicine  ordered  to  be  taken.  In  the  majority  of  cases  scarcely 
gr.  ij  were  necessary  to  establish  a  cure  without  risk  of  a  relapse  or  the 
occurrence  of  secondary  symptoms.  Where  syphilis  and  scabies 
were  encountered  in  the  same  subject,  the  cure  of  the  former  was 
commenced  first.  The  worst  complication  was  found  to  be  secondary 
syphilis  in  the  form  of  eruptions,  &c.,  and  scrofula.  Baths  of  Merc. 
corros.  (33 -ij)  produced  striking  benefit  here  ;  but  when  the  patients 
had  previously  undergone  a  course  of  Mercury,  the  medicament 
which,  more  frequently  than  any  other,  though  not  always,  did  the 
most  good,  was  Acid.  nitr.  in  repeated  doses. 

In  sore  throat,  Lycopodmm  ;  in  ostitis,  or  exostitis,  Silicea  ;  and  in 
tetters  and  herpetic  sores,  Sarsaparilla  (ptisan)  proved  the  most 
serviceable. 

Dr.  Attomyr  observes  that  "  With  respect  to  the  treatment  of  the 
various  forms  of  the  venereal  disease,  we  have  in  general  nothing 
farther  to  add,  except  that  in  this  disease  as  in  all  others,  the  ho- 
moeopathic law  of  cure  by  similarity  of  symptoms  is  applicable, 
and  here  too  proves  its  validity. 

cc  Before  entering  specially  upon  the  homoeopathic  treatment  of 
the  venereal  disease,  it  will  be  necessary  to  premise  some  few  remarks, 

*  Allg.  Horn.  Zeit.,  No.  17,  30ster  Band,  p.  258. 
t  Ruoff's  Repertorium,  hy  A.  H.  Okie,  M.D. 


TREATMENT  OE  VENEREAL  DISEASES.  501 

which   deserve    consideration    when    viewed    in    reference    to    my 
therapeutical  results. 

6i  Syphilitic  patients,  with  very  few  exceptions,  are  young  unmar- 
ried men,  who  either  board  at  the  hotels  or  sit  at  table  with  their 
relations,  or  probably  superiors.  In  either  case  it  is  unfortunate  for 
the  observance  of  the  homoeopathic  diet,  and  indeed  much  worse  here 
than  it  would  have  been  in  Germany  or  any  other  Austrian  province* 
for  in  Hungary  far  greater  quantities  of  condiments  and  acids  are 
used  with  food  than  in  other  places.  To  this  must  be  added  the  fact 
that  patients  conceal  their  disorders,  and  in  order  not  to  excite  suspi- 
cion, dare  not  venture  on  the  slightest  aberration  from  their  accustomed 
diet.  In  consequence  of  these  uncertain  dietetic  circumstances,  I 
resolved  in  treating  such  patients,  to  administer  larger  doses  than 
usual. 

"  I  am  still  of  the  opinion,  that  the  lower  dilutions  recall  reaction 
quicker,  but  that  their  effects  are  less  intensive  and  permanent  than 
the  higher.  Four  grains  of  calomel  in  the  space  of  a  few  hours  ope- 
rate violently,  and  excite  diarrhoea,  while  the  same  four  grains,  if 
taken  in  minute  portions,  result  in  an  indisposition,  which  continues 
several  days,  and  in  a  more  intense  commotion  of  the  organism.  I 
moreover  concluded  from  these  premises  that  the  larger  doses  could 
be  repeated  more  frequently,  which  would  seem  essential  on  account 
of  the  necessarily  frequent  dietetical  errors.  Within  the  period  of 
two  years  I  treated  156  patients  labouring  under  the  venereal  disease. 
Every  physician  knows  how  it  is  with  office  practice,  how  difficult  to 
learn  anything  or  obtain  any  certain  experience  in  this  manner.  Gene- 
rally one  half  of  this  class  of  patients  stay  away,  so  that  it  is  impos- 
sible for  us  to  decide  with  certainty  upon  the  termination  of  their 
disorders.  The  one  remains  away  because  the  effects  of  the  treat- 
ment did  not  fulfil  his  anticipations,  the  other  (and  among  syphilitic 
patients  the  majority)  because  he  is  approaching  convalescence,  and 
is  desirous  of  avoiding  the  burdensome  thanksgiving  for  his  cure.  This 
last  occurred  so  frequently  to  me  that  during  the  treatment  of  an 
interesting  case,  I  was  always  fearful,  as  I  was  led  to  expect  that  as 
the  cure  progressed,  my  patient  would  remain  away,  and  I  be  unable 
to  arrive  at  any  certainty  with  regard  to  the  termination  of  the 
case. 

"I  requested  a  patient  with  eleven  chancres  (seven  of  which  >  of  the 
size  of  a  lupine-seed,  were  situated  on  the  scrotum),  after  all  were 


502  URINARY  AND  GENITAL  ORGANS. 

healed,  but  two  of  them  still  presented  cicatricular  depressions,  to 
return  in  eight  days,  and  let  me  see  if  the  two  scars  had  also  disap- 
peared. My  patient,  however,  did  not  return,  notwithstanding  I  had 
clearly  given  him  to  understand  that  I  had  no  reference  to  his  return- 
ing thanks,  but  merely  as  a  subject  of  scientific  interest.  This  plan 
was  so  often  adopted  towards  my  patients,  that  they  ironically  termed 
me  the  <  gratis  Doctor/  for  which  I  in  return,  during  the  last  three 
months  of  my  residence  in  Presburg,  punished  them  very  sensibly, 
although  I  am  sorry  that  punishment  in  many  instances  fell  upon 
those  who  were  innocent.  So  it  happened  that  of  the  156  patients 
treated,  I  cannot  cite  more  than  84  who  persevered  until  perfectly 
cured,  and  most  of  these,  at  my  request,  returned,  and  were  examined 
by  me  fourteen  days  after  their  convalescence. 
"  Were  cured  of 


Chancres 

34 

Gonorrhoea     .. 

24 

Gleet      . 

9 

Balano-blenorrhcea  . 

2 

Bubo      . 

10 

Hernia  humoralis    . 

2 

Nodes  and  eruptions 

2 

"  I  have  observed  the  following  five  varieties  of  chancre  : 

ci  First  form. — The  edges  more  or  less  jagged,  elevated,  slightly 
painful,  but  sensitive  when  rubbed  by  the  linen,  with  a  copper- 
coloured  circumference.  The  base  of  the  sore  is  indurated,  lard-like, 
the  ichor  adheres  so  firmly  to  it,  that  it  cannot  be  removed  by  wash- 
ing. The  ichor  is  of  a  light  yellow  colour,  viscid,  glutinous,  resem- 
bling pus,  sometimes  acrid,  offensive ;  it  makes  spots  on  the  linen  as 
if  from  melted  tallow.  The  sore  extends  far  more  in  depth  than  in 
breadth.  This  form  appears  on  all  parts  of  the  glans,  and  also  on  the 
prepuce,  but  more  frequently  on  the  posterior  part  of  the  glans,  near 
its  junction  with  the  prepuce. 

"  Second  form. — The  sores  are  superficial,  not  only  do  not  extend 
in  depth,  but  are  perceptibly  elevated  above  the  surface.  The  edges 
are  never  jagged,  always  sharply  circumscribed,  painless.  The  sore 
looks  clean,  of  a  flesh-red  colour,  almost  spongy,  it  is  never  necessary 


TREATMENT    OF   VENEREAL    DISEASES.  503 

to  clean  it,  as  the  ichor  does  not  adhere.  The  ichor  is  somewhat 
thinner  than  in  the  first  form,  usually  more  copious  and  mixed  with 
blood.  This  form  heals  sooner  than  the  first,  appears  almost  exclu- 
sively on  the  prepuce,  and  there  are  always  several  sores  present  at 
the  same  time. 

"  Third  form. — The  sores  of  the  second  form  gradually  become 
elevated  so  much  above  the  surface  of  the  prepuce,  that  they  resemble 
more  a  horizontal  section  of  a  wart  than  an  ulcer.  This  form  dis- 
charges very  profusely.  The  ichor  is  more  offensive  than  in  the  two 
preceding  forms,  but  still  not  so  bad  as  it  is  in  those  which  follow. 
It  is  unusual  for  all  the  chancres  of  the  second  form  to  become  con- 
verted at  the  same  time  into  those  of  the  third,  therefore  these  two 
forms  are  usually  co-existent.  This  variety  frequently  heals  very 
quickly.  I  have  never  seen  true  condylomatous  forms  of  disease  arise 
from  this.  In  my  case-book  I  have  given  the  compound  name  of 
f  chancre  wart5  to  this  form,  which  term,  on  account  of  its  brevity,  I 
will  still  retain. 

"  Fourth  form. — The  corona  of  the  glans  is  almost  one  ulcerated 
surface.  This  frequently  extends  to  the  posterior  part  of  the  glans  ; 
occasionally,  at  the  same  time,  to  the  prepuce  also.  The  sore  is  quite 
superficial,  here  and  there  lard-like,  but  the  greater  part  red  and 
thinly  coated  with  matter,  which  can  be  readily  washed  off.  The 
ichor,  which  is  very  profuse,  is  somewhat  less  consistent  in  this  than 
in  the  varieties  already  described,  and  is  of  a  very  fetid  odour,  which 
apparently  depends  upon  the  simultaneously  increased  secretion  of 
smegma.  The  sore  appears  as  if  the  skin  had  been  torn  off.  This 
form  either  heals  as  such  by  contracting  from  the  edges  towards 
particular  points,  forming  several  chancres,  which  are  nearly  sepa- 
rated or  only  united  by  linear  excoriations;  or  the  above  described 
lard-like  spots  extend  more  in  depth,  and  chancres  of  the  first  form 
appear.  This  fourth  variety  of  chancre  has  a  tendency  to  appear  in 
company  with  gonorrhoea. 

"  Fifth  form. — A  chancre  which  in  its  incipient  state  has  the 
appearance  of  the  first  form,  in  a  few  days  becomes  covered  with  a  scab 
which  presents  the  appearance  of  a  psoric  sore.  The  scab  absorbs  the 
fluid  secreted  beneath  it,  and  thus  becomes  thicker  and  does  not  fall 
off  until  the  sore  beneath  it  has  healed.     This  variety  appears  either 


504  URINAUY  AND  GENITAL  ORGANS. 

on  the  common  integument  of  the  penis  or  directly  on  the  verge  of 
the  prepuce,  which  becomes  swollen,  looks  as  if  excoriated,  burns 
severely  while  and  after  urinating,  when  walking  is  disturbed  by  the 
pressure  of  the  linen,  to  which  it  slightly  adheres.  This  variety  I 
term  the  'psoric  chancre/  and  conjecture  that  it  arises  from  a  com- 
plication of  syphilis  and  psora,  which  conjecture  is  strengthened  not 
only  by  the  appearance  of  the  sore,  but  also  by  the  violent  pruritus 
and  the  favorable  results  attending  the  administration  of  Sulphur. 
This  form  generally  appears  simultaneous  with  one  of  the  varieties 
already  described. 

In  the  treatment  of  these  different  forms  of  chancre,  I  have  by 
degrees  been  obliged  to  resort  to  the  following  eleven  remedies : 

Mercurius  sokibilis,  Merc,  dulcis,  Merc,  sublimatus  corrosivus,  Acidum 
nitric,  Thuja,  Hejpar  sulphur.,  Corallia  rubra,  Acid,  phosphor.,  Sulphur, 
Causticum,  Staphysagria. 

In  the  first  variety  of  chancre,  Merc,  solub.  is  the  chief  remedy,  it 
is  not,  however,  adapted  to  half  the  cases.  Thuja  comes  next  to  the 
quicksilver  in  this  variety.  The  patient  usually  took  a  few  doses  of 
Mercur.,  then  a  few  doses  of  Thuja,  and  when  its  beneficial  influence 
appeared  to  cease,  the  Mercury  was  resumed.  In  addition  to  these,  I 
administered  Merc,  dulcis,  Sublim.  corrosiv.  and  Causticum  in  several 
obstinate  cases,  and  I  believe  I  have  observed  considerable  improve- 
ment in  this  form  after  each  of  these  remedies. 

In  the  second  form  Acidum  nitric,  is  the  chief  remedy.  When 
this  form  is  purely  pronounced  without  complication,  particularly 
with  the  third  form,  the  Nitric  acid  acts  very  promptly,  and  in  twenty 
days,  at  the  extent,  the  disease  is  cured.  I  have,  however,  cured,  or 
evidently  assisted  the  cure  of  several  of  these  cases  with  Mercur.  and 
Thuja. 

In  the  third  form  Thuja  appears  preferable  to  Acid,  nitric,  although 
the  latter  as  well  as  Mercurius  solub.  is  a  very  effectual  remedy  in  this 
variety.  In  one  case,  Acid,  phosph.  acted  very  strikingly.  Staphysa- 
gria  in  another  in  the  same  prompt  manner. 

In  the  fourth  form,  preference  must  be  given  to  Corallia  rubra. 
Although  this  remedy  is  capable  of  curing  a  chancre  of  this  variety 
in  fourteen  or  at  the  extent,  eighteen  days,  yet  still  it  does  not  appear 
to  be  able  to  prevent  this  form  from  becoming  converted  into  the 
first,  by  which  the  treatment  is  considerably  prolonged.  Nitric  acid 
may  be  ranked  with  Corallia  in  the  treatment  of  this  form,  and  in 
several  cases  in  which  rapid  improvement  did  not  succeed  the  admi- 


TREATMENT  OE  VENEREAL  DISEASES.  505 

nistration  of  Corallia;  and  where  the  pruritus  was  very  vehement,  I 
gave  Sulphur,  which  cured  the  disease  in  toto. 

"  In  the  fifth  form,  which  was  the  most  rare,  Sulphur  was  the  chief 
remedy.  Hepar  sulphur,  operated  favorably  in  this  form,  when  com- 
plication with  bubo  existed. 

"  At  first  I  gave  Merc,  solub.  in  doses  of  a  drop  of  the  fourth  dilu- 
tion, and  when  this  was  all  gone  I  resorted  to*  the  fifth.  At  the 
beginning  of  the  treatment  I  repeated  the  medicine  every  six  or 
seven  days,  and  afterwards  every  three  or  four  days.  I  have,  however, 
cured  several  chancres  with  X000  and  4000.  Nitric  acid  and  Thuja  were 
given  in  similar  doses,  but  also  with  effect  in  the  thirtieth  dilution. 
Of  Corallia  I  gave  about  a  grain  of  the  third  trituration.  Sulphur  and 
the  liver  of  sulphur  I  always  administered  in  the  X000,  also  Causticum, 
Staphysagria  and  Phosphoric  acid,  and  the  two  other  preparations  of 
Mercury  in  the  third  potence.  One  month  was  about  the  average 
time  required  to  cure  a  chancre,  several  healed  in  fourteen  days,  in 
which  cases  I  must  remark  that  these  patients  were  individuals  who 
were  able  to  follow  strictly  the  homoeopathic  dietetic  regulations. 
In  several  cases,  six  weeks  or  more  were  consumed  in  the  cure  of 
the  chancres,  for  which  the  patients  themselves  were  in  fault,  as 
several  confessed  to  me  that  they  were  not  able  to  refrain  from  coition 
during  the  treatment. 

"  The  articles  of  diet  wThich  I  forbade  were — 

"  1.  Acids  :  as  vinegar  and  lemon-juice. 

"  2.  Spirituous  drinks :  wine,  whiskey,  beer,  liquor,  and  all  alcoholic 
drinks ;  beer  I  would  have  allowed,  had  it  not  been  adulterated  with 
bitter  plants. 

"3.  Spices,  or  rather  medicines  which  have  crept  from  the  apothe- 
cary^ shop  into  the  kitchen,  as  coffee,  tea,  pepper,  cinnamon,  vanilla, 
the  cayenne  pepper  (Capsicum  annum)  which  is  used  in  Hungary, 
cloves,  caraway,  and  aniseed. 

"I  also  advised  my  patients  to  avoid  the  use  of  pomatum,  medicated 
dentifrice,  and  perfumery  of  every  description.  Smoking  I  did  not 
forbid,  because  no  one  would  have  obeyed  me  in  this  particular. 

"  One  of  the  most  important  directions  during  the  treatment  of 
chancre  relates  to  mental  and  particularly  bodily  quietude.  The 
patient  should  go  out  as  little  as  possible,  walk  very  slowly,  not  wear 
tight  pantaloons,  or  remain  long  standing,  and  on  no  account  drive 
or  •  take  horse  exercise.  My  attention  was  directed  to  this  latter 
circumstance  several  years  ago,  by  the  experienced  Dr.  Mueller, 


506  URINARY  AND  GENITAL  ORGANS. 

attached  to  the  medical  staff  in  Pesth.  As  I  treated  but  few  venereal 
patients  after  that  period,  this  circumstance  was  forgotten.  In  Pres- 
burg,  I  treated  a  young  man  more  than  seven  weeks  for  a  large 
deep  chancre,  which  did  not  lose  at  all  its  lard-like  base,  and  although 
it  did  not  extend  either  in  breadth  or  depth,  it  evinced  no  disposition 
to  heal.  The  patient  was  too  well  acquainted  with  the  superiority 
of  homoeopathy  to*  adopt  the  advice  of  trying  allopathic  treatment. 
While  we  were  discussing  the  probable  cause  which  impeded  the 
cure,  my  patient  inquired  whether  it  was  not  probable  that  daily 
horse  exercise  could  be  an  injury ;  Dr.  Mueller's  advice  now  struck 
me.  I  forbad  riding  on  horseback,  and  in  the  course  of  eleven  days 
the  chancre  was  healed,  the  patient  having  remained  in  his  room  in 
his  drawers,  generally  reclining  upon  the  sofa.  Corporeal  rest  is 
decidedly  the  best  prophylactic  against  the  formation  of  buboes.  I 
must  mention  still  another  serious  obstacle  which  greatly  impedes 
the  cure  of  all  venereal  diseases.  I  refer  to  the  excessive  anxiety  of 
those  youths  who  are  infected  for  the  first  time ;  they  fancy  that  they 
see  themselves  walking  about  without  their  olfactory  organs,  and 
covered  with  eruptions  and  sores. 

"  At  first  I  applied  charpie  to  the  sores ;  but  as  this  became  deranged 
and  formed  lumps,  I  preferred  fine,  clean,  washed  linen  (not  new). 
I  subsequently  abandoned  this  also,  as  every  foreign  body  adheres  to 
the  sore  as  soon  as  it  commences  healing  and  discharging,  and  on 
removing,  irritates  the  chancre,  and  in  general  incommodes  more 
than  the  secretions  of  the  sore. 

"\  have  treated  patients  with  several  chancres  conjoined  with 
phimosis,  without  having  seen  the  sores  more  than  once,  as  the  phi- 
mosis occurred  a  few  days  afterwards  and  continued  to  the  conclu- 
sion of  the  treatment.  When  the  prepuce  could  be  retracted,  the 
chancres  were  either  completely  cured  or  very  nearly  so. 

"  When  washing  the  sores,  care  must  be  taken  not  to  press  too 
violently  upon  them.  Many  patients  gave  themselves  much  trouble 
in  endeavouring  to  wash  off  the  lard- like  matter  forming  the  base  of 
the  chancre.  Patients  should  be  informed  that  this  is  futile  and 
injurious.  It  is  entirely  impossible  to  clean  the  base  of  the  sore,  as 
this  must  be  removed  by  the  process  of  suppuration,  produced  by 
the  action  of  the  appropriate  remedy.  Chancres  of  the  first  form 
generally  discharge  copiously,  and  for  a  long  time,  so  that  the  pa- 
tient's linen  appears  as  much  soiled  as  in  gonorrhoea.  When  I 
perceive  this  increased  discharge  make  its  appearance,  I  always  con- 


TREATMENT   OF  VENEREAL   DISEASES.  507 

tinue  the  remedy  which  produced  it,  because  this  increased  suppu- 
ration of  the  sore  is  the  most  natural  remedy  to  cleanse  and  heal  it. 
The  period  of  increased  discharge  frequently  occupies  two  thirds  of 
the  whole  time  employed  in  the  cure.  I  have,  however,  frequently 
seen  perfectly  healthy  sores,  which  were  much  diminished  in  size  and 
superficial,  remain  in  statu  quo  without  healing  completely.  This 
apparently  depends  upon  the  conduct  of  the  patient,  on  whom  the 
cure  has  advanced  thus  far. 

"  If  doubt  arises  respecting  the  nature  of  sores  on  the  genitals, 
whether  they  are  really  chancres  or  not,  it  is  advisable  to  wait  several 
days  before  administering  our  remedy.  If  in  the  course  of  six  or 
eight  days  the  sores  are  not  healed,  but  have  become  larger,  deeper, 
and  the  base  lard-like,  there  can  then  be  no  doubt ;  the  patient  may 
talk  as  much  as  he  pleases  about  the  fidelity  of  his  sweetheart. 

"  In  concluding  this  subject  I  have  still  to  remark,  that  in  the 
cases  of  three  patients  afflicted  with  chancres  I  observed  vermin, 
which  are  not  uncommon  in  syphilis,  and  by  us  termed  'Filz  lause/ 
(Pediculus  pubis.)  One  of  these  patients,  who  was  somewhat  of  a 
scrofulous  diathesis,  was  troubled  with  them  in  two  instances.  I 
need  scarcely  remark  that  these  patients  observed  the  utmost  clean- 
liness; as  I  do  not  at  all  consider  these  vermin  as  the  result  of  filthi- 
ness,  it  is  not  improbable  that  they  are  produced  per  generationem 
aequivocam,  in  the  same  manner  as  in  the  itch,  either  by  the  dis- 
charge from  the  chancre,  or  in  transpiration  of  the  patient,  and  con- 
sequently may  be  ranked  as  the  product  of  the  venereal  disease. 

"  Buboes.  Swelling  of  the  inguinal  glands,  consequent  upon 
syphilis,  are  more  dreaded  by  patients  than  any  other  form  of  this 
disease.  It  is  well  known  how  under  allopathic  treatment  they  are 
plastered,  cauterized  and  incised  again  and  again.  I  have  treated 
eight  patients  with  venereal  buboes,  without  the  necessity  of  one  of 
them  being  confined  to  bed  for  a  single  day.  A  day  or  two  before 
the  spontaneous  rupture  of  the  swelling,  the  patient  experienced  a 
slight  tensive  pain  when  walking,  but  not  any  other  inconvenience 
either  before  or  after  that  circumstance  occurred.  The  buboes 
usually  broke  while  patients  were  walking,  and  had  they  not  expe- 
rienced the  sensation  produced  by  the  moisture,  they  would  not  have 
been  aware  of  its  occurrence.  I  have  witnessed  neither  sinuses, 
fistulous  openings,  callous  edges,  nor  partial  remaining  indurations, 
&c.,  in  any  of  these  cases,  although  I  never  made  use  of  cataplasms 


508  URINARY  AND  GENITAL  ORGANS. 

to  prevent  induration,  leeches  for  inflammation,  or  of  the  knife  or 
caustics  in  opening  them. 

"There  is  no  doubt  that  buboes,  which  appear  simultaneously 
with  chancres,  or  immediately  after  their  suppression  with  external 
remedies,  partake  of  the  venereal  character.  Scrofulous  glandular  affec- 
tions are  usually  readily  recognisable  from  the  general  diathesis,  and 
the  disorders  of  the  glands  in  other  parts  of  the  body  which  are  com- 
monly present.  But  there  are  also  buboes  which  appear  sooner  or 
later  after  coition  without  any  other  symptom  of  venereal  infection. 
Whether  these  glandular  swellings  are  to  be  considered  as  venereal 
has  not  yet  been  determined  by  adequate  experience.  I  have  seen 
two  such  cases.  The  one  an  arthritic  man,  aged  thirty-eighty  the 
other  a  young  man  of  three-and-twenty.  Both  cases  were  preceded 
by  frequent  coition,  and  in  the  case  of  the  first  individual,  it  was 
inordinate.  In  the  first  case  the  bubo,  which  was  confined  to  one 
side,  was  cured  by  resolution  under  the  use  of  Stdphur  and  Nitric 
acid,  the  second  by  suppuration  by  Nitric  acid  alone.  In  the  latter 
case  there  were  two  buboes  of  the  size  of  a  hen's  egg,  one  on  each  side. 

"  Buboes  are  treated  homceopathically  by  the  same  remedy  that  is 
indicated  for  the  particular  variety  of  chancre  which  they  accompany. 
The  medicament  that  cures  the  chancre  frequently  operates  so  power- 
fully upon  the  bubo,  that  the  latter  suppurates  and  heals  before  the 
chancre  is  completely  cured,  so  that  in  this  case  the  bubo  does  not 
alter  the  peculiar  treatment  adapted  to  the  chancre.  Sometimes, 
however,  the  bubo  remains  after  the  chancre  has  healed,  and  in  this 
particular  case  does  it  first  become  necessary  to  adapt  our  therapeu- 
tical efforts  to  the  bubo  itself. 

"  I  made  use  of  five  remedies  in  the  cure  of  buboes.  Merc,  solubilis, 
Acid,  nitric,  Sulp/mr,  Hepar  sulph.,  Cole,  and  Silicea.  The  first  two 
remedies  I  gave  in  drop  doses  of  the  fourth  dilution,  at  intervals  of 
four  or  six  days,  the  last  three  in  the  thirtieth  dilution,  every  eight 
days. 

"  Mercurms  and  Acid,  nitric,  operated  better  during  the  inflamma- 
tory state  of  the  swellings,  previous  to  their  opening.  After  this 
had  occurred,  I  administered JklpL,  SiUcea,  and  the  liver  of  sulphur 
with  good  effect. 

"  I  have  frequently  seen  swellings  of  the  inguinal  glands  arise  in 
patients  afflicted  jyith  very  painful  gonorrhoeas,  in  which  much  violent 
exercise  was  taken,  particularly  in  individuals  infected  for  the  first 
time.     In  such  cases  I  recommend  the  observance  of  strict  corporeal 


TREATMENT  OE  VENEREAL  DISEASES.  509 

rest  for  a  few  days,  and  proceeded  in  the  treatment  of  the  gonorrhoea 
without  reference  to  the  inguinal  swellings,  and  I  have  never  seen 
them  pass  into  suppuration  or  induration,  or  remain  after  the  cure  of 
the  gonorrhoea. 

"  Condylomata.  The  cases  of  this  affection,  which  have  come 
under  my  notice,  are  too  few  in  number  for  me  to  determine  whether 
this  form  of  the  venereal  disease  belongs  to  the  syphilitic,  or  whether 
it  depends  on  one  of  the  various  cachexies  of  Hahnemannian  sycosis. 
The  first  view  is  favored  by  the  fact  of  the  concomitant  presence  of 
chancre  and  condylomata,  as  well  as  the  degeneration  of  many  chan- 
cres' into  condylomatous  structures  ;  while  the  circumstance  that  this 
form  of  disease  frequently  appears  entirely  alone  without  any  admix- 
ture with  the  other  forms  of  venereal,  and  has  the  peculiarity  which 
is  foreign  to  chancre  of  occupying  the  anus  at  the  same  time,  or 
selecting  this  part  alone  as  its  seat,  favours  the  Hahnemannian  views 
of  sycosis.  Be  this  as  it  may,  the  distinction  is  of  no  practical 
utility.  The  symptoms  of  this  disease  direct  the  physician  to  the 
appropriate  remedy,  no  matter  whether  he  considers  the  first  or  last 
view  as  correct — a  superiority  possessed  by  homoeopathy  in  the 
treatment  of  this  as  well  as  other  diseases,  which  is  not  acknow- 
ledged only  because  it  is  desirable  to  arrogate  the  appearance  of  science. 

"  In  the  case  of  a  patient  with  two  large  condylomatous  ex- 
crescences on  the  anus,  who  had  been  previously  treated  by  caustics, 
neither  Thuja,  Nitric  acid,  Acid,  phosphor.,  Zycopod.,  Sulphur,  Psorin,  nor 
Sycosin  were  of  any  benefit.  Staphysagria  X000,  repeated  every  five  days, 
removed  the  disease  almost  entirely  in  the  course  of  two  weeks,  so  that  I 
gave  the  patient  a  few  doses  more  of  the  latter  remedy,  in  hopes  that 
the  disease  would  be  completely  overcome  in  a  short  time ;  the  pa- 
tient, however,  did  not  return  ;  I  therefore  cannot  say  how  the  case 
terminated,  although  it  is  very  probable  that  the  patient  was  cured. 

"The  condylomatous  case,  which  I  have  mentioned  as  cured,  was 
that  of  a  patient  with  three  condylomatous  excrescences,  which  had 
been  cauterized,  but  were  reproduced.  1  gave  him  Thuja  X10,  seven 
days  after  Sulphur  X,  seven  days  later  Acid,  nitric.  A,  gutt.  una,  for 
two  successive  days,  all  without  effect.  The  Thuja  was  now  repeated 
but .  in  the  fourth  dilution,  a  drop  every  third  day,  after  which  the 
excrescences  were  diminished  one  half  in  size.  The  repetition  of 
Thuja  of  the  fourth  dilution  entirely  cured  the  disease. 

"  Throughout  this  work  I  have  avoided  the  recital  of  cases,  for  in 


510  URINARY  AND  GENITAL  ORGANS. 

this  disease  one  case  very  much  resembles  all  of  the  others.  In 
sycosis  I  have  made  an  exception  in  order  to  be  able  to  introduce  the 
remark  that  Thuja,  which  in  this  case  was  the  proper  curative  when 
first  administered,  was  not  attended  with  any  success,  and  did  not 
prove  beneficial  until  administered  in  a  lower  dilution  after  two  other 
remedies  had  been  given.  I  am  perfectly  willing  that  this  favor- 
able result  should  be  ascribed  to  the  lower  dilution,  but  must  remark 
that  in  at  least  ten  cases  of  intermittent  fever,  in  which  Ipecacuanha 
proved  fruitless,  and  several  other  remedies  given  subsequent  to  it, 
likewise  proved  inefficient,  that  Ipecac,  then  administered  in  the  same 
dilution  and  dose,  was  attended  with  the  most  favorable  result. 

"  Gonorrhoea. — This  form  of  the  venereal  disease  is  of  all  others 
the  most  troublesome,  as  well  for  the  patient  as  his  physician.  To 
the  patient,  as  it  is  the  cause  of  much  pain,  sleepless  nights,  fever 
and  other  analogous  symptoms,  which  may  result  in  inflammation 
and  induration  of  the  testicles,  stricture  of  the  urethra,  &c,  either 
owing  to  the  misconduct  of  the  patient  or  to  the  preposterous  and 
violent  allopathic  treatment.  Gonorrhoea  is  a  troublesome  disease  to 
the  physician,  owing  to  its  tendency  to  become  chronic,  and  in  the 
form  of  a  gleet  to  continue  long  and  obstinately.  It  appears  to  be 
the  general  character  of  diseases  of  mucous  membranes  to  run  their 
course  sluggishly.  We  frequently  see  catarrhs,  in  themselves  unim- 
portant, continue  for  several  weeks.  This  is  also  the  case  with 
various  mucous  diseases  of  the  nose,  ear,  vagina,  &c,  which  are 
rendered  chronic  as  soon  as  an  increased  mucous  secretion  appears. 

The  usual  time  required  to  cure  an  acute  gonorrhoea  was  one 
month.  Several  were  cured  in  fourteen  days;  a  few  cases  degene- 
rated into  gleet. 

"I  experienced  the  best  effect  in  the  treatment  of  this  disease 
from  the  exhibition  of  Cannabis  in  the  fourth  dilution,  in  drop  doses, 
which  were  repeated  at  intervals  of  five  or  six  days.  I  occasionally 
repeated  the  remedy  for  two  or  three  days  in  succession,  and  then 
waited  seven  or  eight  days. 

"Pulsatilla  was  given  with  effect  also  in  drop  doses  of  the  fourth 
dilution,  where  general  corporeal  agitation,  very  diminished  appetite, 
evening  chill,  increased  thirst,  &c,  were  present.  In  three  or  four 
days,  this  febrile  state  was  usually  allayed,  and  I  then  again  continued 
the  Cannabis. 

"  A  few  globules  of  the  30th  dilution  of  Cantharides  were  always 


TREATMENT    OF   VENEREAL   DISEASES.  511 

effectual  in  very  painful  erections,  violent  burning  and  strangury. 
In  one  case  hematuria  supervened,  which  was  not  relieved  by  Can- 
tharides  but  by  Mezereum. 

"  Mercur.  solub.  4  gutt.  una,  effected  a  rapid  cure  in  a  case  of  gonor- 
rhoea attended  with  a  greenish  discharge.  In  this  case,  however, 
several  sores  were  present,  which  indicated  the  application  of  Mercury. 
The  gonorrhoea  was  cured  before  the  chancres. 

"  At  first,  before  I  had  effectually  tried  the  efficacy  of  Cannabis,  I 
tried  Blenorrhin,  in  doses  of  several  globules  of  the  thirtieth  dilution. 
A  gonorrhoea  in  which  Capaiva  'proved  inefficient,  was  cured  in  two 
weeks  by  two  doses  of  Blenorrhin.  In  several  other  cases,  this  remedy 
effected  considerable  improvement,  although  it  did  not  produce  a 
complete  cure.  But  as  Cannabis  with  an  intercurrent  dose  of  Pulsa- 
tilla, Cantharides,  or  in  cases  of  very  frequent  urination,  Petroselinum, 
acted  very  favorably  in  a  majority  of  cases.  I  made  no  farther  trials 
with  Blenorrhin  in  acute  gonorrhoea,  although  I  made  use  of  it  in 
gleet. 

"  Gleet.  Nine  cases  of  this  disease  were  cured  with  Blenorrhin 
30th,  Sulphur  30th,  and  Cannabis  4th  gutt.  una.  I  repeated  Cannabis 
every  five,  and  the  other  two  remedies  every  eight  days.  I  am 
unable  to  mention  any  particular  indications  for  the  employment  of 
any  of  these  remedies.  Generally  Sulphur,  given  at  first,  produced 
considerable  improvement,  diminished  the  discharge  perceptibly,  but 
excited  slight  burning  in  the  urethra,  after  which  I  usually  gave 
Cannabis  with  effect.  I  observed  this  frequently.  I  have,  however, 
perfectly  cured  painless  gleets  with  Cannabis  aided  by  Sulphur  or 
Blenorrhin. 

"  As  regards  the  dietetic  treatment  in  gonorrhoea,  all  violent  exer- 
cise must  be  avoided.  If  the  testicles  are  sympathetically  affected, 
the  patient  must  wear  a  suspensory  bandage,  or  at  least  support  the 
testicles  with  a  handkerchief.  •  Beer  should  not  be  taken  during  the 
existence  of  acute  or  chronic  gonorrhoea. 

"  I  saw  discharges  unattended  with  pain,  reproduced  in  several 
patients  who  indulged  freely  in  wine  immediately  after  their  gonor- 
rhoeas had  been  cured  ;  it,  however,  soon  disappeared ;  the  very  severe 
burning  can  be  much  diminished  by  the  patient's  drinking  water 
very  freely,  by  which  means  the  urine  is  increased  in  quantity  and 
rendered  less  acrid.  This  innocent  palliative  produces  great  relief  to 
the  patient,  and  should  therefore  never  be  neglected. 


512  URINARY  AND  GENITAL  ORGANS. 

66  Inflammation  of  the  testicles.  I  treated  but  two  cases. 
One  was  in  company  with  a  gonorrhoea,  or  rather  gonorrhoea  con- 
joined with  swelled  testicle.  The  patient  being  afflicted  with  gonor- 
rhoea, went  out  a  hunting  in  cold  damp  weather,  and  returned  with 
violent  pain  in  the  testes.  The  disease  increased  during  the  night, 
and  both  testicles  wrere  swollen,  hard,  not  bearing  the  slightest  touch, 
the  scrotum  red  and  tense,  some  fever  which  continued  until  the 
evening  of  the  succeeding  day.  There  was  scarcely  any  discharge 
from  the  urethra.  Two  doses  of  Clematis,  12th  dilution,  three  glo- 
bules repeated  every  three  days,  cured  the  disease,  after  which  the 
gonorrhceal  discharge  reappeared.  Swelling  of  the  epididymis  of  one 
of  the  testes,  which  still  remained,  was  removed  by  Aurum  iv  dis- 
solved in  water. 

ee  The  second  case  was  a  relapse,  which  had  previously  been  sub- 
jected to  allopathic  treatment.  It  was  relieved  by  China  IV000,  and 
Aurum  IV000.     China  was  administered  three  times,  Aurum  twice. 

"  The  patient  should  remain  in  bed  and  have  the  testes  properly 
supported. 

"  Gonorrhoea  glandis.  Incorrectly  so  termed.  It  could  with 
more  propriety  be  called  inflammation  of  the  glans  penis.  I  treated 
two  cases.  One  case  was  conjoined  with  gleet.  The  glans  was  very 
red  and  swollen,  small  fissures  appeared  on  various  parts  of  it,  and 
in  a  few  days,  a  very  offensive  mucous  secretion  succeeded,  which 
increased  very  much  in  a  short  time,  and  affected  the  prepuce  also. 
Corallia  3,  one  grain  repeated  in  four  days  cured  the  balano-blenor- 
rhoea,  and  Cannabis  and  Sulphur  the  gleet.  The  second  case  was 
connected  with  chancre,  was  not  so  violent,  and  was  cured  by  the 
use  of  Mercury. 

"  A  few  years  ago  I  cured  several  of  these  cases  with  Thuja  X000. 

"  Nodes.  The  patient  had  been  afflicted  three  years  before  with 
a  chancre  which  was  cauterized.  After  taking  a  violent  cold  from 
exposure  to  moisture,  the  patient  had  a  gouty  attack.  It  was  treated 
without  effect ;  a  depot  formed  on  the  tibia,  which  wa&  attended  with 
such  violent  boring  and  rending  pains,  particularly  at  night,  that  he 
was  deprived  of  all  nocturnal  rest,  and  obliged  to  quit  his  bed.  He 
then  underwent  a  course  of  '  Dzondischer'  pills,  which  rather  in- 
creased than  relieved  his  malady.  After  the  administration  of  half  a 
grain  of  Eepar  sulpha  Calc.  3d  trituration,  he  was  able  to  sleep  several 


TREATMENT    OF    VENEREAL    DISEASES.  513 

hours  in  the  morning.  Two  additional  doses  of  Hepar,  given  at 
intervals  of  eight  days,  removed  the  pain  almost  entirely,  the  patient 
ate,  drank,  and  slept  as  in  health,  though  the  swelling  was  not  per- 
ceptibly diminished ;  this,  however,  disappeared  entirely  on  adminis- 
tering three  doses  of  Acid,  nitric,  x,  at  intervals  of  from  eight  to  ten 
days. 

"The  other  patient  had  two  osseous  swellings  of  the  size  of  a 
pigeon's  egg  on  the  head,  and  an  eruption  over  the  whole  body,  for 
the  relief  of  wrhich  he  had  taken  several  hundred  baths,  and  as  many 
mercurial  pills.  The  patient  was  cured  after  eighteen  months'  treat- 
ment which  was  repeatedly  interrupted.  Of  course  he  took  very 
many  homoeopathic  medicines,  so  that  I  am  unable  to  mention  the 
results  obtained  by  any  particular  one,  especially  as  during  the  latter 
period  I  treated  him  only  by  letter. 

"  Complications. 

"  Chancre  and  Bubo. — The  treatment  of  this  form  of  compli- 
cation has  been  described  under  Bubo. 

"  Chancre  and  Gonorrhoea. — If  the  gonorrhoea  is  very  painful, 
the  treatment  of  the  chancre,  which  otherwise  is  preferable,  must  be 
suspended,  and  Cantharides  or  some  other  appropriate  remedy  be 
exhibited.  This  also  holds  good  if  profuse  and  continued  hematuria 
supervenes, 

"  Chancre  and  Condylomata. — In  this  case,  the  treatment 
can  be  united,  as  Thwja  and  Nitric  acid  are  particularly  indicated  in 
both  forms. 

"  Gonorrhoea  and  Hernia  humoralis. — Here  of  course  the 
latter  must  be  treated  without  delay. 

"  The  other  complications  are  not  of  importance,  and  the  treat- 
ment of  them  is  obvious. 

"  Syphilis  secundaria.      Secondary  Syphilis. 

"  Aurum. — Nasal  speech,  stinking  ichor  and  small  pieces  of  bone 
discharged  from  the  nose,  ulcers  on  the  palate,  the  tonsils  are  cor- 
roded by  ulcers,  offensive  discharge  from  the  ears,  with  violent  boring 
pains  in  them,  painful  periosteal  swelling, on  the  hairy  scalp,  forearm 
and  tibia,  on  the  head  itching  nodes,  rending  pains  in  the  bones  of 
the  extremities. 

"Aurum. — Inveterate  syphilis,  the  nasal,  frontal  and  superior 
maxillary  bones  swollen  and  reddened,  with  sticking  pains  in  them, 

33 


514  URINARY  AND  GENITAL  ORGANS. 

bloody,  fetid  discharge  from  the  nostrils,  the  margins  of  the  eyelids 
reddened  at  their  inner  canthi;  if  the  head  is  not  kept  warm,  head- 
ache as  if  a  draught  of  air  passed  through  it. 

"  Acichm  nitric—On  the  head  isolated,  humid  pustules  ;  the  face 
full  of  maturated  pustules,  with  broad  red  margins,  which  after  some 
days  form  crusts;  on  the  right  ala  nasi,  a  condylomatous  protube- 
rance of  the  size  of  a  bean,  covered  with  a  scab  ;  tonsils  red  and 
swollen ;  there  was  formerly  a  raw  spot  on  the  anus  between  the  legs ; 
pruriency  and  humidity  of  the  integuments. 

cc  Hepar  suVphuris,  Rhus. 

"Sepia. — Inveterate  syphilis,  with  ulcers  of  the  glans  and  pre- 
puce. After  Mercur.,  Acidum  nitric,  and  Thuja  had  been  given  without 
perceptible  improvement. 

"Thuja,  with  the  aid  of  Graphit.  and  Sepia.,  were  given,  copious 
discharge  of  pure  mucus  from  the  urethra  in  a  subject  who  had  pre- 
viously taken  much  Mercury,  slight  burning  when  urinating,  the 
bulbous  portion  of  the  urethra  painful  internally,  the  orifice  of  the 
urethra  red,  swollen,  the  inner  surface  of  the  prepuce  red,  pain  in 
the  region  of  the  bladder,  ulceration  of  the  base  of  the  glans,  scro- 
tum painful,  many  nocturnal  pollutions,  headache,  melancholy, 
inclined  to  suicide." 


DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS, 
OR  OF  THE  SYSTEM  IN  GENERAL. 


GOUT. 

Arthritis. 

This  disease,  particularly  when  it  has  assumed  the  chronic*  form, 
requires  a  long  and  discriminative  course  of  treatment.  The  chief 
danger  arises  from  its  liability  to  transfer  its  seat  from  the  part 
first  attacked  to  some  of  the  principal  internal  organs,  such  as  the 
head  or  stomach ;  in  such  instances,  it  assumes  a  peculiar  critical 
character. 

From  some  peculiar  predisposition,  gout  is  often  hereditary ;  until 
therefore  this  constitutional  tendency  is  eradicated  by  a  proper  mode 
of  treatment,  where  practicable,  it  is  useless  to  expect  a  permanent 
cure. 

Diagnosis.  Pains  in  the  joints,  with  inflammatory  or  chronic 
cold  swelling,  and  symptoms  of  deranged  digestion. 

These  signs,  however,  may  only  partially  declare  themselves,  or  be 
marked  by  some  other  chronic  malady;  indeed  there  is  scarcely  any 
disease  of  that  character,  with  which  gout  may  not  be  complicated. 

Prior  to  the  attack,  we  generally  find  symptoms  of  general  derange- 
ment of  the  digestive  functions,  with  a  slight  access  of  fever :  the 
veins  of  the  feet  become  swollen,  and  a  sense  of  numbness,  cramps* 
or  twitching  is  present,  with  a  deficiency  of  perspiration.  When  the 
attack  comes  on,  which  most  frequently  occurs  in  the  evening,  or 
during  the  night,  it  is  generally  attended  with  a  feeling  of  dislocation 
in  the  joints  of  the  feet,  and  burning  or  severe  scalding  pain  in  the 
part  attacked,  more  or  less  intense  ;  after  a  time  these  sensations  dis- 
appear, leaving  the  part  red  and  tumefied :  the  fit  occurs  again  at 
intervals,  generally  diminishing  in  intensity ;  in  many  instances  con- 
siderable fever  is  present. 


516     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Among  the  exciting  causes  of  gout  may  be  numbered  the  follow- 
ing :  a  luxurious  mode  of  life ;  stimulating  diet  or  drinks  ;  a  sudden 
check  of  perspiration ;  mental  emotions ;  sedulous  application  to 
studious  pursuits,  and  neglect  of  proper  exercise  in  the  open  air ;  and 
the  use  of  aperient  medicines  and  tonics.  In  plethoric  habits,  the 
gout  shows  a  considerable  inclination  to  shift  its  seat  to  the  head,  and 
in  dyspeptic  individuals  to  the  stomach  and  intestines. 

Therapeutics.  In  general  cases  of  this  affection,  the  principal 
medicaments  are  Aconite,  Pulsatilla,  Nux  vomica,  and  Bryonia,  etc. 

Aconite,  in  plethoric  or  corpulent  habits,  where  there  is  consider- 
able inflammatory  fever,  with  hard  and  quick  pulse. 

Pulsatilla,  where  the  pains  are  of  a  shifting  nature,  exacerbated 
towards  evening  or  in  led,  with  a  paralytic  or  torpid  sensation  in  the 
part  affected,  and  more  particularly,  when  the  dyspeptic  symptoms, 
given  under  this  medicine  (see  Indigestion  or  Dyspepsia)  present 
themselves,  and  when  the  pain  is  relieved  by  uncovering  the  affected 
limb. 

When,  on  the  contrary,  the  pain  is  increased  by  uncovering,  and 
relieved  by  warmth,  and  the  patient  is  weak,  depressed  and  ex* 
hausted,  Arsenicum  will  be  found  of  material  service  in  affording  relief. 
Pains  worse  at  night,  with  restlessness  and  constant  necessity  to 
change  the  position  of  the  extremities,  pale  and  anxious  or  haggard 
countenance,  are  generally  relieved  by  Ferrum,  or  Ferrum  and  Rhus  in 
alternation ;  and,  in  other  cases,  by  Cinchona,  especially  when  there  is 
sensibility  to  the  touch,  and  aggravation  of  the  sufferings  from  the 
most  trivial  pressure  or  blow. 

Nux  vomica,  when  the  pains  are  worse  towards  the  morning ;  para- 
lytic and  torpid  sensations,  with  cramps  and  throbbings  in  the  muscles  : 
and  moreover,  when,  in  addition  to  other  dyspeptic  symptoms,  we  find 
constipation  and  hemorrhoids,  or  an  inclination  to  that  affection,  and 
an  irritable  or  choleric  temperament :  furthermore,  when  indulgence 
in  wine  or  fermented  liquors  has  been  the  inducing  cause. 

Bryonia,  where  the  pains  are  increased  by  the  slightest  motion; 
aggravation  of  suffering  at  night;  coldness  and  shivering,  with  gene- 
ral perspiration  or  fever.  For  the  dyspeptic  symptoms  present,  see 
article  Indigestion. 

Each  of  the  medicines  here  mentioned  may  successfully  follow 
Aconitq,  when  the  febrile  symptoms  have  been  in  some  measure  sub- 
dued by  the  administration  of  that  medicament. 


RHEUMATISM.  517 

In  chronic  cases,  the  applicability  of  the  following  medicines  should 
be  consulted :  Argentum,  Lyeopodinm,  Aurum,  Sulphur,  Calcarea  car- 
bonica,  Colocynth,  Hepar  sulphuris,  Colchimm,  Phosphoms,  Conium  macu- 
latum,  Daphne,  Kali,  Guaiacum,  lodium,  Rhododendron*,  Clematis  viticella, 
and  Manganum.  Also,  as  intermediate  remedies,  —  Arnica,  Ledum 
palustre,  and  Sabina. 

In  Arthritis  vaga  the  following  remedies  have  been  recom- 
mended in  addition  to  Pulsatilla:  Nux  v.,  Arnica,  Manganum,  Nux 
moschata  :  and  also  Rhododendron,  Plumbum,  Daphne,  and  Assafoetida. 

Arthritic  Nodosities,  or  Nodes  :  Lycopodium,  Aurum,  Ledum, 
Graphites,  Calcarea,  Rhododendron,  Calcarea,  Silicea,  Sepia,  Berber  is,  and 
Staphysagria  in  alternation ;  as  also  Agnus,  Antimonium,  Bryonia,  Phos- 
phorus, Sabina,  Zincum.  Arthritic  contractions  are  sometimes 
benefited  by  Sulphur,  Bryonia,  Rhus,  Guaiacum ;  or  Colocynth,  Silicea, 
Calcarea,  etc.  Arthritis  occurring  in  individuals,  whose  occupations 
compel  them  to  work  in  the  water,  is  chiefly  to  be  relieved  by  Calcarea, 
Pulsatilla,  Sarsaparilla,  and  Sulphur ;  and  in  some  cases  by  Arsenicum, 
Dulcamara,  Antimonium,  Nux  moschata,  and  Rhus.  Nux  v.  is  one  of  the 
most  important  remedies  against  the  precursory  symptoms  of  gout ; 
and  Belladonna  against  recent  metastasis.  In  Chiragra  :  Nux,  Bry., 
Lye,  Cocc,  Ant,  Agn.,  Rhod.,  Sulph.,  Lach.,  Led.,  etc.,  are  the  most 
generally  appropriate  remedies.  And  in  Podagra:  Arnica,  Sabina, 
Ledum;  but  in  many  cases  the  following  are  equally  important :  Bry., 
Sulph.,  Calc,  Cocc,  Am.  c.  et  m.,  Amhr.,  Lyc>  etc. 


rheumatism,   rheumatic  fever. 

Febris  rheumatica.     Rheumatismus. 


Diagnosis,  Pains  in  the  muscular  or  membranous  structure, 
generally  with  swelling  of  the  adjacent  cellular  tissue,  with  slight  red- 
ness and  increased  generation  of  heat,  caused  by  taking  cold, 

This  disease  is  of  twTo  kinds,  the  Acute  and  Chronic  :  the  former  is 
accompanied  by  fever,  preceded  by  restlessness;  heat  alternating  with 
chills ;  thirst ;  coldness  of  the  limbs  and  extremities ;  constipation 
and  accelerated  pulse,  followed  by  pains  in  the  large  joints,  generally 
shifting  their  situation,  leaving  redness,  swelling,  and  tenderness  of 
the  parts  affected ;  it  is  also  frequently  attended  with  excessive  per- 


518  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

spiration  and  weakness.  In  the  latter,  or  Chronic  Rheumatism,  the 
swelling  of  the  parts,  except  in  very  severe  cases,  is  commonly  less 
perceptible ;  sometimes  there  is  present  a  feeling  of  general  stiffness  or 
numbness,  with  little  or  no  fever. 

Other  symptoms  incidental  to  this  complaint,  we  shall  notice  more 
particularly  under  the  head  of  the  different  medicaments  most  effica- 
cious in  the  treatment.  The  principal  exciting  causes  are  damp,  chill, 
or  a  sudden  check  of  perspiration.  People  who  have  resided  long  in 
a  tropical  climate,  or  have  been  subject  to  continual  exposure  to 
cold  or  wet,  are  very  liable  to  suffer  from  rheumatism  in  the  chronic 
form. 

Therapeutics.  In  the  treatment  of  this  affection,  the  following 
medicaments  have  been  found  particularly  useful :  Aconitum,  Bella- 
donna, Bryonia,  Chamomilla,  Nux  vomica,  Mercurius,  Pulsatilla,  Rhus 
toxicodendron,  etc. 

Aconitum,  when  we  find  high  fever,  dry  heat,  thirst,  and  redness 
of  the  cheeks ;  excessive  shooting  or  tearing  pains,  extremely  violent  at 
night ;  occasionally  redness  or  shining  swelling  of  the  parts  affected ; 
aggravation  of  pains  by  the  touch  ;  excessive  irascibility  of  temper. 

Belladonna  is  useful  when  the  pains  are  of  a  shooting  or  burning 
description,  principally  in  the  joints,  aggravated  by  movement,  and 
worse  at  night;  when  the  parts  attacked  are  much  swollen,  rigid, 
very  red,  and  shining,  and  particularly  when  there  is  fever,  with 
determination  of  blood  to  the  head,  throbbing  of  the  vessels  of  that 
part,  and  redness  of  the  face;  heat  of  skin,  thirst,  accelerated  pulse 
and  sleeplessness,  aggravation  of  the  pains  on  movement. 

Bryonia  may  follow  Aconite,  or  the  preceding  medicine,  writh  great 
benefit,  or  be  administered  independently.  The  following  are  its 
more  prominent  indications  :  severe  shooting  pains,  much  increased 
by  motion  of  the  affected  part,  or  by  a  cold  draught  of  air ;  swelling 
of  the  joints  of  the  upper  and  lower  extremities ;  fever ;  headache, 
gastric  derangement,  and  constipation ;  pains  aggravated  at  night,  or 
particularly  on  the  slightest  irritation ;  irascibility  and  perverseness  of 
temper;  the  pains  seem  situated  more  in  the  muscles,  and  particu- 
larly about  the  joints,  than  in  the  bones.  Bryonia  is,  like  Belladonna, 
particularly  indicated  in  rheumatic  fever,  wrhen  the  pains  are  exces- 
sively increased  by  the  slightest  movement,  but  the  accompanying 
fever  less  of  a  synochal  type  than  that  which  calls  for  Bella. 

Chamomilla,  when  we  find  dragging  or  tearing  pains,  with  a 


RHEUMATISM .  519 

sensation  of  numbness  of  of  paralysis  in  the  parts  affected,  feverish- 
ness;  great  agitation  and  tossing;  desire  to  remain  lying  down; 
perspiration;  exacerbation  of  suffering  at  night,  with  temporary  relief 
from  sitting  up  in  bed,  or  frequent  changing  of  posture ;  dragging 
rheumatic  pains  in  the  gums  or  upper  and  lower  extremities,  with 
nocturnal  exacerbations,  or  excessive  aggravation  of  pain  from  the 
slightest  movement.  Aching  pains  all  over  on  waking  in  the  morning, 
and  chilliness  during  the  day. 

Nux  vomica  : — Sensation  of  numbness,  paralysis,  or  tightness  in 
the  parts  affected,  with  cramps  and  palpitation  of  the  muscles ;  pains 
of  a  dragging  description,  chiefly  confined  to  the  joints,  trunk  of  the 
body,  back,  loins,  and  chest,  aggravated  by  cold  •  gastric  derange- 
ment ;  constipation;  irritability  of  temper.  In  rheumatism  in  the 
muscles  of  the  neck,  with  stiffness  and  drawing  of  the  head  to  one 
side,  and  nocturnal  exacerbations  ;  as  also  in  rheumatism  having  its 
seat  in  the  gums,  muscles  of  the  chest,  abdomen,  and  back,  with 
flatulence  and  constipation,  Nux  is  one  of  the  best  remedies.  (Coccu- 
lus  and  Ignatia  are  sometimes  called  for,  when  Nux  brings  only 
temporary  relief.) 

Mercurius  is  indicated  in  cases  where  the  pains  are  increased  by 
the  warmth  of  the  bed  or  exposure  to  damp  or  cold  air,  aggravated  at 
night,  and  especially  towards  morning  ;  also  where  there  is  considerable 
puffy  swelling  of  the  parts  affected.  This  medicine  is  particularly 
useful  when  the  pains  seem  seated  in  the  bones  or  joints ;  profuse 
perspiration  without  alleviation  of  suffering,  is  also  a  good  indication  for 
its  employment ;  rheumatic  fever  with  continual  alternations  of  chills 
and  heats,  or  internal  heat,  with  fugitive  chills  in  the  affected  parts. 
(Lachesis  is  often  efficacious  when  Mercurius  fails  to  relieve  the  fore- 
going symptoms.) 

Pulsatilla  is  useful  in  shifting  rheumatic  pains,  particularly  if 
attended  with  a  sense  of  torpor  or  paralysis  in  the  parts  upon  which 
the  patient  has  been  lying,  relieved  by  exposure  to  cool  air,  and  worse 
at  night  or  in  the  evening;  rheumatic  fever,  with  predominating 
chills,  and  pains  in  the  long  bones.  (Camphora  is  often  of  great  ser- 
vice in  pains  which  disappear  in  one  place  to  reappear  in  another, 
such  as  from  the  feet  to  the  arms,  and  so  on,  when  Pulsatilla  or  Rhus, 
etc.,  produce  merely  palliative  amendment.) 

Rhus  toxicodendron  is  indicated  by  a  sensation  of  torpor,  dull- 
ness, and  crawling,  with  feeling  of  numbness,  or  creeping  in  the 
affected  parts,  especially  those  on  which  the  patient  lies:  paralytic 


520  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

weakness  or  trembling  of  the  extremities,  when  attempting  to  move  them  ; 
a  sensation  of  bruising  or  of  laceration,  as  if  the  flesh  were  torn  from 
the  bones,  or  as  of  scraping  of  the  bones ;  pains  worse  during  rest,  re- 
lieved by  motion ;  inflammatory  or  shining  redness  in  the  joints,  with 
stiffness,  and  sometimes  a  darting  pain  when  handled.  This  remedy 
is  particularly  useful  when  rheumatism  or  rheumatic  fever  has  arisen 
after  a  thorough  wTetting,  or  when  the  sufferings  are  aggravated  in 
cold  or  damp  weather,  and  when  in  rheumatic  fever  the  pains  set  in 
especially  during  the  chills,  and  the  chilliness  alternates  with  heat 
throughout  the  course  of  the  disease,  except  during  the  night,  when 
heat  prevails,  and  gives  rise  to  a  constant  inclination  to  stretch  the 
limbs.  This  medicament  may  sometimes  follow  Bryonia  with  con- 
siderable advantage.  Ferrum  is  sometimes  useful  in  alternation  with 
Rhus,  particularly  when  the  pains  are  relieved  by  frequently  shifting 
the  position  of  the  limbs ;  or  after,  or  in  alternation  with  Pulsatilla, 
when  the  pains  fly  about  from  one  part  to  another,  and  are  of  a  lanci- 
nating description. 

Arsenicum  is  a  most  valuable  remedy  when  the  pains  are  of  a 
tearing^  dragging,  lancinating,  burning  character,  accompanied  by 
anxiety  and  uncontrollable  restlessness  and  sleeplessness,  with  great 
heat  of  skin  and  excessive  thirst,  small  accelerated  pulse  and  swelling 
of  the  extremities.  In  rheumatic  metastasis  to  internal  organs,  espe- 
cially the  heart,  Arsenicum  is  one  of  the  most  important  remedies. 
Accessions  of  sweat,  w7ith  mitigation  of  suffering,  is  a  characteristic 
indication  for  Arsenicum, 

Col chi cum  : — Rheumatism,  with  gastric  derangement  and  slight 
fever,  during  the  prevalence  of  cold,  damp  weather;  or  rheumatic 
fever  (continua  remittens),  exacerbated  in  the  afternoon,  with  general 
dry  heat,  palpitation  of  the  heart,  thirst,  and  fugitive  sweats;  shooting, 
tearing  pains  in  the  affected  parts,  becoming  almost  insupportable  at 
night,  subsiding  towards  morning,  and  then  suddenly  fixing  upon 
some  other  part  of  the  body,  which  in  its  turn  becomes  painful  and 
inflamed^  whilst  the  previously  affected  part  loses  its  former  redness, 
but  remains  in  a  tumefied  state  for  a  few  hours. 

China  is  of  much  service  at  the  commencement  of  an  attack  of 
rheumatic  fever,  when  the  following  symptoms  are  met  with:  noc- 
turnal, pressive,  aching  pains  in  the  head,  with  excessive  general 
restlessness,  which  disturbs  sleep ;  fugitive  chills  in  the  back,  and 
tendency  to  sweat  on  covering  up  the  parts,  or  on  the  slightest  excess 
of  clothing ;  the  chilliness  gradually  extends  over  the  whole  body,  but 


RHEUMATISM.  521 

consists  more  of  an  internal  than  an  external  feeling  of  chilliness, 
with  exception  of  the  hands  and  feet,  which  are  as  cold  as  ice ;  by 
degrees  partial  heat  supervenes,  with  exacerbation  of  headache,  and 
distension  of  the  vessels,  dragging,  tearing  pains  in  the  back,  sacrum, 
thighs,  and  knees,  with  weakness  in  the  affected  parts,  and  aggrava- 
tion or  renewal  of  suffering  on  touching  or  handling  them ;  sometimes 
symptoms  of  gastric  or  bilious  derangement  make  their  appearance  at 
the  same  time,  as  bitter  tase,  with  yellow  furred  tongue,  bitter  eruc- 
tations, nausea,  and  even  vomiting,  and  excessive  thirst.* 

Ranunculus  bulbosus.  This  remedy  is  also  of  considerable 
efficacy  in  rheumatic  fever,  and  is  indicated  by  some  of  the  charac- 
teristic symptoms  which  call  for  the  employment  of  China,  such  as 
aggravation  or  renewal  of  the  tearing,  shooting  pain  by  the  touch, 
or  by  movement  or  alteration  of  posture.  The  fever  partakes 
of  the  type  of  a  continua  remittens,  becomes  exacerbated  towards 
evening,  and  is  attended  with  a  strong  full  pulse.  The  pains  are  of  a 
fugitive  character,  and  are,  in  addition  to  the  above  peculiarity,  which 
is  common  to  China,  generally  aggravated  by  cool  air.  Semilateral 
heat,  with  coldness  of  the  hands  and  feet,  is  likewise  an  indication  for 
Ranuncukts  bulb.  in.  rheumatic  fever. f 

Rhododendron  chrysanthum.  Rheumatic  fever  (of  the 
character  of  synochus),  in  which  the  chilliness  alternates  with  heat, 
accompanied  with  pressive  headache  from  within  outwards,  and 
drawing  in  the  limbs ;  dry  heat  in  the  trunk  during  the  night,  with 
restlessness  and  sleeplessness,  followed  by  slight  general  heat  towards 
morning,  on  mitigation  of  pain.  The  nocturnal  drawing,  or  dragging 
and  tearing  pains  occupy  the  periosteum  chiefly,  are  aggravated  by 
bad,  changeable  weather,  and  by  rest. 

Sulphur  : — Drawing,  pricking,  or  drawing,  tearing  pains  in  the 
extremities  and  joints.,  with  slight  swelling  of  the  latter ;  mitigation  of 
pain  from  external  warmth,  and  aggravation  from  cold  ;  exacerbation 
or  accession  of  pain  when  at  rest,  and  amelioration  on  movement; 
but  chiefly  when  the  pains  are  of  a  fixed  character.  Rheumatic 
fever,  with  alternate  heats  and  chills,  anxietas  praecordii,  and  pains  in 
the  head  and  neck,  and  severe  pricking  in  the  sacral  region ;  the 
headache  increases,  by  its  violence,  the  great  tendency  to  restless- 
ness and  disturbed  sleep,  and  admits  of  no  rest  in  any  position. 
The  accompanying  fever  is  a  continua  remittens,  with  exacerbations 
in  the  evening,  or  after  retiring  to  rest,  consisting  of  shivering  chills^ 
*  Hartniann's  Therapie.  f  Ibid. 


522     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

which  it  is  impossible  to  allay  by  warmth,  and  which  terminates  in 
heat  after  an  hour  or  two  ;  towards  morning,  sweat  of  an  acid  odour. 
Commonly,  there  is  complete  absence  of  appetite,  or  desire  for  acid 
food  only,  with  great  thirst,  parched  mouth  (or  sensation  of  dryness), 
sour  eructations,  distension  of  the  scrobiculus  and  abdomen,  and 
sensibility  to  the  touch ;  costiveness.* 

Arnica  is  characteristically  indicated  when  the  extremities  are 
affected  with  tensive,  tearing  pains,  or  pains  as  if  caused  by  a 
bruise,  attended  with  debility,  redness,  and  swelling,  exacerbation 
from  the  slightest  movement,  and  yet  it  is  found  impossible  to  retain 
the  limbs  long  in  one  posture,  in  consequence  of  the  unremitting  pain 
and  the  restlessness  which  arises  from  so  doing.  In  pains  of  a  simi- 
lar description  affecting  the  thorax,  particularly  the  posterior  portion, 
this  remedy  is  still  more  efficacious,  with  the  contradistinction  that 
they  are  mitigated  by  movement  $  chilliness  and  heat  exist  at  the 
same  time,  i.  e.,  whilst  one  part  feels  warm  to  the  touch,  another  feels 
cold.f 

Lachesis  has  been  found  of  great  efficacy  in  rheumatic  fevers,  and 
especially  in  those  occurring  after  the  abuse  of  mercury.  It  is  chiefly 
indicated  by  pain  and  stiffness,  with  swelling  of  the  affected  part, 
sensibility  to  the  touch,  and  exacerbation  of  the  pains  during  move- 
ment, towards  evening  and  at  night ;  sweat,  which  brings  no  relief. 

Mezereum  is  equally  efficacious  in  rheumatic  fever  after  a  course 
of  mercury  in  large  doses,  when  the  pains  occupy  the  long  bones,  and 
are  principally  of  a  drawing  and  tensive  description. 

Carbo  v.: — Drawing  tearing  pains  in  the  thorax,  with  paralytic 
sensation,  and  obstructed  respiration ;  also  when  excessive  flatulency 
is  present. 

Euphorbium.  Tearing,  or  pressive,  aching,  shooting  pains,  ex- 
acerbated during  rest,  ameliorated  by  movement. 

Obstinate  cases  of  rheumatism  frequently  require  a  long,  careful, 
and  discriminative  treatment.  In  some  cases  much  benefit  will  be 
obtained  from  repeated  doses  of  Sulphur ;  in  others,  Calcarea,  par- 
ticularly when  the  pains  are  increased  at  every  change  of  the  weather. 
Hejpar  sulphuris  and  Lachesis  alternately  have  been  recommended  in 
the  severest  kinds  of  acute  rheumatism.  Colocgnth  is  frequently  useful 
against  the  stiffness  which  remains ;  or  N%xy  Cocculus,  and  Ignatia, 
when  there  is  stiffness  of  the  entire  frame,  with  threatening  rheumatic 
paralysis.  In  the  event  of  a  sudden  metastasis  to  the  chest,  attended 
*  Hartmann's  Therapie.  f  Ibid. 


RHEUMATISM.  523 

with  oppressed  respiration,  palpitation  of  the  heart,  and  excessive 
agitation,  Aconitum  should  be  immediately  administered  in  repeated 
doses  until  relief  is  obtained ;  but  should  the  improvement  only 
prove  temporary,  Sulphur  and  Pulsatilla  have  been  recommended  to 
be  given  in  alternation.  Belladonna  and  Bryonia  may  also  be  of 
service  in  dangerous  results  of  this  kind.  When  the  heart  becomes 
implicated  in  acute  rheumatism  or  rheumatic  fever  {Endocarditis  or 
Pericarditis  rheumatica),  Belladonna,  in  repeated  doses,  is  frequently, 
in  addition  to  Arsenicum,  a  most  useful  remedy  if  timely  administered ; 
and  may,  in  some  cases,  be  advantageously  employed  in  alternation 
with  Aconitum,  and  followed  by  Spigelia  1 — 3  and  Digitalis  I — 3,  or 
Cannabis  or  Bryonia,  according  to  circumstances. 

These  remedies,  together  with  Cannabis,  Arsenicum^  Lachesis,  in  some 
instances,  are  the  most  valuable  in  the  treatment  of  idiopathic  Endo- 
carditis, Carditis,  or  Pericarditis,  which  see. 

Against  rheumatism  with  Fever  {rheumatic  fever),  Aconitum,  Bella- 
donna, Bryonia,  and  Chamomilla  are  the  most  appropriate  medicaments 
when  the  accompanying  fever  runs  high  or  is  of  a  synochal  type ; 
and  Merc,  Rhus,  Nux  v.,  Puis.,  Cocc,  Calc,  Chin.,  Ars.,  Ran.,  Rhod., 
Bide,  Indig.,  Am.,  and  Sulph.,  when  it  is  of  a  sub-inflammatory  type. 

Against  Non-febrile  rheumatism :  Argent,  m.,  Assa.  (when  the 
pains  proceed  from  below  upwards,  as,  for  instance,  from  the  hand 
to  the  arm  and  shoulder),*  Clem.,  Hep.,  Lach.,  Lye,  Phosph.,  Veratr., 
Nux,  Puis.,  Thija,  Sang,  can.,  Tgn.,  Merc,  Bulc,  Sulph.  chiefly. 

For  rheumatism  in  the  Joints,  with  or  without  swelling  {articular 
rhetimatism),  Aeon.,  Bry.,  Bella.,  Rhus,  Ant.,  Clem.,  Am.,  Led.,  Lye, 
Hep.  s.,  Sulph.,  Calc,  Sep.,  Argent,  metal,  (without  fever). 

For  rheumatism  in  the  upper  extremities:  1st,  The  Shoulder: 
Aeon.,  Bry.,  Puis.,  Rhus, — Kali,  Magn.,  Assa.,  Card,  v.,  Sil.,  Thuja,  Nux, 
Staph.,  Hep.,  Sec.  2d,  The  arm  :  Assa.,  Cocc,  Led.,  Puis.,  Sab.,  Veratr., 
Guaj.,  Chin.,  Ant.  c,  Bella.,  Bry.,  Kali,  M.  arct.,  Sec.  3d,  The  Fore- 
arm :  Rhus,  Merc,  Staph.,  Calc,  Nux  v.,  Sulph.,  Sep.,  Sil.,  Hep.,  Lye, 
Ran.  bulb.,  Ran.  seel.,  Sec.  Lower  extremities  :  1st,  The  Hip  or 
Hip- joint  :  Bry.,  Calc,  Led.,  Rhus,  Ant.,  Coloc,  Chin.,  Bulc,  Tgn., 
M.  austr.,  Merc,  Nux  v.,  Puis.,  Veratr.,  Phosph.,  Am.,  Bella.,  Sec.  2d, 
The  Thigh  :  Merc,  Guaj.,  China.,  Bella.,  Bry.,  Calc,  Carb.  a.,  Clem., 
Coloc,  Ign.,  Puis.,  Sulph.,  Am.,  Carb.  v.,  Cocc,  Nux  v.,  Rhus,  Thuja,  Sec. 
3d,  The  Leg  :    Calc,  Lye,  Puis.,  Sep.,  Sil.,  Staph., — Ant.  e,  Am.,  Ars.y 

*  Allg.  Horn.  Zeit.  No.  21,  31ster  Bd. 


524  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Cham.,  Chin:,  Coloc,  Guaj.,  Led.,  Mag.  arct.,  Mag.  ami.,  Phosph.,  Thuja, 
Veratr.,  Merc,  Nux  v.,  Ran.  seel.,  &c. 

Against  rheumatism  in  the  Thorax  (pectoral  and  intercostal 
muscles  particularly) :  Am.,  Phosph.,  Ban.  bulb.,  Spig.,  Sulph., — Ars., 
Bella.,  Carb.  v.,  Hep.,  Merc.,  Ran.  seel.,  Sep.,  Sil.,  Bry.,  Calc.,  Chin., 
Bulc,  Led.,  Lye.,  Cocc.,  Nux  v.,  Rims,  Staph.,  Veratr.,  &c.  In  the 
Heart:  Aeon.,  Lach. ;  and  Ars.,  Bry.,  Bella.,  Puis.,  Spig.,  Sulph., 
Calc.,  Cham.,  Chin.,  Merc,  Nux.,  Thuja,  Tabin.,  Carb.  v.,  Rhus,  Phosph.,  &c. 
Back  :  1st,  The  Shoulder-blades  (scapulae) :  China,  Merc,  Rhus, 
Sep., — Aeon.,  Am.,  Bry.,  Coloc,  Phosph.,  Ac  ph.,  Ran.  bulb.,  Rhod.,  Staph., 
Assa.,  Bella.,  Calc,  Cocc,  Nux  v.,  Sulph.,  Veratr.,  &c.  2d,  The  Dorsum  : 
Am.,  Ars.,  Bella.,  Cocc,  Nix,  Puis.,  Sulph., .Calc,  Lye,  Sep.,  Sil., — Assa., 
Bry.,  Cham.,  Bulc,  Hep.,  Ign.,  Lach.,  Led.,  Mag.  aust.,  Phosph.,  Ac  ph., 
Rhod.,  Spig.,  Staph.,  Thuja,  China,  Coff.,  Guaj.,  Merc,  Rhus,  Veratr. 
(See  Lumbago).  3d,  The  Sacrum  :  Nux  v.,  Puis.,  Rhus,  Sep.,  Sulph., — 
Ars.,  Bella.,  Carb.,  Bulc,  Hep.,  Mag.  aust.,  Ac  ph.,  Staph.,  Thuja,  Am., 
Bry.,  Calc,  Cham.,  China,  Cocc,  Ign.,  Lye,  Phosph.,  Veratr.,  &c.  _  For 
rheumatism  in  the  Head;  Spigelia  is  one  of  the  most  effective  reme- 
dies ;  in  other  cases,  Aeon.,  Bella.,  Bry.,  Lye,  Acid,  nitr.,  Merc,  Ipecac, 
Ign.,  Coloc,  Sulph.,  Led.,  Lach.,  China,  Phosph.,  or  Cham.,  followed  if 
required,  by  Nux.  v.  and  Puis,  at  intervals  of  twelve  hours.  In 
rheumatism  arising  from  the  abuse  of  Mercury,  Sulph.,  Carbo  v., 
Sass.,  Lycop.,  Guaj.,  China, — Acid,  n.,  Hep.,  Lach.,  Bella.,  Calc,  Ac.  ph., 
Puis.,  Bulc,  are  the  most  useful  in  general  cases.  In  that  which 
has  been  produced  by  the  excessive  and  injudicious  employment  of 
Cinchona  :  Puis.,  Ars.,  Carb.  v.,  Merc,  Sulph.,  Sep.,  Veratr.,  and  Calc. 
And  in  Gonorrhceal  rheumatism,  Clem.,  Sass.,  Thuja,  Puis,  Tussilago 
petas.,  Baph.,  Lye,  and  Sulph.,  may  be  considered  the  most  appropriate 
medicines. 

For  Chronic  Rheumatism  the  following  are  the  principal  reme- 
dies :  Veratrum,  Phosphorus,  Carbo  v.,  Sulph.,  Lycop.,  Hepar,  Lach.,  Clem., 
Indigo,  Valeriana.  When  the  pains  are  aggravated  or  excited  by  the 
slightest  chill, — Aconite,  Calc,  Bry.,  Bulc,  Merc,  Sulph.,  Acid. phosph., 
will  generally  be  found  the  best  remedies  from  which  to  select. 
When  the  attacks  are  excited  by  unfavorable  weather, — Calc,  Rhtis, 
Bulc,  Rhod.,  Verat.,  or  Lycop.,  Carbo  v.,  Lach.,  Hepar,  Mang.,  Nux  m.  ; 
and  when  every  change  of  weather  brings  on  a  relapse, — Calc,  Silicea, 
Sulph,,  Bulc,Merc,  Lach.,  Rhus,  an&Veratnim  are  usually  the  mostuseful. 

For  rheumatism  arising  from  a  chill  in  the  water,  or  from  cold, 
moist  weather, — Calcdrea,  Nux  m.,  Sarsaparilla,  or  Stdph.,  Bulc,  Carbo  v. 


LUMBAGO.  525 

Rheumatism  with  paralytic  weakness,— Arnica,  Fernim;  China,  &c, 
or  Electro-magnetism,  when  painful  jerkings  are  experienced  in  the 
part. 

Against  unsettled  or  shifting  rheumatic  pains,  in  addition  to 
Pulsatilla:  Rfais,  Arnica,  Bryonia,  Nux  m.,  and  in  some  instances, 
Mod.,  Dap/me,  Mang.,  Plumb.,  or  Crocus,  Valeriana,  and  Assafcetida, 
are  the  most  appropriate  medicines. 

Rheumatism  from  congelation, — Arsenicum,  Bryonia,  Nux  moschata, 
chiefly. 


LUMBAGO. 

Diagnosis.  Violent  pain,  of  a  rheumatic  character,  in  the  lumbar 
region,  either  periodical  or  permanent,  frequently  accompanied  with 
a  considerable  degree  of  fever. 

Therapeutics.  The  medicines  most  valuable  in  its  treatment  are, 
Aconite,  Bryonia,  Nux  vomica,  Rhus  toxicodendron,  Belladonna,  Pulsatilla, 
and  Mercurius. 

Aconite  may  be  given  at  the  commencement,  if  much  fever 
declare  itself. 

Bryonia  where  the  pains  in  the  back  are  of  a  severe  aching  or 
lancinating  description,  constraining  the  individual  to  walk  in  a  stoop- 
ing position ;  aggravated  by  the  slightest  motion,  or  draught  of  cold 
air,  and  attended  with  a  general  sensation  of  chilliness. 

Nux  vomica  is  particularly  indicated  when  the  pains  resemble 
those  produced  hy  a  bruise,  or  by  excessive  fatigue :  also  when  they  are 
much  increased  by  motion  and  turning  in  bed  at  night,  and  attended 
with  considerable  weakness ;  and  moreover,  when  irritability  of  temper 
and  constipation  are  present.  Nux  v.  is  often  of  great  service  after 
Bryonia  in  acute  lumbago.  In  chronic  cases  it  is  a  remedy  of  no 
mean  importance. 

Rhus  toxicodendron  :  Dragging  or  shooting  pain  in  the  dorsal 
and  lumbar  region ;  severe  aching  or  pain  as  if  from  the  effects 
of  a  bruise  or  a  sprain  in  the  loins ;  a  feeling  of  stiffness  or  tension 
in  the  affected  parts  on  attempting  to  move,  but  aggravation  of  the 
pains  when  in  a  state  of  rest,  or  when  pressure  is  made  on  the  seat  of 
the  sufferings.     It  is  also  a  useful  remedy  in  chronic  cases. 


526  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Belladonna,  where  the  pains  are  deeply  seated,  causing  a 
sensation  of  heaviness,  gnawing,  or  stiffness ;  it  may  follow  Aconite 
with  considerable  benefit,  when  slight  inflammatory  symptoms  are 
present. 

Pulsatilla,  when  the  pains,  resembling  those  mentioned  under 
Nux  vomica  are  moreover  attended  with  a  sensation  of  tension  or 
constriction  at  the  affected  parts ;  it  is  particularly  indicated,  as  re- 
marked in  other  parts  of  this  work,  for  females,  or  individuals  of 
mild,  sensitive,  or  phlegmatic  temperaments. 

Mercurius,  when  the  pains  are  much  of  the  same  description 
as  those  given  under  Nux  vomica,  but  considerably  aggravated  at 
night,  incapacitating  the  sufferer  from  taking  rest,  (See  also  art. 
Rheumatism.) 

INFLAMMATION  OF  THE  PSOAS  MUSCLE. 
Psoitis. 

Diagnosis.  Pain  in  the  renal  region,  hip,  and  downwards  to  the 
leg.  The  limb  can  neither  be  stretched  or  drawn  upwards  without 
pain;  in  walking  there  is  a  hobbling  in  the  gait,  with  the  body 
inclined  forward ;  turning  in  bed,  or  lifting  any  weight  increases  the 
pain.  Occasionally,  but  seldom,  we  find  a  swelling  of  the  psoas 
muscle  and  in  the  region  of  the  groin.  The  affection,  in  some 
measure,  resembles  Nephritis,  from  which,  however,  it  is  dis- 
tinguishable by  the  absence  of  disturbances  of  the  urinary  system, 
&c. 

This  disease  is  generally  more  painful  than  dangerous;  it  may, 
however,  prove  fatal  from  matter  forming  and  discharging  itself  into 
the  cavity  of  the  abdomen,  but  more  frequently  abscesses  open  in 
the  groins,  anus,  perinaeum,  or  thighs  ;  it  may  also  produce  caries. 

Therapeutics.  The  remedies  given  under  Lumbago  and  Rheu- 
matism (which  see),  are  equally  useful  in  most  cases  of  this  disorder ; 
however,  as  there  is  generally  a  greater  degree  of  fever  present  than 
in  that  affection,  Aconitum,  followed  by  Belladonna,  should  generally 
form  the  commencement  of  our  treatment. 

The  following  may  be  mentioned  in  addition  : 

Colocynth,  when  there  is  a  feeling  of  contraction  in  the  psoas 
muscles  when  walking,  and  the  disease  is  more  of  a  chronic  nature. 

When  rigors  are  complained  of,  followed  by  a  sensation  of  throb- 


SCIATICA.  527 

bing,  and  increase  of  pain  in  the  affected  part,  and  we  have  reason 
to  apprehend  incipient  suppuration,  we  may  give  Staphysagria  in 
repeated  doses,  followed  by  Silicea  or  Hepar,  to  bring  the  abscess  to 
a  head  as  quickly  as  possible,  and  thereby  relieve  the  sufferings  of 
the  patient. 

In  by  far  the  greater  number  of  cases  of  Psoas  or  Lumbar  abscess, 
however,  we  have  no  premonitory  symptoms  which  might  lead  us  to 
anticipate  such  a  disease,  and  are  but  too  often  unaware  of  the 
existence  of  the  disorder,  until  an  external  tumour  is  formed.  (See 
Chronic  abscess.) 

When  the  bones  have  become  affected,  or  when  an  abscess  has 
arisen  from  diseased  vertebrae,  Silicea  may  be  productive  of  all  the 
benefit  we  can  look  for  in  so  serious  a  case. 

Staphysagria  may  follow  the  above  when  a  discharge  of  a 
peculiarly  offensive  sanies  takes  place, 

A%irum,  Assafoetida,  Argentum,  Plumbum,  or  Sulphur  may  also  prove 
of  service  in  the  latter  form  of  lumbar  abscess. 


SCIATICA. 

Diagnosis.  Pain  in  the  region  of  the  hip-joint,  which  frequently 
extends  to  the  knee  and  foot,  following  the  course  of  the  sciatic  nerve. 
It  often  interferes  with  the  motion  of  the  foot,  causing  stiffness  and 
contraction. 

Therapeutics.  The  principal  remedies  in  ordinary  cases,  are 
Aconitum,  Arsenicum,  Chamomilla,  Ignatia,  Nux  vomica,  Pulsatilla,  Colo- 
cynth,  and  Rhus  toxicodendron. 

Aconitum.  When  considerable  constitutional  disturbance  at- 
tended with  fever  is  present. 

Arsenicum.  When  burning  pains  are  complained  of,  or  some- 
times a  sensation  of  coldness  in  the  affected  part— acute  dragging 
pains  in  the  hips,  with  great  restlessness,  obliging  the  patient  to 
move  the  limb  frequently  in  order  to  obtain  relief,  occasional  inter- 
missions of  suffering  or  periodical  returns ;  great  weakness  and  incli- 
nation to  lie  down— mitigation  from  the  application  of  external  heat. 
It  is  also  useful  in  those  cases  of  marasmus  or  emaciation  which  arise 
from  a  long  continuance  of  want  of  rest>  the  result  of  pain,  and  from 
derangement  of  the  digestive  system. 


528  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Chamomilla  is  more  particularly  indicated  when  the  pains  are 
frequent  at  night,  attended  with  excessive  sensibility  and  irritability 
of  fibre  :  sensation  of  torpor  in  the  affected  parts. 

Ignatia.  When  the  pains  are  of  an  incisive  nature,  particularly 
on  moving  the  limb,  and  more  especially  when  they  occur  in  indi- 
viduals of  a  mild  melancholic  temperament,  or  in  those  who  are  sub- 
ject to  alternations  of  extremely  high  and  low  spirits. 

Nux  vomica.  When  the  pain  becomes  aggravated  towards  morn- 
ing, and  is  attended  with  a  sensation  of  stiffness  and  contraction  so 
as  to  interfere  with  the  motion  of  the  foot,  and  also  a  sensation  of 
paralysis  or  torpor  and  chilliness  in  the  parts  affected, — particularly 
in  individuals  of  an  irritable  temperament. 

Pulsatilla.  When  the  pains  are  aggravated  towards  evening, 
and  during  the  night,  or  when  the  patient  is  seated,  but  somewhat 
relieved  in  the  open  air ;  this  remedy  is  best  adapted  for  persons  of 
mild  disposition  and  leucophlegmatic  temperament. 

Colocynth  is  an  important  remedy  in  this  distressing  disease. 
It  has  been  found  of  the  greatest  service  in  cases  where  the  right  leg 
was  affected,  and  the  pains  liable  to  be  excited,  or  much  aggravated 
by  a  fit  of  anger  or  indignation. 

Rhus.  This  medicament  is  more  peculiarly  indicated  when  the 
pains  are  aggravated  by  rest,  relieved  by  motion,  or  by  warmth: 
with  disposition  to  melancholy  or  an  unaccountable  feeling  of  dread. 

Veratmm,  Btaphysagria,  Manganum,  Mezereum,  Hepar  s.,  Sepia,  Phos- 
phorus, Buta,  Kali  c.,  Conium,  Sec,  may  also  be  found  useful  in  parti- 
cular cases  of  this  complaint,  or  Neuralgia,  generally,  which  see. 
(See  also  the  remedies  described  for  the  treatment  of  rheumatic  pains, 
art.  Rheumatism.) 

PAIN  IN  THE  HIP.     HIP-GOUT.     RHEUMATISM  IN  THE  HIP. 

Coxalgia,  Coxagra.     Ischias. 

Diagnosis.  A  pain  in  the  hip-joint  dependent  upon  a  true  gouty 
inflammation,  almost  universally  of  an  acute  description;  the  pain  is 
extremely  violent,  and  extends  from  the  hip-joint  to  the  neighbouring 
aponeurosis,  the  periosteum,  and  the  adjacent  ligaments  :  it  conse- 
quently, sometimes  reaches  upwards  to  the  back,  or  downwards  to  the 
thigh,  rendering  motion  excessively  painful,  either  in  walking,  rising 
up,  sitting  down,  or  turning  in  bed.  When  the  pain  is  not  deeply 
seated,  there  is  generally  absence  of  either  swelling  or  redness. 


HIP  DISEASES.  529 

This  species  of  gout  usually  assumes  the  irritable  character,  runs 
its  course  quickly,  and  forms  an  active  local  inflammation,  which  very 
rapidly  terminates  in  suppuration,  when  unchecked.  It  occurs  more 
frequently  in  the  male  than  in  the  female  subject. 

When  suppuration  supervenes,  the  pain  becomes  more  obtuse, 
pressing,  and  throbbing;  the  inflammatory  fever  assumes  the  suppu- 
rative character  (febris  suppuratoria),  indicated  by  shivering  and  shud- 
dering, alternating  with  heat,  to  which  a  number  of  other  sufferings 
become  united,  such  as  swelling,  pains  in  the  knee,  limping,  luxatio 
spontanea,  &c. 

Therapeutics.  The  following  remedies  have  been  found  most 
effective  in  the  treatment :  Mercurius,  Rhus  toxicodendron,  Aconitum, 
Belladonna,  Chamomilla,  Pulsatilla,  ffepar  sulphuris,  Colocynth,  Ar- 
senicum, &c. 

Mercurius  is  a  useful  remedy  when  the  disease  is  attended  with 
halting  in  the  gait,  and  sharp,  cutting,  tearing,  and  burning  pains, 
which  are  materially  aggravated  at  night  and  during  every  move- 
ment, and  are  usually  attended  with  profuse  nocturnal  sweating ; 
also  where  exudation  threatens,  or  has  already  taken  place. 

Rhus  toxicodendron.  When  darting,  tearing,  or  dragging 
pains  are  experienced  in  the  hip-joint,  attended  with  tension  and 
stiffness  in  the  muscles,  aggravated,  or  chiefly  felt,  during  rest. 
Also  painful  sensibility  of  the  joint  when  rising  from  the  sitting 
posture. 

Aconitum.  When  the  affection  is  attended  with  marked  febrile 
symptoms,  or  inconsiderable  inflammation  of  the  joint  itself  exists 
from  the  commencement. 

Belladonna  is  particularly  indicated  in  the  inflammatory  stage 
when  attended  with  a  marked  redness  of  the  skin,  and  considerable 
pain  on  the  slightest  movement,  with  lameness ;  in  such  instances  it 
may  advantageously  precede  Mercurius. 

Chamomilla  is  of  great  efficacy  in  recent  cases,  with  exacerbation 
of  pain,  at  night  in  bed. 

Pulsatilla  is  occasionally  found  serviceable  in  mild  cases  of 
this  disorder,  partaking  of  a  rheumatic  character,  when  the  patient 
complains  of  wrenching  pains  in  the  hip-joint,  which  are  aggravated 
towards  night,  and  even  when  in  a  state  of  rest.  (Acid.  nitr.  is 
sometimes  useful  after  Puis.) 

34 


530  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

Hepar  sulphuris  is  chiefly  useful  in  case  of  exudation,  and  may 
in  such  instances  follow  Mercurius  with  some  advantage. 

Colocynth  is  a  useful  remedy  in  subacute  or  chronic  cases,  when 
the  pain  is  constant,  and  of  a  squeezing  description,  accompanied  by 
a  sensation  as  if  the  entire  joint  were  tightly  and  painfully  bound ; 
also  when  the  attacks  are  liable  to  be  brought  on  or  aggravated  by  a 
fit  of  passion,  indignation,  or  mortification. 

Arsenicum  deserves  a  preference  to  other  remedies  when  the  pain 
extends  or  shoots  along  the  interior  of  the  affected  limb  like  a  hot 
stream  (increased  by  every  movement,  and,  especially,  hj  every  change 
of  temperature) ;  great  prostration  of  strength,  disappearing  in  the 
intervals  between  the  paroxysms ;  paleness  of  the  face,  oppression  at 
the  chest,  or  even  attacks  of  faintness  from  the  slightest  exertion. 
(Hygea,  xvi,  67-74.) 

The  following  remedies  have  also  been  found  useful  in  many  cases : 
Sulphur,  Silicea,  Graphites,  Bryonia  alba,  Calcarea  carbonica,  Digitalis, 
Argentum,  Acidum  nitricum,  Kreosotum,  Assafatida,  Aurum  foliatum,  Can- 
tharides,  Lachesis,  Chamomilla,  Staphysagria,  Nux  vomica,  Acidum  phos- 
phoricum,  Sepia,  and  Calcarea  phosphorata.  (See  also  the  following 
article  on  Hip-disease,  and  that  on  Rheumatism,  where  indica- 
tions for  some  of  the  above-mentioned  will  be  found.) 


hip-disease. 

Morbus  coxarius. 

Diagnosis.  Chronic  inflammation  of  the  bones  composing  the 
hip-joint  (particularly  the  acetabulum),  frequently  commencing  only 
with  pain  or  uneasiness  in  the  knee  of  the  limb  attacked,  or  a  slight 
weakness  of  the  part  affected,  attended  with  limping;  afterwards 
emaciation,  and  elongation  of  the  limb  itself  takes  place,  and  as  the 
complaint  progresses,  a  severe  fixed  pain  is  felt  behind  the  trochanter 
major,  increased  by  pressure  on  the  front  of  the  acetabulum,  extend- 
ing down  to  the  knee,  ankle,  and  foot,  which  is  accompanied  with 
feverish  symptoms,  restlessness,  and  flattening  of  that  part  of  the 
nates  which  is  generally  fullest  and  roundest,  depression  of  the  crest 
of  the  ileum,  and  distortion  of  the  spine. 

This  complaint  is  most  frequently  met  with  in  children,  but  no  age, 
sex,  or  condition  of  life  is  exempt  from  its  attacks ;  it  is  peculiarly 


HIP-DISEASE.  531 

insidious  in  its  approach,  the  pain  and  uneasiness  in  the  knee  above- 
mentioned  being  frequently  the  first  symptom  denoting  its  presence; 
hence  it  is  not  unfrequently  mistaken  for  some  complaint  of  that 
joint, — a  deplorable  oversight,  since  it  is  only  in  the  incipient  period 
of  the  disease  that  a  favorable  prognosis  can  be  given ;  if  no  appro- 
priate relief  be  timely  administered,  matter  forms  within  the  joint ; 
the  acetabulum,  and  sometimes  the  head  of  the  femur,  becomes 
destroyed  by  caries,  luxation  upwards  and  outwards  takes  place,  and 
the  limb,  which  had  previously  been  preternaturally  elongated,  now 
becomes  contracted  and  shortened ;  the  sufferer  is  then  either  de- 
stroyed by  excessive  constitutional  irritation,  or  recovers  with  an 
anchylosed  joint. 

Causes.  An  inherent  constitutional  taint,  such  as  scrofula,  is  no 
doubt  the  principal  predisposing  cause  ;  but  it  is  generally  attributed 
to  external  violence,  or  exposure  to  damp  or  cold,  as  lying  down  on 
damp  grass  in  summer,  &c. 

Therapeutics.  Mercurius,  Belladonna,  and  Rhus  are  our  prin- 
cipal remedial  agents,  at  the  commencement  of  the  disease ;  and 
Calcarea,  Colocynth,  Sulphur,  Silicea,  Calcarea  pkosphorata,  Pulsatilla, 
Sepia,  and  Stcvphgsagria  in  more  advanced  stages,  or  after  the  previous 
employment  of  the  first-named  medicines. 

Mercurius  : — This  remedy  is  of  itself  sometimes  found  to  act  as 
a  specific  in  the  early  and  curable  stage  of  the  disease ;  it  is  more 
particularly  indicated  when  the  patient  is  of  a  scrofulous  diathesis 
and  sallow  complexion,  and  when  no  pain  is  complained  of,  but  the 
disease  is  insidiously  advancing. 

Belladonna  is  more  especially  called  for  in  the  inflammatory 
stage,  when  the  patient  suffers  considerable  pain. 

In  some  cases  it  may  be  found  advantageous  to  alternate  these 
remedies  according  to  the  symptoms  that  present  themselves. 

Rhus  toxicodendron  : — In  the  first  stage  of  the  disorder,  with 
darting  or  dragging  or  tearing  pains  in  the  hip-joint,  increased  by 
suddenly  pressing  the  head  of  the  femur  into  its  socket,  accompanied 
with  tension  or  stiffness  of  the  muscles,  most  painful  when  in  a  state 
of  rest ;  and  severe  pain  on  arising  from  a  sitting  posture. 

Colocynth  has  been  found  of  much  value  in  this  disorder,  either 
after  Belladonna  and  Mercurius,  or  in  preference  to  those  medicines 
when,  from  the  commencement,  the  hip-joint  is  described  to  feel  as 


532  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

if  firmly  and  painfully  bound  by  an  iron  clasp,  with  pain  extending 
down  the  limb,  and  stiffness  in  the  knee-joint. 

Sulphur  is  generally  required  in  chronic  cases,  particularly  when 
arising  from  a  scrofulous  or  psoric  metastasis. 

Calcarea  carhonica  has  been  recommended  as  particularly  worthy  of 
attention  at  the  commencement  of  the  second  stage  of  the  disorder. 

In  cases  of  abscess  or  caries  in  this  disease,  Silicea  and  Calcarea 
phosphorata  may  be  employed  with  advantage. 

The  following  remedies  are  likewise  deserving  of  attention  in  the 
treatment  of  this  serious  malady :  Calcarea,  Bryonia,  Hepar  s.,  Acidum 
phosphoricum,  Phosphorus  (in  the  stage  of  shortening),  and  Lachesis. 

Affections  of  the  Knee.  In  affections  of  the  knee-joint, 
Silicea  forms  one  of  the  most  important  remedies,  particularly  when 
the  disease  begins  in  the  synovial  membrane.  Acid,  nitricum,  Aurum, 
Ac.  phosphoricum,  Lycopodium,  Lachesis,  Sulphur,  or  Calcarea,  have,  in 
addition  to  Silicea,  been  found  useful  in  inflammation  of  the  synovial 
membrane  of  the  joints,  in  consequence  of  the  effects  of  Mercury ; 
and  Rhus,  Bryonia,  Lycopodium,  Nux  v.,  China,  or  Sulphur,  when  the 
complaint  occurs  as  a  result  of  gout  or  rheumatism.  Sulphur  and 
Calcarea  have  chiefly  been  recommended  in  lymphatic  or  scrofulous 
enlargement  of  the  knee ;  but  also  the  following,  in  some  cases : 
Silicea,  Lycopodium,  Arsenicum,  Iodium,  and  Arnica. 

In  the  event  of  suppuration :  Silicea,  Mercurius,  Hepar  s. ;  and  in 
that  of  serous  infiltration :  Silicea  and  Sulphur ;  or  Calcarea,  Mercu- 
rius, and  Iodium.  In  glazed  or  shining,  white,  soft  or  doughy  swell- 
ings of  the  knee,  Pulsatilla  is  an  excellent  remedy,  and  is  indeed 
more  or  less  useful  as  a  general  remedy  in  soft,  colourless  swellings 
of  the  knee,  whether  painful  or  otherwise.  Sometimes  the  alternate 
employment  of  Iodium  and  Pulsatilla  is  required,  especially  in  strur 
mous  habits.  When  the  swelling  is  red,  and  very  painful,  Bryonia  is 
more  appropriate,  (or  Bryonia  and  Iodium  in  alternation,  in  scrofulous 
subjects). 


DETERMINATION  OF  BLOOD  TO  THE  ABDOMEN.  533 


DETERMINATION  OF  BLOOD  TO  THE  ABDOMEN. 

Congestio  viscerum  abdominis.      Congestio  ad  abdomen. 

This  derangement  is  characterized  by  a  disagreeable  or  painful 
sensation  of  weight,  heat,  and  burning,  with  hardness  and  tension  in 
the  lower  portion  of  the  abdomen* 

Nux  vomica  is  one  of  the  most  frequent  sources  of  relief  in  those 
who  lead  a  sedentary,  life,  or  are  much  addicted  to  over-indulgence  in 
the  pleasures  of  the  table,  particularly  when  the  following  symptoms 
are  complained  of:  hardness.,  tension,  and  fixed  pain  in  the  abdomen, 
sense  of  great  weakness  or  prostration,  rendering  it  difficult  or  almost 
impossible  to  walk  about;  constipation,  with  pain  in  the  loins,  spirits 
oppressed  and  irritable. 

Sulphur  will  frequently  be  found  serviceable  in  completing  the 
cure  after  the  above,  or  it  may  be  selected  in  preference  in  cases  of 
long  standing,  when  we  meet  with  the  following  indications :  dull 
pains,  and  a  disagreeable  sensation  of  distension  in  the  abdomen, 
constipation,  tendency  to  obstinate  hemorrhoidal  attacks,  extreme 
dejection. 

Carbo  vegetabilis,  may  be  selected  when  the  symptoms  are 
accompanied  with  excessive  flatulency,  and  will  frequently  be  found  of 
great  service  in  some  obstinate  cases,  when  alternated  with  the  two 
preceding  remedies. 

Arsenicum  will  also  be  found  useful,  especially  when  there  is  a 
disposition  to  diarrhoea  with  extreme  weakness  ;  or — 

Capsicum,  when  these  symptoms  occur  in  individuals  of  a  lymph- 
atic temperament. 

Sepia  is  often  of  much  utility  in  the  case  of  females,  particularly 
when  the  symptoms  are  analogous  to  those  enumerated  under 
Sulphur. 

In  particular  cases,  the  following  will  also  be  found  useful  :  Pulsa- 
tilla, Lycopodium,  Belladonna,  Mercurius,  Bryonia,  Chamomilla,  Rhus 
toxicodendron,  Veratrum.  By  consulting  the  articles  on  Dyspepsia, 
and  Hemorrhoids,  the  reader  will  find  further  assistance  in  the 
selection  of  the  above  remedies. 

Daily  exercise  in  the  open  air,  together  with  a  careful  attention  to 
regimen,  must  be  observed  by  those  who  are  afflicted  with  this 
disease. 


534  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 


ACUTE  INFLAMMATION  OF  THE  EYES. 

Ophthalmia. 

Diagnosis.  Superficial,  bright  scarlet  redness,  pain,  and  heat  of 
the  eye,  generally  with  marked  sensibility  to  the  action  of  light ; 
either  with  dryness  or  an  increased  secretion  of  ophthalmic  humours. 
When  severe,  accompanied  by  cephalalgia,  febrile  symptoms,  and 
increased  intolerance  of  light,  particularly  when  the  entire  eyeball 
{Ophthalmitis),  or  the  sclerotic  coat  {Sclerotitis)  is  affected,  in  which 
latter  case,  moreover,  the  redness  presents  a  pink  appearance. 

This  affection  may  arise  from  a  variety  of  causes,  such  as  exposure 
to  extreme  light,  the  strong  heat  of  a  fire,  particularly  after  coming 
out  of  an  extremely  cold  atmosphere,  external  injuries,  or  cold. 

Therapeutics.  The  following  remedies  are  those  which  are 
more  generally  required  in  the  treatment  of  this  affection,  according 
to  the  form  in  which  it  presents  itself,  namely  :  Aconitum,  Belladonna, 
Nux  vomica,  Cinchona,  Digitalis,  Euphrasia,  Ignatia,  Arnica  Montana, 
Pulsatilla,  Mercurius,  and  Sulphur. 

Aconitum  : — Valuable  at  the  commencement  of  the  treatment,  in 
general  cases  of  non-catarrhal  inflammation;  but  even  in  simple 
inflammation  of  the  conjunctiva  or  simple  catarrhal  ophthalmia, 
should  the  inflammation  be  considerable  and  attended  with  fever. 

Belladonna  may  follow  Aconitum,  if  great  sensibility  to  light 
remains.  Also  in  Acute,  Arthritic,  Rheumatic  and  even  Scrofulous 
ophthalmia,  when  the  following  symptoms  present  themselves :  red- 
ness in  the  conjunctiva,  margin  of  the  eyelids,  and  corner  of  the 
eyes,  with  a  swollen  and  tumid  appearance ;  or  redness  of  the  sclero- 
tica, with  intolerance  of;  and  pain  increased  by,  light ;  great  sensi- 
bility of  the  eyes  and  eyelids ;  aching  pains  above  and  around  the 
orbits,  or  pains  which  penetrate  deeply  into  the  orbits  and  head, 
with  aggravation  on  moving  the  eyes ;  flashes  of  light,  sparks,  or 
darkness  before  the  eyes,  with  extreme  dimness  of  vision  towards 
evening  ;  objects  appearing  reversed  or  double  j  moreover,  when  there 
are  the  following  catarrhal  symptoms  :  severe  cold  in  the  head,  with 
acrid  discharge,  causing  excoriation,  and  sometimes  an  eruption  of 
pimples  under  the  nose,  and  on  or  about  the  lips ;  periodical  return 
of  short,  dry,  barking,  spasmodic  cough,  aggravated  towards  night,  and 


& 


ACUTE  INFLAMMATION  OF  THE  EYES.  535 

severe  headache.     (Mercurius  and  Hepar  &,  are  often  required  to  com- 
plete the  cure  after  the  employment  of  Belladonna.) 

Nux  vomica  : — In  catarrhal,  arthritic,  or  rheumatic  inflammation 
of  the  eye,  when  there  are  burning,  pressive,  or  aching  pains,  a  feeling 
as  of  sand  in  the  eye,  with  stiffness,  smarting,  tickling,  and  itching ; 
foul  tongue,  and  other  symptoms  of  disordered  stomach ;  slight  fever 
in  the  morning  and  towards  evening ;  irritable  temper ;  pressure  on 
the  eyes  and  eyeballs  on  attempting  to  open  them ;  redness  of  the 
canthi ;  the  eye  streaked,  bloodshot,  and  swollen,  with  adhesion  of 
the  eyelids;  sensibility  to  light ;  briny  lachrymation ;  affection  worse 
towards  morning.  Nux  v.  and  Pulsatilla  are  two  of  the  most  useful 
remedies  in  simple  inflammation  of  the  conjunctiva,  particularly  at 
the  commencement  of  the  attack ;  but  Sulphur  is  often  required  to 
complete  the  cure. 

Cinchona.  When  the  inflammation  is  less  intense,  but  the 
motion  of  the  eye  painful,  accompanied  by  the  sensation  before  noted 
as  of  sand  in  the  eye,  with  the  distinction  that  an  exacerbation  takes 
place  towards  evening ;  when  the  pains  are  of  a  burning  or  pressive 
nature,  with  headache  in  the  forehead,  as  if  arising  from  a  suppression 
of  the  nasal  secretion. 

Arsenicum,  chiefly  in  catarrhal  and  scrofulous  ophthalmia,  when 
there  exists  a  violent  burning  pain  or  pains  of  so  severe  a  description 
as  almost  to  drive  the  patient  distracted ;  specks  and  ulcers  on  the 
cornea. 

Euphrasia.  For  the  employment  of  this  medicine,  the  particular 
indications  are,  white  of  the  eye  much  inflamed  and  of  a  pink  or 
rose  colour  (Sclerotitis) ;  painful  pressure  and  smarting  in  the  eyes ; 
profuse  and  acrid  flow  of  tears,  excited  or  increased  by  exposure  to  cold ; 
copious  secretion  of  mucus,  sometimes  sanguinolent ;  or  bright  red- 
ness of  the  conjunctiva,  with  distension  of  the  veins ;  minute  pustules 
on  different  parts  of  the  conjunctiva ;  white  opaque  specks  on  the 
cornea;  excessive  intolerance  of  light  (scrofulous  inflammation  of 
the  conjunctiva) ;  severe  cold  in  the  head  with  profuse  fluent  nasal 
discharge;  violent  headache,  aggravation  of  the  symptoms  towards 
evening. 

Ignatia  may  be  administered  with  advantage  when  there  is 
pressure  in  the  eyes,  a  profuse  flow  of  tears,  great  intolerance  of 
light,  but  with  little  or  no  perceptible  redness  of  the  eyeball ;  severe 
coryza ;  in  catarrhal^  rheumatic,  or  scrofulous  inflammation. 

Pulsatilla.     Aching  or  burning  and  smarting  irritation  in  the 


536     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

eye,  as  if  from  the  insertion  of  sand  under  the  lids,  with  scarlet  red- 
ness of  the  eyes  and  eyelids,  and  copious  secretion  of  mucus,  disordered 
stomach,  foul  tongue,  and  chilliness  towards  evening,  followed  by 
febrile  heat ;  or  pricking,  shooting,  piercing  pains  in  the  eye,  with 
bright  redness  of  the  eyes,  and  profuse  lachrymation,  especially  on 
looking  at  the  light,  or  on  going  into  the  open  air,  and  generally  ot 
a  scalding  or  acrid  nature ;  or,  on  the  other  hand,  excessive  dryness 
of  the  eyelids,  especially  in  the  evening,  with  nocturnal  agglutination ; 
photophobia;  swelling  of  the  eyelids;  aggravation  of  the  symptoms 
towards  evening;  sensitiveness  with  disposition  to  weep.  (Ferrum 
is  occasionally  very  serviceable  after  Pulsatilla,  especially  in  scrofulous 
ophthalmy ;  at  other  times  Sulphur  is  preferable.) 

Mercurius.  In  many  cases  of  catarrhal,  rheumatic,  and  scrofulous 
ophthalmia,  as  also  in  iritis,  this  medicine  is  frequently  to  be  employed 
with  advantage.  Its  ordinary  indications  are  lancinating  pains,  or 
painful  and  irritating  pressure,  as  if  from  sand,  especially  on  reading, 
or  otherwise  fatiguing  the  eyes,  but  also  when  at  rest  in  bed;  prick- 
ing and  itching  in  the  eyes,  particularly  in  the  open  air;  rose-coloured 
redness  of  the  eye  (sclerotitis),  with  injection  of  the  veins ;  profuse 
lachrymation ;  great  sensibility  to  light,  but  especially  that  of  the 
fire  or  a  candle;  vesicles  and  pustules  on  the  sclerotica;  ulcers  ori 
the  cornea;  pustules  and  scabs  round  the  eyes,  and  at  the  margins  of  the 
eyelids  ;  cloudiness  of  the  sight ;  violent  pains  in  the  orbit  and  fore- 
head ;  renewal  of  the  inflammation  on  the  slightest  exposure  to  cold. 
(ffepar  s.  or  Sulphur  are  frequently  required  after  Mercurius.) 

Sulphur  is  an  important  remedy  in  inflammations  of  the  eye  of 
all  kinds,  whether  catarrhal,  rheumatic,  or  scrofulous,  when  of  an 
obstinate  or  inveterate  character.  It  is,  however,  more  particularly 
indicated  by  the  following  symptoms  :  pressure,  smarting,  and  burning, 
as  if  from  sand  ;  itching  in  the  eyes  or  eyelids ;  dimness  of  sight, 
with  dusky  appearance  of  specks,  vesicles,  or  pustules  and  ulcers  on  the 
cornea;  pustules  or  granular  elevations  in  the  eyelids,  and  scabs 
round  the  orbits ;  inflammation  of  the  iris,  with  irregularity  of  the 
pupil;  copious  lachrymation,  and  excessive  photophobia,  and  aggravation 
or  suffering  on  moving  the  eyes ;  painful  dryness  of  the  eyes,  especially 
within  doors;  contraction  of  the  eyelids;  imperfect  vision,  with 
scintillations ;  cephalalgia,  and  violent  pains  in  the  orbit,  &c. 

Chronic  cases  of  this  affection  frequently  require  a  long  and  careful 
course  of  constitutional  treatment  to  effect  a  perfect  cure;  one  of 
our  best  remedial  agents  for  this  end  is  Hepar  stilphuris,  which  is  also 


DISEASES  OF  THE  EYE.  537 

of  great  service  in  acute  attacks  after  Bella,  or  Merc,  in  individuals 
predisposed  to  this  affection.  Among  the  other  medicines  which 
may  be  consulted  with  advantage  in  catarrhal,  rheumatic,  or  even 
scrofulous  ophthalmia  are,  Sulphur,  Calcarea  carhonica,  or  Graphites, 
Sepia,  Spigelia,  Acidum  sulphuricum,  Petroleum,  Lachesis,  Acidum  nitri- 
cum,  Ferrum  metallicum,  Colocynth,  &c. 

If  inflammation  arise  from  '"external  injury,  caused  by  a  blow,  or 
the  entrance  of  any  foreign  body  into  the  eye,  we  should  employ 
Aconitum,  which  is  eminently  superior  to  Arnica  in  lesions  of  the  ball 
of  the  eye;  in  severe  cases  it  may  be  used  externally  as  well  as 
internally.  Should  Aconite  not  suffice  to  effect  a  cure,  Sulphur  must 
be  had  recourse  to,  followed,  if  called  for,  by  Calcarea,  or  any  other 
remedy  which  may  appear  better  indicated.  When  the  lids  have 
been  injured  Arnica  is  more  appropriate ;  and  when  both  the  ball 
and  the  lids  have  suffered,  Aconite  and  Arnica  should  be  employed 
alternately ;  or  a  dose  or  two  of  Aconite  given  first,  and  subsequently 
a  lotion  of  Arnica  applied.  Finally,  the  following  medicaments  may  be 
pointed  out  as  being  eminently  useful,  or  worthy  of  attentionin  the 
varieties  of  ophthalmia  enumerated. 

For  Catarrhal  ophthalmia,  in  addition  to  those  above  men- 
tioned :  Chamomilla,  Hepar  sulphuris,  Lycopodium. 

Rheumatic  [Sclerotitis) :  Bryonia,  Chamomilla,  Rhus,oxi&  Veratrum; 
Lycopodium,  Spigelia,*  in  addition  to  those  described  under  the  heading 
of  Inflammation  of  the  eye. 

Scrofulous:  Arsenicum,  Conium,  Hepar  s.,  Sulphur,  and  Calcarea; 
also  Dulcamara,  Ferrum,  Graphites,  Sepia,  Petroleum;  or  Aurum,  Baryta  c. 
et  m.,  Lycopodium,  Cannabis,  Chamomilla,  Bigitalis,  Iodium,  Mercurius 
corrosivus,f  Magnesia,  Natrum  m.,  in  conjunction  with  the  remedies 
alluded  to,  as  suitable  to  this  variety  of  the  disease,  at  the  commence- 
ment of  this  article. 

Syphilitic:  Mercurius  and  Acid,  nitricum  chiefly;  in  some  cases 
Aurum,  Lachesis,  Sulphur,  Bella.,  &c. 

Sycosic  :  Thtija,  Acid,  nitricum,  and  sometimes  Mercurius. 

Gonorrhceal  :  Pulsatilla,  chiefly.  Tussilago  petasitis  ?  Arnica 
(in  Hypopyum) .  Sulphur  is  still  more  serviceable  than  Am.  in  hypopyum. 

*  Spigelia  is  specific  in  a  large  number  of  cases  of  arthritic  and  rheumatic  ophthalmia. 
Aconitum  is  sometimes  required  in  the  first  place.  Sulphur,  preceded  by,  or  alternated  with 
Aeon,  is  of  nearly  equal  efficacy  in  some  instances.    Rummell,  Allg.  hom.  Zeit.  No.  21,  32  Bd. 

f  This  remedy  has  been  found  exceedingly  efficacious  in  the  acute  form  of  scrofulous 
ophthalmia,  with  ulceration  of  the  cornea  and  disposition  to  staphyloma,  hypopyon,  &c. — 
Hygea,  XIX  Band,  1  Heft. 


538  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Abuse  of  Mercury  under  allopathic  treatment :  Hepar  sulphuris, 
Acid,  nitricum,  Sulphur,  Pulsatilla;  and  in  some  cases  Belladonna^ 
Lachesis,  Staphysagria,  Lycopodium,  Thuja,  or  Cinchona. 

Fungus  hjimatodes  :  Thuja,  Carlo  a.,  and  Phosphorus.* 

Iritis  arthritic  a  :  Cocculus,  Staphysagria,  Conium,  Lycopodium, 
Calcarea,  Nux  v.,  Bryonia,  Spigelia. 

Iritis  mercurialis  :  Hepar  s.,  Acidum  nitricwm,  Lachesis. 

In  Ulceration  of  the  Cornea,  the  following  remedies  have 
hitherto  been  employed  with  the  most  satisfactory  results :  Acidum 
nitr.,  Arsenicum,  Euphrasia,  Sulphur,  Lachesis,  Calcarea,  Belladonna, 
Mercurius,  Hepar  sulphuris,  Silicea,  and  Natrum  m. 

Specks  on  the  Cornea,  or  opacity  of  the  same :  Belladonna, 
Euphrasia,  Sulphur,  Calcarea,  Hepdr  sulphuris,  Pulsatilla  ;  as  also  Arseni- 
cum, Acid,  nitricum,  Cannabis,  Magnesia,  Aurum,  Lycopodium,  Silicea, 
Sepia. 

Cataract:  The  remedies  which  have  chiefly  been  described  as 
efficacious  in  this  affection  of  the  eye  are,  Sulphur,  Silicea,  Cannabis, 
Conium,  Magnesia,  Phosphorus,  &c.f 

Strabismus:  In  addition  to  the  ordinary  simple  mechanical 
remedies,  great  assistance  has  been  derived  from,  and  in  some 
instances  the  cure  has  been  solely  effected  by  Belladonna,  and  Hyoscya- 
mus,  when  the  affection  had  not  been  of  too  long  standing. 

Fistula  lachrymalts.  The  following  remedies  have  been 
employed  with  success  in  this  affection:  Petroleum,  Silicea,  Slannum, 
Calcarea,  Ptdsatilla,  Sulphur,  Lachesis,  and  Acid,  fluor.  ?% 

*  For  the  description  of  an  interesting  cure  of  fungus  hsematodes  in  the  eye,  vide 
*  Brit.  Journ.  of  Homoeopathy/  No.  2. 

f  After  surgical  operations  on  the  eye,  Aconitum  is  a  most  valuable  remedy.  In  many 
instances  it  alone  is  sufficient  to  conduct  the  consecutive  effects  to  a  happy  issue.  It  ought 
to  be  given  immediately  after  the  operation,  and  repeated  as  soon  as  any  abnormal  symptoms 
threaten  to  break  out.  In  individuals  of  mild  and  easy  disposition  Aconite  does  not 
always  answer ;  severe  shooting  pains  in  the  temples,  as  also  in  the  eyes,  are,  in  such  cases, 
generally  more  readily  subdued  by  Ignatia.  When  intense  pains  supervene,  accompanied 
by  vomiting,  Bryonia  is  useful.  When  the'  pains  are  of  a  jerking  or  twitching  description, 
attended  with  vomiting  and  lienteria,  Asarum, — and  when  they  are  burning,  accompanied 
by  diarrhoea,  Arsenicum  are  of  great  service.  Crocus  relieved  throbbing  and  jerking  pains 
in  the  eyes  ;  Thuja  shooting  pains  proceeding  from  the  temples,  with  entire  loss  of  appe- 
tite. W7hen  depression  failed,  but  the  lens  broke  in  pieces  under  the  operation,  Senega  pro- 
moted the  absorption  of  the  particles.  When,  on  the  completion  of  the  cure,  the  sight  was 
impaired  by  a  false  perception  of  colours,  and  particularly  when 'every  object  appeared  to  be 
covered  with  blood,  Strontiana  completely  succeeded  in  restoring  matters  to  a  normal  state. 
—Dr.  Wurzler.     Allg.  Horn.  Zeit.,  No.  i,  21  Band. 

%  There  are  very  few  instances  in  which  I  have  failed  to  cure  Fistula  lachrymalis  by 
means  of  homoeopathic  remedies  administered  internally.    In  the  majority  of  cases,  and  par- 


DISEASES  OE  THE  EYE.  539 

Weeping  or  Watery  eye  involuntary  flow  of  tears).  When  this 
affection  proceeds  from  an  obstruction  of  the  lachrymal  duct,  it  must 
be  treated  by  the  remedies  above  enumerated ;  but  when  it  merely 
consists  in  a  relaxed  condition  of  the  glandular  apparatus  of  the  eye, 
with  a  superabundant  secretion  of  tears  [epiphora)^  the  subjoined 
remedies  have  been  found  successful :  Euphrasia,  Spigelia,  Paris.  In 
other  cases  a  selection  may  be  made  from  amongst  the  following : 
Puis.,  Bromiwm  (especially  the  right  eye),  Sulph.,  Euphorb.,  Clematis* 
Sepia,  Merc,  Ferrum,  Ledum,  Graphites,  Phosph.,  Lycopod.,  Silicea,  Acid, 
sulph.,  Thuja,  Veratrum,  Petrol,,  Rhus,  Sabad.,  Digitalis,  Nux  v.,  &c. 

Aegylops  (Anchylops).  Against  this  sore,  which  has  its  seat 
immediately  under  the  internal  angle  of  the  eye,  Acidum  nitricum  has 
chiefly  been  employed.  (See  also  Fistula  lachrymalis,  of  which 
this  affection  is  now  commonly  considered  to  be  a  mere  modification 
or  only  a  certain  stage.) 

Bloodshot  eye.  This  derangement  may  arise  from  a  blow  or 
fall,  the  act  of  retching,  vomiting,  or  violent  coughing,  crying,  &c. 
It  presents  a  bright  scarlet  appearance  in  most  instances  at  the  com- 
mencement, but  usually  assumes  a  livid  hue  at  a  subsequent  period. 
The  affection  generally  disappears  of  itself;  but  as  it  is  occasionally 
liable  to  prove  exceedingly  obstinate,  absorption  is  materially  facili- 
tated, and  the  unsightliness  removed  by  the  internal  and  external 
employment  of  Arnica.  (See  External  Injuries.)  Belladonna, 
Lachesis,  Nux  v.,  or  Chamomilla  may  be  required  in  certain  cases. 

Against  hemorrhage  from  the  eyes,  the  following  have  hitherto 
been  employed  with  the  most  success :  Belladonna,  Carlo  vegetabilis, 
Chamomilla,  and  Nux  v. 

Short-sight,  Near-sightedness  {Myopia).  The  medicines  which 
have  been  employed  with  the  greatest  effect  in  this  affection  are: 
Pulsatilla^  Sulphur,  Carbo  v,,  Acid,  phosph.,  Phosphorus,  Conium,  Acidvmi 
nitricum,  Ammonium  c,  Anacardium,  and  Petroleum.  Of  these  Pulsa- 
tilla and  Sulphur  have  proved  the  most  serviceable  in  the  affection 
when  occurring  as  a  sequel  of  ophthalmia ; — Acidum  phosph.,  when 
resulting  from  typhus,  or  from  a  debilitating  loss  of  fluids, — and  Carbo  v., 
Acidum  nitricum,  and  Sulphur,  when  attributable  to  the  effects  of 
mercurial  action. 

ticularly  when  on  the  right  side,  Petroleum  proved  efficacious.  I  could  never  enforce  a  cure 
with  lower  potencies  when  X  (the  30th)  failed.  In  addition  to  Petrol.,  Calcarea  was 
sometimes  useful,  especially  when  given  alternately  with  the  former ;  in  other  cases,  Ruta 
and  Staphysagria,  or  Stannum  and  Pulsatilla.  In  some  instances,  Silicea  did  good — Con- 
stantine  Hering.     Arch.,  3ter  Bd.,  Istes  Heft,  p.  122. 


540  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

Against  sudden  attacks  of  blindness :  Aconitum,  followed  by  Mer- 
curius,  Sulphur,  and  Silicea.  Against  blindness  towards  evening,  Bella- 
donna is  the  principal  remedy,  but  in  some  cases,  Veratmm  will 
answer  better.  Should  neither  of  these  effect  much  improvement, 
Hyoscyamus  may  be  administered. 


HORDEOLUM. 

Stye* 

Diagnosis.  This  is  a  little  hard  tumour  appearing  like  a  small 
dark-red  boil,  generally  in  the  corner  of  the  eye,  or  upon  the  eyelids, 
attended  with  severe  inflammation,  and  frequently  causing  fever,  con- 
siderable pain  and  suffering.  It  suppurates  slowly  and  imperfectly, 
and  has  no  tendency  to  burst  spontaneously. 

Therapeutics.  The  two  most  valuable  medicines  in  the  treatment 
of  this  affection  are  Pulsatilla  and  Aconitum. 

Pulsatilla  will,  in  most  cases,  suffice  to  remove  the  stye,  if  given 
on  its  first  appearance. 

Aconitum.  When  inflammation  runs  high,  attended  with  great 
pain,  fever,  and  restlessness. 

In  some  instances,  Staphysagria  may  be  found  useful  to  complete 
the  cure,  particularly  when  the  swelling  degenerates  into  a  hard  white 
tumour.  In  obstinate  cases,  Sep.,  Calc. ;  and  in  some  scrofulous  habits, 
Arsenicum,  Sulphur,  Lycopodium,  &c,  may  be  required. 

Lippitudo  (Blear-eyedness)  :  Aconitum,  Euphrasia,  Mercuritis,  Pulsa- 
tilla, chiefly,  but  possibly  also  :  Sulph.,  Calc,  Kali,  Lycopod.,  Sep.,  Staph., 
Silic,  Phosph.,  Magn.  c.  et  m.,  Cham.  Carl,  v.,  Cic.  or  Sass.  &c. 

Against  Blepharitis  {{inflammation  of  the  eyelids) :  Aconitum,  Bella- 
donna, Hepar,  Pulsatilla,  Nux  v.,  Chamomilla,  and  Euphrasia  have  chiefly 
been  employed  with  the  most  success  in  the  acute  form  of  the  com- 
plaint ;  and  Arsenicum,  Sulphur,  Calcarea,  Antimonium,  Cinchona,  &c,  in 
the  chronic  variety. 

In  Inflammation  of  the  margins  of  the  eyelids,  or  meibo- 
mian glands  {ophthalmia  tarsi) :  Belladonna,  Mercurius,  Hepar,  Eu- 
phrasia, Nux  v.,  Pulsatilla,  Chamomilla,  &c. 


DISEASES  OF  THE  EYE  AND  EYELIDS.  541 

Catarrhal  inflammation  of  the  eyelids  (inflammation  of  the 
conjunctiva  palpebrarum) :  Arsenicum,  Mercurius,  Hepar,  chiefly. 

When  the  external  surface  of  the  eyelid  is  inflamed,  Aconitum,  Bel- 
ladonna, Hepar  sulphuris,  and  Sulphur  are  more  particularly  called  for. 


ECTROPIUM. 

This  affection  consists  in  a  retraction  or  e version  of  the  eyelids, 
owing  to  which  circumstance  their  conjunctival  tunic  or  internal  sur- 
face is  turned  outwards. 

There  are  two  species  of  the  disorder :  one  occasioned  by  turgescence 
and  relaxation  of  the  lining  of  the  eyelids,  produced  by  violent  inflam- 
mation ;  the  other  is  caused  by  contractions  of  the  skin  covering  the 
eyelids,  or  of  that  in  the  vicinity,  induced  by  the  cicatrices  of  con- 
fluent smallpox,  burns,  or  wounds.  In  the  former  variety  the  morbid 
swelling  not  only  pushes  the  margins  of  the  eyelids  from  the  ball,  but 
renders  them  everted ;  in  the  latter  the  edges  are  primarily  displaced 
to  some  distance  from  the  eye,  and  afterwards  turned  entirely  outward, 
along  with  the  whole  of  the  affected  eyelid. 

In  both  varieties  the  eyeball,  from  being  exposed,  and  submitted 
to  constant  irritation,  is  rendered  dry  and  inflamed,  the  tears 
escape  over  the  cheeks,  vision  is  impaired,  and  sometimes  ulceration 
or  opacity  of  the  cornea  supervenes.  The  conjunctiva,  from  the  same 
circumstance,  becomes  thickened,  fleshy,  and  finally  indurated. 

Therapeutics.  When  ectropium  arises  from  turgescence  and 
relaxation  of  the  palpebral  lining,  Mercurius  and  Hepar  sulphuris  are 
often  sufficient  to  effect  a  cure ;  but  in  other  cases,  Arsenicum,  Sulphur, 
or  Calcarea  are  required,  particularly  when  the  affection  is  met  with, 
as  it  commonly  is,  in  debilitated,  unhealthy  subjects. — Belladonna, 
Euphrasia,  China,  &c,  have  also  been  found  useful.  When  contrac- 
tion of  the  skin  has  produced  the  complaint,  the  cure  may  be  said  to 
be  only  attainable  by  means  of  an  operation. 


542  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 


ENTROPIUM. 


In  this  complaint  the  eyelashes  and  the  margin  of  the  eyelids  are 
inverted  towards  the  ball  of  the  eye,  and  cause  great  pain  and  inflam- 
mation. When  it  has  existed  for  a  considerable  time,  the  cornea  is 
rendered  opaque,  prominent,  and  indurated,  or  ulceration  and  even 
complete  loss  of  vision  result.  Relaxation  of  the  skin  of  the  eyelids, 
in  consequence  of  previous  chronic  inflammation,  disease  of  the  mei- 
bomian glands,  and  the  cicatrices  of  ulcerations,  or  wounds  on  the 
palpebral  conjunctiva,  form  the  general  exciting  causes  of  the  dis- 
order. 

Therapeutics.  Pulsatilla  is  one  of  the  most  serviceable  medi- 
cines in  entropium,  and  is  frequently  sufficient  to  effect  a  cure.  In 
other  cases,  Borax  has  been  found  useful.  Belladonna,  Mercurius, 
Hepar  s.,  Euphrasia,  and  occasionally  Nux  v.  and  Chamomilla  may  also 
prove  efficacious,  particularly  where  the  malady  has  originated  in  dis- 
ease of  the  meibomian  glands.  When  the  contraction  of  cicatrices 
has  given  rise  to  the  affection,  it  is  to  be  remedied  by  cutting  out  as 
large  a  portion  of  the  skin  of  the  affected  eyelid,  opposite  the  centre 
of  the  entropium,  as  will  be  adequate,  on  the  approximation  of  the 
lips  of  the  wound,  by  means  of  adhesive  plaster  or  a  small  suture,  to 
replace  the  tarsus  and  ciliae  in  their  normal  position. 


Swelling  of  the  lips  {scrofulous) :  Belladonna  and  Mercurius  are 
two  of  the  most  useful  remedies  in  this  affection,  when  there  is 
simultaneous  retraction  of  the  lip.  If  ulceration  and  incrustations 
accompany  the  disorder,  Belladonna,  Mercurius,  Hepar,  Sulphur,  Staphy- 
sagria,  Silicea,  and  Sepia.  If  there  be  tumefaction  simply,  Aurum, 
Mercurius,  Bryonia,  Belladonna,  Hepar,  Lachesis,  Sulphur,  and  Calcarea. 
(See  Scrofula.) 

Scirrhus.  Against  indurations  of  this  serious  character,  either 
in  the  face  or  lips,  Belladonna,  Conium,  Sulphur,  Silicea,  Carlo  a.  et  v., 
Phosphorus,  Staphysagria,  and  Magnesia  m.  are  chiefly  to  be  recom- 
mended; and  the  following  against  carcinomatous  ulcerations  (both 


INFLAMMATION  OF  THE  EAR.  543 

internally  and  externally) ;  Arsenicum,  Lachesis,  Clematis,  Conium,  Sul- 
phur, Silicea,  Acidum  nitricum,  Aranea,  Carlo  v.  et  a,,  &c. 

Warts  on  the  face.  Kali,  Sepia,  Dulcamara,  Thuja,  Acidum  nitricum, 
and  Sulphur  are,,  generally,  the  most  useful.  The  employment  of  the 
knife  or  of  caustic  in  such  cases  is  highly  improper,  and  often  attended 
with  the  worst  effects.  Against  these  excrescences  on  other  parts  of 
the  body,  such  as  the  hands,  Sec,  Sulphur  and  Calcarea  form  two  of 
the  best  remedies  in  cases  of*  long  standing  ;  Lycopodium,  when  large, 
and  intersected  with  deep  clefts ;  when  moist,  Thuja,  Acid.  nit.  and 
Sabina  (externally  and  internally) ; — Natrum,  Sepia,  and  Rhus  have  also 
proved  useful  in  some  cases. 


INFLAMMATION  OF  THE  EARS  AND  EARACHE. 

Otitis.     Otalgia. 

Otitis.  Diagpntosis.  Violent,  frequently  insupportable,  pain  in 
the  ear,  with  sensibility,  and  even  inflammation  of  the  meatus  audi- 
torius  externus,  and  greater  or  less  fever. 

The  pain  when  excessive,  communicating  with  the  whole  head, 
may  bring  on  delirium,  or  even  inflammation  of  the  brain. 

Otalgia  may  either  exist  as  the  effect  of  otitis,  or,  if  neglected, 
may  pass  on  to  inflammation ;  in  many  cases  again,  it  may  arise 
by  sympathy  from  toothache,  or  declare  itself  as  a  purely  neuralgic 
affection. 

Therapeutics.  The  medicaments  applicable  to  the  majority  of 
cases  of  these  troublesome  and  painful  disorders  are  Mercurius,  Pulsa- 
tilla, Belladonna,  Nux  vomica,  Arnica,  Dulcamara,  and  Chamomilla,  Hepar, 
Cinchona,  Sulphur,  Sec 

Mercurius  :  When  the  pain  is  attended  with  a  sensation  of  cold- 
ness in  the  ears,  and  exacerbation  of  suffering  in  the  warmth  of  the  bed ; 
shooting  or  tensive  pains  in  the  internal  ear,  extending  to  the  cheeks 
and  teeth;  inflammation  and  induration  of  the  ear,  with  soreness  of 
the  orifice,  and  discharge ;  swelling  of  the  glands.  When  Mercurius 
affords  only  partial  relief,  a  dose  of  Hepar  s.  will  often  subdue  the 
remaining  symptoms  ;  but  if  a  purulent  discharge  continue,  accom- 
panied by  humming  in  the  ear,  and  pricking  pains,  Sulphur  will  gene- 
rally be  found  requisite. 


544    DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Pulsatilla  is  a  most  valuable  remedy  in  this  affection.  It  is 
particularly  indicated  when  the  external  ear  is  much  affected,  and 
appears  inflamed  and  swollen ;  attended  with  heat,  shooting  and 
tensive  excoriating  pain  internally ;  moisture  in  the  ear,  or  somewhat 
copious  discharge.  This  medicament  is  particularly  useful  for  females, 
and  individuals  of  chilly  habit. 

Belladonna,  wThen  there  is  determination  of  blood  to  the  head,  with 
redness  of  the  face,  digging,  boring,  tearing  or  shooting  pains  extending 
to  the  throat,  fever,  and  extreme  sensibility  to  the  slightest  noise  j  when  the 
pains  are  more  severe  internally;  also  when  the  brain  partakes  of  the 
irritation  or  inflammation,  and  delirium  is  present.  (Hepar  is  sometimes 
required  after  Belladonna  to  complete  the  cure  in  obstinate  cases ;  and 
particularly  when  the  inflammation  has  ended  in  suppuration.) 

Nux  vomica  : — When  the  pains  are  of  a  tearing,  shooting  nature, 
extending  to  the  forehead,  temples,  and  bones  of  the  face,  worse 
towards  morning ;  dryness  of  the  ear ;  particularly  when  the  affection 
occurs  in  persons  of  a  lively,  choleric  disposition. 

Assafcetida  :  —Burning,  shooting  pain,  occurring  in  paroxysms,  and 
proceeding  from  within  outwards. 

Arnica  :■ — In  individuals  of  nervous,  excitable  temperament,  sub- 
ject to  be  attacked  from  slight  causes ;  also,  when  great  sensibility  to 
noise  is  present.  (Cinchona  is  often  useful  after  Arnica,  especially  when 
the  pains  are  aggravated  by  lying  on,  or  touching  the  affected  ear. 
In  other  cases,  Sulphur  will  be  found  more  efficacious,  particularly 
when  the  sensibility  is  excessive.) 

Dulcamara,  wrhen  the  affection  has  arisen  from  a  chill  or  wetting, 
will,  in  many  cases,  prove  sufficient  for  its  removal ;  it  is  also  indi- 
cated when  the  pains  increase  at  night,  and  are  attended  with 
nausea. 

Chamomilla  : — When  there  are  stabbing  pains  in  the  ear,  as  from 
knives;  great  sensibility  to  noise,  or  even  to  music,  extreme  sensi- 
tiveness, susceptibility,  and  irritability. 

In  external  inflammation  of  the  ear,  Pulsatilla  forms  one  of  the  most 
generally  useful  medicaments.  Sulphur  is  also  of  frequent  efficacy, 
especially  after  the  previous  employment  of  Pulsatilla;  Calcarea  is 
sometimes  required  after  Sulphur.  When  the  inflammation  runs  high, 
or  threatens  to  extend  to  the  face  or  scalp,  Belladonna  usually  becomes 
requisite.  Merctirius,  Magnesia,  and  Boras  sodce,  have  also  been  recom- 
mended  in  this  form  of  otitis.     Against  chronic  inflammation,  or 


INFLAMMATION  OF  THE  EARS  AND  EARACHE.  545 

scrofulous  ulceration  of  the  external  ear,  Merc,  Hep.,  Puis.,  Lye. 
Sulph.,  Ahem.,  Kreos.,  Kali,  Phosph.,  Stan.,  Cale.,  Baryta,  etc.-,  are  the 
most  useful. 

Against  hemming  or  buzzing  in  the  ears,  Nuxv.  will  be  found  service- 
able in  recent  cases,  when  the  annoyance  is  worse  in  the  morning  ; 
Pulsatilla  when  in  the  evening ;  Dulcamara  when  at  night,  or  Mercu- 
rius  when  accompanied  by  sweating.  China,  Carlo  v.,  and  Acidum 
nitricum,  Hepar,  Lack.,  etc.,  when  the  affection  occurs  in  individuals 
who  have  taken  mercury  in  large  quantities.  In  chronic  cases,  Aurum, 
Petroleum,  Sulph.,  Baryta  c.,  Natr.  m.,  Lye.,  Phosph.,  Sep.,  Con.,  etc., 
have  been  found  useful;  the  last-named  remedy  particularly,  when 
there  is  great  sensibility  to  cold,  and  a  tendency  to  suffer  from  rheu- 
matic pains  in  the  limbs. 

Otorrhcea.  When  this  disorder  results  from  acute  inflammation 
of  the  ear,  Pulsatilla,  Sulphur,  and  Mercurius  are  the  principal  remedies. 
In  chronic  otorrhcea  occurring  after  repercussed  scabies,  Cale.  c.,  in 
repeated  doses,  has  been  found  very  efficacious.* 

Catarrhal,  or  mucous  otorrhcea  :  Belladonna,  Mercurius, 
Pulsatilla,  and  Sulphur  chiefly. 

Purulent  otorrhcea  : — Mercurius,  Pulsatilla,  Sulphur,  Belladonna, 
and  Hepar, — or,  Silicea,  Calcarea,  Acid,  nitricum,  Assafmtida,  Lachesis, 
Petroleum,  etc.  When  the  discharge  is  offensive,  Hepar,  Aurum,  Carlo  v., 
Sulphur,  and  Silicea. 

Sanguineous  otorrhcea  :  Mercurius,  Pulsatilla,  and  Silicea, — 
also  Lacheds,  Cicuta,  etc.  When  the  disorder  has  arisen  from  the 
abuse  of  mercury ;  Hepar  s.,  Acid,  nitricum,  Aurum,  Assafmtida,  Sulphur, 
and  Silicea,  have  proved  the  most  useful:  and  when  over-doses  of 
sulphur  appear  to  have  given  rise  to  it,  Pulsatilla  and  Mercurius. 

When  we  have  reason  to  apprehend  caries  of  the  ossicula  auditoria ; 
Silicea,  Sulphur,  Aurum,  and  Natrum  m.,  are  the  remedies  from  which 
we  may  hope  to  obtain  the  most  assistance. 

Against  the  effects  of  suppressed  otorrhcea :    Belladonna,  Pulsatilla, 

*  Dr.  Maly.     Hygea,  XX  Bd.,  2tes  Heft. 

35 


546     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

and  Mercurius ;  and,  in  some  cases,  Nux  v.,  Bryonia,  or  Dulcamara 
may  be  selected,  according  to  circumstances.  Belladonna  and  Bryonia 
chiefly  when  there  is  fever,  headache,  or  unequivocal  signs  of  cerebral 
irritation  :  Mercurius,  Belladonna  and  Pulsatilla  followed,  if  required, 
by  Sulphur,  Calcarea,  and  Hepar,  when  the  glands  of  the  neck  or  the 
parotids  become  tumefied.  When  orchitis  results:  Pulsatilla  and 
Nux  v.,  or  Mercurius. 

In  Dysecoia,  or  deafness,  the  following  remedies  have  chiefly 
been  employed  with  the  most  success  :  Pulsatilla,  Mercurius,  Sulphur, 
Calcarea,  Causticum,  Graphites,  Ledum,  Acid*  nitricum,  Phosphorus,  Petro- 
leum, Ammonium c,  etc. 

For  Congestive  deafness:  Belladonna,  Hyoscyamus,  Sulphur, 
Silicea,  Mercurius,  Graphites,  Phosphorus,  etc.,  have  more  particularly 
been  recommended. 

Nervous  deafness: — Causticum,  Petroleum,  Phosphorus,  Acid. 
phosph.,  etc. 

Catarrhal,  or  rheumatic  deafness  :  Mercurius,  Pulsatilla, 
Arsenicum,  Belladonna,  Ledum;  or,  Sulphur,  Calcarea,  Hepar,  Lachesis, 
Acid,  nitricum,  Chamomilla,  and  Coffea. 

Deafness  from  the  repercussion  of  eruptions:  Sulphur  and  Antimo- 
nium;  or,  Causticum,  Graphites,  etc.  When  deafness  occurs  as  a  sequel 
of  measles,  Pulsatilla  is  one  of  the  most  useful  remedies ;  in  other  cases, 
Carlo  v.  will  be  found  requisite. 

When  it  results  from  Scarlatina:  Belladonna  and  Hepar;  and 
when  it  is  produced  by  Smallpox  :  Mercurius  and  Sulphur. 

Deafness  from  the  abuse  of  Mercury  is  generally  capable  of  being 
removed,  or  materially  relieved  by  Acidum  nitricum,  Staphysagria, 
Assafcetida,  or  Aurum;  Hepar  s.,  Petroleum  or  Sulphur.  When  the 
disorder  is  attributable  to  hypertrophy  of  the  amygdalae,  Aurum, 
Mercurius,  Acid,  nitricum,  and  Staphysagria  have  principally  been  recom- 
mended. When  it  comes  on  as  a  sequel  of  fevers,  or  other  disorders, 
particularly  of  a  nervous  character,  Phosphorus,  Phosphoric  acid,  Vera- 
trum,  and  Arnica;  and  when  it  occurs  as  a  result  of  a  suddenly  checked 


BLEEDING  OF  THE  NOSE.  547 

discharge  from  the  nose  or  eaxs,Hepar,  Lachesis,  and  Ledum;  and  also, 
Belladonna,  Mercurius,  and  Pulsatilla,  have  generally  been  found  the 
most  appropriate. 


BLEEDING  OF  THE  NOSE. 

Epistaxis. 

Bleeding  of  the  nose  often  appears  at  the  termination  of  many 
diseases,  such  as  fevers,  epilepsy,  etc.,  and  is,  in  such  instances, 
salutary ;  it  also  frequently  relieves  or  cures  headache,  vertigo,  etc., 
and  ought  therefore  not  to  be  interfered  with,  unless  it  be  excessive, 
last  too  long,  recur  too  frequently,  or  take  place  under  a  debilitated 
state  of  the  system.  The  attack  is  occasionally  preceded  by  a  degree 
of  quickness  of  the  pulse,  flushing  of  the  face,  throbbing  in  the  tem- 
poral arteries,  confusion  or  dimness  of  sight,  heat  and  itching  in  the 
nostrils,  and  other  signs  of  congestion. 

The  remedies  usually  required  are,  Aconitum,  Arnica  Montana,  Bella- 
donna, Bryonia,  Cinchona,  Pulsatilla,  Mercurius,  Rhus  toxicodendron, 
Secale  cornutum ;  or,  Carlo  vegetabilis,  Graphites,  Magnes  artificials, 
Ammonium  muriaticum,  Ferrum,  Kali,  Sepia,  Sulphur,  Calcarea,  Acidum 
nitricum,  Baryta,  Bovista,  Crocus,  Conium,  Cina,  &c. 

When  the  bleeding  is  excessive,  Aeon.,  Am.,  Bellad.,  Cin.,  Merc., 
Puis.,  Rhus,  or  Sec,  are  the  most  useful. 

When  the  hemorrhage  arises  from  congestion  in  the  head,  a  preference 
may  be  given  to  Aeon.,  Bellad.,  Cin.,  Crocus,  Con.,  or  to  Graph.,  Rhus, 
Chamom.,  Alum,  &c. 

When  from  being  overheated,  or  in  consequence  of  indulging  to 
excess  in  spirituous  Uguors,  &c,  Nux  vomica,  or  Aeon.,  Bellad.,  Bryonia, 
Thuja. 

Epistaxis  in  females,  who  have  too  scanty  catamenia :  Puis.,  Graph., 
Caust,  Sep.,  or  Sec.  In  those,  on  the  contrary,  who  have  too  copious  a 
menstrual  discharge  :  Aeon.,  Calc,  Croc,  Sabina. 

In  debilitated  subjects,  or  those  who  have  previously  been  exhausted 
by  loss  of  humours :  China  chiefly,  or  Ferrum,  Sec,  and  Ac  nitr. 

In  consequence  of  physical  exertion :  Rhus,  or  Arnica  principally. 

In  consequence  of  a  blow  or  contusion :  Arnica. 

Bleeding  from  the  nose  in  children,  arising  from  worms :  Cina  or 
Merc 

Accompanying  every  attack  of  coryza :  Pulsatilla  or  Arsenicum. 


548     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

When  nasal  hemorrhage  is  liable  to  occur  from  the  most  trivial 
cause :  Sulphur,  Silicea,  Sepia,  Calcarea,  and  Carlo  v.,  and  in  some  cases, 
Graphites  and  Lycopodium,  are  the  best  remedies  to  eradicate  the  con- 
stitutional tendency. 

The  following  are  characteristic  indications  for  some  of  .the  above 
remedies  : 

Aconitum.  Prolonged  or  violent  bleeding  at  the  nose,  in  plethoric 
subjects,  with  a  considerable  degree  of  fever,  flushing  of  the  face, 
pulsation  of  the  temporal  and  carotid  arteries,  or  general  fulness  of 
the  vessels  of  the  head. 

Belladonna  is  frequently  of  the  greatest  service,  after,  or  in 
alternation  with,  the  above  remedy,  but  also  when  there  is  bleeding 
from  the  nose  at  night,  which  awakens  the  patient  from  sleep,  and  some- 
times returns  in  the  morning ;  bleeding  from  the  nose  from  being 
overheated.     (See  Bryonia  and  Rhus.) 

Bryonia,  bleeding  from  the  nose,  chiefly  in  the  morning,  or  at 
night  during  sleep,  causing  the  patient  to  awake ;  or  when  it  arises 
from  suppressed  menstruation :  or  from  overheating  during  warm 
weather ;  obstinate  or  irritable  disposition. 

Mercurius,  bleeding  of  the  nose  during  sleep,  or  while  coughing, 
with  speedy  coagulation,  so  that  the  blood  hangs  in  clots  at  the 
nostrils  :  or  when  the  affection  is  preceded  by  a  sensation  of  tightness 
round  the  head,  as  if  it  were  bound. 

Carbo  v. — Bleeding  at  the  nose  during  the  night,  with  ebullition  of 
blood ;  violent  nasal  hemorrhage  in  the  morning  while  in  bed,  followed 
by  pain  in  the  chest ;  discharge  of  a  few  drops  of  blood  from  the 
nose  every  forenoon  ;  excessive  bleeding  from  the  nose  several  times 
a  day,  particularly  after  stooping,  or  after  every  exertion,  preceded  and 
followed  by  great  paleness  of  the  face.     (See  Rhus.) 

Graphites  :  Bleeding  of  the  nose  towards  night,  with  heat  in  the 
face,  preceded  by  determination  of  blood  to  the  head  in  the  after  part 
of  the  day,  particularly  in  females  who  have  scanty  catamenia.  (See 
Pulsatilla  and  Causticum.) 

Pulsatilla  : — Hemorrhage  from  the  nose  every  afternoon,  even- 
ing, or  before  midnight,  especially  in  females  with  suppressed  or  scanty 
catamenia,  or  in  those  of  a  mild  and  placid  disposition. 

Calcarea  : — Violent  bleeding  at  the  nose,  chiefly  in  plethoric, 
lymphatic  persons ;  or  in  females  in  whom  the  menstrual  flux  returns 
too  early,  and  is  excessively  copious. 

Magnes  artificialis.     Bleeding  from  the  nose,  particularly  in 


BLEEDING  OF  THE  NOSE.  549 

the  afternoon,  preceded  by  aching  and  weight  or  pressure  at  the  fore- 
head ;  protracted  bleeding,  after  blowing  the  nose. 

Arnica,  in  addition  to  being  the  principal  medicine  in  violent 
nasal  hemorrhage  from  external  injury,  or  from  great  physical  exer- 
tion, is,  moreover,  an  important  remedy  in  all  cases  in  wThich  the 
hemorrhage  is  preceded  by  itching  in  the  nose  and  forehead ;  and 
when  the  nose  feels  hot,  and  the  blood  discharged  is  red  and  liquid. 

Rhus  : — Bleeding  of  the  nose  from  physical  exertion,  such  as  lifting 
a  heavy  weight,  or,  when  blowing  the  nose,  spitting,  &c.,  or  nasal  he- 
morrhage which  becomes  aggravated  or  renewed  on  stooping,  or  during 
the  night. 

Ferrum  : — Nasal  hemorrhage  in  debilitated  subjects,  with  excessive 
paleness  of  the  face.     (Especially  after  China.) 

Sepia  : — Frequent  attacks  of  hemorrhage  from  the  nose,  with  pale 
or  sallow  complexion,  especially  in  females  with  obstructed  catamenia. 
Sulphur,  either  alone  or  in  alternation  with  Sepia,  and  sometimes  Carlo 
vegetabilis,  Graphites,  and  Lycopodium,  is  of  great  service  in  removing  a 
susceptibility  to  this  affection.  (See  also  the  remedies  enumerated 
under  Nasal  hemorrhage  from  the  most  trivial  cause?) 

Nux  v., — bleeding  of  the  nose,  especially  in  the  morning,  from  being 
overheated,  or  after  drinking  wine,  &c,  or  in  habitual  drunkards. 
(Lachesis  and  Calearea  carbonica  are  sometimes  requisite  here,  in  addi- 
tion to  Nux  v.) 

Dulcamara: — Bleeding  at  the  nose  after  getting  the  feet  wet ; 
flow  of  hot,  clear  blood  from  the  nose. 

Crocus  : — Discharge  of  dark -coloured,  thick  or  viscous  blood  from 
the  nose,  particularly  in  females  who  menstruate  too  copiously,  some- 
times followed  by  fainting. 

Moschus  :  Frequently  serviceable  when  the  nasal  hemorrhage 
occurs  in  nervous,  hysterical  females. 

Ammonium  c,  bleeding  from  the  nose  after  a  meal. 

Silicea,  nasal  hemorrhage  in  scrofulous  subjects. 

When  the  hemorrhage  is  of  an  active  kind,  the  patient  should  be 
placed  in  the  erect  posture,  and  kept  cool  and  quiet  for  some  time 
afterwards.     The  diet  in  all  cases  must  be  low  and  unstimulating. 

When  there  is  reason  to  fear  suffocation  from  the  bleeding  con- 
tinuing inwardly,  and  getting  into  the  throat,  as  is  liable  to  happen 
in  extremely  debilitated  subjects,  in  whom  little  or  no  reaction  appears 
to  follow  the  administration  of  the  remedies,  the  anterior  and  pos- 
terior outlets  from  the  nose  may  be  plugged ;  the  latter  by  passing 


550  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

threads  up  the  nostrils,  and  bringing  them  out  at  the  mouth,  then 
securing  pieces  of  sponge,  or  small  rolls  of  lint  to  the  ends  ;  after  this, 
the  threads  should  be  drawn  back,  and  tied  sufficiently  tight  so  as  to 
bring  the  plugs  somewhat  firmly  against  the  orifices. 

Sprinkling  or  dashing  cold  water  on  the  face,  exposing  the  face  to 
a  current  of  cold  air ;  placing  the  feet  or  hands  in  warm  water ;  apply- 
ing a  wet  cloth  round  the  abdomen,  and  even  dipping  the  head  into 
a  pail  of  iced  water,  or  salt  and  water,  are  among  the  best  of  the  po- 
pular means,  or  occasional  auxiliary  modes  of  stopping  an  excessive 
or  prolonged  discharge  of  blood  from  the  nose. 

"With  regard  to  the  administration  of  the  remedies,  the  repetition 
of  the  dose,  if  called  for,  must  depend  upon  the  greater  or  less  degree 
of  the  severity  of  the  attack.  We  ought  to  be  in  no  hurry  to  repeat 
in  the  majority  of  cases.  (See  also  what  has  been  said  on  this  matter 
in  the  Introduction.) 


SWELLING  OF  THE  NOSE. 

The  remedies  for  this  as  well  as  all  other  maladies  must  be  selected 
according  to  the  cause,  where  known.  Thus,  if  the  affection  has 
arisen  from  a  contusion,  Arnica  (externally  and  internally)  must  be 
prescribed. 

If  the  disorder  is  encountered  in  scrofulous  subjects,  one  or  more 
of  the  following  must  be  had  recourse  to :  Aurum  or  Assafcetida  ;  or 
Sulph%ir,  followed  by  Calcarea ;  or  Belladonna,  followed  by  Mercurius 
and  Hepar  s.  When  the  disease  has  been  excited  by  the  abuse  of 
mercury  :  Hepar  s.,  Acidum  nitricum,  Aurum,  Belladonna,  or  Sulphur  will 
be  found  the  most  efficacious.  When  attributable  to  the  habitual  use 
of  spirituous  liqtwrs :  Calcarea,  Arsenicum,  Nux  v.,  Pulsatilla,  Sulphur ; 
or  Bachesis,  Bellad.,  Merc,  Hepar  s.  Finally,  Bellad.,  Merc,  and  Hepar 
have  been  found  most  serviceable  in  cases  where  the  tumefaction  was 
red  and  very  painful ;  in  similar  cases  of  an  obstinate  character  ; 
Bryonia,  Sulphur,  Calcarea,  and  Bhus  have  proved  efficacious.  When 
there  are,  moreover,  incrustations  in  the  nose,  Silicea,  Sepia,  Carlo  v., 
and  Natrum  m.,  are  the  most  appropriate  remedies.  Redness  of  the 
point  of  the  nose,  Calc,  Carlo  animalis,  or  Rhus  toxicodendron*  Coppery 
redness,  Arsenicum  and  Cannalis,  Sec. 

Acne  rosacea :  Bach.,  Bhus,  Cic,  Bed.,  Buta,  Sepia  ;  or,  Ars,  Calc, 
Kreos.,  Aiw.,  Carlo  v.  et  a.,  Canth.,  Hepk,  Cau.,  Thuja,  Acid,  nit.,  &c. 


SWELLING  OF  THE  NOSE.  551 

Against  swelling  of  the  interior  of  the  nose  (Schneiderian  mem- 
brane), Teucrium  marum  verum  especially;  but  also  Staph.,  Phosph., 
Cole,  Sep.,  Sil.,  Sulph.  These  remedies,  together  with  Stannum,  Au- 
rum,  and  Kreosotum  have  likewise  been  employed  with  success  against 
nasal  polypi. 

In  Caries  of  the  bones  of  the  nose,  whether  of  a  scrofulous  or 
mercurial  origin,  Aurum  is.  the  most  important  remedy.  When  of 
syphilitic  origin,  Mercurius  is  to  be  preferred,  provided  the  patient  has 
not  already  been  placed  under  an  injurious  course  of  that  powerful 
medicine,  in  which  case  the  affection  is  as  likely  to  have  arisen  from 
the  remedy  as  from  the  disease,  and  will  consequently  require  to  be 
combated  by  anti-mercurial  medicines,  among  which  Aurum  will  in 
this  instance  form  the  most  valuable  remedial  agent ;  the  other  ge- 
neral antidotes  to  the  injurious  effects  of  mercury  on  the  constitution, 
such  as  Hepar  s.,  Acidum  nitr.,  Sulphur,  and  Calcarea ;  or,  Lachesis, 
Carl,  v.,  Staphysagria,  Lycopodmm^  Assafcetida,  Acid,  phosph.,  Silicea, 
&c,  may,  in  some  cases,  become  necessary,  particularly  when  the 
system  generally  has  become  impaired  by  the  cause  in  question.  (See 
Ostitis.) 

Ozjena.  This  disorder  consists  of  an  ulcer,  having  its  site  in  the 
nose,  from  which  a  fetid  purulent  matter  is  discharged. 

It  usually  commences  with  slight  inflammation  and  tumefaction 
about  the  alae  nasi,  accompanied  with  sneezing,  increased  flow  of 
mucus,  with  which  the  nostril  becomes  obstructed,  and  sometimes 
slight  hemorrhage.  The  ulceration  soon  spreads  from  the  Schnei- 
derian membrane  to  the  nasal  cartilages,  the  mucus  gradually  assumes 
the  nature  of  pus,  and  if  the  disease  be  not  checked,  the  bones 
become  implicated,  and  caries  results  ;  a  thin,  acrid,  offensive  matter 
or  sanies  is  then  constantly  discharged,  and  often  excoriates  the  lips 
and  throat,  and  the  sense  of  smelling  becomes  abolished ;  eventually 
the  ossa  spongiosa  inferior,  and  also  the  vomer,  and  in  the  worst 
cases, — particularly  when -there  is  complication  with  scrofulous  and 
venereal  or  mercurial  disease, — even  the  palate  and  superior  maxillary 
bones  exfoliate,  the  bridge  of  the  nose  falls  in,  and  leaves  a  frightful 
deformity  of  countenance. 

Therapeutics.  The  remedies  which  have  chiefly  been  employed 
in   this   malignant   disease   are,    Teucrium  marum  verum,   Pulsatilla, 


552  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Sulphur,  Calcarea ;  or  Magnes.  m.,  Bryonia,  Belladonna,  Lachesis,  Ly co- 
podium,  Natrum  m.,  Causticum,  in  the  first  stage,  with  mucous  obstruc- 
tion ;  Mercurius  and  Aurum  in  the  second,  with  discharge  of  pus,  and 
also  affection  of  the  bones ;  followed,  if  required,  in  Oz-<ena  scro- 
fulosa,  by  Sulphur,  Silicea,  Acidum  nitricum,  Phosphorus,  Conium,  or 
Potassa  lich.  In  Syphilitic  Oz^ena,  Mercurius  forms  the  principal 
remedy ;  but  if  the  patient  has  already  been  subjected  to  an  injurious 
course  of  that  medicine,  Aurum  is  to  be  preferred,  and  succeeded,  if 
requisite,  by  Acidum  nitricum,  Hepar  s.,  Assafcetida,  Lachesis,  Conium,  or 
Thuja. 

In  disease  in  the  Antrum  Highmorianum,  the  following  have  been 
recommended :  Teucrium  marum  verum,  Arsenicum,  Lycopodium,  Sulphur, 
Silex,  Aurum,  Mercurius,  Hepar  s.,  Mezereum,  Staphysagria,  Carl,  v., 
Antimonium  c,  Kali  hydr.,  Phosphorus ;  and  Spigelia,  Nux,  China, 
Phosphorus,  as  palliatives  when  the  pains  are  very  severe.* 

Cancer  Nasi  ; — Arsenicum,  Carlo  v.,  Aurum,  Sepia,  Silicea,  Sulphur, 
and  Calcarea  are  the  remedies  which  have  principally  been  pointed 
out  as  the  most  appropriate  to  combat  this  serious  and  frightful 
malady. 


CANKER  OF  THE  MOUTH.     SCURVY  IN  THE  MOUTH. 
Cancrum  Oris.     Gangrena  Oris.     Stomacace. 

This  affection  consists  of  a  fetor  in  the  mouth,  with  a  viscid, 
bloody  discharge  from  the  gums,  which  are  at  the  same  time  hot,  red, 
tumid,  spongy,  very  sensitive,  retracted  from  the  teeth,  and  subse- 
quently,  ulcerated  along  their  margins.  Sometimes  there  are  also 
glandular  swellings,  salivation,  or  ptyalism ;  and  usually  looseness  of 
the  teeth,  impeded  mastication  and  deglutition,  great  debility,  and 
slow  fever. 

Therapeutics.  Mercurius  is  the  most  useful  remedy  here,  and 
may  generally  form  the  first  prescription  in  almost  every  case  of  the 
kind,  as  it  will  rarely  fail  to  prove  serviceable,  if  not   sufficient  to 

*  Goullon  considers  Arsenicum  and  Lycopodium  as  almost  specific  in  this  disease.  He 
recommends  Arsenicum  to  be  given  when  the  pains  are  excessively  severe,  of  a  throb- 
bing and  splitting,  or  bursting  description,  when  at  their  height.  Lycopodium  when  there 
is  a  thick  and  yellow  discharge.— A.  H.  Z.     2,  24. 


CANKER  OF  THE  MOUTH.  553 

effect  a  perfect  cure.  When,  however,  we  have  reason  to  conclude 
that  the  symptoms  above  described  have  in  reality  been  created  by 
the  injurious  employment  of  mercury,  under  allopathic  treatment,  it 
will  be  necessary  to  have  recourse  to  the  appropriate  antidotes  to 
that  powerful  mineral,  amongst  which  Carlo  v.  will  be  found  of  pri- 
mary importance ;  should  the  improvement  effected  by  Carl.  v.  be 
only  of  a  partial  character,  the  treatment  must  be  followed  up  by 
Hepar  s.  and  Acidum  nitricum  alternately ;  or  by  Staphysagria,  if  fun- 
gous excrescences  form  on  the  gums.  Carlo  v.  is,  moreover,  of  great 
service  when  the  disorder  has  arisen  from  unwholesome  food,  the 
daily  use  of  kitchen  salt  in  excess,  or  the  prolonged  use  of  salt  meat  ;* 
when  the  gums  smell  most  offensively,  and  bleed  during  mastication ; 
the  teeth  loose,  mouth  hot,  tongue  much  excoriated,  and  moved  with 
difficulty. 

After  the  employment  of  Carlo  v.  we  may  have  recourse  to  Arseni- 
cum, if  the  ulceration  continues  extensive,  and  the  patient  complains 
of  luming  pains  in  the  gums,  with  great  prostration  of  strength ; 
or  Arsenicum  and  China  in  alternation,  if,  in  addition  to  the  foregoing 
symptoms,  the  gums  present  a  black,  spongy,  and  somewhat  gan- 
grenous appearance. 

Nux  v.  is  an  admirable  remedy  in  this  disorder,  particularly  when 
it  occurs  in  meagre,  dark-complexioned  subjects,  of  bilious  tempera- 
ment and  choleric  disposition,  who  lead  a  sedentary  life  ;  the  gums 
presenting  a  putrid  aspect,  and  so  much  swollen  as  completely  to 
cover  the  teeth ;  countenance  pale  and  sunken. 

Capsicum  has  been  found  useful,  under  nearly  similar  circum- 
stances, the  affected  party  being,  moreover,  of  a  plethoric  habit  and 
phlegmatic  temperament. 

Dulcamara  may  be  used  with  advantage  after  Mercurius,  when 
the  glands  of  the  throat  are  implicated  in  the  derangement ;  or  it 
may  be  selected  in  preference  to  Mercurius,  when  the  disease  is  prone 
to  be  excited  by  the  least  exposure  to  cold,  during  damp,  or  cold, 
raw,  wet  weather. 

Nat  rum  m.  is  frequently  a  valuable  remedy  in  completing  the 
cure  after  the  administration  of  Carlo  v.3  Acid,  nitr.,  Hepar,  &c.  It  is 
more  especially  indicated  when  the  ulcers  are  indolent,  and  do  not 
put  on  a  healing  aspect ;  the  gums  being  at  the  same  time  much 

*  Constantine  Hering  recommends  a  drop  of  Spiritus  cetheris  nitrosi  once  or  twice  a  day 
in  the  event  of  Carlo  v.  or  Arsenicum  failing  to  bring  about  a  favorable  action  in  such  cases. 


554    DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

swollen,  very  sensitive  to  heat  or  cold,  and  disposed  to  bleed  at  the 
slightest  touch ;  moreover,  when  painful  vesicles  or  blisters  are 
observed  on  the  tongue,  inner  surface  of  the  lips,  and  cheeks,  which 
impede  speech,  and,  together  with  the  irritable  gums,  render  the  act 
of  mastication  a  work  of  labour  and  excessive  torture.  When,  not- 
withstanding the  employment  of  the  last-mentioned  remedy,  the 
complaint  seems  disposed  to  linger,  Sulphur  may  be  prescribed,  and 
followed  or  alternated  with  Acidum  sulp/mricum,  Sepia,  or  any  of  the 
other  medicines  already  treated  of,  if  required  by  the  bent  of  the 
succeeding  changes  in  the  features  of  the  case,  &c.  Silicea,  Sub-boras 
soda,  Helleb.  and  Iodium  may  also  prove  useful  in  some  cases. 

Lemon-juice,  which  is  well  known  as  a  most  valuable  remedy  in 
scurvy,  is  equally  useful  as  a  domestic  remedy  in  stomacace ;  but  its 
use  must  be  discontinued  during  the  employment  of  the  above 
medicaments. 

Sage  is  equally  useful  in  some  varieties  of  the  disorder.  Rinsing 
the  mouth  with  brandy  has  also  been  found  of  service. 

The  use  of  wholesome,  easily-digested  food,  with  a  due  proportion 
of  vegetables,  must  be  enjoined  in  order  to  expedite  the  cure. 


SCURVY. 

Scorbutus. 

This  disorder  is  characterized  by  excessive  debility,  pale  and 
bloated  countenance:  oedematous  swelling  of  the  inferior  extremities- 
hemorrhages  ;  livid  spots  on  the  skin,  or  foul  ulcers ;  offensive  urine, 
and  extremely  fetid  stools.  The  gums  are  spongy,  or  otherwise 
diseased,  as  described  in  the  preceding  article. 

It  chiefly  affects  sailors,  or  others  who  from  circumstances  are 
deprived  of  fresh  provisions  and  an  adequate  quantity  of  ascescent 
food,  and  are  exposed  to  cold  and  moisture,  together  with  fatigue. 
Intemperance,  want  of  exercise,  impure  air,  uncleanliness,  with  de- 
pressing emotions,  further  tend  to  predispose  to  the  disease,  when  com- 
bined with  unwholesome  food,  or  the  aforesaid  alimentary  deficiency. 

In  the  cure,  as  also  the  prevention  of  this  malady,  it  is  requisite, 
in  the  first  place,  to  remove  the  probable  causes  of  its  invasion, 
where  that  is  practicable;  and  to  supply  the  patient,  if  possible,  with 


scurvy.  555 

wholesome  diet,  fresh  vegetables,  and  those  fruits  which  furnish 
citric  acid,  such  as  lemon,  the  juice  of  which  made  into  a  drink  forms 
an  invaluable  remedy.  Sour  kraut,  and  other  substances  which  have 
undergone  the  acetous  fermentation,  cider,  spruce-beer,  and  the  like, 
as  also  vinegar,  have  been  likewise  recommended. 

The  homoeopathic  medicines  which  may  be  prescribed  with  the 
most  advantage  against  the  ulcers  and  diseased  gums  are,  Carlo  v.> 
Nux  v.,  Arsenicum,  Mercurius,  Staphysagria,  and  Sulphur;  or  also  Acid. 
oiitr.,  Cistus,  Nat.  m.,  Ammonium  c.  et  m.,  Dulcamara,  Kreosotum,  Acid, 
mur.,  Sepia,  &c.  (See  the  preceding  article,  and  also  that  on  Ulcers.) 

The  use  of  lemon-  or  lime-juice  and  other  acids  must  be  discon- 
tinued during  the  employment  of  the  above  remedies. 

Gumboil  (Parulis).  Silicea,  Staphysagria,  and  Calcarea,  but  par- 
ticularly the  first,  are  the  principal  remedies  against  this  affection. 
When  there  is  much  inflammation  and  considerable  swelling,  Bella- 
donna may  be  prescribed,  followed  by  Mercurius  and  Hepar  sulph., 
if  little  relief  is  obtained  from  its  use.  Nux  v.,  Pulsatilla,  and  Sulphur 
are  sometimes  very  useful.  In  swelling  of  the  jaw,  with  suppuration, 
whether  in  consequence  of  carious  teeth,  or  the  unskilful  abstraction 
of  a  tooth,  Silicea  is  the  most  important  remedy.  In  gumboil  from 
irritation,  arising  from  the  cutting  of  the  wisdom-teeth,  Aconitum  and 
Calcarea  are  useful ;  as  also  Belladonna,  Arnica,  and  Chamo?mlla,  par- 
ticularly when  there  is  considerable  inflammation  with  swelling  of 
the  face,  &c. 

Against  hemorrhage  from  the  gums  Staphysagria  is  one  of  the 
principal  remedies.  Mercurius  is  also  a  good  remedy  in  such  cases, 
especially  when  the  gums  are  painful,  swollen,  spongy,  and  jagged 
at  the  margins ;  but  when  the  foregoing  abnormal  state  of  the  gums 
has  evidently  originated  in  the  abuse  of  Mercury,  they  must  be  com- 
bated by  such  remedies  as  Carlo  v.,  China,  or  Hepar  s.,  Acid,  nitr., 
&c.  Acidum  phosph.  is  another  important  remedy  in  bleeding  from 
the  gums,  especially  when  it  is  readily  excited  by  touching  or  rub- 
bing the  gums,  and  when  the  gums  feel  as  if  excoriated.  Alumina, 
Sepia,  Natrum  m.,  Silicea,  Lycopodium,  Kali  c,  Acid,  sulph.,  Rhus,  Amir  a, 
and  Buta  may  also  be  enumerated  as  useful  remedies  in  affections  of 
the  gums,  such  as  ulceration,  &c,  with  tendency  to  bleeding  from 
the  most  trivial  cause.  In  the  case  of  morbid  growths  or  excrescences 
on  the  gums,  Staphysagria  is  deserving  of  notice. 


556  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS, 


INFLAMMATION  OF  THE  TONGUE. 

,  Glossitis. 

Diagnosis.  Tumefaction,  with  heat  and  redness  of  the  tongue, 
the  swelling  is  sometimes  so  great  as  to  fill  the  whole  cavity  of  the 
mouth,  rendering  swallowing  impossible,  and  threatening  suffocation ; 
unless  resolution  takes  place,  it  may  terminate  in  induration,  suppu- 
ration, or  gangrene. 

Causes.  Besides  a  general  strumous  habit,  local  injuries,  acrid 
substances,  rheumatism,  catarrh,  and  metastasis. 

Therapeutics.  The  following  medicines  will  be  found  most 
appropriate  in  the  treatment  of  this  affection,  according  to  the  ex- 
citing cause  :  Arnica  Montana,  Vrtica  urens,  Mercurius,  Aconitum,  Bella- 
donna, 'P%dsatilla,  Lachesis,  and  Arsenicum. 

Arnica,  in  cases  of  lesion  of  the  tongue  from  the  points  of  decayed 
teeth,  &c,  or  of  burns  or  scalds.  (Acid.  pkospL  is  occasionally 
required  after,  or  may,  in  severe  cases,  be  given  in  preference  to 
Arnica :  in  other  instances,  Silicea  and  Sulphur  will  be  required  to 
complete  the  cure.) 

Urtica  urens  has  been  recommended  in  preference  to  Arnica  in 
burns  and  scalds  of  the  tongue  and  mouth. 

Mercurius  is  almost  specific  when  glossitis  presents  itself  in  the 
form  of  a  disease  of  the  tongue,  attended  with  excessive  inflammatory 
swelling  or  induration. 

Aconitum  may,  with  advantage,  precede  the  above  remedy,  should 
the  inflammation  be  very  intense. 

Belladonna.  When  the  affection  does  not  speedily  yield  to 
Mercurius,  or  when  the  inflammation  is  of  an  erysipelatous  or  active 
phlegmonous  nature.  After  the  inflammation  has  abated  we  may, 
in  many  cases,  return  to  Mercurius. 

Pulsatilla  has  been  found  useful  in  cases  arising  from  sup- 
pressed hemorrhoidal  and  arthritic  affections. 

Against  indications  of  threatening  gangrene,  Arsenicum  and  Lachesis 
are  the  principal  remedies.  They  may  both  be  given,  and  repeated 
according  to  results. 

In  some  rare  cases  when,  from  great  tumefaction  of  the  tongue, 
suffocation  threatens,  it  may  be  found  necessary  to  have  recourse 


OFFENSIVE  BREATH.  557 

to  longitudinal  incisions ;  and  after  having  thus  warded  off  the 
more  pressing  danger,  exhibit  Cinchona,  and  then  fall  back  upon  the 
more  specific  remedies. 

In  some  extreme  cases  of  this  nature,  where  the  disease  has  made 
head  before  the  arrival  of  professional  assistance,  it  may  be  found 
necessary  to  resort  to  tracheotomy.  This  is,  however,  a  dangerous 
mode  of  relief,  from  the  risk  of  consequent  tracheal  inflammation ; 
but,  when  it  should  be  found  absolutely  necessary,  we  may,  by  the 
exhibition  of  Arnica,  two  globules,  internally,  and  also  in  the  form 
of  lotion, — in  the  proportion  of  four  minims  of  the  mother-tincture 
to  a  hundred  of  water, — materially  diminish  the  danger  of  so  serious 
a  result. 

Such  cases  will,  however,  rarely  if  ever,  occur  to  the  homoeopathic 
practitioner,  if  the  disease  be  taken  in  time,  and  the  remedies  judi- 
ciously selected. 

In  cases  of  soreness  or  ulceration  of  the  tongue,  Merc,  Nux  v.,  Ars., 
Carlo  v.,  Sulph.,  Ac.  nilr.,  Acid,  sulph.,  Natr.  m.,  Acid,  fluor.,  Silic,  and 
Staph.,  are  the  most  effective  remedies. 

Against  Ranula,  or  the  formation  of  an  inflammatory  or  indolent 
tumour  under  the  tongue,  in  consequence  of  obstruction  of  the 
salivary  ducts  from  cold,  inflammation  or  other  irritating  causes, 
Mer curias,  Calc,  and  Thuja  have  chiefly  been  employed.  In  some 
cases,  one  or  more  of  the  following  remedies  may  be  requisite  for  the 
removal  of  the  obstruction,  after  the  tumour  has  burst,  and  left 
the  usual  obstinate  ulcer  behind :  'Petroleum,  Sulph.,  Silicea,  Puis., 
Stann.,  or  Staphys.,  provided  Mercurius  or  Calc.  should  not  be  more 
appropriate  in  this  stage  of  the  disease  likewise.  When  the  tumour 
is  of  an  inflammatory  nature  Merc,  and  Silicea  may  generally  be 
resorted  to. 


OFFENSIVE  BREATH. 

The  most  frequent  cause  of  this  unpleasant  affection  are,  uncleanli- 
ness,  leaving  particles  of  food  in  the  teeth;  an  accumulation  of 
tartar;  carious  teeth;  a  diseased  state  of  the  gums;  aphthae  in  the 
mouth ;  derangement  of  the  stomach ;  or  an  abuse  of  mercury. 

Therapeutics.  When  there  is  reason  to  suppose  that  4he  first- 
named  circumstances  is  the  chief  cause  of  the  complaint,  its  removal 


558     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

will  be  readily  effected  by  proper  attention,  rinsing  the  mouth  with 
tepid  water,  and  brushing  the  teeth,  with  a  moderately  hard  brush 
night  and  morning,  as  also  after  every  meal. 

When  attributable  to  the  second  cause,  a  dentist  of  known  skill 
and  respectability  ought  to  be  consulted.  Lastly,  when  the  an- 
noyance can  be  traced  to  any  of  the  remaining  sources  enumerated, 
the  remedies  given  under  these  different  headings  should  be  had 
recourse  to. 

When,  on  the  other  hand,  no  apparent  cause  of  the  derangement 
can  be  assigned  or  detected,  benefit  will  often  be  derived  from  one 
or  more  of  the  following  medicines  :  Nux  v.,  Silicea,  Pulsatilla,  Sulphur 
and  Ckamomilla ;  or  Arnica,  Bellad.,  Hyos.,  &c. 

If  the  heaviness  or  fetor  of  the  breath  is  chiefly  perceptible  in  the 
morning,  Nux  v.  and  Silicea  will  frequently  be  found  successful  in 
affording  relief.  Arnica,  Bellad.,  and  Sulph.  have  also  proved  effectual 
in  similar  cases.  If  after  a  meal,  Nux  v.  succeeded  by  Ckamomilla  and 
Sulphur.     If  in  the  evening,  or  during  the  night,  Pulsatilla  or  Stdphur^ 

Mercurius,  Bryonia,  Arsenicum,  Hyoscyamus,  Agaricus,  Ambra,  Carbo 
v.  et  a.,  Sepia,  Lycopodium,  &c,  may  also  prove  useful  in  particular 
cases.  In  young  girls  at  the  age  of  puberty,  Aurum  is  often  the 
most  appropriate  medicine  ;  but  occasionally,  Pulsatilla,  Sepia,  Bella- 
donna, or  Hyoscyamus  will  be  found  preferable  here.  When  the  abuse 
of  Mercury  has  evidently  been  the  cause  of  the  evil,  Aurum,  Carlo  v., 
Lachesis,  Sulphur,  Hepar,  Belladonna,  or  Acidum  nitricum,  &c,  will  be 
found  the  most  suitable  remedies. 


CRAMP  IN  THE  LEGS. 

Veratrum,  Nux  vomica,  Sulphur,  Calcarea,  Lycopodium,  Acidum  nitri- 
cum, Sepia,  Camphora,  Argilla,  Colocynth,  and  Rhus  are  amongst  the  best 
remedies  for  cramps  in  the  calves  of  the  legs.  Veratrum  has  been 
recommended  as  one  of  the  most  useful  medicaments  for  eradicating 
the  tendency  to  frequent  returns  of  this  painful  and  troublesome 
disorder,  succeeded  by  Sulphur,  and  Colocynth,  should  it  not  suffice  to 
effect  a  cure.  Rhus,  when  the  attacks  occur  during  the  day  when* 
sitting,  as  well  as  at  night,  Sepia,  Zycopodium,  and  Acid,  nitr.,  when  the 
affection  is  experienced  chiefly  in  walking.  Sulphur,  after  Nux  v.,  or 
Rhus,  wnen  the  attacks  occur  chiefly  during  the  night.  Calcarea 
when  stretching  out  the  limb  brings  on  the  cramp.  Argilla,  in  cramps 


DERBYSHIRE  NECK.  559 

which  arise  on  crossing  the  legs,  or  even  on  descending  stairs.  Colo* 
cynth  is  frequently  beneficial,  when  stiffness  and  pain  are  always  expe- 
rienced in  the  limb  for  some  time  after  the  attack. 


BRONCHOCELE.    GOITRE. 

Derbyshire  neck. 

This  disfigurement  arises  from  a  tumefied  state  of  the  glandula 
thyroides.  As  the  enlargement  increases,  it  is  productive  of  a  con- 
siderable degree  of  obstruction  to  free  inspiration,  from  the  pressure 
which  it  exerts  against  the  windpipe.  The  disorder  is  most  frequently 
encountered  amongst  the  inhabitants  of  mountainous  districts. 
Women  are  more  prone  to  be  afflicted  with  it  than  men,  and  particu- 
larly those  who  have  suffered  from  severe  labours.  An  inherent  con- 
stitutional taint  seems  to  be  the  chief  predisposing  cause. 

In  the  treatment  of  the  affection,  Spongia  marina  has  generally  been 
found  the  most  useful  remedy,  administered  in  repeated  doses.  In 
cases  of  long  standing,  one  or  more  of  the  following  remedies  may 
prove  of  service  in  materially  diminishing  the  size  of  the  tumour,  if 
not  sufficient  to  disperse  it  entirely.  Calcarea,  Carlo  v.,  Staphysagria, 
Lycopodium,  Iodkim,  Ammonium  e.,  and  Natmm  c.  et  m.  Or :  Ferrum, 
Sepia,  Thuja,  particularly  when  the  superficial  veins  of  the  swelling  are 
in  a  varicose  and  painful  state,  and  Curbo  v.,  or  Lycopod.  fail  to  effect  any 
amendment.  When,  either  from  exposure  to  cold  or  otherwise,  the 
thyroid  gland  has  become  slightly  tumefied,  and  there  is  at  the  same 
time  redness  of  the  integuments  over  and  around  the  swelling, 
attended  with  impeded  deglutition,  violent  headache,  cough,  and  a 
considerable  degree  of  fever,  a  dose  or  two  of  Belladonna,  at  intervals 
of  twelve  hours,  will  act  beneficially ;  should  the  accompanying  fever 
become  intense,  Aconitiim  may  be  resorted  to.  If,  on  the  other  hand, 
there  be  no  discoloration  of  the  surrounding  skin,  and  the  fever  be  of 
a  less  active  character,  Mercurim  should  be  prescribed.  When  symp- 
toms of  suppuration  have  set  in,  Mercurius  is  still  called  for,  and  should 
then  be  administered  every  four  to  six  hours,  in  order  to  forward  the 
bursting  of  the  abscess.  Silicea  is  sometimes  required,  if  the  suppura- 
tive process  proceeds  very  tardily. 

When  the  tumefied  gland  does  not  disperse  under  the  action  of 


560  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Bella,  or  Merc,  or  when  it  has  already  become  indurated  before  medi- 
cal aid  has  been  sought,  Spongia,  Natrum,  Conium,  Sulphur,  and  Calcarea 
are  amongst  the  most  useful  remedial  agents. 


SWEATING  EEET. 

Some  individuals  are  much  troubled  with  a  disagreeable,  clammy 
sweating  of  the  feet,  to  such  an  extent  as  to  render  it  necessary  to 
change  the  stockings  several  times  daily.  This  evil  is,  moreover,  a 
source  of  extreme  annoyance  to  others,  from  the  offensive  odour 
which  is  usually  exhaled  at  the  same  time.  The  utmost  attention  to 
cleanliness  is  insufficient  to  remedy  the  complaint ;  and  to  attempt 
to  suppress  the  secretion  by  cold  water,  or  powerful  astringents,  is 
highly  culpable,  from  the  dangerous  consequences  which  are  liable 
to  ensue  from  producing  a  sudden  suppression. 

Amongst  the  homoeopathic  remedies,  by  which  a  safe  and  perma- 
nent cure  has  most  frequently  been  brought  about,  Silicea  and  Rhus 
toxicodendron  merit  priority  of  notice.  A  few  globules  of  the  former 
may  be  taken  every  four  days,  for  a  fortnight  or  three  weeks ;  at  the 
expiration  of  which  period,  a  few  days  may  be  allowed  to  elapse,  and 
if  improvement  then  set  in,  the  medicine  may  be  continued,  at  inter- 
vals of  increasing  length,  until  the  cure  is  effected.  But  should  no 
melioration  result,  Silicea  may  be  had  recourse  to  in  the  same  man- 
ner. After  Silicea,  Rhus  may  again  be  resorted  to,  if  required. 
These  two  remedies  are  also  the  most  appropriate  to  be  administered 
against  the  deleterious  consequences  of  a  suddenly  checked  foot- 
sweat. 

Other  remedies  may  be  required  in  obstinate  cases  of  this  com- 
plaint, or  in  those  where  a  general  derangement  of  the  system 
coexists.  The  following  may  therefore  be  pointed  out  as  worthy  of 
being  referred  to  in  such  cases:  Mercurius,  Baryta  c,  Graphites, 
Kali  c,  Cyclamen;  or  Sulphur,  Calcarea,  Bachesis,  Blmmbum  aceticum, 
Carlo  v.,  Bycopodium,  Sepia,  Acid,  nitr.,  &c. 


SLEEPLESSNESS.  561 


SLEEPLESSNESS. 

Agrypnia. 

Sleep  is  essential  to  renew  the  vital  energy  which  has  been  ex- 
hausted during  the  day,  as  also  to  assist  the  function  of  nutrition. 
When,  therefore,  anything  occurs  to  deprive  us  of  this  indispensable 
necessary  for  a  protracted  period,  or,  at  all  events,  so  materially  to 
disturb  it  as  to  render  it  inadequate  to  fulfil  its  requisite  purpose,  the 
health  will  eventually  give  way  under  the  deprivation. 

The  average  duration  of  sleep  is  from  six  to  eight  hours ;  but  it  is 
liable  to  variation  from  several  causes.  Some,  from  peculiarity  of 
constitution,  require  less,  others  a  little  more.  Habits  of  idleness, 
&c.  tend  to  prolong  it ;  and  it  may  here  be  remarked,  that  when  not 
restrained  within  proper  limits,  sleep,  instead  of  repairing,  exhausts 
the  strength  ;  and  is,  as  well  as  the  derangement  of  M'hich  it  is  our 
object  at  present  to  treat,  consequently,  occasionally  productive  of 
serious  diseases,  such  as  madness  and  idiocy, — these  distressing 
maladies  having  unquestionably  been  traced  in  some  instances,  to 
indolent  habits  of  prolonging  sleep  beyond  the  period  required  for 
healthy  recreation. 

In  almost  all  cases,  sleeplessness  is  but  symptomatic  of  some  other 
disease,  and  can  only  be  remedied  by  the  removal  of  the  abnormal 
source.  It  frequently,  however,  forms  so  prominent  a  feature  as  to 
render  it  necessary  that  we  should  treat  it  as  an  idiopathic  disease, 
and  direct  our  attention  to  the  selection  of  medicines  conformably. 

Intense  mental  application,  continued  up  to  the  period  of  going  to 
rest;  sedentary  habits;  the  habitual  use  of  coffee  (often  for  the 
express  purpose  of  warding  off  inclination  to  sleep),  also  weakness  of 
the  digestive  functions,  are  frequent  causes  of  sleeplessness.  Under 
such  circumstances,  Nunc  v.  will  generally  be  found  the  most  appro- 
priate remedy ;  but,  unless  the  acquired  habits  above  detailed  are 
given  up,  or  materially  altered,  no  permanent  benefit  can  be  expected 
from  the  employment  of  the  remedy  referred  to. 

Overloading  the  stomach,  particularly  towards  night,  with  the 
habitual  employment  of  stimulating,  or  rich,  indigestible  food,  form 
additional  fertile  sources  of  disturbed  sleep,  which  can  only  be  obvi- 
ated by  the  observance  of  a  more  simple  mode  of  living.      The 

36 


562  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

attainment  of  the  desired  relief  may,  however,  be  considerably  for- 
warded by  means  of  a  dose  or  twTo  of  Pulsatilla. 

Mental  emotions  often  originate  sleeplessness. 

When  excessive  joy  is  the  excitable  cause,  Coffea  is  a  useful  remedy. 
When  the  affection  arises  from  dejection,  caused  by  grief,  unpleasant 
ideas,  vexation,  &c,  Ignatia.  If  it  be  attributable  to  fear,  or  fright, 
or  when  the  sleep  is  disturbed  by  fantastic  or  frightful  visions,  Opium, 
followed,  if  required,  by  Belladonna  in  the  latter  instance :  and 
when  anxious,  annoying,  or  agitating  events  disturb  or  retard  sleep, 
Aconitum. 

Sleeplessness  arising  from  nervous  excitement  in  sensitive  or  irri- 
table subjects  will  often  yield  to  Hyoscyamus  ;  or  to  Belladonna,  wThen 
there  exists  a  strong  but  ineffectual  desire  to  obtain  sleep.  The 
latter  medicine  is  further  indicated  when  agitation  or  anguish,  with 
frightful  visions,  timidity  or  terror,  apprehension  of  real  objects,  &c. 
are  complained  of;  or  when  the  sleep  is  disturbed  by  frequent  start- 
ing, and  is  attended  with  extreme  sleeplessness  early  in  the  evening, 
or  towards  morning. 

Moschus  is  a  useful  remedy  in  sleeplessness  occurring  in  hyste- 
rical or  hypochondriacal  individuals,  arising  from  nervous  excite- 
ment.  Acid.phosjQh.  and  Sepia  are  also  occasionally  useful  in  such  cases. 

Sleeplessness  in  old  people  can  scarcely  be  considered  a  disease. 
But  when  it  occurs  in  children,  it  almost  invariably  arises  from  some 
bodily  ailment,  which  ought  to  be  attended  to  and  removed  without 
delay,  if  practicable,  as  deprivation  of  sleep  is  more  detrimental 
during  infancy  and  childhood,  than  at  any  other  period  of  life.  (See 
Sleeplessness  in  Children,  Part  III.) 

Coldness  of  the  feet  is  a  frequent  cause  of  retarded  or  disturbed 
sleep.  Daily  exercise  in  the  open  air  is  here,  as  in  most  other  cases, 
to  be  recommended ;  also  gentle  and  general  friction,  when  there  is, 
at  the  same  time,  chilliness  or  stiffness  of  the  limbs.  The  application 
of  a  vessel  containing  hot  water  to  the  feet  is  the  only  mode  of 
obtaining  any  refreshing  sleep  in  some  cases,  when  coldness  of  the 
feet  is  the  disturbing  cause. 

This  languid  state  of  the  circulation  is  often  capable  of  being  per- 
manently removed  by  means  of  homoeopathic  remedies,  combined 
with  frequent  bathing  of  the  feet  in  cold  water,  and  appropriate  exer- 
cise. Ammonium  m.  and  Carlo  v.  et  a, ;  as  also  Graphites,  Kali  c., 
Nux  v.,  Bycopodium  or  Sulphur,  &c,  will  generally  be  found  the  best 
adapted  to  the  attainment  of  this  object.     When  the  digestion  is  in 


SLEEPLESSNESS.  563 

a  deranged  state,  the  remedies  noted  under  Dyspepsia  must  be 
resorted  to. 

When,  on  the  other  hand,  sleep  is  prevented  or  retarded  by  burning 
heat  in  the  feet, — Lachesis,  and,  in  other  cases,  Pulsatilla,  Acid,  phos- 
phoricum,  Stannum,  Lycopodium,  Kali  c,  Sepia,  or  Secale  c,  &c.  must  be 
selected. 

Sleeplessness  from  a  harsh,  dry,  and  imperspirable  state  of  the 
skin,  may  be  remedied,  after  the  removal  of  the  said  cause,  when  not 
impracticable  from  too  long  continuance,  &c,  by  means  of  Graphites, 
Natrum  c,  Silicea,  Sepia,  Acid,  nitr.,  or  Calcarea,  &c. 

Sleeplessness  and  other  derangements  resulting  from  tea,  require 
the  employment  of  the  antidotes  to  that  drug  for  their  removal,  Of 
these,  Cinchona  will  usually  prove  the  best ;  should  it  not  be  adequate 
to  effect  the  purpose  required,  Fermm  will  often  succeed.  (Cqffea  is 
to  be  preferred  in  sleeplessness,  or  other  more  serious  cases  of  indis- 
position arising  from  green  tea;  but  it  must  be  followed  by  the 
exhibition  of  Cinchona,  if  relief  is  not  soon  obtained.) 

When  coffee  is  the  originating  cause  of  the  affection,  Nux  v.,  as  has 
been  already  remarked,  is  the  principal  remedy  ;  on  other  occasions 
Chamomilla  will  be  required,  particularly  when  sleeplessness  and  other 
sufferings,  such  as  headache,  colic,  &c.  occur  in  nervous,  highly 
excitable,  and  irritable  subjects,  who  are  extremely  impatient  under 
sufferings  even  of  a  description  that  would  be  deemed  trivial  by 
ordinary  people.  Ignatia,  particularly  in  the  case  of  mild,  sensitive, 
or  changeable  dispositions.  Cocculus,  in  nearly  similar  circumstances 
to  those  described  under  Chamomilla,  with  the  distinction  of  a  sensa- 
tion of  emptiness  or  lightness  in  the  head. 

When  sleep  is  prevented,  disturbed,  or  accompanied  by  the  symp- 
toms hereafter  noted,  the  remedies  mentioned  will  be  more  or  less 
indicated,  and  must  be  selected  according  to  the  entire  group  of 
symptoms. 

Aching  pains  in  the  body  (sleep  disturbed  by)  :  Lye,  Mang., 
Phosph.  ac,  Merc, — Am.  m.,  Anac,  Aur.,  Baryta  c,  Lach. 

Anxiety  (sleep  disturbed  or  prevented  by) :  Ars.,  Bella.,  Ferr.,  Kali, 
Op.,  Petr.,  Bhus,  Veratr.,  Calc,  Carlo  v.,  Cham.,  Merc.,  Hep.,  Phosph., 
Puis.,  Nux  v.,  Sulph.,  &c. 

Arms,  heaviness  in  the  (sleep  disturbed  by  a  feeling  of),  Biadema. 

Agitated  sleep  :  Nux  v.,  Led.,  Ac.  nitr.,  Oleand.,  Sulph.,  Zinc. 

Arms,  swelling,  enlargement  of  the  (sensation  of) :  Biadema. 


564     DISEASES  OV   PARTICULAR  ORGANS  AND  REGIONS. 

Back,  pain  in  the :  Am.  m. 

Bulimy  :  Cinchona,  Bry.,  Phosph.,  Sel.,  Sulph. 
Burning  heat  in  the  blood-vessels:  Arsenicum. 

Carphologia  (during  sleep) :  Op.,  Bella.,  Hyos.,  Coce,  Ars.,  Phosph., 

Phosph.  ac,  Rhus,  Stram. 
Chest,  pain  in  the  (aching  and  oppression) :  Alum.,  Am.  e,  Am.  m. 
Coldness  or  shivering:  Ahim.,  Amb.,  Am.  m., Carlo  v.  et  a.,  Graph.,  Kali, 

Nux,  Sulph.,  Merc,  Arg.,  Ars.,  Daph.,  Staph.,  Calc,  Acid,  m.,  Arg.,  &c. 
Coldness,  sensation  of,  during  sleep :  Ambra. 
Congestion  in  the  chest  during  sleep  :  Puis. 
Colic  :  Lye,  Plumb.,  Sep.,  Staph.,  Aeon.,  Amb.,  Am.  c,  Am.  m.,  Kali, 

Magn.,  Magn.  s.,  Ac.  nitr.,  Rhus,  Ars.,  Aur.,  Merc,  N.  mos.,  Puis., 

Sulph.,  Ac.  sulph.,  Per.,  &c. 
Convulsions  :  Cin.,  Cup.,  Hyos.,  Calc,  Lye,  Merc,  Op.,  Puis.,  Sec 
Cramps   (in  the  calves  of  the  legs) :  Anac,  Kali  c,  Rhus,   Sulph., 

Nux  v.,  Lye,  Bry.,  Carbo  v.,  Cham.,  Magn.,  Magn.  m.,  Sep.,  Staph., 

Veratr.,  &c.  (See  Jerking.) 
Cramps  in  the  legs :  Anac,  Kali,  &c.  (See  Cramps.) 
Creeping,  crawling  sensations  (formication) :  Sulph.,  Lye,  Carbo  v. 
Cries  during  sleep :    Puis.,  Sulph.,  Bella.,  Bry.,  Calc,  Cham.,   Cin., 

Coce,  Lye,  Sep.,  Sil.,  Stram.,  Croc,  Gran.,  Ac  nitr.,  &c. 

Deglutition,  during  sleep :  Calcarea. 

Delirium,  wandering  during  sleep  :  Nux  v.,  Lach.,  Op.,  Puis.,  Sulph., 
Bella.,  Bry.,  Cham.,  Aur.,  Big.,  Camph.,  Coloc,  Sec. 

Breams. 
Dreams,  sleep  disturbed  by  Agitated,  Anxious:  Nux,  v.,  Puis., 
Am.,  Graph.,  Magn.,  Phosph.,  Sulph.,  Thuja. — Alum.,  Ant.  tart.,  Bar., 
Car.,  Carb.  a.  et  v.,  Cham.,  China,  Coce,  Con.,  Coce,  Big.,  Graph., 
Guaj.,  Hyos.,  Laur.,  Led.,  Lye,  M.  arct.,  M.  austr.,Mang.,  Mez.,  Merc, 
Mur.  ac,  Natr.,  Natr.  m.,  Nitr.,  Op.,  Petr.,  Ph.  ac,  Plat.,  Plumb., 
Ran.  bulb.,  Ran.  seel.,  Spig.,  Stann.,  Staph.,  Verb.,  Ac,  Sulph.,  Veratr., 
Zinc,  &c. 

Amorous  Dreams  (sleep  disturbed  by) :  Lack.,  Viol,  trie,  M.  arct., 
Natr.,  Nux  v.,  Staph.,  Op. — Alum.,  Bism.,  Calc,  China,  Coce,  Hyos., 
Led.,  Lye,  Magn.,  Merc,  Natr.  m.,  Phosph.  ac,  Rhod.,  Samb.,  Spig., 
Stann.,  Stram.,  Sulph.,  Thuj.,  Valer.,  Veratr.,  Canth.,  Lgn.,  Graph.) 
Oleand.,  Sep.,  Plat.,  Puis.,  Sabad.,  Par.,  &c. 


SLEEPLESSNESS.  565 

Animals,  dreams  of  (sleep  disturbed  by) :  Am.,  Merc,  Bella.,  Phosph., 

Hyosc,  Sil.,  Ac.  sulph.,  Nux  v.,  Sulph.,  Sec. 
Apprehension  (attended  with)  :  Arsenicum. 
Assassins  (dreams  of) :  Belladonna,  Silica,  &c. 

Bodies,  mutilated  :  Am.,  Nux  v.,  Con. 

Business,  Occupations,  Events  of  the  Day:  Nux  v.,  Bry.,  Puis., 

Sulph.,  Bella.,  Lye,  Merc,  Sil.,  Oic,  Hep.,  Phosph.,  Rhus,  Ac.  nitr., 

Magn.,  Staph.,  Stan.,  &c. 
Business,  of  urgent :  Nux 


Cares,  of:  Arsenicum. 

Complicated,  confused  dreams :  Aeon.,  Alum.,  Bar.,  Bry.,    China, 

Hell.,  M.  arct.,  M.  aust.,  Magn.,  Phosph.,  Puis.,  Sil.,  Valer.,  Cann., 

Cic,  Stann.,  Sec. 
Contradictory,  irritating :  Asar.,  Aeon.,  Ambr.,  Amon.,  Anac,  Ars., 

Calc,  China,  Cina,  Big.,  Lye,  Ign.,  Mag.  m.,  Mur.  ac,  Natr.,  Nux  v., 

Op.,  Phosph.,  Rheum,  Rhus,  Sil.,  Staph.,  Sulph.,  Bry.,  Calc,  &c. 
Continued  after  waking :  Aeon.,  Bry.,  Natr.,  Calc,  Ign.,  Natr.  c,  Sec. 
Cruelties,  dreams  of:  Nux  v.,  Silica. 

Dangers,  of :  Anac,   Calc  ph.,  Con.,  Hep.,  Kali,  Nitr.,  Ran.,  Thuj., 

Sulph. 
Darkness,  of:  Arsenicum. 
Death,  of:  Ars.,  Magn.,  Thuja.— Anac,  Am.,  Calc,  Graph.,  Kali,  Lye, 

Magn.  m.,  Phosph.,  Phosph.  ac,  Plat.,  Sassa.,  Ac  sulph.,  Verb.,  Lach., 

Cocc,  Con.,  Puis.,  &c. 
Death,  dreams  with  fear  of :  Alum.,  Thuja. 
Demons,  dreams  of:  Kali  carhonicum,  Natrum  carbonicum. 
Disease,  of:  Nux  vomica. — Calc,  Cocc,  Kreos.,  Kali.- — Amm.  m.,  Bar., 

Hep.,  Phosph.,  Sil. — Anac,  Bros.,  M.  arct.,  Can.,  Scill.,  Zinc 
Disgusting  dreams  :    Nux  v. — Stilph.,  Magn.  m.,  Natr.  m.,    Zinc. — 

Aurum,  Anac,  Chel.,  Kreos.,  Mur.  ac,  Phosph.,  Puis. 
Disagreeable,  unpleasant :  Nux  v.,  China,  Laur.,  Phosph.,  Natr.  m., 

Rims,  he. 
Dancing,  of:  Magnesia  carbonica,  Magnesia  muriatica. 
Disappointments,  Mortifications,  of:  Big.,  Mosch.,  Ign.,  Staph., 

Rheum,  Sec. 

Falling,  of:   Thuja, — Amm.  m.,  Big.,  Aur.,  Bella.)  Kreos.,  Hep.,  Magn. 
m.,  Merc,  Sep.,  &c. 


566  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Fantastic  dreams :  Calcarea,  Natrum  muriaticum,  Opium. — Carb.  a., 

Con.,  Graph.,  Kali,  Lye,  Natr.  c,  Sep.,  Sulph. — Bary.  c,  Carb.  v.,  Lack., 

Nux  v.,  Sil.,  Spong.,  Led.,  Amb.,  Puis.,  Sec. 
Festivities  (dreams  of) :  Antimonium  cruclum,  Mgs.,  Ac.  nitr.,  Sec. 
Fire,  of:  Hepar  sulphuris,  Magnesia  carbonica,  Magnesia  murialica. — 

Anac,  Croc,  Phosph. — Alum,  Ars.,  Bella.,  Calc,  Kreos.,  Laur.,  Mag. 

austr.,  Spig.,  Sulph.,  Sulph.  ac,  &c. 
Floods,  of:  Magnesia  carb.,  Mercurius,  Natrum  carb. 
Flying,  of:  Natrum  sulphuricum. 
Frightful  dreams  (sleep  disturbed  by) :  Nux  v.,  Op.,  Cocc,  Graph., 

Puis.,  Lye,  Merc,  Phosph.,  Ban.  sc,  Sass.,  Sep.,  Sulph.,  Calc,  Bella., 

Ars.,  Lach.,  Ac  nitr.,  &c. 
Furunculi:  Pmnus  spinosa,  &c.     (See  Breams  of  Biseases.) 

Haemoptysis  (dreams  of)  :  Mephites,  &c.     (See  Breams  of  Biseases.) 
Hemorrhage:  Phosphorus,  Sec.     (See  Breams  of  Biseases.) 
Historical,  dreams  :  Amm.  c,  Mercurius,  &c. 

Indecision,  of:  Arnica  montana. 

Ignominious,  Humiliating  dreams  :  Moschus,  Asar.,  Alum.,  Am., 
Am.,  Con.,  Staph.,  &c. 

Learned  Subjects,  of:  Lgnatia,  M.  arct. 

Linen  (of  foul) :  Kreosotum. 

Lively,  Vivid  :  Phosphorus,  Rhus  toxicodendron,  Sulphur,  Silicea. — 
Nux  v.,  Puis.,  Op.,  Lye,  Calc,  Anac,  Am.,  Bella.,  Bry.,  Cic,  Mag., 
Mar.,  Natr.,  Phosph.  ac,  Sabad.,  Sep.,  Stann.,  Ambra.,  Ars.,  Carb.  v., 
Clem.,  Cham.,  Con.,  Lach.,  Croc,  Graph.,  Bros.,  Mgs.,  Mag.  arct., 
Magn.,  Mar.,  Mur.,  Mosch.,  Mur.  ac,  Natr.  m.,  Petr.,  Bheum,  Spig., 
Staph.,  Tart.,  Stram.,  Valer.,  Viol,  tr.,  &c. 

Losses,  of:  Mephites. 


Marriage  : 

Meditation,  Reflection  (dreams  with) :  Bryonia,  lgnatia,  Nix  vo- 
mica.—Lach.,  Anac,  Sabad.,  Sabin.,  Thuja,  Aeon.,  Am.,  Camph.,  Carb. 
a.,  Graph.,  M.  arct.,  M.  austr.,  Puis.,  Rhus,  Sec. 

Misfortunes,  dreams  of:  Nux  vomica,  Pulsatilla,  Bycopodium,  Gra- 
phites, Thuja. — Amm.  m.,  Am.,  Bella,  Cham.,  China,  Kali  c,  Phosph., 
Sassa.,  Sulph.,  Sulph.  ac. — Alum.,  Anac,  Ars.,  Cocc,  Ign.,  Led.,  Merc, 
Ran.  bulb.,  Staph.,  Sec. 

Money,  of :  Cyclamen,  Magnesia,  Pulsatilla. 


SLEEPLESSNESS.  567 

Murders,  or  crimes:  Bella.,  Lye,  Natr.  m.,  Nitr.ae,  Rhus  vernix, 
Silicea. 

Perplexing  dreams  :  Arsenicum,  Graphites.  (See  Complicated,  Con- 
fused Dreams?) 

Pleasant,  Agreeable  :  Calcarea, Natrum  carhonicum,  Opium,  Pulsa- 
satilla,  Sepia,  Staphysagria,  Viola  tricolor. — Ant.  c,  Aw\,  Carb.  a., 
Graph.,  Kali,  Lacli.,  Magn.,  Natr.  m.,  Phosph.,  Phosph.  ac,  Plat.,  Sil., 
Alum.,  Amm.  m.,  Carb.  v.,  Croe,Magn.,  Ars.,  Bary.,  Bism.,  Cocc,  Coff., 
Ign.,  Hyos.,  Magn.  m.,  Merc,  Ac.  nitr.,  Olead.,  Spig.,  Thuj.,  Veratr., 
&c.  &c. 

Poetic  :  Lachesis,  Calcarea,  Spongia,  Amm.  c. 

Poisoning,  of :  KreosoUcm,  &c. 

Projects,  of:  Anacardium. 

Pursuits  :  Kreosotum. 

Quarrels  :  Nux  vomica,  Am.,  Magn.,  Phosph.,  Stann.,  Alum.,  Aw., 
Calc,  Hep.,  M.  austr.,  Puis.,  Selen.,  Staph.,  &c. 

Realities,  dreams  which  appear  to  be  :  Natrum  carbonicum,  Natrum 

muriaticum. 
Remembrance  with,  of  things  forgotten :  Caladium. 
Remembrance,  dreams  of  which  one  loses  the :  Bella.,  Hell.,  Cic, 

Cocc,  Lye,  Selen.,  Spig.,  Tar  ax.,  Veratr.,  Vil.,  Am.,  Aur.,  Bry.,  Con., 

Lack,  Laur.,  M.  arct.,  Men.,  Merc,  Natrum  m.,  Rims,  Sabad.,  Stram., 

Sulph.,  &c. 
Repentance,  dreams  of:  Arsenicum. 
Reproaches  :  Arnica. 
Revolts  :  Mercurius. 
Robbers  :  Magnesia  carbonica,  Merc,  Magn.  m.,  Alum.,  Aur.,  Kali,  Sil., 

Natr.  c,  Plumb.,  Veratr. 

Sad,  Melancholy  dreams  :  Rheum,  Lye,  Spong. 

Serpents,  or  Reptiles  (dreams  of) :  Kali  carbonicum. 

Shots  :  Hepar  sulphuris,  Mercurius. 

Show:  Kreosotum. 

Spectres,  or  Frightful  Visions :  Alum.,  Bella.,  Calc,  Ammon.  c,  Carb. 

v.,  Ign.,  Kali  c,  Merc,  Ac  nitr.,  Puis.,  Sil.,  Stclph.,  Nux  v. 
Storm,  of  a :  Arnica,  Arsenicum,  Euphr.,  Natr. 

Teeth,  of  the  falling  out  of  the  :  Nux  vomica. 
Threats,  of:  Arsenicum, 


568  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

Travels,  Voyages,  Journies  :  Magnesia  carbonica,  Natrum  carlo- 

nicum,  Opium,  Amm.  m.,  Amm.  c,  Magn.  m. 
Typhus  Fever,  of  death  from  :  Kali  chloroticum. 

Vermin,  dreams  of:  Nux  v.,  Acid,  muriat.,  CAel.,  PAospA.,  Am.  c 

War,  of:  TAuja,  Verb.,  Plat.,  Per. 

Water,  of :  Ammon.  muriat.,  Graph.,  Magn.,  Alum.,  Big.,  Kali,  Magn.  m., 

Merc,  Pan.  bulb.,  Sil.,  &c. 
Water,  of,  desire  to  void,  (of  inclination  to  urinate) :  Kreosokim. 

Sleep)  disturbed  or  prevented  by  : 

Excitement  (nervous)  ColcA.,  Merc,  Coffea,  Nux  v.,  LacA.,  Amb., 
CampA.,  CantA.,  Caps.,  CAin.,  Hyos.,  MoscA.,  Puis.,  Sep.,  Lye,  Laur., 
Ac.  nitr.,  Mags,  aust.,  Teuc,  &c. 

—  vascular  :  Pry.,  Nuos  v.,  Puis.,  Sep.,  Sil.,  Calc,  Baryt.  c, 
Natr.  m.,  Carb.  a.,  Merc,  PAospA.,  Sabin.,  Sep.,  Am.  c,  Asar.,  PAus, 
Pan.,  Sec. 

—  by  vascular,  in  the  chest :  Puis.,  Cyc 

—  vascular,  in  the  head :  Puis. 

Abnormal  states  during  sleep  : 

Eyes,  open :  Bella.,  Op.,  Bry.,  Veratr.,  SulpA.,  Coloc,  PAospA.  ac,  Per., 
Sell.,  Tart.,  Samb. 

—  convulsed  :    Op.,  Hell.,  PAospA.  ac 

—  fixed :  Tart. 


Face,  puffiness  of  the : 

—  coldness  of  the:  Belladonna. 

—  paleness  of  the :  Belladonna. 

—  redness  of  the  :   Op.,  Arnica,  Viola  tricolor. 
Fatigue,  feeling  of,  during  sleep:  Kreos.,  Antim.,  Ambra. 
Fear,  during  sleep :  Carb.  v.,  Puis.,  Cocc 

—  or  dread  of  losing  one's  reason  :  Calc  carb. 
Fright  :  Puis.  Silica,  SulpA.,  Veratr.,  Kali  c,  Am.,  Tab. 

Gastric  sufferings :    CAam.,  Con.,  Hep.,   Kali,  Ac.  nitr.,  Sil.,  PAus, 
Graph,  &c. 


SLEEPLESSNESS.  569 

Grinding  of  the  teeth  :  Ars. 

Hallucinations  :  Bella.,  Cham,,  Sulph.,  Led.,  Merc,  Phosph.,  Stram. 
Hands,  coldness  of  the :  Bella.,  Merc.,  Carl.  v. 

—  heat  in  the  :  Lack.,  Staph. 

Head,  pain  in  the  :  Sulph.,  Merc.,  Lye,  China,  Calc,  Carlo,  v.,  Cham., 
Con.,  Hep.,  Haem.,  Kreos.,  Mag.,  Ac.  nitr.,  Phosph.,  Phosph.  ac,  Puis., 
Sil.,  Mags,  arc,  Zinc,  &c. 

Head,  congestion  in  the:  Puis., Sil.,  Am,  c 

—  heat  in  the  :  Silica,  Camphora. 
Hearing,  delusions  of:  Cham.,  Sep.,  Carl.  v. 
Heart,  pain  in  the  :  Baryta  carl. 

— •       palpitation  of  the :  Ars.,  Lye,  Puis.,  Sulph.,  Merc,  Acid,  nitr., 

Calc,  Baryt.  c,  Natr.,  Agar.,  Bide,  Sec. 
Heat,  general:    Nux  v.,   Puis.,   Lach.,    Cham.,    JDulc,  Hep.,   Merc, 

Magn.  m.,  Calc,  Petr.,  Phosph.,  Bry.,  Ars.,  Natr.  m.,  Sep.,  Sil.,  Carl.  a. 

et  v.,  Bry.,  Viol,  tr.,  Alum.,  Am.  c,  Colch.,  Graph.,  Stilph.,  Sec. 
Heat,  with  anxiety  :  Puis.,  Natr.  m. 

—  with  dread  of,  or  aversion  to  being  uncovered :  Magn 


Ideas,  sleep  disturbed  or  prevented  by  flow  of:  Nux  v.,  Puis.,  Coffea, 

Lye,  China. — Sulph.,  Calc,  Staph.,  Sil.,    Graph,,  Hep.,  Kal.,    Cocc, 

Led.,  Salad.,  Bar.,  &c. 
Ideas,  by  fixed :  Pulsatilla. 

—      gloomy,  annoying :   Graph.,  Rhus,  Alumina. 
Inquietude,  restlessness  in  the  limbs,  (sleep  disturbed  by)  :   Puis., 

Nux  v.,  Sulph.,  Kreos.,  China. 
Itching,  or  tickling  in  the  body:  Nux  v.,  Puis.,  Merc,  Sulph.,  Thuj., 

Am.  c,  Am.  m.,  Baryt.  c,  Cocc,  Croc,  Kreos.,  Mez.,  Berl.,  Sec. 

Jactitation  :  Aeon.,  Ars.,  Bella.,  Cham.' — Coffea,  Alum.,  Asa.,  Calc, 
Lach.,  Hep.,  Kreos.,  Plat.,  Guaj.,  Hell.,  Tart.,  Nix  v.,  Op.,  Gran., 
Carl.  a.  et  v.,  Merc,  Puis.,  Rhod.,  Phosph.,  Sil.,  Jalap,  Clem.,  Cin.,  &c. 

Jaw,  hanging  of  the,  during  sleep :  Nux  v.,  Op. 

Jerking,  Shocks,  Starts  or  twitchings  (sudden) :  Ami.,  Ars.,  Bella., 
Cupr.,  Kali.,  Lye,  Natr.,  Puis.,  Sil.,  Sulph.,  Tart.,  Thuj.,  Carl,  v., 
Cham.,  Op.,  Lgn.,,Con.,  Staph.,  Sep.,  Mgs.  arc,  Merc  c,  Phosph., 
Cast.,  Sec. 

Jerkings,  or  Convulsions  in  the  eyes  :  Cocc,  Puis. 
—  —  in  the  face :  Op.,  Rheum. 


570  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

Jerkings,  or  Convulsions  in  the  fingers:  Coce,  Rheum,  Ac.  sulph., 
Anac,  Ars. 

—  —  in  the  feet :  Phosph.,  &c. 

—  — :  of  the  head:  Coce,  Magnetus  polusArcticus 

—  —  of  the  legs  :  Phosphorus. 

—  —  of  the  mouth  :  Op.,  Anac,  Puis. 

—  —  of  the  tendons  (subsultus  tendinum)  : 
Belladonna. 

Joints,  sleep  disturbed  by  pain  in  the  :  Silicea. 

Lamentations  (during  sleep) :  Stan.,  Nux  v.,  Alum.,  Phosph.,  Sulph. 
Lancinations,  or  shooting  pains  indifferent  parts  of  the  body: 

Cann.,  Buph. 
Laughter  (during  sleep) :  Alumina,  Bycopod.,  Stram. 
Limbs,  pains  in  the :    Nux  #.,  Lack.,  Sulph.,  Calc.,  Con.,  Ac.  nitr., 

Am.  c,  Am.  m.,  Anac,  Berb.,  Card,  v.,  Phosph. 
Loins,  pains  in  the  :  Am.  m.,  Berh.,  Kreos. 

Mastication  (while  sleeping)  :  Calcarea. 

Meditation,  reflection,  during  sleep :  Back.,  Anac,  Bry.,  Ign. 

Moaning,  during  sleep  :  Bach.,  Puis.,  Acid,  m.,  Ipecac,  Bella.,  Alum., 

Bry.,  Nux  v.,  Cham.,  Op.,  Sulph.,  Lye,   Veratr.,  Phosph.,  Ars.,  Am., 

Rheum,  &c. 
Murmurs,  or  muttering  during  sleep  :  Op.,  Sulph. 
Mouth  open,  during  sleep :  Op.,  Merc,  Rhus,  Samb.,  Mgs. 

Nightmare  {Incubus.  Bphialtes) :  Nux  v.,  Puis.,  Op.,  Sulph., — Silicea, 
Ruta,  Valeriana,  Aeon.,  Am.  carb. — Bye,  Magn.  m.,  Natr.  m.,  Bry., 
Hep.,  Con.,  Bella.,  Am.  m.,  Kali,  Alum.,  &c. 

Oppression  at  the  chest  (during  sleep,  or  at  night  and  preventing 
sleep)  :  Arsen.,  Carb.  v.,  Cham.,  Graph.,  Sulph., — Calc,  Bye,  Op., 
Aeon.,  Alum.,  Kali,  Kali  ch.,  Phosph.,  Ran.,  &c. 

Pollutions,  during  sleep :  Kali  c,  Kali  h.,  Sulph.,  Bye,  Ac  phosph., 
Phosph.,  Con.,  Carb.  v.,  Puis.,  Petr.,  Bed.,  Par.,  &c. 

Quarrelling,  during  sleep  :  Ars. 

Respiration,  intermittent,  during  sleep  :  Opium. 
—  rapid,  accelerated :  Aeon. 


SLEEPLESSNESS,  571 

Respiration,  short :  Aeon.  Cham.,  Rhus,  Mere. 

—  slow :   Op.,  Cinchona. 

—  Wheezing,  whistling :  Nuxv. 

Scrobiculus  cordis,  pain  in  the :  Cede,  c,  Kali  e. 

Sighs,  during  sleep :  Lack,,  Merc. 

Singing  :  Bella.,  Croc,  Phosph.  ac,  Mgs.  arc. 

Sliding,  or  sinking  down  to  the  foot  of  the  bed  during  sleep  :  Ars., 

Acid.  m. 
Snoring  loud,  or  stertorous  breathing :  Op.,  Cart,  v.,  Stram.,  Nux  v., 

Ign.,  Cham.,  Sulph.,  Sil.,  China.,  Rheum,  Rhus,  &c. 
Somnambulism  :  Op.,  Bry.,  Phosph. — Alum.,  Natr.  m.,  Sil.,  Sulph. 
Soreness  of  the  throat  (pain  in  the)  during  sleep ;  Ammon.  m. 
Starts  :  A^nb.,  An.,  Bella.,  Cham.,  Cupr.,  Bros.,  Hep.,  Lye,  Puis.,  Sil., 

Sulph.,  Tart.,  Thuja. — Nux  v.,  Hep.,  Calc,  Carl,  v.,  Chin.,  Cocc,  Castor, 

Baph.,  Hyos.,  Aeon.,  Agn.,  Alum.,  Am.  c.,  Ant.  c.,  Merc.,  Magn.,  Ign., 

Bach.,  Kali,  Plumb.,  &c. 
Starts,  when  touched  :  Stram. 

—       with  gestures  indicative  of  fright  or  terror  :  Stram. 
Stomach,  pain  in  the  :    Bye,  Con.,  Alum.,  Graph.,  Kali,  Am.  c,  Acid. 

nitr.,  Sulph.,  Sil.,  Rhus,  Sen.,  &c. 

Talking,  during  sleep :  Puis.,  Sulph.,  Nux  v.,  Ahim.,  Am.,  Ars., 
Bella.,  Calc,  Camph.,  Carlo,  a.  et  v.,  Cham.,  Kali,  Magn.,  Magn.  m., 
Merc,  Muriat.  ac,  Natr.  m.,  Nitr.  acid.,  Phosph.,  Phosph.  acid.,  Plumb., 
Sep.,  Sil.,  Stram.,  &c. 

Toes,  pains  in  the,  during  sleep  :  Am.  carb. 
Trembling  :  Eiophorbium. 

—  internal :  Natrum  m. 

Uncovering  of  the  arms,  &c,  during   sleep :    Plat.,    Corr.  mbra, 

Magn.  polus  arcticus. 
Uneasiness,  general,  sensation  of,  during  sleep :  Ars.,  Merc 
Urine,  emission  of,  during  sleep  :  Am.  carb.,  Am.  muriat.,  Bach.,  Con., 

Graph.,  Hepar,  Bella.,  Ars.,  Baph.,  lod.,  Cup.,  Coffea,  Natr.  m.,  Sulph., 

Calc,  Carb.,   Op.,  Bye,  Sep.,  Sil.,  Merc  Petr.,  Mgs.  aus.,  Cin.,  &c. 

(See  Enuresis.) 
Vertigo  :  Sulph.,  Calc,  Am.  c,  Natr.,  Phosph.,  Spong.,  &c. 
Visions,  during  sleep  :  Bella.,  Cham,,  Bed.,  Merc,  Phosph.,  Phosph,  ac> 

Stram.,  Sulph, ,  &c. 


572     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Visions,  frightful  :    Bella.,  Sulph.,  Calc,  Card,  v.,  Merc,  Sil. 

—       horrible :   Card,  anim.,  Sec. 
Voluptuous,  sleep  retarded  or  disturbed  by:  Calc.  carl. 

Weeping,  during  sleep:  Puis.,  Sulph.,  Calc,  Nux  v.,  Alum., Am., Ars., 
Bella.,  Camp7i.,  Carlo  a.  et  v.,  Cham,,  IKali.,  Magn.,  Magn.  m.,  Mgs., 
Merc,  Mur.  ac,  Natr.  m.,  Nitric  acid.,  Phosph.,  Phosph.  acid-,  Plumb., 
Rhus,  Salin.,  Sep.,  Sil.,  Stann.,  Tart.,  Zinc 


Sleep,  Lethargic,  stupefying :  Aeon.,  Ant.,  Bella.,  Calad.,  Camph., 
Graph.,  Bach.,  Nux  v.,  Op.,  Puis.,  Hyos.,  Laur.,  Led.,  Mosch.,  Nux 
mosch.,  Phosph.  ac,  Plumb.,  Stram.,  Tart.,  Veratr.,  Mag.  arc,  &c. 

Sleep,  lethargic,  alternately  with  sleeplessness  :  Bachesis. 

Somnolency,  or  drowsiness  in  the  open  air :  Tartarus. 

—  day  and  night :  Baryta,  c 

—  in  the  evening  :  Ant.,  Ars.,  Tart. 

—  in  the  forenoon ;  Ant.  crudum. 

—  in  the  morning  :  Mephites  putorius. 
Sleep,  broken,  interrupted  :  Cocc,  Ars.,  Big.,  Par.,  Zinc 

—  incomplete,  imperfect,  half  asleep  :  Ars.,  Bella.,  Bry.,  Bach., 
Merc,  Hepar.,  Cham.,  Cocc,  Op.,  Acid,  nitr.,  Cic,  Euph.,  Sil.,  M.  arc, 
Graph.,  Kali,  &c. 

Sleep,  light:  Nuxv.,  Bach.,  Ign.,  Sulph.,  Merc,  Aeon.,  Alum.,  Ars., 
Sel.,  Sil.,  Calad.,  01.  an.,  Tart. 

Sleep,  protracted,  too  prolonged  :  Merc,  Stdph.,  Plat.,  Puis.,  Hepar, 
Berl.,  Bar.,  01.  an.,  Phil.,  &c. 

Sleep,  profound  :  Ant.  tart.,  Nux  mosch.,  Op. — Ars.,  Bella.,  Ign.,Baur., 
Bed.,  Mgs.,  Phosph.  ac,  Puis.,  Bhod.,  Sec.  corn.,  Seneg.,  Stram.,  Veratr., 
Aeon.,  Anac,  Ant.  c,  Bar.,  Bry.,  Camph.,  Con.,  Croc,  Cup.,  Hyos., 
Petr.,  Phosph.,  Ruta,  Sep.,  Spig.,  Zinc,  &c. 

Sleep,  unrefreshing :  Bry.,  Con.,  Hepar,  Op.,  Sulph. — Ami.,  Bism., 
Calc,  Cann.,  Bach.,  Bye,  Natr.  m.,  Nitric  acid,  Petr.,  Selen.,  Sil., 
Staph.,  Ahim.,  Am.  m.,  Anac,  Carl,  a  et  v.,  Cham.,  Kali,  Mag.  arc, 
Magn.,  Magn.  m.,  Merc,  Ban.  lull.,  Sepia,  Spig.,  Stann.,  Stram., 
Veratr.,  Sec. 

Sleep,  of  too  short  duration  :  Nux  v.,  Calc.  carl. 

—  tendency  to  fall  asleep  when  in  the  open  air :  Aeon.,  Tart., 
M.  aust. 

Sleep,  tendency  to  fall  asleep  early  in  the  morning  :  Nux  v.,  Bach., 


SLEEPLESSNESS.  573 

Puis.,  Sulph.,  Phosph.  ac,  SiL,  Con.,  Croc,  Calc,  Carl.  v.,  Bye,  Plat., 
Sep.,  Kali,  Hepar,  China,  Sec. 
Sleep,  tendency  to,  during  exercise  :  Aeon. 

—  during  and  after  a  meal :  Nux  v.,  Sulph.,  Aeon.,  Anac,  Arum., 
Aur.,  Bor.,  China,  PhospL,  Phosph.  ac,  Verb.,  Natr.  m.,  Graph.,  Kali, 
Calc.,  SiL,  Zine.,  &c. 

Sleepiness  in  the  afternoon  :  Sulph.,  Puis.,  Bov.,  Bruc.,  Canth.,  Grat., 

Viol,  tri.,  &c.  (See  Sleep,  tendency  to,  after  a  meal.) 
Sleep,  tendency  to,  during  employment :  Sulphur. 

—  when  reading  and  writing :  Natrum  sulph. 

—  when  sitting  :  Bruc.,  Ferr.,  Mg.,  Petr.,  Tart.,  Sec. 

—  during  a  storm  :  Silica. 

—  retarded:  Calc,  Carlo  a.  et  v.,  China,  Cj/e.,  Per.,  Graph.,  Hyos., 
Kali,  Bach.,  Bye,  Merc,  Natr.,  01.  an.,  Phel.,  Phosph.,  Phosph.  ac, 
Puis.,  Ban.,  Stann.,  Staph.,  Sulph.,  Nux  v.,  Natr.  m.,  Nitr.  ac,  Sep.,  &c. 

Sleep,  retarded,  or  difficult  to  be  renewed  after  waking  during  the 
night :  Natr.  m.9  Sep.,  Sulph.,  Puis.,  Magn.,  Am.  c,  Ars.,  Berb.,  Bor., 
Per.,  Phosph.,  Ban.,  Ban.  sc,  Sec. 

Sleeplessness,  alternately  with  somnolency;  Bachesis. 

—  after  midnight :  Nux  v.,  Coffea,  Ars.,  Cap.,  Kali  carl., 
Sil. — Assaf.,  Aur.,  Cann.,  Bulc,  Hepar,  Magn.,  Natr.,  Ban.  seel.,  Sep., 
Sulph.  ac,  Aeon.,  Am.,  Ant.  c,  Bry.,  Calc,  Con.,  Bach.,  Graph.,  Merc, 
Mez.,  Nitr.  ac,  Phosph.  ac,  Plat.,  Rhus,  Staph.,  Sec. 

Sleeplessness,  before  midnight :  Bry.,  Calc  carl.,  Carl,  v.,  Merc, 
Phosph.,  Puis.,  Rhus  toxi.,  Sep. — Ars.,  Bella.,  Bar.,  Calad.,  Carl,  a., 
.  China,  Graph.,  Hep.,  Ign.,  Kali.,  Bach.,  Bed.,  Bye,  M.  aitst.,  Mar., 
Mur.  ac,  Selen.,  Spil.,  Sig.,  Sulph.,  Nux  v.,  Con.,  Alum.,  Am.  m.,  Ant. 
tart.,  Am.,  Bar.,  Kreos.,  Nitr.  acid.,  Natr.  m.,  Stann.,  Staph., 
Veratr.,  Sec. 

Sleeplessness,  with  desire  or  inclination  to  sleep  :  Bella.,  Cham., 
Phosph.,  Puis.,  Sep. — Ars.,  Bry.,  Calc,  China,  Can.,  Hep.,  Kali  c, 
Merc,  Natr.,  Nux  v.,  Phosph.  ac,  Rhus,  SiL,  Sulph.,  Carl,  v.,  Graph., 
Hyos.,  Bach.,  M.  arct.,  Natr.  m.,  Nitr.  acid.,  Staph.,  Veratr.,  Selen,  Sec. 

Sleeplessness,  arising  from  griping  pains  in  the  intestines  :  Bye, 
Plumb.,  Sep.,  Staph.,  Kali.,  Amir.,  Am.  c,  Am.  m.,  Magn.  c,  Magn.  s., 
Natr.,  Ac.  nitr.,  Bhus,  Phosph.,  Sec. 

Waking,  difficult  and  retarded  :  Nux  v.,  Calc,  Graph.,  Sepia. — Natr., 
Natr.  m.,  Nitr.  ac,  Phosph.  ac,  Tab.,  Teuc,  Alum.,  Mgs.,  Magn.  m., 
Merc,  Natr.,  Phosph.,  Phosph.  ac,  SiL,  Sulph.,  Euphr.,  Anac,  Am., 


574    DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Asaf.,  Carl,  v.,  Hep.,  Hyos,,  Kali,  Baur.,  Natr.  m.,  Nitr.  ac,  Puis., 
Veratr.,  &c. 

Waking  too  early  :  Nux  vomica,  Kali  carbonicum,  Natrum  carbonicum, 
Banunculus  bulbosus. — Ars.,  Atir.,  Caps.,  Bulc,  Magn.  c,  Mur.  ac, 
Sulph.  ac,Assqf.,  Calc,  Graph.,  Hep.,  Lack.,  Mang.,  Merc,  Mez.,  Nitr., 
Nitr.,  ac,  Plat.,  Ban.  so.,  Bhocl.,  Sep.,  Sil.,  Staph.,  Thuja,  &c. 

Waking  early 5  and  always  at  the  same  hour :  Selenmm. 

—  incomplete  :   Conium. 

—  with  a  start :  Amb.,  Ars.,  Bella.,  Cham.,  Bros.,  Hep.,  Lye, 
Bids.,  Sulph.,  Bheum.,  Tart.,  Thuja,  Bry.,  Graph.,  Carbo  v.,  Calc,  &c. 

Waking  at  the  slightest  touch  (generally  with  a  sudden  start  or  cry)  : 

Selenium. 
Waking  at  the  slightest  noise  :  Selenium. 

—  early^  from  a  feeling  of  coldness  :  Aciclum  muriaticum,  Fer.  mg. 
Waking  caused  by  violent  shocks  or  jerks  in  the  head  and  neck  : 

Magnetis  polus  arclicus. 
Waking  caused  by  a  feeling  of  suffocation  or  obstructed  respiration  : 

Hepar,  Ipecac,  Sambucus  nigra. 
Waking  w-ith  headache :  Bachesis,  Belladonna,  Anacardium,  Berb.,  Fer. 

mg.,  Bheum. 
Waking  with  colic :  Hmmatoxylum  campechianum. 

—  congestion  in  the  head  :  Berberis. 

—  congestion  and  heat  in  the  legs  :  Mephites  putorius. 

—  diarrhoea:  Hcematoxylmm. 

—  dizziness  or  giddiness  :  Ars.,  China,  Flat.,  Puis.,  Sol.  m. 

—  erections :  Bachesis, 

—  fear  of  gosts  or  spectres :  Sulphur. 

—  hallucinations:  Sulphur. 

—  hunger:  Belladonna. 

—  vexatious  thoughts  or  ideas  :  Alumina. 

—  lassitude  in  the  arms  :  Ferrum  magneticum. 

- —  lassitude  general^  or  fatigue.     See  Sleep,  unrefreshing. 

—  pains  in  the  limbs  :  Ntix  vomica,  Bachesis. 

—  pains  as  if  beaten  :  Bachesis,  Viola  odorata. 

—  pains  in  the  loins :  Bachesis. 

—  a  sensation  of  paralysis :  Kreosotum. 

—  perspiration:    Merc,  Clem.,    Chel.,    Cic,    Bros.,    Fer. 
mg.,  &c. 

Waking  with  rigidity  or  stiffness  in  the  limbs :  Bachesis. 

—  stretchings  and  convulsive  yawning :  Nux  v. 


SLEEPLESSNESS.  575 

Waking,  with  bitter  taste :  Bryonia,  Rhus  toxicodendron,  &c. 

—  putrid  taste :  Rheum,  Sec. 

—  tears,  cries,  &c. :  Mercurius. 

—  thirst :  Berberis. 

—  sore  throat :  Lachesis. 

—  trembling :  RatanJiia,  Sambucus. 

—  visions  (visions  are  seen  on  waking) :  JDulc,  Sulph. 

—  weakness  in  the  knees  :  Ferrum  magneticum. 

Yawning,  incessant :  Bry.,  Can.,  LJuph.,  Lye,  Oleand.,  01.  an.,  Phett., 

Rhus,  Staph.,  SulpJi.,  Viol,  od.,  Zinc.,  Nux  v.,  Puis.,  Ign.,  Amm.,  Ant. 

tart.,  Am.,  Ars.,  Bry.,  Cina.,  Kreos.,  Che\.,  Croc,  Laur.,  M.  arct.,  Men., 

Mtor.  ac,  Natr.  m.,  Oleand.,  Bar.,  Phosph.,  Ph.  ac,  Sabad.,  Sassqfr., 

Sep.,  Sil.,  Stann.,  Staph.,  Ahim.,  China,  Card,  v.,  Sulph.,  Merc,  Veratr., 

Bella.,  Caps.,  Bar.,  Canth.,  Hep.,  Zinc,  &c. 
Yawning,  abortive :    Lycopodium,    Cham.,   Ruta,   Aeon.,   Ign.,  Croc, 

Phosph. 
Yawning,  violent:  Ignatia,  Hepar,  Platina,  BJms,  Agar., Mosch.,  Cor., 

Per.  mg.,  Magn.,  Mgs.  arc. 
Yawning,  spasmodic  :  Platina,  BJms. — Ignatia,  Hepar,  M.  arc,  Sep. — 

Ang.,  Bry.,  Cap.,  M.  aust.,  Mosch.,  Laur.,  Natr.  m.,  Scill. 
Yawning,  without  feeling  sleepy :  Platina,  Rhus. — Ign.,  Mag.  arc, 

M.  aust.,  Sep.,  Bry.,  Hep.,  Lach.,  Scill.,  Ang.,  Natr.  m.,  Mosch.,  Cham., 

Cup.,  SulpJi.,  StapJi.,  Alum.,  Amm.  m.,  Sec. 
Yawning,  frequent,  in  the  afternoon :  Canth.,  Ign.,  Plat. 

—  —  morning :  Nux  v.,  Ign.,  Viol.  od. 

—  while  walking :  EupJwrhium. 

—  —  Natrum  sulphuricum. 

—  Cutis  anserina ;  Lauroceresus,  Paris  quadrifolia. 

—  shaking,  shivering,  or  shuddering :  Laur.,  Kreos.,  Natr.  s., 
Par.,  Sil. 

Yawning,  lachrymalian :  MepJi.,  Violod.,  Staph.,  Kreos. 

—  with  oppression  or  tightness  at  the  chest :  Stannum. 

—  stretching:    StapJi.,  Nux  v.,  CJiina,   Guaj.,  Natr.  s., 
01.  an.,  Ruta,  Sabad.,  CantJi.,  Oniscus,  Tart.,  &c. 

Yawning,  with  tremor:  Cina,  Oleander. 

—  vertigo :  Agaricus  rmiscarius. 


576  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 


Position  during  Sleep. 

Arms  above  the  head  (during  sleep)  :  Pulsatilla,  Nux  v.,  Plat.,  Calc, 

Coloc. — Rheum,  Ruta,  Thuja,  Veratr.,  Sulph. 
Arms  across  the  abdomen  :  Pulsatilla,  Coc,  Mags* 

Back,  on  the  (dorsal) :  Bryonia,  Pulsatilla,  Rhus. — Nux  v.,  Sulph.,  Calc, 
Lye.,  Ign.,  Cic.,  Ferr. — Aeon.,  Ant.  tart.,  Aur.,  China,  Coloc.,  Dros.y 
Mgs.,  Mgs.  arct.,  Phosph.,  Plat.,  Viol.,  &c. 

Hands  under  the  head  :  Nux^  v,,  Ars.,  Bella.,  Plat.,  Coloc.,  Men. — Aeon., 
Amir.,  Ant.  tart.,  Ign.,  Mgs.,  M.  ausl.,  Puis.,  Rhus,  Sabad.,  Spig., 
Viol.  od. 

Head  inclined  forwards,  with  the:  Staph.,  Aeon.,  Puis.,  Cic.,  Cup., 
Viol.  od. 

Head  inclined  to  one  side :   Cina,  Spong.,  Tar  ax. 

—  elevated^  high,  with  the  :  Sulphur. 

—  low,  or  buried  under  the  bedclothes  :  Spong.,  Am.,  Sep.,  Nux  v. 

—  thrown  back,  with  the :  Bella.,  Cina,  Spong. — Cic,  Hep.,  Hyos., 
Ign.,  Sep. — China,  Nux  v.,  Cap.,  Mgs.,  Stan.,   Viol.  tr. 

Knees,  bent :    Viola  odorata,  Ambr.,  Mgs. 

Legs  drawn  up :    Puis.,  Plat.,   Card,  v.,  Stann. — Anac,   Cham.,  Chin., 

Mang.,  Men.,  Rhod. 
Legs  widely  separated :    Cham.,   Puis.,   Bella.,   Plat.,   Rhus. — Agar., 

China,  Pule. 
Legs,  one  of  the,  bent,  the  other  extended  :  Stannum. 

—  crossed :  Rhodendron  crysanthum. 

—  stretched  out :   Cham.,  Plat.,  Mgs.,  Puis.,  Viol.  od. 

Seated  (in  a  sitting  posture) :  Sulph.,  Cina.,  Bye,  Ars.,  Rhus. — China, 

Hep.,  Phosph.,  Puis.,  Sabin.,  Spig. 
Forwards  :  Cic.,  Cap. 
Side,  on  the  left :  Baryta  carbonica,  Sabina. 

Positions  in  which  it  is  impossible  to  recline  or  sleep* 

Back,  on  the ;  Phosphorus. 

Recumbent  posture,  inability  to  remain  in  the  :  Sulphur,  Lycopodium. 

Side :  Aconitum,  Sulphur. 

—  left  (incapability  of  lying  on  the) :  Lycopodium. 


NIGHTMARE.  577 


NIGHTMARE. 
Incubus.     Ephialtes. 

When  this  well-known  and  distressing  disturbance  occurs  very 
frequently  in  an  aggravated  form,  it  becomes  necessary  to  prescribe 
for  it.  The  homoeopathic  remedies  which  have  chiefly  been  em- 
ployed against  it  to  the  best  advantage  are  Aconitum,  Nux  #.,  and 


Aconitum.  When  there  is  considerable  febrile  excitement,  with 
quickness  of  pulse,  thirst,  palpitation  of  the  heart,  oppression  at  the 
chest,  anxiety,  and  agitation. 

Nux  v. :— When  nightmare  is  occasioned  by  sedentary  habits,  the 
habitual  indulgence  in  spirituous  or  malt  liquors,  &c. 

Pulsatilla  : — When  there  is  derangement  in  the  digestive  func- 
tions, arising  from  gross  living,  heavy  suppers,  &c. 

Opium  is  a  remedy  of  importance  in  all  cases  of  a  severe  character; 
but  particularly  when,  during  the  attack,  the  respiration  is  nearly 
suspended,  or  stertorous,  the  eyes  only  half  closed,  the  mouth  open, 
the  countenance  expressive  of  extreme  anguish,  and  bedewed  with 
cold  perspiration  ;  subsultus  tendinum.  When  any  of  the  foregoing 
remedies,  but  especially  Nux  v.  and  Pulsatilla,  are  insufficient  to  effect 
a  cure,  Sulphur  or  Silicea  may  be  resorted  to  in  repeated  doses.  In 
other  cases,  one  or  more  of  the  following  may  prove  useful :  Phos- 
phorus, Ruta,  Valerian,  Ammonium  c,  and  Hepar.  Every  apparently 
exciting  cause  of  the  attacks  must  at  the  same  time  be  avoided  ;  the 
diet  should  be  light  and  wholesome ;  suppers  altogether  abstained 
from,  and  a  glass  of  cold  water  taken  instead,  on  retiring  to  rest. 

Daily  exercise  in  the  open  air,  the  shower-bath,  or  sponging  with 
cold  water  every  evening,  are  useful  preventives,  or  auxiliaries  during 
treatment. 


37 


57S  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

RUPTURE. 

Hernia. 

By  this  term  is  understood  a  swelling  occasioned  by  the  protrusion 
of  some  of  the  viscera  from  the  cavity  of  the  abdomen.  In  the  ge- 
nerality of  cases,  the  displaced  intestines  are  included  or  contained  in 
a  bag,  derived  from  the  peritoneum,  which  they  push  before  them  in 
their  descent.  The  situations  in  which  the  swelling  most  commonly 
makes  its  appearance  are  the  groin,  the  navel,  the  scrotum,  the  labia 
pudendi,  and  the  upper  and  anterior  part  of  the  thigh.  It  also  occurs 
in  the  vagina,  perinaeum,  foramen  ovale,  and  sciatic  notch,  and  occa- 
sionally at  every  point  of  the  fore  part  of  the  abdomen.  The  viscera 
which  are  most  frequently  protruded  are  the  omentum  and  the  small 
and  large  intestines,  or  a  portion  both  of  omentum  and  intestine. 
But  the  stomach,  liver,  spleen,  bladder,  uterus,  and  ovaria,  &c,  have 
been  known  to  form  component  parts  of  hernial  tumours.  ,In  con- 
sequence of  the  tumour  escaping  at  the  different  situations  above 
mentioned,  it  has  received  the  appellations  of  inguinal,*  umbilical,^ 
scrotal,^  pudendal,^  crural  or  femoral,  vaginal,  perineal,  thyroideal,\ 
ischiatic  and  ventral,  &c.  Further,  from  containing  different  kinds  of 
viscera,  it  has  been  designated  epiplocele,  when  its  contents  consist  of 
a  piece  of  the  omentum  only ;  enterocele,  when  of  a  fold  or  portion 
of  intestine ;  and  entero-epiplocele,  if  both  intestine  and  omentum  con- 
tribute to  form  the  swelling.  A  hernia  or  rupture,  for  the  most  part, 
appears  suddenly  after  some  violent  corporeal  exertion,  and  presents 
an  indolent,  and  usually  soft  and  elastic  tumour,  at  some  of  the  points 
or  situations  already  referred  to,  but  most  frequently  at  the  lower  and 
lateral  part  of  the  abdomen  (the  groin),  or  towards  the  inner  part  of 
the  bend  of  the  thigh,  or  at  the  navel  (descending  from  the  abdominal 
ring  in  the  first-mentioned  instance ;  from  below  Poupart's  ligament 
in  the  second;  and  out  of  the  umbilicus  or  navel  in  the  third).  The 
swelling  is  subject  to  a  change  of  size :  being  smaller  or  quite  im- 
perceptible when  in  the  recumbent  position ;  larger  or  only  apparent 
on  assuming  the  erect  posture,  and  particularly  when  taking  a  full 

*  Or  a  bubonocele.  t  Or  an  exomphalos.     Omphalocele. 

X  Or  an  oscheocele.  §  Or  a  bubonocele. 

(i  Or  hernia  foraminis  ovalis. 


RUPTURE.  579 

breath/ coughing^  or  sneezing;  also  on  walking  or  standing  long  after 
a  hearty  meal.  It  is  frequently  diminished,  or  caused  to  recede  com- 
pletely when  pressed  upon,  but  returns  as  soon  as  the  pressure  is 
removed.  Vomiting,  constipation,  colic,  and  other  signs  of  a  deranged 
state  of  the  stomach  and  intestines,  are  frequent  concomitants  of 
rupture,  arising  from  the  abnormal  situation  of  the  viscera. 

The  nature  of  the  contents  of  the  hernial  tumour  are  generally 
known  by  the  following  distinctions :  if  the  case  be  an  enterocele,  the 
swelling  is  smooth,  elastic,  rendered  tense  by  coughing,  or  by  holding 
the  breath ;  is  in  general  very  easily  returnable,  and  usually  attended 
with  a  gurgling  noise  when  ascending.  An  epiplocele,  or  omental 
hernia  is,  on  the  other  hand,  of  a  more  uneven  and  doughy  or  flabby 
texture ;  is  neither  made  tense,  nor  receives  any  impulse  from  cough- 
ing; is  more  compressible,  and,  if  large,  or  in  the  scrotum,  is  more 
oblong  and  heavier  that  enterocele ;  it  recedes  very  gradually,  and  its 
reduction  is  unattended  by  any  gurgling  noise. 

An  enter  o-epvplocele,  or  a  hernia  composed  both  of  intestine  and 
omentum,  has  the  characteristic  marks  less  distinct  than  either  of  the 
preceding  cases ;  when  reducible,  it  is  known,  in  pressing  back  the 
contents,  by  the  gurgling  noise  which  attends  the  ascent  of  the  in- 
testinal portion,  while  that  of  the  omentum  is  reduced  without  noise, 
and  with  greater  difficulty ;  otherwise,  the  feeling  communicated  to 
the  touch  is  often  sufficient  to  render  this  variety  distinguishable 
from  the  others. 

Causes.  The  predisposing  causes  of  hernia  are  :  general  relaxa- 
tion, or  unusual  largeness  of  the  natural  openings  of  the  abdomen. 
When  any  such  proclivity  exists,  particularly  in  children  and  the 
aged,  the  viscera  are  occasionally  protruded  by  trivial  circumstances, 
such  as  crying,  coughing,  sneezing,  or  even  by  the  act  of  a  somewhat 
full  inspiration ;  but  in  other  cases,  or  where  there  is  no  marked 
predisposition,  the  protrusion  only  takes  place  under  great  bodily 
exertion,  or  in  consequence  of  external  injury.  When  rupture  ensues 
in  consequence  of  predisposition,  or  seems  to  take  place  sponta- 
neously, its  formation  is  very  gradual ;  but  when  it  results  from  ex- 
treme corporeal  exertion,  it  appears  very  suddenly,  and  if  the  opening 
through  which  the  bowels  protrude  be  small,  as  is  generally  the  case 
in  such  instances,  there  is  much  danger  of  strangulation. 

Hernia  is  termed  reducible  when   it   can  at  airy  time  be  readily 


580     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

returned  into  the  abdomen,  and  when,  in  an  unreduced  state,  it  is 
productive  of  no  pain,  or  hinderance  to  theperformance  of  the  intes- 
tinal functions ;  irreducible,  when  it  cannot  be  replaced,  in  consequence 
of  its  bulk,  or  from  the  contraction  of  adhesions ;  and  strangulated, 
when  the  protruded  parts  are  not  only  incapable  of  being  returned, 
but  are  moreover  affected  with  constriction,  pain,  and  inflammation, 
attended  with  nausea,  frequent  retching  or  vomiting,  tension  of  the 
abdomen,  obstruction  of  the  bowels,  quick,  hard,  pulse,  and  more  or 
less  fever.  If  the  return  of  the  intestine  be  not  effected  under  such  a 
state  of  matters,  an  aggravation  of  all  the  said  symptoms  at  first 
ensues,  and  subsequently  the  vomiting  is  exchanged  for  a  convulsive 
hiccough,  with  frequent  bilious  eructations ;  after  the  abdominal  ten- 
sion, fever  and  extreme  restlessness  have  continued  for  a  few  hours 
in  an  increased  degree,  the  patient  suddenly  becomes  relieved  from 
pain,  the  pulse  low,  feeble,  and  intermittent,  the  eyes  dim  and  glassy, 
the  belly  ceases  to  be  tumid  and  tense,  and  the  skin,  particularly 
that  of  the  extremities,  becomes  cold  and  moist ;  the  hernial  swelling 
disappears,  and  the  integuments  over  the  part  often  change  to  a  livid 
hue,  but  invariably  convey  an  emphysematous  feel  or  crepitus  to  the 
touch,  indicative  of  the  establishment  of  gangrene  :  finally,  spasmodic 
rigors  and  convulsive  twitching  in  the  tendons  supervene,  and  death 
soon  terminates  the  scene. 

Therapeutics.  When  the  disease  has  not  been  neglected,  or  is 
not  of  long  standing,  it  may  very  generally,  if  not  invariably,  be  cured 
by  means  of  internal  homoeopathic  remedies. 

In  effecting  the  reduction  of  a  hernia  by  the  taxis,  the  patient 
should  be  laid  upon  his  back,  a  pillow  being  placed  under  the  chest 
and  pelvis,  so  as  to  curve  the  trunk  of  the  body,  and  thereby  relax 
the  abdominal  muscles.  If  the  case  be  one  of  inguinal  or  femoral 
hernia,  the  muscles,  &c,  of  the  thigh  must  also  be  relaxed,  by  placing 
the  limb  in  a  state  of  flexion,  so  as  to  be  rotated  inwards.  Then 
gently  compressing  the  tumour,  we  should  push  upwards  and  out- 
wards, in  the  case  of  inguinal  hernia ;  and  first  backwards  and  then 
upwards,  in  the  case  of  femoral,  if  the  tumour  be  small ;  but  first 
downwards,  and  then  backwards  and  upwards,  when  it  is  large  and 
reflected  over  Poupart's  ligament.* 

*  In  Umbilical  hernia  the  pressure  is  to  be  made  directly  backwards. 


RUPTUItE.  581 

Even  strangulated  hernia  is  capable  of  being  reduced  by  the  taxis 
with  facility,  after  the  employment  of  the  proper  remedies,  particularly 
Aconite  and  Nux  vom. ;  the  operation,  which  is  always  more  or  less 
dangerous,  being  thereby  avoided. 

In  almost  every  instance,  but  particularly  when  the  rupture  causes 
pain,  and  is  tender  to  the  touch,  the  appropriate  medicine  ought 
first  to  be  prescribed, — since,  if  the  remedy  selected  should  not 
prove  adequate  to  produce  reduction,  it  will  at  all  events  have  the 
effect  of  removing  the  irritability,  and,'  consequently,  of  rendering  re- 
placement by  the  taxis  comparatively  easy,  and  free  from  the  danger 
which  would  otherwise  have  attended  any  attempt  at  manual  reposi- 
tion, preparatory  to  the  dispersion  of  the  irritation.  In  some  cases, 
the  application  of  w7arm  fomentations  to  the  part  reduces  the  hernia, 
and  the  general  relaxing  effects  of  a  warm  bath  are  well  known  as 
being  useful  in  facilitating  reduction.  The  following  treatment  has 
been  strongly  recommended  when  the  symptoms  encountered  are  as 
described : — 

Aconitum.  When  there  is  considerable  fever,  with  quick,  hard, 
full  pulse,  inflammation  of  the  affected  parts,  with  excessive  sensibility 
to  the  touch ;  violent  burning  pain  in  the  abdomen ;  hitter >  bilious 
vomiting ;  agonizing  restlessness,  and  cold  perspiration.  A  second 
dose  to  be  given,  if  required,  an  hour  after  the  first,  or  even  a  third 
after  a  similar  interval.  In  the  majority  of  cases,  marked  benefit  has 
resulted  after  the  administration  of  the  first  dose  of  Aconitum,  under 
the  circumstances  mentioned ;  but  when  no  change  for  the  better  re- 
sulted after  the  third  exhibition,  or  when  the  bilious  eructations  and 
vomiting  become  converted  into  an  acid  character,  Sulphur  must 
be  prescribed,  and  if  the  patient  fall  asleep  thereafter,  he  should  be 
allowed  to  repose  quietly. 

When  the  tumour  is  not  so  painful  or  tender  to  the  touch, 
and  the  vomiting  less  severe,  but  the  respiration  oppressed  and 
laborious,  and  the  strangulation  has  arisen  from  errors  in  diet,  from 
exposure  to  cold,  from  being  overheated,  or  from  a  violent  fit  of  passion, 
etc.,  Nux  v.  is  to  be  preferred,  and  may  be  repeated  every  two  hours 
or  so. 

If  no  change  results  in  about  two  hours  after  the  second  dose  of 
Nux  v., — Opium  should  be  prescribed,  or  this  remedy  may  be  had 
recourse  to  from  the  first,  and  repeated  every  quarter  of  an  hour, 
until  improvement  takes  place,  should  there  be  hardness  and  disten- 
sion of  the  abdomen,  putrid  eructations,  or  even  vomiting  of  faecal 


582  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

matter.  (Plumbum  may  be  given  after  the  third  or  fourth  dose  of 
Opium,  if  no  decided  change  for  the  better  become  perceptible.) 

When  there  is  retching  and  vomiting,  with  cold  moist  skin  and 
coldness  of  the  extremities, — Veratrum  should  be  administered  and 
repeated  in  from  half  an  hour  to  an  hour  or  so ;  and  in  the  event  of 
no  favorable  turn  taking  place  after  the  second  dose, — Belladonna 
should  be  prescribed. 

When  the  case  has  been  neglected,  or  we  find,  on  visiting  the  pa- 
tient, the  malady  already  advanced  so  far  that  the  integuments  over 
the  rupture  have  assumed  a  livid  hue,  and  there  is  reason  to  appre- 
hend the  invasion  of  gangrene,  the  patient  may  yet  be  saved  by  the 
administration  of  Lachesis  in  repeated  doses;  if  no  relief  follow  in 
the  space  of  about  two  hours,  Arsenicum  may  be  tried.  Rhus  has 
also  been  spoken  of  as  being  serviceable  in  extreme  cases.  The 
operation  should  not  be  delayed,  when  symptoms  of  a  serious  character 
do  not  speedily  yield  to  the  remedies  indicated;  but  the  latter  should 
always  be  tried  first,  as  no  bad  consequences  will  result  from  the  delay 
under  the  precautions  stated ;  on  the  contrary,  the  subsequent  manual 
treatment  has  been  found  to  be  thereby  materially  facilitated. 

[The  following  practical  remarks  of  M.  Traub,*  on  the  homoeo- 
pathic treatment  of  incarcerated  hernia,  appear  to  us  to  require  no 
apology  for  their  insertion  here.] 

Incarcerated  Ruptures.      {Hernia  incarcerate.) 

Incarcerated  herniaebelong  undeniably  to  those  diseases,  in  the  treat- 
ment of  which,  the  old  method  appeared  in  one  of  its  brightest  lights ; 
having,  in  most  cases  of  incarcerated  ruptures  treated  in  accordance 
with  its  dictates,  succeeded  in  accomplishing  the  two  desirable  ends, 
viz. :  the  removal  of  the  incarceration,  and  the  reposition  of  the  pro- 
lapsed parts,  without  resorting  to  an  operation.  According  to  my 
own  calculation,  this  has  always  been  the  case  in  three  out  of  four. 
But  if  we  consider  that  the  remedies  which  the  old  method  employed 
for  this  purpose,  wTere  by  no  means  of  the  most  agreeable  descrip- 
tion to  the  unfortunate  patient,  but  that,  on  the  contrary,  he  had  to 
suffer  excessively  during  the  treatment,  we  may  justly  rank  homoeo- 
pathy above  her  older  sister,  (even  if  we  were  to  take  it  for  granted 


*  Beitrage  Zur  Homceopathie,  vom  Landchirurgus  Traub  in  Schonigen. — Allg.  Horn.  Zeit. 
No.  12,  31ster  Bd. 


RUPTURE.  583 

that  the  former  also  succeeds  only  in  three  cases  out  of  four)  because 
she  attains  her  object  by  far  more  gentle  means. 

But  homoeopathy  does  more,  though  not  so  much  as  some  exag- 
gerating panegyrists  boast,  yet  decidedly  more  than  some  talented 
practitioners  are  disposed  to  admit.  Dr.  Lobethal,  of  Breslau,  e.  g., 
assures  us  in  his  contributions  to  the  "  Pharmako  dynamik.  nach 
homceopathischen  principien,"  (Allgem.  Homceop.  Zeitung,  13  Band, 
18  Nummer),  where  he  describes  the  effects  of  Nux  vomica  with  his 
customary  exactness,  that  he  has  not  observed,  in  incarcerated  her- 
nial, the  effects  ascribed  to  and  expected  from  this  remedy,  and  he 
adds  that  the  external  treatment  of  hernia,  appears  to  him,  according 
to  the  character  of  the  incarceration,  to  be  more  efficacious  than  the 
employment  of  Nux,  Belladonna,  and  Aumm. 

It  were  much  to  be  regretted,  if  the  prejudice  caused  and  promul- 
gated by  such  unfavorable  experience,  wTere  to  induce  practitioners 
never  to  have  recourse  to  specific  medicines  in  cases  of  incarcerated 
hernia,  or,  at  all  events,  to  do  so  with  but  little  confidence.  In  order 
to  prevent  the  possibility  of  this  prejudice  taking  place,  it  is  desirable 
that  many  such  cures  should  be  made  known  ;  and  this  is  the  reason 
which-  induces  me  to  communicate  the  observations  that  I  have 
hitherto  had  an  opportunity  of  making,  in  my  own  practice,  on  the 
homoeopathic  treatment  of  incarcerated  hernia.  From  the  time  that  I 
commenced  to  treat  my  patients  on  the  principles  of  homoeopathy, 
but  few  incarcerated  ruptures  have  occurred  to  me  in  which  the 
homoeopathic  medicines  have  failed  to  prove  their  specific  power, 
(the  proportion  is  as  one  to  ten,)  through  which  I  have  become  con- 
vinced that  homoeopathy  has  obtained  a  great  triumph  over  the  old 
method  in  the  cure  of  this  disorder  also. 

In  treating  incarcerated  herniae  with  homoeopathic  remedies,  I 
consider  it  necessary  that  the  patient  should  preserve,  uninterrupt- 
edly, such  a  position  that,  after  the  incarceration  has  been  removed^ 
the  protruded  parts  shall  either  fall  back  into  the  cavity  of  the  abdo- 
men by  their  own  gravity,  or  be  drawn  back  by  the  other  intestines, 
and  no  manual  efforts  whatever  be  made  to  attempt  the  reduction. 

To  remove  the  incarceration,  homoeopathy  selects,  as  is  well  known, 
such  medicines,  which,  if  taken  by  a  healthy  person  in  an  appropriate 
manner  and  in  sufficient  quantity,  produce  positive  symptoms,  very 
similar  to  those  of  Hernia  incarcerata,  with  the  view  of  lessening 
and  removing  the  morbid  muscular  contraction  by  the  reaction  of 
the  vital  power,  (according  to  the  unchangeable  law  of  nature,  through 


584  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

which  the  reacting  vital  power  constantly  strives  to  call  forth  a  tone 
and  activity  opposed  to  that  which  has  been  positively  excited  in 
the  organismus  by  some  extraneous  influence,  and  thus  restores  the 
equilibrium  and  the  harmony  of  the  vital  functions). 

In  order  to  ensure  the  most  favorable  action  of  specific  remedies, 
the  patient  should  be  kept  as  quiet  as  possible,  and  allowed  to  remain 
undisturbed,  all  manipulations  made  for  the  purpose  of  accomplishing 
reposition,  having  the  effect  of  producing  a  primary,  or  so  to  speak, 
violent  or  forcible  dilation  of  the  contracting  muscles,  by  which  an 
increased  contraction  is  caused  through  the  reaction  of  the  vital  power, 
and  in  consequence  of  which  the  beneficial  effects  of  the  medicine 
employed  is  thereby  materially  obstructed.  The  same  is  the  case 
with  most  remedies  which  are  applied  externally,  wherefore,  the 
external  treatment  of  an  incarcerated  rupture  is,  in  most  cases 
wrhere  homoeopathic  remedies  are  employed,  not  only  superfluous, 
but  even  detrimental. 

If,  in  treating  an  incarcerated  hernia,  both  homoeopathic  medi- 
cines and  external  treatment  are  employed,  and  the  reposition  suc- 
ceeds, this  result  is  no  doubt  to  be  looked  upon  rather  as  the  effect 
of  the  latter  than  of  the  former,  because  the  homoeopathic  medicines 
are  interrupted  in  the  display  of  their  positive  effects,  and  the  vital 
power  cannot,  under  such  circumstances,  exert  a  beneficial  reaction ; 
in  this  case  Dr.  Lobe  thai  is  perfectly  right  when  he  says :  The  exter- 
nal treatment  of  a  rupture  appears  to  him  to  effect  more  than  Nux9 
Belladonna,  and  Aunim.  But  if,  under  the  external  treatment  of  a 
rupture,  the  reposition  does  not  succeed,  the  bad  effects  of  the 
incarceration  will  increase  the  more  rapidly,  and  the  necessity  of  an 
operation  will  be  indicated  the  sooner ;  moreover,  the  success  of  the 
latter  will  be  rendered  the  more  doubtful  the  greater  the  degree  of 
external  violence  which  may  have  been  used,  since  the  evil  conse- 
quences of  these  rude  interferences  continue  even  after  the  ope- 
ration. 

The  homoeopathic  materia  medica  possesses  already  a  considerable 
number  of  remedies  by  which  the  symptoms  of  incarcerated  hernia 
can  be  more  or  less  simulated,  but  only  a  few  of  these  have  been 
employed  up  to  the  present  time.  In  my  own  practice  I  found  the 
greatest  assistance  from  the  following  : 

1.  Nux  VOMICA, 

2.  acidum  sulphuricum, 

3.  Lycopodium, 

4.  Belladonna. 


RUPTURE.  585 

And,  finally,  I  must  mention  one  more  remedy,  which,  although  it 
does  not  offer  in  the  series  of  symptoms  that  it  is  capable  of  pro- 
ducing, those  which  accompany  the  formation  and  incarceration  of  a 
hernia,  can  yet  not  be  dispensed  with  as  an  appropriate  intermediate 
or  auxiliary  remedy  in  certain  forms  of  incarcerated  ruptures,  on 
account  of  the  unlimited  influence  which  it  exercises  upon  the 
vascular,  and  chiefly  upon  the  capillary  system,  and  accordingly  not 
only  comprises  among  its  symptoms  the  type  of  inflammatory  fever, 
but  also  the  type  of  acute  local  inflammation ;  farther,  on  account  of 
its  effects  upon  the  mind,  which  manifest  themselves  particularly  in 
the  form  of  inconsolable  anguish,  forebodings  of  death,  and  great 
disposition  to  be  frightened, — states  of  mind  which  we  not  unfre- 
quently  meet  with  in  persons  affected  with  incarcerated  hernia :  I 
allude  to  Aconitum  Napellus. 

The  method  I  have  hitherto  adopted  in  the  treatment  of  incar- 
cerated ruptures  is  as  follows  : — 

Having  convinced  myself  of  the  existence  of  an  incarceration,  I 
first  place  the  patient  in  a  comfortable  reclining  posture,  the  chest 
and  the  pelvis  somewhat  raised,  in  order  that  the  abdominal  muscles 
may  be  relaxed  as  much  as  possible;  the  "lower  extremities  being,  at 
the  same  time,  moderately  drawn  up.  The  patient  having  continued 
in  this  position  for  a  few  minutes,  I  proceed  to  the  selection  of  the 
remedies. 

In  reference  to  the  concomitant  symptoms,  we  meet  with  three 
forms  of  incarcerated  herniae,  which  present  materially  different  marks 
of  distinction. 

First  form  of  Incarceration. 

The  rupture  has  just  occurred  for  the  first  time,  or  one  that  had 
formerly  existed  has  reappeared,  and  has  suddenly  become  incar- 
cerated, in  which  case  the  rupture  is  always  small,  the  symptoms 
appear  suddenly  and  with  greater  intensity ;  they  consist  in  a  pinch- 
ing or  squeezing  and  pressive  sensation  in  the  region  of  the  rupture ; 
violent  dragging  pain  with  periodical  tearing,  and  a  sort  of  spas- 
modic constriction  in  the  abdomen ;  nausea,  inclination  to  vomit, 
and  actual  vomiting  of  an  acid  mucus ;  obstruction,  with  frequent 
inclination  for  stool ;  most  of  these  symptoms  are  increased  by  the 
slightest  pressure  on  the  rupture,  as  also  by  movement. 

Nux  vomica  corresponds  with  the  symptoms  of  this  form  of  incar- 
ceration.    I  accordingly  give  10 — 15  globules  of  one  of  the  higher 


586     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

potencies  every  half  hour  or  every  hour.  Frequently  a  remission  of 
the  symptoms  takes  place  after  the  first  dose  or  two ;  if,  at  the  same 
time,  a  sensation  of  movement  takes  place  in  the  rupture,  or  if  a 
gurgling  noise  be  heard,  then  a  remission  of  the  incarcerating  mus- 
cular contraction,  and  a  speedy  replacement,  without  any  external 
treatment,  may  be  expected.  Should  this  not  be  the  case,  but/  on 
the  contrary,  the  sufferings  return  again  with  unabated  vigour ;  or  if 
an  oppressive  soreness  or  pain  as  if  from  a  wound,  and  a  violent 
burning,  prevail  in  the  region  of  the  rupture,  and  the  superincumbent 
integuments  become  very  sensitive  to  the  slightest  touch  ;  or  if  the 
heat  in  the  affected  parts  increases,  and  thus  betokens  an  increased  de- 
termination of  blood  towards  these  parts ;  or  should  the  incarceration 
have  been  preceded  by  a  fright,  or  some  other  mental  affection,  and 
the  patient  be  in  a  state  of  general  irritation  or  excitement,  then  I 
usually  give  one  drop  of  Aconitum  of  the  third  to  the  sixth  dilution, 
and,  an  hour  afterwards,  Nux  vomica  at  a  lower  dilution  than  in  the 
first  instance,  and  in  a  liquid  form  in  preference,  (Nux  vom.9  2.  gtt. 
x — xv,  Aq.  destill.  5\j)  a  teaspoonful  every  half  hour  to  an  hour. 

Second  form  of  Incarceration* 

The  rupture  becomes  suddenly  incarcerated  and  is  generally  small ; 
tearing,  dragging  pain,  both  in  the  rupture  itself,  and  in  the  whole 
abdomen  predominates ;  the  patient  sometimes  experiences  fugitive 
stitches  in  the  region  of  the  rupture ;  the  pains  undergo  periodical 
remissions — disappearing  almost  entirely  for  a  time,  and  then  return- 
ing wTith  increased  violence  ;  the  patient  feels  much  exhausted  during 
the  remissions;  he  complains  of  a  general  sensation  of  cold;  the  abdo- 
men is  much  distended  by  flatus  ;  after  a  continued  desire  to  vomit, 
the  patient  eventually  vomits  an  acid-tasting  fluid;  and,  notwith- 
standing a  very  urgent  inclination  for  stool,  no  evacuation  takes 
place. 

In  this  form  of  incarceration  likewise,  Nux  vomica  is  an  excellent 
medicine,  but  Lycopod/bum  vies  with  it  in  efficacy  ;  I  generally  admi- 
nister both  these  medicines  alternately,  at  intervals  of  one  to  two 
hours.  If,  however,  these  symptoms  appear  in  a  crural  rupture,  if 
they  take  place  in  a  woman,  or  has  the  incarceration  in  the  latter 
case  taken  place  during  or  immediately  after  the  appearance  of  the 
menses,  and  if,  moreover,  the  individual  is  of  a  mild,  yielding,  dispo- 
sition, Lycopodium  is  to  be  preferred.  I  give  this  medicine  in  the 
middle   attenuations    (10—15)   either  in  globules   or  in  the  liquid 


ILUPTURE.  587 

form  (Tinct.  lycop.  gtt.  xv;  Aq.  destill.  gj),  a  teaspoonful  every 
half  hour,  or  every  hour.  If  throbbing,  burning,  and  other  symp- 
toms indicating  Aconitum  become  predominant,  I  administer  the 
latter  as  an  intermediate  remedy. 

Third  form  of  Incarceration. 

The  third  form  of  incarcerated  hernia,  (which  occurs  chiefly  in 
aged  peif&ons,  and  in  ruptures  of  long  standing,  that  have,  for  the 
most  part,  been  kept  back  by  appropriate  bandages,  or  have  been 
continually  protruding,  and  have  attained  a  large  size)  is  that  in 
which  the  incarceration  comes  on  insidiously  and  imperceptibly,  and 
betrays  itself  at  first  only  by  a  distressing,  pinching,  and  constrictive 
sensation  of  the  region  of  the  rupture,  by  uneasiness  and  fulness  in 
the  abdomen,  and  by  periodical  sickness  and  constipation.  The 
rupture  is  not  very  painful  to  the  touch,  the  incarcerated  part  is  also 
not  so  tense  and  hard  as  in  the  two  preceding  forms,  but  feels  more 
doughy.  This  incarceration  may  often  exist  for  days,  without  any 
perceptible  increase  in  the  concomitant  symptoms ;  gradually,  how- 
ever, twitchings  and  pinchings,  combined  with  periodic,  transitory, 
tearing  pains,  supervene  in  the  abdomen  and  groin;  the  sickness 
then  becomes  more  lasting,  a  sweetish,  saline,  or  bitter  fluid  is  some- 
times eructated,  and  is  not  unfrequently  followed  by  vomiting  of  a 
watery  fluid,  and  subsequently  of  ingesta. 

In  this  form  also,  two  medicines  concur,  and  the  one  is  again  Nux 
vomica,  which  competes  here  with  Acidum  suljj/mricum  for  the  rank  of 
priority.  If  the  patient  is  of  a  sanguineo-choleric  temperament, 
which,  however,  is  but  seldom  the  case,  Nuos  vomica,  at  a  low  dilution, 
must  be  given  first ;  and  should  the  removal  of  the  incarceration, 
not  be  effected  within  twelve  hours  Acidum  sulp/mricum  must  be 
administered.  If  the  incarceration  takes  place  on  the  left  side,  and 
the  patient  is  of  a  melancholic-phlegmatic  temperament,  Acid,  sulp/m- 
ricum should  be  employed  from  the  beginning.  I  have  hitherto  been 
in  the  habit  of  prescribing  in  the  disorder  in  question,  a  drop  of  the 
tenth  dilution  of  this  medicine  to  be  taken  every  hour. 

By  means  of  the  foregoing  treatment  of  incarcerated  hernia,  I  say 
it  with  heartfelt  joy,  I  have  always  more  readily  and  more  frequently 
succeeded  in  attaining  the  desired  result,  than  was  the  case  in  my 
former  practice,  when  I  treated  my  patients  in  accordance  with  the 
principles  of  the  old  school.  If  my  assistance  was  sought  sufficiently 
early,  it  formed  a  rare  exception  to  the  rule,  when  an  incarceration 


588  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

of  the  first  and  second  form  was  not  removed  within  eight  hours,  and 
that  of  the  third  form  within  twenty-four  hours.  Still  more  rarely 
did  it  happen  that  the  homoeopathic  medicines  entirely  failed  to 
remove  the  incarceration,  and  where  it  consequently  became  neces- 
sary to  perform  an  operation. 

It  is  very  much  to  be  regretted  that  homoeopathy  cannot  yet 
renounce  the  operation  as  the  last  resource  in  the  treatment  of  incar- 
cerated hernia ;  whether  this  will  ever  be  possible,  I  Shall  not 
investigate  here ;  we  may,  however,  presume,  with  every  appear- 
ance of  certainty,  that  those  cases  in  which  the  operation  is  now 
deemed  indispensable,  will  become  more  and  more  scarce,  the  more 
closely  that  the  re-provings  of  medicines  already  known,  and  the 
provings  of  others  yet  unknown,  or  untried,  will  be  discovered  to 
approach  in  similarity  individual  forms  of  this  disease. 

If  the  homoeopathic  medicines  do  not  remove  the  incarceration 
within  a  given  space,  to  be  determined  by  each  individual  case ;  but 
if,  on  the  contrary,  symptoms  of  a  more  troublesome  and  dangerous 
character  make  their  appearance ;  if  not  only  the  rupture  itself,  but 
also  the  abdomen  and  the  epigastric  region  become  very  sensible  to 
the  slightest  touch ;  if  the  existing  pains  and  the  tension  of  the 
abdomen  become  more  intensely  violent ;  if  nausea,  the  inclination 
to  vomit,  and  the  vomiting  itself  increase,  and  the  patient  vomit  more 
liquid  than  he  has  taken,  even  during  the  prevalence  of  excessive 
thirst ;  should  traces  of  bile  or  of  other  intestinal  contents  be  dis- 
covered in  the  matter  ejected;  if  high  fever,  with  a  hard,  full  pulse 
supervene,  and  the  patient  become  more  and  more  restless,  it  is  to  be 
presumed  that  the  medicines  administered  (although  no  others  can 
be  found  that  correspond  better  with  the  form  of  the  disease  under 
treatment,)  are  either  not  strictly  homoeopathic  to  the  case,  or  that 
they  have  been  employed  in  an  improper  dose,  or,  finally,  that  the 
medicine  appropriate  to  this  individual  case,  is  as  yet  unproved,  and 
therefore  unknown.  Under  such  circumstances  I  never  hesitate  for 
a  moment  to  propose  an  operation,  and  if  the  patient  consents,  to 
perform  it  as  soon  as  possible. 


FAINTING.  589 


FAINTING.     SWOONING. 

Syncope. 

Individuals  of  weak  nerves  and  delicate  constitutions,  particularly 
of  the  female  sex,  are  frequently  subject  to  fainting  fits,  which,  al- 
though rarely  dangerous,  yet  when  utterly  neglected,  or  inappro- 
priately treated  by  violent  or  very  debilitating  means,  are  prone  to 
become  serious,  and  even  fatal. 

The  usual  causes  are  sudden  transitions  from  cold  to  heat ;  breath- 
ing vitiated  atmospheres ;  great  fatigue  ;  loss  of  blood ;  long  fasting ; 
grief,  fear,  and  other  mental  emotions. 

When  fainting  occurs,  the  patient  ought  immediately  to  be  removed 
to  where  a  stream  of  pure  fresh  air  can  be  obtained,  and  freed  from 
all  tight  clothing  about  the  neck,  chest,  and  abdomen  ;  he  should  at 
the  same  time  be  placed  in  a  comfortable  position,  with  the  head  low. 
If  the  foregoing  prove  insufficient  to  effect  restoration,  sprinkle  cold 
fresh  water  on  the  face  and  neck,  and,  if  necessary,  on  the  pit  of  the 
stomach.  Should  there  still  be  no  marked  benefit  produced,  or  if 
the  patient  becomes  cold,  a  little  spirits  of  camphor  may  be  applied 
to  the  nose.  When  the  fainting  has  arisen  from  fright,  the  best  medi- 
cines for  the  consequences  are  Aconite  or  Opium,  and  sometimes  Colo- 
cynth.  (See  Mental  Emotions.)  After  great  depletion,  or  other 
debilitating  causes,—  Cinchona,  and,  in  some  instances,  Nux  v.,  Card, 
v.,  and  Veratrum;  also  a  little  wine  in  very  small  quantities  at  a  time, 
or  a  little  bread  or  biscuit,  soaked  in  wine,  and  sometimes  a  little 
strong  soup  may  be  administered.  Should  the  fainting  arise  from 
mental  emotions,  Ignatia  and  Chamomilla  are  the  remedies  in  general 
cases.  (See  Mental  Emotions.)  When  slight  pain  causes  fainting, 
Hepar  sulph.  Fainting  from  violent  pain,  Aconite,  Chamomilla,  or 
Cocculus.  If  the  affection  is  liable  to  result  from  even  the  most  trivial 
degree  of  fatigue,  Veratrum.  When  it  is  produced  by  excessive  mental 
application,  or  in  those  who  have  been  addicted  to  the  use  of  ardent 
spirits,  Nux  vomica. 

In  other  cases,  the  following  remedies  have  been  recommended 
where  the  corresponding  symptoms  are  met  with : — 

Aconitum.  When  there  is  a  palpitation  of  the  heart,  with  deter- 
mination of  blood  to  the  head,  humming  in  the  ears ;  or  when  the 
paroxysms  come  on  usually  on  assuming  the  erect  posttire,  and  are  accom- 


590  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

panied  with  shivering  and  flushing  of  the  face,  succeeded  by  deadly 
paleness. 

Coffea  may  be  prescribed  after  Aconitum  in  highly  excitable  or 
nervous  subjects,  when  the  fainting  fit  has  arisen  from  fright,  and  the 
last-named  medicine  has  not  relieved  much. 

Hepar  sulphuris,  when  the  fit  generally  comes  on  towards 
evening,  and  is  preceded  by  vertigo. 

Lachesis,  when  the  faintingfits  are  either  preceded,  accompanied, 
or  followed  by  asthmatic  symptoms,  vertigo,  paleness  of  the  face,  nausea, 
vomiting,  convulsions,  spasms  of  the  jaw,  rigidity  of  the  body;  bloated 
appearance  of  the  face ;  epistaxis ;  aching  pain  or  stitches  in  the  fore 
part  of  the  chest ;  cold  perspirations.     (See  Veratrum.) 

Moschus  : — Fainting  fits,  attended  with  spasms  in  the  chest,  or 
succeeded  by  headache,  and  occurring  towards  evening,  during  the 
night,  or  in  the  open  air. 

Veratrum,  when  the  attacks  are  excited  by  the  slightest  fatigue  ; 
or  when  they  are  often  preceded  by  a  feeling  of  extreme  anguish 
and  excessive  dejection,  or  despair,  and  accompanied  by  spasmodic 
clenching  of  the  teeth,  and  convulsive  movements  of  the  eyes  and 
their  lids. 

Nux  v.  is  a  beneficial  remedy  when  the  fits  take  place  particularly 
in  the  morning,  after  a  meal,  or  after  taking  exercise;  and  there  is 
nausea,  with  paleness  of  the  face ;  also,  when  the  patient  complains, 
on  recovery,  of  pain  in  the  stomach,  sparks  before  the  eyes,  or  dimness 
of  sight,  together  with  a  feeling  of  anxiety ;  and  is,  further,  affected 
with  anxiety,  trembling,  and  congestion  in  the  head,  or  oppression  at 
the  chest. 

Acidum  phosphoricum  has  been  found  useful  after  JSlux  v.,  when 
that  remedy  has  not  removed  or  diminished  the  tendency  to  suffer 
from  fainting  fits  after  a  meal. 

When,  as  is  frequently  the  case,  the  fits  of  swooning  or  fainting 
take  place  in  hysterical  females,  the  remedies  which  will  commonly 
be  found  the  most  appropriate  are,  Ignatia,  Nux  moschata,  Cocculus, 
Chamomilla,  Nux  v.,  Natrum  m.,  or  Arsenicum,  Sec. 

If  the  attacks  are  attended  with  asthmatic  symptoms,  Kreosotum 
and  Berheris  in  addition  to  Nux  v.  When  accompanied  by  headache, 
Lycopodium,  Moschus,  Graphites,  Natrum  m.,  Stram. ;  loss  of  conscious- 
ness, Lycopodium,  Oleander,  Arnica,  &c.  Creeping  or  crawling  in  the 
limbs,  Nux  v.,  Borax.  Humming,  buzzing,  or  tingling  in  the  ears, 
Aconitum,  Nux  v.,  Petroleum,  &c.     Paleness  of  the  face,  Berheris,  Na- 


PAINS  IN  THE  LOINS.  591 

trum  m.,  Pulsatilla,  &c,  in  addition  to  Nux  v.  Copious  perspiration 
or  sweating,  Calcarea.  Pain  in  the  heart,  Lachesis,  &c.  Benumbed 
limbs,  Natr.  m.  Coldness  or  shivering,  Aconitum,  Calearea,  Colocynth,  &c. 
Vertigo,  Sulphur,  Arsenicum,  Berberis,  Lachesis,  &c.  Vomiting,  Lachesis, 
Nux  v.,  Pulsatilla,  Kali  e.,  &c. 

In  conclusion,  it  may  be  remarked  that  Caladium,  in  addition  to 
Aeon.,  is  useful  in  cases  that  are  liable  to  come  on  after  assuming  the 
erect  posture.  Kreosotum  and  Spigelia,  when  occurring  from,  the  heat 
of  the  room.  Lycopodium  and  Silieea,  when  in  the  recumbent  posture. 
Caladium,  when  engaged  in  meditation.  Carlo  v.  Natrum  m.9  Kreoso- 
tum, in  addition  to  Nux  v.,  when  in  the  morning.  When  writing, 
Caladium. 

Persons  who  are  subject  to  fits  of  fainting  or  swooning  should,  if 
possible,  strictly  avoid  all  those  frequent  causes  of  fainting  fits  which 
have  been  alluded  to  at  the  commencement  of  this  chapter ;  as  also, 
where  practicable,  any  other  cause  known  by  experience  to  be  pro- 
ductive of  the  attacks;  otherwise  the  cure  will  be  rendered  difficult, 
or  even  hopeless. 


PAINS  IN  THE  LOINS. 
Notalgia. 

As  these  pains  are  frequently  purely  symptomatic,  the  treatment 
must  be  directed  against  the  disease  from  which  they  originate.  Thus 
as  Hemorrhoids,  Leucorrhma,  Metritis,  Myelitis,  &c,  are  frequent  sources 
of  the  complaint.  The  reader  is  referred  to  the  treatment  of  these 
affections  in  their  respective  chapters. 

When  the  pains  arise  from  the  habitual  indulgence  in  wine  or 
spirituous  liquors,  coupled  with  confirmed  sedentary  habits,  or  late 
hours,  an  occasional  dose  of  Nux  v.  will  generally  afford  relief;  and 
when  a  strain  from  lifting  a  heavy  weight,  or  from  any  sudden  twist 
on  turning  the  body,  or  throwing  up  a  window,  &c,  has  given  rise  to 
the  pain,  Rhus  toxicodendron  must  be  had  recourse  to ;  followed,  if 
required,  by  Sulphur  and  Calearea.  (Vide  also  Lumbago,  Rheuma- 
tism, &c. ;  and  for  pains  in  the  back,  or  lumbosacral  pains,  occurring  in 
females  during  pregnancy,  see  that  article,  Part  II.) 


592  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 


DROPSY. 
Hydrops. 

The  term  dropsy  is  used  to  imply  an  abnormal  or  unusual  collec- 
tion of  serous  or  watery  fluid  in  the  cellular  tissue,  or  in  any  of  the 
cavities  of  the  body.  It  has,  consequently,  received  the  following 
different  appellations  according  to  the  particular  seat  of  the  effusion : 
Hydrocephalus,  when  the  fluid  is  deposited  in  the  cavity  of  the 
cranium ;  Hydrothorax,  when  in  the  chest ;  Ascites,  when  in  the  abdo- 
men :  Hydrocele,  when  in  the  scrotum ;  Hydrometra,  when  in  the 
uterus ;  and  Anasarca,  when  it  is  diffused  through  the  cellular  sub- 
stance. 

The  usual  symptoms  of  dropsy  are,  pale  and  sickly  complexion ; 
dryness  of  the  skin ;  red  and  parched,  furred  and  moist,  or,  on  the 
contrary,  a  preternaturally  clean  and  florid  tongue ;  failure  of  appetite, 
and  impaired  digestion ;  constipation,  but  sometimes  diarrhoea,  and, 
occasionally,  an  alternation  between  these  two  states ;  urine  scanty, 
high-coloured,  in  some  instances  coagulable  by  heat,  and  of  low  specific 
gravity;  pulse  variable,  being  sometimes  quick,  at  others  slow,  and 
frequently  irregular  and  intermitting  ;  general  debility :  feverishness, 
especially  towards  night.  In  some  cases  there  is  cough,  with  dyspnoea, 
or  a  feeling  of  suffocation,  particularly  in  the  recumbent  posture ;  and 
occasionally  violent  palpitation  of  the  heart,  with  sudden  starting 
during  sleep. 

The  remedies  which  have  hitherto  been  employed,  with  greatest 
advantage,  by  homceopathists,  are  :  Arsenicum  album,  Helleborus  niger, 
Lycopodium,  Zincum  rn.,*  Ononis  spin.,  Awrum  m.,  Digitalis  purpurea, 
Ledum  palustre,  Cinchona,  Mercurkis,  Stdphur,  Euphorbium,  Kali  carlo- 
nicum,  Dulcamara,  Colchicum  autumnale,  Prunus  spinosa,  Sepia  (especially 
in  drunkards),  Bryonia,  Ferrum,  Phosphorus,  Rhus  toxicodendron,  Sam- 
ftucus,  Solanum  nigrum,  Camphora,  Cantharides,  Scilla  maritima,  Convol- 
vulus arvensisy  Teratrum,  Lactuca  virosa. 

In  dropsy  supervening  after  the  retropulsion  of  exanthema.tous  dis- 
eases: Helleborus,  Arsenicum,  Digitalis,  Rhus  and  Sulphur  are  found 

*  Zincum  m.  is  one  of  the  most  important  remedies  in  dropsical  affections,  and  especially 
when  pains  or  disagreeable  sensations  are  experienced  in  the  region  of  the  kidneys.— Wahle, 
Neues  Archiv.    Dritter  Band,  Erstes  Heft,  p.  28. 


ASCITES.  593 

the  most  efficacious.  In  that  resulting  from  intermittent  fevers :  Ar- 
senicum, Ferrum,  Dulcamara,  Mercurius,  Solanum  nigrum,  and  Sulph.  In 
drunkards :  Arsenicum,  Hellehorus,  Sulphur,  'Rims,  and  Ledum.  In  that 
from  depletion :  Cinchona,  Ferrum,  Mercurius,  Sulphur  and  Phosphorus. 
And  in  that  from  the  excessive  use  of  mercurial  preparations  :  Sulphur, 
Cinchona,  Dulcamara,  and  Helleborus.  For  further  particulars,  see 
Ascites,  Anasarca,  Hydrothorax,  Hydrocephalus,  &c. 

Hydrops  occurring  at  an  advanced  period  of  life  is  chiefly  to  be 
relieved  by  the  employment  of  Kali  c,  Conium,  Sulphur,  Lycopodium, 
and  Oleum  terebinthinm.  The  diet  of  patients  affected  with  dropsy 
should  be  light,  but  of  nutritive  quality. 


ascites. 

Ascites,  or  dropsical  effusion  in  the  cavity  of  the  peritoneum,  may 
be  complicated  or  not  with  hydrothorax  or  general  anasarca.  In  the 
majority  of  cases  there  is  also  oedema  of  the  lower  extremities,  or 
other  parts  of  the  body.  The  disease,  in  many  cases,  goes  on  gra- 
dually and  insidiously,  the  abdominal  distension  being  at  first  attri- 
buted to  corpulency.  In  others,  again,  and  especially  the  idiopathic 
and  acute  forms,  whilst  there  is  an  equal  absence  of  marked  consti- 
tutional disturbance,  the  effusion  takes  place  so  suddenly,  accom- 
panied with  such  characteristic  indications,  that  there  is  little  risk  of 
falling  into  error  as  to  the  true  nature  of  the  enlargement.  But  on 
some  occasions  the  invasion  of  the  disease  is  announced  by  striking 
premonitory  symptoms,  such  as  fever,  restless  nights,  thirst,  impaired 
digestion,  foul  tongue,  nausea  or  vomiting,  costiveness,  scanty  high- 
coloured  urine,  pain  in  the  lumbar  or  hepatic  regions,  &c. 

The  swelling  of  the  abdomen  in  ascites  is  somewhat  tense,  the 
sound  on  percussion  dull,  and  when  the  quantity  of  the  effusion  is  con- 
siderable, the  swelling  gravitates  to  the  side  towards  which  the  patient 
inclines,  and  a  sense  of  fluctuation  will  be  felt  on  placing  one  hand 
on  one  side  of  the  abdomen,  and  striking  the  opposite  side  sharply 
with  the* other.  There  is  frequently  more  or  less  difficulty  of  breath- 
ing, with  incapability  of  lying  in  the  recumbent  posture,  either  in 
consequence  of  accelerated  circulation,  or  from  the  encroachment  of 
the  accumulated  fluid  on  the  thorax.  Muscular  attenuation  is  a 
common  attendant  on  this  form  of  the  disorder,  as  well  as  on  general 

38 


594  DISEASES   OF  PARTICULAR  ORGANS  AND  REGIONS. 

dropsy.     Those  parts  of  the  body  which  are  not  puffed  up  by  serous 
infiltration  are  accordingly  found  to  be  in  a  state  of  emaciation. 

The  prognosis  in  dropsy  must  be  regulated  by  the  nature  of  the 
case,  and  the  age  and  temperament  of  the  patient.  When  combined 
with  any  organic  disease  of  the  abdominal  viscera,  or  the  contents 
of  the  thorax,  with  effusion  into  its  cavities,  we  can  scarcely  antici- 
pate any  other  than  an  unfavorable  termination.  When  occurring  in 
individuals  at  an  advanced  time  of  life,  or  in  sickly  children,  accom- 
panied with  emaciation  and  extreme  prostration  of  strength,  fever, 
cough  and  difficulty  of  breathing,  scanty  and  offensive  urine,  feeble, 
irregular,  and  intermitting  pulse,  petechiae  and  hemorrhages,  we  must 
generally  expect  a  like  unfortunate  issue.  But  when  the  disorder  sets 
in  as  a  consequence  of  scarlatina  or  other  exanthemata,  or  arises  sud- 
denly after  the  suppression  of  some  accustomed  discharge,  or  from 
exposure  to  cold,  or  exhaustion  from  fatigue,  although  properly  held 
as  a  serious  malady,  it  is  yet,  in  such  cases,  by  no  means  to  be  con- 
sidered in  the  light  of  a  fatal  one. 

Therapeutics.  Helleborus  niger,  Arsenicum,  Cinchona ,  Mercurius, 
Sulphury  Bryonia  alba,  Ledum  palustre,  Kali  carbonicum,  and  Lycopodium., 
&c,  are  amongst  the  must  useful  medicaments. 

Helleborus  niger.  This  important  medicine  is  often  of  equal 
service  here,  and  in  dropsy  in  general,  as  in  anasarca,  and  particularly 
in  the  acute  idiopathic  form  of  the  disease,  in  which  indeed  it  is 
almost  superior  to  any  other  remedy.  Occasionally  it  will  be  found 
necessary  to  have  recourse  to  Aconite  in  the  first  instance,  in  order  to 
allay  any  excessive  degree  of  arterial  excitement;  but  when  that  is 
inconsiderable,  or  when  the  febrile  symptoms  are  accompanied  with 
great  debility,  and  a  tendency  to  torpor  or  lethargy;  the  urine 
extremely  scanty,  or  almost  suppressed,  and  the  motions  loose 
and  gelatinous ;  also  when  shooting  or  other  pains  are  complained  of 
in  the  extremities,  Helleborus  should  at  once  be  employed.  In  chronic 
dropsy,  Helleborus  is  also  sometimes  of  unequivocal  utility  as  an  inter- 
mediate medicament.  Bryonia,  Ledum,  Lachesis,  or  Mercurius,  are  useful 
auxiliaries  to  Helleb.,  when  required,  in  the  acute  variety  of  anasarca. 

Arsenicum.  As  has  already  been  stated,  under  the-  head  of 
Anasarca,  this  remedy  is  peculiarly  valuable  when  extreme  debility  is 
a  characteristic  feature,  and  has  arisen  from  the  depressing  effects  of 
other  maladies.  It  is  of  speedy  efficacy  in  acute  cases,  when  called 
for,  but  is  also  valuable  in  the  chronic  forms  occurring  in  shattered 


ASCITES.  595 

or  broken-up  constitutions  ;  and  even  in  cases  connected  with  organic 
affection  of  some  imporant  viscus,  it  will  be  found  a  most  useful 
palliative,  however  inadequate  it  may  be  to  effect  a  cure  in  such 
hopeless  cases.  Digitalis,  Ledum,  Bryonia,  Solatium  nigrum,  and  Helle- 
lorus  are  sometimes  useful  after  Arsenicum.  (See  Anasarca,  for 
some  of  the  principal  symptomatic  indications  for  this  remedy.) 

Cinchona.  In  ascites  occurring  in  constitutions  which  have 
been  much  debilitated  by  loss  of  fluids,  Cinchona  can  rarely  be  dis- 
pensed with.  But  also  in  chronic  dropsy  arising  from  organic  disease 
of  the  liver  or  spleen,  particularly  the  latter,  considerable  advantage 
is  obtained  from  its  employment.  When,  in  connexion  with  either 
of  the  above  conditions,  we  meet  with  a  short  distressing  cough, 
accompanied  or  not  with  some  expectoration,  extreme  paleness  of  the 
skin,  general  chilliness,  small,  feeble,  and  slow  pulse,  frequent  calls 
to  make  water,  which  are  usually  ineffectual  or  followed  by  a  scanty 
discharge, — there  will  be  additional  reason  for  having  recourse  to 
this  remedy.  Arsenicum  and  Ferrum  are  often  found  exceedingly 
useful  after  or  in  alternation  with  Cinchona. 

Mercurius,  together  with  Arsenicum,  Cinchona,  Belladonna,  Bryonia, 
Lachesis,  and  Sulphur  forms  an  important  remedy  in  chronic  cases 
associated  with  disease  of  some  viscus,  such  as  the  liver  or  spleen, 
attended  with  great  debility,  incipient,  short,  and  shaking  cough,  &c. 

When  we  encounter  symptoms  of  peritoneal  inflammation  Aconitum, 
Bryonia,  Belladonna,  Lachesis,  or  Mercurius  are  chiefly  brought  into 
requisition.  In  ascites  connected  with  the  suppression  of  accustomed 
discharges,  Sulphur  and  Lycopodium,  as  also  Sepia,  Calcarea,  Kali,  Pul- 
satilla, and  Silicea  are  the  most  useful  medicaments. 

Cantharides  has  been  recommended  as  particularly  serviceable  in 
hydrops  connected  with  deficiency  of  tone  in  the  urinary  organs,  and 
attended  with  strangury,  tenesmus,  and  pains  in  the  limbs,  &c. 

In  ascites  consecutive  on  scarlatina  or  other  exanthemata,  Hellehorus, 
Arsenicum,  Rhus,*  Belladonna,  Sulphur,  and  Digitalis  form  the  most 
valuable  remedial  agents.  And  in  the  chronic  forms  of  the  malady, 
especially  when  occurring  at  an  advanced  period  of  life,  the  following 
are  the  most  important :  Kali  c,  Con.,  Sulph.,  lod.,  Lycopod.,  and  01. 
tereb.     (See  also  Hydrops  and  Anasarca.) 

*  In  general  I  found  Rhus  more  useful  than  any  other  remedy  in  hydrops  occurring  after 
scarlatina,  but  the  other  remedies,  and  especially  Hettebarus,  occasionally  proved  useful. 
The  extent  of  the  anasarcous  swelling  does  not  always  indicate  the  degree  of  danger,  as 
children  are  often  carried  off  by  hydrothorax  or  by  hydrocephalus,  who  have  exhibited  only 
a  slight  degree  of  tumefaction.     (Rummell,  Allg.  horn.  Zeit.  21 — 32.) 


596  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 


DROPSY  OF  THE  CELLULAR  TISSUE. 

Anasarca. 

This  form  of  dropsy  consists  in  a  preternatural  accumulation  of 
serous  fluid  in  the  cellular  membrane,  immediately  under  the  skin. 

As  the  collection  of  fluid  increases,  the  skin  is  frequently  rendered 
inflamed  and  swollen,  and  exhibits  an  erysipelatous-like  aspect.  An 
outlet  is  eventually  given  to  the  effused  liquid  by  the  partition  of  the 
distended  cuticle ;  but  the  serous  infiltration  into  the  cellular  texture 
continues  with  undiminished  rapidity.  The  affection  is,  in  the 
greater  number  of  cases,  symptomatic  of  some  other  disease,  and  is 
most  frequently  met  with  in  combination  with  general  dropsy.  It 
sometimes,  however,  exists  as  an  idiopathic  affection,  particularly  in 
the  sthenic  form.  The  disease,  in  the  acute  form,  generally  affects 
those  who  are  in  the  prime  of  life.  It  comes  on  suddenly,  either  after 
taking  a  large  draught  of  cold  water  when  the  body  is  heated,  or 
after  exposure  to  cold  under  similar  circumstances;  and  generally 
gives  the  first  indication  of  its  invasion  by  a  feeling  of  oppression  at 
the  chest,  occasionally  attended  with  a  distressing  cough  and  pain, 
particularly  on  drawing  a  full  breath.  In  the  course  of  a  few  hours, 
dropsical  swelling  becomes  apparent,  at  first,  for  the  most  part,  in 
the  face,  from  whence  it  spreads  downwards  to  the  trunk  and  extre- 
mities. The  urine  in  this,  as  in  the  other  forms,  is  scanty  and  high- 
coloured.  The  pulse  is  frequently  neither  above  nor  below  the  natural 
standard,  although  in  some  cases  it  is  rather  quick,  and  accompanied 
with  heat  and  dryness  of  skin,  whilst  in  others  it  is  wTeak  or  irregular. 
If  the  disease  be  unchecked,  the  swelling  increases,  respiration  is 
performed  with  increasing  difficulty,  and  the  patient  is  incapacitated 
from  assuming  the  recumbent  posture,  or  at  the  utmost  can  only 
recline  in  one  particular  position.  A  fatal  termination  may  take 
place  in  a  few  days,  but  several  weeks  sometimes  elapse  before  the 
patient  sinks  exhausted. 

The  asthenic  form  of  anasarca  generally  comes  on  slowly.  It  is 
most  frequent  amongst  the  lower  orders,  who  are  necessitated  to 
dwell  in  damp,  dark,  and  ill-ventilated  apartments,  and  who,  from 
poverty,  can  only  obtain  the  most  unwholesome  food.  When  met 
with  in  a  higher  walk  of  life,  it  is  commonly  superinduced  by  seden- 


ANASARCA.  597 

tary  habits,  depressing  emotions,  excessive  depletion,  arising  either 
from  the  loss  of  blood,  diarrhoea,  or  dysentery.  The  abuse  of  spirituous 
liquors,  or  debility  resulting  from  chlorosis,  scurvy,  rheumatism,  etc, 
may  also  be  enumerated  as  appertaining  to  the  predisposing  causes  of 
this  variety.  The  feet  are  commonly  first  observed  to  be  in  a  swollen 
state,  especially  towards  evening,  and  are  found  to  pit  on  pressure ; 
occasionally  the  face  is  also  noticed  to  be  puffy,  and  the  anasarcous 
swelling  then  gradually  ascends  higher,  until  it,  in  some  cases,  per- 
vades and  distends  the  cellular  tissue  of  the  entire  body.  The  pulse 
varies ;  sometimes  there  is  considerable  fever  and  dry  skin ;  but  the 
temperature  of  the  parts  affected  is  in  general  diminished.  The 
bowels,  although  usually  costive,  are  sometimes  met  with  in  the  oppo- 
site extreme  ;  the  urine,  small  in  quantity  and  dark  red,  depositing  an 
abundant  sediment.  A  great  thirst  is  generally  complained  of.  The 
skin  becomes  pale  and  often  milk  white ;  soft,  but  deprived  of  its 
natural  moisture,  and  as' the  collection  of  fluid  increases,  its  vitality  is 
so  depressed  by  the  effects  of  prolonged  distension,  that  the  slightest 
injury  will  induce  erysipelas,  ulceration,  and  gangrene. 

There  is  another  form  of  anasarca  which,  from  the  circumstance  of 
its  supervening  after  exanthemata,  has  received  the  appellation  of 
consecutive  anasarca.  This  variety  is  much  more  frequently  encoun- 
tered in  children  than  in  adults,  and  especially  as  a  consequence  of 
scarlet  fever.  It  is  apparently  of  an  inflammatory  nature,  and  con- 
nected with  imperfect  cutaneous  transpiration,  or  obstructed  secretions 
and  excretions.  Exposure  to.  cold  or  wet,  or  to  a  cold  and  damp 
atmosphere,  favours  its,  occurrence. 

Therapeutics.  The  remedies  required  for  the  treatment  of 
anasarca  are,  for  the  most  part,  the  same  as  those  which  are  employed 
in  general  dropsy.  The  following  may,  however,  be  specified  as  more 
particularly  applicable  to  meet  the  several  varieties  of  this  species : — 

Helleborus  niger,  Bryonia,  Phosphorus,  Mercurius,  Arsenicum,  Cinchona, 
Ferrum,  Sulphur,  Ledum,  Dulcamara,  Colchicum,  Lactuca  virosa,  Sepia, 
Lycopodium,  Prunus  spinosa,  Digitalis,  etc. 

In  the  acute  form  of  anasarca,  Helleborus,  Bryonia,  Phosphorus, 
Arsenicum,  and  Mercurius  are  commonly  the  most  serviceable.  Helle- 
borus, especially  where  we  encounter  febrile  symptoms,  with  constriction 
in  the  chest  and  lancinating  pains  in  the  extremities,  and  almost  total 
suppression  of  urine ;  or  where  there  is  coma  somnolentum,  with 
great  debility  and  looseness  of  the  bowels,  the  motions  generally 


598  DISEASES  OF  PAKTICULAB,  OUGANS  AND  REGIONS. 

presenting  a  gelatinous  appearance ;  prolonged  shivering,  short  and 
rapid  respiration,  much  thirst.  [Arsenicum  is  sometimes  required  to 
complete  the  cure  after  the  previous  employment  of  Helleborus.) 

Bryonia  is  of  very  great  service  in  some  cases  of  the  acute, 
asthenic  variety,  whether  idiopathic  or  otherwise,  where  there  is  op- 
pression at  the  chest,  with  acute  pricking  pain  particularly  during 
a  full  inspiration ;  increase  of  the  anasarcous  swelling  during  the 
day.  and  diminution  at  night ;  constipation.  Should  the  foregoing 
symptoms  have  come  on  suddenly  after  partaking  of  a  long  draught 
of  cold  water  when  in  a  heated  state,  or  should  the  dropsical  swelling 
make  its  appearance  during  an  attack  of  pneumonia,  there  wdll  be 
additional  reason  for  selecting  this  remedy.  Occasionally,  however, 
it  may  be  found  necessary  to  follow  up  the  treatment  with  Cinchona 
or  Lycopodium,  the  latter  particularly  where  there  are  obstinate  con- 
stipation and  diminished  activity  of  the  skin. 

Phosphorus  is  chiefly  used  in  anasarca  accompanied  with  inflam- 
mation of  the  lungs  ;  here  it  forms  one  of  the  most  important  remedies. 
Should  it  not  prove  sufficient  to  overcome  the  entire  disease,  Sulphur, 
Lycopodium,  and  perhaps  also  Arsenicum  and  Lachesis,  will,  in  general, 
be  found  the  most  appropriate  medicaments  to  combat  the  remain- 
ing symptoms. 

Mercurius.  In  acute  or  chronic  anasarca,  attended  with  oppres- 
sion at  the  chest,  incessant,  short,  and  extremely  fatiguing  cough,  this 
is  a  useful  remedy,  particularly  in  the  asthenic  form,  with  disordered 
liver,  general  heat,  thirst,  great  weakness.  Dulcamara  and  Colchicum 
have  been  found  useful  in  anasarca  resulting  from  the  effects  of  a 
chill  from  exposure  to  cold  and  wret  when  heated. 

In  the  asthenic  or  in  the  chronic  form  of  anasarca,  Arsenicum, 
Cinchona,  Ferrum,  Mercurius,  Sulphur,  Camphora,  Lycopodium,  Sepia, 
Ledum  pa  lustre,  Rhus,  Helleborus,  &c.,form  the  principal  medicaments. 
Arsenicum  is  one  of  the  most  invaluable  remedies  in  anasarca  with 
debility,  either  when  the  attack  has  come  on  suddenly  as  an  idiopathic 
affection  after  a  chill  from  drinking  copiously  of  cold  water  while  in  a 
state  of  perspiration ;  or  when  it  has  been  induced  by  the  depressing 
effects  of  other  maladies,  such  as  dysentery,  diarrhoea,  scorbutus,  &c., 
and  the  habitual  indulgence  to  excess  in  spirituous  liquors ;  or 
further,  when  the  disorder  occurs  in  combination  with  gastritis, 
pericarditis,  and  other  affections  of  the  heart  or  other  viscera.  The 
following  symptoms  constitute  some  of  the  leading  characteristic 
indications  for  the  employment  of  Arsenicum.    Tightness  in  breathing, 


ANASARCA.  599 

or  attacks  of  oppression  at  the  chest,  which  threaten  suffocation  on 
assuming  the  recumbent  posture,  and  particularly  when  lying  on  the 
back ;  dry,  harsh,  and  thickened  skin,  w7hich  is,  at  the  same  time, 
of  extreme  paleness,  or  of  an  earthy,  greenish  hue,  particularly  at 
the  face  ;  parched  and  somewhat  reddened  tongue  ;  excessive  thirst ; 
aching  or  dragging  and  rending  pains  in  the  back  and  limbs  ;  extreme 
weakness  amounting  to  complete  prostration ;  feeble  or  irregular  pulse  ; 
coldness  of  the  extremities.  Helleborus  niger  occasionally  proves  of 
essential  service  after  or  alternately  with  Arsenicum.  In  other  cases 
Cinchona,  Bryonia,  Lachesis,  Ledum,  or  Solanum  nigrum  may  claim  a 
preference. 

Cinchona.  In  anasarca  combined  with  affections  of  the  liver  or 
spleen ;  or  when  the  disorder  has  been  induced  by  debility  arising 
from  loss  of  blood,  diarrhoea,  or  dysentery,  &c\,  this  remedial  agent 
is  of  much  utility,  but  will  generally  require  to  be  succeeded  by 
Arsenicum,  Ferrum,  Helleborus,  Mercurius,  or  Sulphur,  &c.  Shooting 
or  pricking  pains  in  the  parts  affected  with  the  dropsical  swelling, 
together  with  a  pale,  sickly,  or  deathlike  hue  of  the  skin,  are  cha- 
racteristic indications  for  Ferrum. 

Mercurius.  Some  general  indications  for  the  employment  of 
this  remedy  have  already  been  given.  In  anasarca  with  debility  it 
is  more  frequently  useful  than  in  the  sthenic  form. 

Sulphur  is  a  useful  general  remedy  in  chronic  cases,  or  in  those 
with  debility  induced  by  Chlorosis,  Scurvy,  Diarrhoea,  Syphi- 
lis, &c,  Sepia,  Lycopodium,  or  Kali,  &c,  are  occasionally  of  some 
service  after  or  in  alternation  with  Sulphur.  In  other  cases  of  anasarcous 
swelling  with  a  deficiency  of  vital  energy,  Camphora,  Rhus,  Phosphorus, 
Prunus  spinosa,  Antimonium  crudtim,  &c,  have  been  found  of  con- 
siderable efficacy. 

Against  consecutive  anasarca,  Hellehoms  niger  and  Belladonna  are 
the  more  generally  appropriate  remedies ;  but  in  some  cases  it  is 
necessary  to  have  recourse  to  Arsenicum,  Mercurius,  Rhus,  Digitalis, 
or  Sulphur.  When  mortification  threatens  in  consequence  of  anasarca, 
Lachesis,  Cinchona,  and  Arsenicum  are  the  remedies  from  which  the 
greatest  possible  assistance  is  to  be  hoped.  (See  also  art.  Hydrops.) 

In  anasarca  arising  from  a  long-continued  residence  in  a  damp, 
unwholesome  dwelling,  Colchicum  may  prove  a  valuable  palliative, 
if  not  a  curative  remedy.  A  radical  cure  was  performed  by  it  in  a 
case  which  appeared  to  have  been  excited  by  the  aforesaid  cause,  in 
which  the  following  were  the  predominant  symptoms :     At  the  com- 


600     DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

mencement  of  the  attack,  slight  gastric  derangement,  then  very 
gradual  anasarcous  swelling,  attended  with  pains  in  the  joints  and 
extreme  sensibility  of  the  skin  to  the  slightest  breath  of  air,  no 
thirst,  and  a  perfectly  normal  state  of  the  urine.  (Kurtz.  A.  h.  Zeit. 
xxvi,  90.) 


DROPSY  OF  THE  CHEST. 
Hydrothorax.     Hydrops  pectoris.     Hydrops  thoracis. 

Dropsy  of  the  chest  may  exist  without  complication  with  effusion 
into  the  cavity  of  the  abdomen  or  any  other  dropsical  affection.  The 
collection  of  fluid  may  take  place  in  both  sides  of  the  chest,  or  in 
one  only.  Occasionally  the  exudation  is  lodged  in  the  cellular  tex- 
ture of  the  lungs  as  wrell  as  in  the  sacs  of  the  pleura.  The  disease 
is  often  ushered  in  by  a  sense  of  uneasiness  at  the  inferior  portion 
of  the  sternum,  attended  by  some  difficulty  of  breathing  which  is 
greatly  increased  by  any  exertion,  but  more  especially  whenever  the 
recumbent  posture  is  assumed.  An  annoying  cough,  at  first  dry, 
but  subsequently  accompanied  with  expectoration  of  thin  mucus,  is 
experienced,  and  the  feet  are  observed  to  be  in  an  cedematous  state 
towards  evening.  In  addition  to  these  symptoms,  we  encounter  those 
which  are  met  with  in  all  forms  of  dropsy,  such  as  paleness  of  the 
skin,  thirst,  and  diminished  secretion  of  urine,  &c. ;  further,  a  fluc- 
tuation of  fluid  is  frequently  perceived  in  the  thorax,  either  by  the 
affected  party  himself  or  by  his  medical  adviser,  on  particular  move- 
ments of  the  body. 

Along  with  the  above  symptoms  the  existence  of  hydrothorax  is  to 
be  detected  by  means  of  auscultation.  Percussion  gives  a  dull  sound, 
and  the  respiratory  murmur  is  either  very  obscure  or  entirely  absent 
except  in  the  vicinity  of  the  spinal  column.  Enlargement  of  one  or 
both  sides  of  the  chest  is  sometimes  observed,  together  with  an 
increased  or.  more  prominent  appearance  of  the  intercostal  spaces. 

As  the  disease  advances  the  dyspnoea  increases,  particularly  at 
night,  when  it  sometimes  creates  a  dread  of  suffocation  ;  the  extremi- 
ties become  more  and  more  swollen,  and  the  patient  is  frequently 
affected  with  palpitation  and  fits  of  excessive  anxiety.  Numbness 
is  often  complained  of  in  one  or  both  arms.     Eventually  the  patient 


DROPSY  OF  THE  CHEST.  601 

finds  it  impossible  to  keep  the  recumbent  posture,  or  even  incline 
backwards,  and  cannot  indeed  fall  asleep  in  any  position,  especially 
if  the  water  is  collected  in  both  cavities  of  the  pleura,  without  starting 
up  suddenly  with  increased  difficulty  of  breathing  and  apprehension 
of  asphyxia.  The  cheeks  and  lips  become  pale  from  the  impeded 
circulation,  and  the  pulse  becomes  irregular  and  intermittent.  Finally, 
the  patient  is  carried  off  by  suffocation  and  exhaustion,  or  becomes 
comatose.  In  some  cases  the  termination  is  sudden,  but  in  others 
death  is  preceded  by  a  spitting  of  blood  for  the  space  of  five  or  six 
days. 

Organic  lesions  of  the  lungs,  heart,  or  their  great  vessels  form  the 
most  frequent  sources  of  hydrothorax ;  but  disease  of  some  of  the 
viscera  of  the  abdomen,  and  especially  induration  or  scirrhus  of  the 
liver,  is  an  additional  frequent  cause  of  the  affection. 

Therapeutics.  The  prognosis  in  this  serious  and  distressing 
malady  must,  in  a  great  measure,  depend  on  the  cause  of  the  effusion. 
But  in  truth,  in  almost  all  cases  we  can  rarely  speak  otherwise  than 
in  the  most  unfavorable  terms.  The  remedies  from  which  the 
greatest  alleviation,  and  occasionally  the  ultimate  cure,  has  hitherto 
been  most  frequently  attained  in  homoeopathic  treatment,  are, 
Aconitum,  Arsenicum,  Carlo  v.,  Helleborus,  China,  Lycopodium,  Colchicum, 
Digitalis,  Spigelia,  Dulcamara,  Sec, 

The  most  important  and  more  generally  applicable  remedy  in 
hydrothorax,  whether  resulting  from  inflammation  of  the  pleura,  or 
organic  affection  of  the  liver  or  spleen,  and  even  of  the  heart,  is 
Arsenicum,  particularly  when  the  following  train  of  symptoms  are 
encountered ;  distressingly  impeded  respiration,  but  especially  after 
any  exertion,  such  as  going  up  stairs,  &c.;  incessant  thirst  with 
inclination  to  drink  but  little  at  a  time;  painfully  obstructed  breath- 
ing on  getting  into  bed,  notwithstanding  that  the  act  is  performed  with 
the  utmost  caution  and  slowness,  attended  with  palpitation  of  the 
heart  and  excessive  anguish  as  if  from  impending  suffocation ;  extreme 
dyspnoea  on  assuming  the  recumbent  posture,  or  on  changing  the 
position  in  bed  during  the  night;  coldness  of  the  extremities; 
oedema  of  the  feet ;  pale  or  greenish  hue  of  the  skin,  pains  in  the 
back  and  loins  ;  complete  prostration  of  strength.  When  the  above 
symptoms  do  not  arise  from  or  are  unconnected  with  organic  lesion 
of  the  heart,  lungs,  &c,  they  will  rarely  fail  to  yield  to  the  employ- 
ment of  Arsenicum. 


602     DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

In  complications  with  organic  affections  of  the  liver,  spleen,  or 
heart,  a  greater  or  less  degree  of  melioration  is  generally  the  utmost 
we  can  look  for  from  the  use  of  this,  and  but  too  often  it  must  be 
added,  of  any  other  remedy.  Carlo  v.,  Cinchona,  Ferrum,  and  Mercurms 
are  of  considerable  assistance  after  Arsenicum,  where  there  is  disease 
of  some  one  or  other  of  the  abdominal  viscera,  such  as  the  liver  or 
spleen,  &c. ;  and  Digitalis,  Colchicum,  and  Shigella  when  there  is  organic 
lesion  of  the  thoracic  viscera,  particularly  the  heart  or  large  vessels. 

Dulcamara  has  been  found  of  considerable  service  in  alleviating 
the  sufferings  in  hydrothorax  when  they  become  aggravated  during 
the  prevalence  of  cold,  foggy,  damp,  or  rainy  weather,  and  continue 
so  until  a  change  takes  place  in  the  form  of  a  pure  and  dry  state  of 
the  atmosphere. 

Colchicum,  as  has  already  been  stated,  is  a  useful  palliative  along 
with  Digitalis  and  Spigelia  in  dropsy  of  the  chest  connected  with  organic 
lesions  of  the  heart  or  great  vessels.  It  is  to  be  preferred  to  Dulcamara 
in  those  cases  where,  in  addition  to  the  tendency  to  an  increase  of 
suffering  during  cold  and  humid  weather,  there  is,  moreover,  extreme 
susceptibility  to  cold. 

In  hydrothorax  resulting  from  inflammation  of  the  pleura  (chronic 
pleurisy),  Arsenicum,  Carlo  vegetabilis,  Lycojoodium,  Lachesis,  Kali  car- 
bonicum  are  the  most  important  remedies  in  the  generality  of  cases. 

When  there  are  febrile  symptoms  accompanied  by  sharp  pains  in 
the  chest,  a  dose  or  two  of  Aconitum  is  occasionally  beneficial ;  but, 
in  most  cases  of  this  description  we  shall  commonly  find  it  more 
advantageous  to  have  recourse  to  Bryonia,  without  the  previous 
employment  of  Aconite. 

The  following  medicines  may  also  be  enumerated  as  likely  to  prove 
of  service  in  hydrothorax :  Stannum,  Ammonium  carlonicum,  Scilla 
marilima,  Aurum,  Mercurius,  and  Senna. 


SCROFULA. 

The  most  common  form  of  this  disease  is  that  in  which  the  con- 
globate glands  in  different  parts  of  the  body,  but  especially  the  neck, 
under  the  chin,  and  behind  the  ears,  become  converted  into  hard, 
indolent  tumours,  and  subsequently  pass  through  the  stages  of  sup- 
puration and  ulceration.     The  discharge  which  succeeds,  instead  of 


SCROFULA.  603 

consisting  of  pus,  is  found  of  a  white  curdled  matter  bearing  some 
resemblance  to  the  coagulum  of  milk.  In  some  cases,  and  those, 
generally  of  an  inveterate  character,  the  eyes  are  the  principal  seat 
of  the  disease;  whilst  in  others,  of  a  still  more  virulent  description, 
the  joints  become  swollen  and  extremely  painful,  and  if  the  course  of 
the  malady  be  not  checked  it  extends  to  the  ligaments,  cartilages, 
and  adjacent  bones  ;  or  tubercles  are  developed  in  the  lungs ;  hectic 
fever  is  then  superadded,  and  often  puts  a  fatal  termination  to  the 
disorder. 

Therapeutics.     The  remedies,  which  have  hitherto  been  chiefly 
employed  in  homoeopathic  practice  in  the  early  stage  of  this  disorder, 

are  Belladonna,  Silicea,  Sulphur,*  Calcarea,  Arsenicum,  Pulsatilla,  Sepia  ; 
and,  when  the  glands  of  the  neck,  &c,  are  prominently  affected,  the 
following,  in  addition  to  the  foregoing,  are  commonly  of  the  greatest 
efficacy :  Conium,f  Dulcamara,%  Mercurius,  Hepar,  Cistus,  Staphysagria, 
Phosphorus,  Aurum,  Baryta  c.  et  m.,§  Rhus,  Clematis,  &c.  (See  Disease 

*  A  one  and  a  half  year  old,  highly  scrofulous  (hereditary)  child ;  treated  for  a  length  of 
time  allopathically,  by  means  of  Baryt.,  Hydr.  pot.,  and  latterly  Calomel,  and  then  Iod. : 
around  the  neck  glandular  swellings  partly  commencing  to  suppurate,  partly  open  and 
discharging  thin  yellow  pus ;  moist  scabs  on  the  head  and  ears ;  eyelids  reddened  and 
swollen ;  cornea  obscured  by  old  cicatrices  and  fresh  ulcers ;  excessive  salivation ;  dry 
cough ;  violent  fever  from  dentition.  Tinct.  Sulph.  1.  a  drop  night  and  morning.  After 
some  little  time  the  child  became  lively  and  vigorous,  and  the  ulcers  healed. 
•  f  Enlarged  and  indurated  cervical  glands  of  scrofulous  children,  which,  if  anything,  rather 
increased  than  otherwise  under  the  employment  of  Calc,  Iod.,  and  Silic,  became  strik- 
ingly diminished  and  softened  within  eight  days  from  the  use  of  Conium  internally  and 
externally.     (Ohlhauth,  Hyg.  xvii,  262). 

X  Dulcamara  (Tr.  gtt.  x,  Sacch.  lact.  Dr.  aliq.),  about  a  fifth  of  a  grain  twice  a  day,  for  a 
period  of  from  six  to  eight  weeks),  cured  hard  circumscribed,  painless  swellings  of  the  cer- 
vical glands,  the  size  of  a  pigeon's  egg,  occurring  in  young  persons  of  from  14  to  18  years 
of  age,  who  were  otherwise  of  parents  sound  and  healthy.     (Diez.  Hyg.  xvii,  262.) 

§  The  sphere  of  action  of  Baryta  mur.,  is  more  particularly  confined  to  the  lymphatic 
system.  I  have  found  it  useful  only  in  scrofulous  cases,  (inflammations  of  the  eye,  eruptions, 
diarrhoea,  blenorrhoea  of  the  lungs.)  Dosis,  3d  trituration,  (4  :  96)  scr.  j,  in  aq.  destil.  Jij, 
for  children  of  a  twelvemonth  old,  a  teaspoonful  every  three  hours,  and  so  on,  increasing  or 
diminishing  the  dose,  according  to  the  age  and  temperament  of  the  patient.  The  following 
cases  are  examples  of  its  successful  employment: — 

A  child,  two  years  of  age ; — the  neck  surrounded  with  glandular  indurations  of  about  the 
size  of  an  egg ;  abdomen  hard  and  distended ;  tongue  furred  ;  appetite  only  for  dry  bread ; 
stools  hard,  white,  and  take  place  only  after  clysters ;  urine  yellowish  and  fetid ;  offensive 
otorrhcea ;  emaciation ;  swelling  of  the  feet ;  hump-back.  (Had  been  treated  allopathically 
for  a  twelvemonth.  Milk,  mucilaginous  diet.  Baryta  mur.,  (9  xij),  as  above,  effected  a 
perfect  cure,  inclusive  of  the  hump,  in  three  months. 

A  child,  one  year  and  a  half  old,  covered  with  ulcers ;  thick  offensive  incrustations  over 


604  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

of  the  Conglobate  Glands.)  A  careful  selection  from  amongst 
these  remedies,  according  to  the  nature  of  the  symptoms,  combined 
with  great  attention  to  cleanliness,  ventilation,  and  the  quality  of  the 
food,  which  should  be  wholesome  and  nourishing,  will  rarely  fail  to  be 
attended  with  satisfactory  results.  In  young  subjects,  indeed,  it  will 
frequently  be  found  practicable  after  patient  perseverance,  completely 
to  eradicate,  by  the  said  means,  the  scrofulous  diathesis.  When 
the  joints  or  bones  have  become  affected,  Sulphur,  Calcarea,  and  Silicea 
are  of  striking  utility :  in  other  cases, — Mercurius,  Aurum,  Lycopodium, 
Phosphorus,  Cistus,  &c,  may  be  called  for.  And  when  the  glands  of 
the  mesentery  are  in  a  diseased  state  (scrofula  mesenterica),  Sulphur, 
and  Calcarea,  as  also  Mercurius,  Arsenicum ,  Baryta,  Lycopod.,  Baryta  c, 
Bella.,  China,  Puis.,  Rhus,  Nux,  &c,  are  those  from  which  we  may 
generally  look  for  the  most  important  aid.  (Vide  also  Enlargement 
and  Induration  of  the  Conglobate  Glands  in  the  Neck,  &c, 
Atrophy,  Rachitis,  Ostitis,  Ophthalmia,  and  Ulcers,  &c.) 


OSTITIS. 

Caries.     Necrosis.     Exostosis. 

Inflammation  of  bone  may  either  be  acute  or  chronic.  It  is  usually 
characterised  by  pain,  more  or  less  severe,  followed  by  swelling,  and 
often  with  heat  and  redness  of  the  integuments  covering  the  affected 
parts.  In  chronic  cases  the  enlargement  takes  place  very  slowly, 
and  the  pain  varies  according  to  the  cause  of  the  attack,  being  much 
more  intense  and  accompanied  by  nocturnal  exacerbation,  in  ostitis 
arising  from  syphilis  or  from  the  abuse  of  mercury,  than  when  induced 
by  the  effects  of  external  lesion.  The  accompanying  fever  is  not 
often  very  intense,  and  displays  itself  chiefly  towards  evening  and  at 


the  head,  fetid  discharge  from  the  ears  ;  inflammation  of  the  eyelids,  photophobia ;  tumid 
belly;  stools,  watery  and  fetid  ;  swelling  of  the  feet.  In  six  months  restoration  to  sound 
health. 

A  girl,  six  years  of  age,  dismissed  as  incurable  after  having  been  under  allopathic  treat- 
ment for  a  twelvemonth.  Complete  dimness  of  the  cornea,  sclerotica  inflamed  and  relaxed ; 
both  nostrils  inflamed  and  excoriated.  After  three  weeks  the  inflammation  was  subdued  ; 
after  four  months,  the  vision  clear  and  normal.     (Altmuller,Allg.  Horn.  Zeit.  xxi,  213.) 


DISEASES  OF  THE    BONES.  605 

night.     When  the  inflammation  is  acute  it  soon,  if  unchecked,  termi- 
nates in  caries,  in  necrosis,   or  in   suppuration    of  the  cancellous 
texture.     Caries  or  ulceration  may  either  arise  in  consequence  of  an 
external  injury  followed  by  considerable  inflammation  and  abscess ; 
or  it  may  occur  as  a  sequel  of  scrofula  and  syphilis.     The  latter  is 
the  more  frequent  source  of  the  disorder.     It  may  take  place  in  any 
of  the  bones,  but  is  most  commonly  encountered  in  those  of  a  spongy 
texture,  such  as  the  bones  of  the  tarsus  and  carpus,  the  sternum, 
vertebrae,  and  the  extremities  of  the  long  bones.  In  the  commencement 
of  caries  an  obtuse,  deep-seated  pain  is  experienced  in  the  affected 
bone,  and    the   superincumbent   integuments    become   discoloured^ 
flabby,  and  tender  to  the  touch ;  the  soft  parts  then  ulcerate,  and 
a  sinus  is  formed,  which  is  in  communication  with  the  caries,  and 
from  whence  a  dark-coloured,  thin,  ichorous  matter,  having  a  peculiarly 
offensive  odour,  and  occasionally  containing  osseous  particles,  is  dis- 
charged.     The  diseased  part  of  the  bone   is   usually  soft,  moist, 
accompanied  with  the  production  of  pale,  spongy  granulations,  and 
sometimes  perforated  at  innumerable  points  {wormeaten  caries) ;  at  other 
times  the  surface  of  the  bone  is  dry,  brittle,  and  of  a  pale  white  colour. 
Partial  absorption  of  the  bony  texture  frequently  takes  place,  some 
of  which  is  rendered  so  fragile  as  to  crumble  away  at  the  slightest 
touch.     Caries  may  take  place  at  any  period  of  life,  but  is  most 
frequently  met  with  in  young  subjects,  particularly  when  originating, 
as  it  so  frequently  does,  in  scrofula.     The  bones  which  are  most 
liable  to  be  affected  with  syphilitic  caries  are  those  of  the  cranium,  the 
tibia,  the  sternum,  the  palate,  and  the  nasal  bones.   While  those  which 
more  commonly  become  carious  from  scrofula  are  the  vertebrae,  the 
bones  of  the  carpus  and  tarsus,  and  the  extremities  of  the  long  bones. 
The  disease  is  attended  with  the  greatest  danger  when  it  exists  in 
the  bones  of  the  cranium,  the  large  joints,  the  vertebrae,  the  carpus 
and  tarsus,  particularly  if,  at  the  same  time,  it  arises  from  a  consti- 
tutional cause.     Necrosis,  or  the  death  of  a  portion  of  a  bone,  may 
be  induced  by  violent  inflammation  of  the  periosteum,  or  by  anything 
which  affects  the  substance  of  the  bone  or  the  medulla  in  such  a 
manner  as  to  interfere  with   or  interrupt  the  process  of  nutrition. 
Consequently  severe  contusions,  compound  fractures,  the  protracted 
exposure  of  the  surface  of  a  bone,  which  has  been  deprived  of  its 
periosteum,  to  the  air;  irritating  applications,  such  as  strong  acids, 
caustics,  &c,  are  frequent  causes  of  the  disease.     But,  in  addition  to 
these  external  means,  it  may  also  proceed  from  an  internal  or  consti- 
tutional source ;  and  accordingly  we  find  some  of  the  worst  forms  of 


606  DISEASES  OE  PARTICULAR  ORGANS  AND  REGIONS. 

it  attributable  to  the  effects  of  scrofula,  lues  venerea,  scorbutus,  the 
abuse  of  mercury,  and  the  debilitating  results  of  typhus  fever,  small- 
pox, &c.  The  symptoms  of  necrosis  vary  according  to  the  nature 
of  the  cause  and  the  extent  of  the  disease.  In  scrofulous  or  syphilitic 
individuals  the  pain  is  deep-seated  and  extremely  violent ;  and 
it  is  in  such  cases  that  a  large  portion,  sometimes  indeed  the 
whole  shaft,  of  a  long  bone  is  destroyed.  In  all  cases  a  swelling 
of  a  greater  or  less  extent  soon  takes  place,  and  the  pain,  when 
excruciating,  is  rarely  relieved  until  matter  forms  and  the  abscess 
bursts.  When  the  necrosis  is  inconsiderable  and  arises  from 
external  injury,  the  patient  being,  at  the  same  time,  of  a  healthy 
habit,  there  is  little  or  no  constitutional  disturbance.  But  when  the 
disease  is  more  extensive  and  occurs  in  scrofulous  or  otherwise 
unhealthy  habits,  the  derangement  of  the  system  is  sometimes  very 
violent.  On  the  bursting  of  the  abscess,  and  particularly  in  the 
severer  forms  of  necrosis,  there  remains  a  large  tumour  of  a  firm, 
unyielding  description,  resulting  in  the  effusion  of  coagulable 
lymph  around  the  dead  bone,  together  with  the  cedematous  and 
thickened  condition  of  the  cellular  membrane.  If  a  probe  be  intro- 
duced through  the  orifice  from  whence  the  matter  escaped,  and 
passed  down  to  the  bone,  the  surface  of  the  latter  will  often  be  found 
bare  and  rough.  Cicatrization  does  not  take  place  after  the  evacua- 
tion of  the  abscess,  but,  on  the  contrary,  the  openings  are,  for  the 
most  part,  converted  into  fistulae,  chiefly  in  consequence  of  the  con* 
tinued  irritation  which  is  caused  by  the  dead  bone,  and  serve  as  a 
passage  for  the  exit  of  any  pus  that  may  be  formed  as  well  as  for  the 
sequestrum  itself. 

We  can  never  be  certain  of  the  existence  of  necrosis  until  we  can 
touch  a  portion  of  dead  bone  with  a  probe,  or  can  obtain  a  sight  of 
the  affected  bone,  and  find  it  presenting  either  an  excessive  whiteness 
or  a  darker  colour  than  natural.  All  the  bones  are  liable  to  necrosis, 
but  the  tibia,  femur,  clavicle,  humerus,  maxilla  inferior,  radius,  and 
ulna,  are  those  which  are  most  frequently  affected.  The  diaphysis 
is  the  general  seat  of  the  disease.  Regeneration  of  the  long,  cylindri- 
cal, or  flat  bones  may  take  place,  but  those  of  the  cranium,  carpus,  and 
tarsus  cannot  be  reproduced. 

Old  age,  lues  venerea,  cancer,  scurvy,  and  rickets  impede  the 
regenerative  process.  Suppuration  principally  takes  place  in  the 
spongy  texture,  or  medullary  cavity  of  a  bone.  Its  invasion  is 
speedily  followed  by  absorption  to  a  greater  or  less  extent :  and  occa- 
sionally, while  the  interior  structure  is  removed  by  the  absorbents, 


DISEASES  OF  THE  BONES.  607 

the  external  shell  is  expanded  (spina  ventosa).  After  the  suppurative 
process  has  gone  on  for  some  time,  the  matter  makes  its  way  under 
the  skin,  and  gives  rise  to  the  foundation  of  a  soft  swelling  or  abscess, 
which,  on  bursting,  affords  considerable  alleviation  of  suffering. 
Necroses  or  caries  frequently  originate  in  disease  of  the  medullary 
membrane,  in  consequence  of  the  obstruction  which  is  thereby  offered 
to  the  nourishment  of  the  bone. 

Therapeutics.  In  inflammation  of  bone  we  shall  rarely  find 
occasion  to  have  recourse  to  Aconitum  ;  at  the  utmost  it  may  only  be 
found  useful  as  a  palliative,  and  that  chiefly  in  idiopathic  ostitis  occur- 
ring in  young  plethoric  subjects.  In  some  of  the  milder  forms,  attended 
with  redness  of  the  integuments,  slight  swelling  of  the  bone  and 
extreme  sensibility  to  the  touch,  Bryonia  and  'Pulsatilla  have  proved 
very  serviceable ;  the  former  particularly  in  persons  of  nervous  or 
bilious  temperament  and  of  a  dry  meagre  habit ;  the  latter  in  those 
of  phlegmatic  temperament,  with  relaxed,  lymphatic  constitutions. 
When  external  violence  has  given  rise  to  the  disorder,  and  the  peri- 
osteum has  been  considerably  injured,  Ruta  is  a  valuable  remedy. 
Lastly,  Mercurius  may  be  named  as  one  of  the  most  important  reme- 
dies in  acute  ostitis  with  excessive  nocturnal  exacerbations  of  pain, 
and  especially  when  the  disorder  occurs  in  persons  of  lymphatic  tem- 
peraments, or  in  those  who  from  having  been  badly  fed,  ill  lodged,  or 
have  had  their  constitutions  otherwise  much  reduced  and  enfeebled. 
Warm  fomentations  may  be  beneficially  applied  along  with  the  internal 
employment  of  the  appropriate  medicines ;  spare  diet  and  perfect  rest 
must,  at  the  same  time,  be  enjoined.  In  chronic  ostitis,  which  is  the 
most  common  form  of  this  inflammation,  Sulphur,  Calcarea,  Silicea, 
Phosph.,  Acid,  ph.,  Staph.,  and  Assqf.  are,  in  general  cases,  the  most  im- 
portant remedies  at  the  commencement  of  the  attack.  In  other  cases, 
and  more  particularly  when  the  affection  has  originated  in  the  abuse 
of  mercury,  Hepar  sulph.,  and  Acid,  nitr.,  are  two  of  the  most  important 
remedies ;  but  when  there  is  a  considerable  degree  of  erysipelatous 
redness,  a  dose  or  two  of  Belladonna  wdll  generally  be  found  requisite 
ere  we  proceed  to  employ  the  aforesaid  medicines,  or  any  other  remedy 
which  may  appear  more  appropriate  to  the  aggregate  features  of  the 
case.  If  traces  of  scorbutus  accompany  the  inflammation,  Carlo  v., 
Merc,  Staph.,  Sulph.,  Ac.  nitr.,  Dulc,  Sepia,  &c,  are  the  most  appro- 
priate. And  when  syphilis,  or  the  joint  effects  of  mercury  and  syphilis, 
have  evidently  given  rise  to  the  disorder,  the  following  medicaments, 
in  addition  to  those  described  as  the  most  applicable  at  the  com- 


608  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

mencement  of  ostitis  in  general,  have  hitherto  been  found  the  most 
useful,  viz.,  Aurum,  Assafatida,  Staphysagria,  Mezereum,  Lycopodium, 
Manganum  acet.,  Lachesis,  Dulcamara,  Baryta,  Carlo  v.,  Acid,  fluoricum. 
Manganum  aceticum  and  Mezerevm  are  more  especially  adapted  to 
inflammation  of  the  periosteum,  attended  with  pains  of  an  almost 
insupportable  nature.*  Mercurius,  Aurum,  Staphysagria,  and  Phosphorus 
generally  claim  a  preference  when  the  bones  of  the  face  form  the 
seat  of  the  inflammation  ;  Mercurius  and  Staphysagria  when  those  of 
the  hip ;  and  Assafoetida  and  Mezereum  chiefly,  when  the  shin  and 
other  superficial  bones  are  affected.  In  the  treatment  of  caries  it  is, 
as  in  ostitis,  of  importance  to  consider  the  cause  from  which  the 
disease  has  arisen.  In  the  early  stage  of  the  malady  the  remedies 
which  wre  have  named  as  being  very  useful  in  the  milder  forms  of 
acute,  and  at  the  beginning  of  chronic  ostitis,  are  frequently  of  con- 
siderable service,  and  indeed  will  often  prove  sufficient,  especially  in 
cases  which  have  arisen  from  a  local  injury,  and  unattended  by  signs 
of  general  constitutional  derangement,  to  stay  the  morbid  action  and 
eventually  effect  a  radical  cure  without  the  expediency  of  an  operation. 
In  cases  depending  upon  a  constitutional  cause,  such  as  scrofula, 
scorbutus,  or  from  syphilis  and  the  abuse  of  mercury,  the  same  medi- 
cines, are  required  as  have  been  quoted  under  Chronic  Ostitis.  We 
must,  in  a  great  measure,  be  regulated  by  the  law  similia  similibus  in  the 
selection  of  the  different  remedies ;  but  when,  from  the  paucity  of  the 
symptoms,  or  the  absence  of  any  of  a  characteristic  or  sufficiently 
well-marked  character,  there  is  some  difficulty  in  finding  the  appro- 
priate remedy,  the  alternate  or  successive  employment  of  two  or  more 
medicaments,  which  embrace  the  main  features  of  the  case,  and 
which  experience  has  proved  to  be  remedies  of  great  value  in  caries 
in  general,  may  be  resorted  to.  Thus,  Sulph.  and  Calc.;  Sulph.,  Calc, 
and  Silicea;  Silicea  and  Phosph.,  administered  in  alternation  or  rotation, 
have  often  succeeded  in  effecting  a  radical  cure.  In  like  manner, 
Perussel  mentions  three  cases  of  caries  which  wTere  cured  by  Hepar  s. 
and  Silicea  in  alternation.  In  another  case  he  had  recourse  to  Meze- 
reum  and  Rhus  in  addition  to  the  foregoing.  And  in  a  fifth,  in  wThich 
there  wTas  considerable  complication  with  mercurial  disease,  Sulphur 
and  Acid,  nitr.,  established  the  cure.  (Bib.  Horn.  d.  G.,  x,  321.) 
Caries  articulationis  cubitalis,  cum  ulceribus  ossis  fistulosis:  Calcarea  c. 


*  Hartmann's  Therapie,  zweite  Ausgabe,  p.  290.  We  have  fomidAssafoetida  andJcid. phosph. 
of  much  efficacy  in  periostitis.  Mercurius  and  Silica,  and  sometimes  Bella.,  Staph.,  Puis., 
China,  &c,  may  also  do  good  in  particular  cases. 


DISEASES  OF  THE  BONES.  609 

{Rhus),  Silic,  Lycqp.  et  Sulph.  (A.  H.  Z.  viii,  120.)  Caries  femoris 
pueri  scrophulosi:  Sepia  10  et  Acid.  nitr.  (Ann.  11,  365.)  Caries 
fungosa  manus:  Rhus  et  Arsenic.  (T.  h.  1.)  Caries  ossium  faciei: 
Calc.  carl,  et  Silic.  (A.  H.  Z.  viii,  309.)  Caries  pedis  cum  febre 
hectica:  Arnica,  Lycopod.,  et  Silicea.  (Arch,  xii,  191.)  Caries  radii 
with  bluish  red  swelling  of  the  fore-arm  and  hectic  fever :  Pulsatilla, 
Mezereum,  Sabina,  Silicea,  Calc.  c,  and  Lycopod.  (Arch,  viii,  1,  42.) 
Caries  tibiarum  et  antibrachii  sinistri,  with  several  fistulous  passages, 
debilitating  diarrhoea,  and  utter  prostration  of  strength.  ,  Sulphur, 
Assafost,  Acidum  nitr.,  and  Acid.phosph.,  accomplished  the  cure.  One 
medicine  alone,  when  homoeopathic  to  the  entire  disease,  is  often 
sufficient  to  stop  the  caries  and  bring  about  a  healthy  action  in  the 
carious  part.  Thus,  Aurum  has  repeatedly  effected  cures  in  caries 
syphilitica  ossium  palati  et  nasi;  as  also  in  caries  syphilitica  pro- 
cessus alveolaris  cum  ozaena.  Silicea,  in  several  doses  (at  the  thirtieth 
potency),  frequently  cured  chronic  caries  in  scrofulous  children. 
Other  cases  required  lower  potencies  of  the  same  remedy  (Kampfer, 
Allg.  h.  Zeit.  xxiv,  135.)  Silicea  30,  cured,  in  two  cases,  caries  of 
the  mastoid  process  (Goullon,  Gr.  u.  St.  Arch,  xv,  3,55.)  Caries 
tibiae  recens :  Silic.  10  (Arch,  viii,  1,  23.)  Caries  of  the  third 
phalanx  of  the  middle  finger,  in  a  female  who  had  applied  all  sorts 
of  unguents  to  the  part  for  a  whole  year,  and  from  which  a  piece 
of  bone  had  exfoliated.  Eight  days  after  the  exhibition  of  Silicea 
the  pain  was  removed,  and  another  small  exfoliation  took  place,  after 
which  cicatrization  ensued.  (Ruchert*s  Therapie).  Acidum  fluoricum* 
has  been  employed  in  some  cases  of  caries  with  striking  effect,  and 
promises  to  be  a  remedy  of  great  value  in  diseases  of  the  bones  in 
general.  We  may  quote  the  two  following  cases  as  illustrative  of 
its  curative  powers  in  disease  of  the  bones  :  Ci  A  boy  became  affected, 
after  scarlet  fever,  with  caries  of  the  temporal  bone,  which,  during 
a  period  of  five  or  six  years,  periodically  broke  out  afresh,  discharged 
an  offensive  pus,  and  then  healed  again.  The  entire  left  side  of  the 
cranium  was  arrested  in  its  growth,  and  consequently  rendered  much 
smaller  than  the  other  side ;  the  left  eye  also  appeared  strikingly 
smaller  than  the  right  one.  The  intellect  of  the  boy  was,  nevertheless, 
not  in  any  way  affected.  Several  remedies  improved,  but  failed  in 
curing  the  caries.   After  the  employment  of  fluoric  acid  the  periodical 

*  The  provings  of  this  important  remedy  appeared  in  the  Neues  Archiv,  zweiter  Band, 
erstes  Heft, 

39 


610    DISEASES  OE,  PARTICULAR  ORGANS  AND  REGIONS. 

attack  came  on  earlier,  and  in  a  more  aggravated  form  than  usual, 
but  never  returned.  From  that  time  onward  the  left  half  of  the 
cranium  commenced  to  grow,  and  the  previous  inequality  of  size 
between  the  two  sides  of  the  head  became  gradually  less,  and  finally 
imperceptible/'  (Neues  Arch.  3ter  Bd.  Istes  Heft.) 

"  The  first  and  second  phalanx  of  the  left  index  finger,  particularly, 
the  former,  w7ere  swollen  to  four  times  their  natural  size,  so  that  the 
finger  presented  the  shape  and  appearance  of  a  pear.  On  the  dor- 
sum of  the  ringer  an  opening  sometimes  made  its  appearance,  from 
which  pus  and  ichor  oozed  out.  The  entire  tumour  was  very  hard 
to  the  touch ;  the  skin  otherwise  unaltered ;  the  cause  of  the  affec- 
tion was  not  ascertainable ;  the  pains  were  intermittent.  With 
exception  of  some  degree  of  dyspepsia,  the  health  of  the  patient  was 
good.  Of  Silicea  x,  two  doses  were  prescribed.  Twelve  days  after- 
wards, the  patient  returned,  and  said  that  she  thought  the  finger 
better ;  but  there  were  no  outward  signs  of  improvement.  Acidum 
fluoricum  x,  in  two  doses,  was  next  prescribed.  The  patient  did  not 
come  back  again  until  about  twelve  weeks  after  her  preceding  visit. 
The  affected  forefinger  was  so  much  restored  that  it  exhibited  little 
or  no  difference  in  its  appearance  from  that  of  the  other  hand.  The 
patient  had  merely  returned  because  her  digestion,  after  having  been 
rendered  much  stronger,  had  threatened  to  become  somewhat  dis- 
ordered again.  Silicea  x,  two  doses,  was  prescribed  for  the  general 
symptoms  remaining.  The  patient  did  not  show  herself  again." 
(Neues  Arch.  3ter  Bd.  Istes  Heft,  Seite  128.) 

In  caries  of  the  ossa  nasi,  Acidum  nitricum  is,  as  well  as  Aurum,  a  most 
efficacious  remedy.  In  that  of  the  inferior  maxilla  (when  the  disease 
has  not  arisen  from  exposure  to  its  vapour)  PAospA.  And  in  caries  of 
the  bones  contributing  to  form  the  Antrum  AigAmorianum,  Arsenicum, 
Lycopoditim,  and  Silicea  have  repeatedly  proved  curative  ;  but  in  some 
instances  it  may  be  found  necessary  to  have  recourse  to  other  medi- 
cines, as  Sepia,  SzilpA,  etc.  Where  caries  is  attended  with  ulceration 
of  the  integuments,  and  thick,  lemon-coloured  discharge,  Lycopodium 
acts  beneficially.  When  caries  fails  to  yield  to  the  agency  of  medi- 
cines, and  the  symptoms  of  constitutional  irritation  increase  in  inten- 
sity, an  operation  for  the  removal  of  the  carious  portion  of  bone 
becomes  necessary. 

The  medicaments  employed  in  the  treatment  of  the  two  preceding 
forms  of  disease  of  the  bones,  are  also  more  or  less  requisite  in 
necrosis.     In  the  first  stage  of  the  disorder,  if  there  be  severe  and 


DISEASES  OF  THE  BONES.  611 

extensive  inflammation  of  the  soft  parts,  Aconitum,  Belladonna,  Bry- 
onia, Pulsatilla,  Mercurius,  and  Sulphur,  together  with  warm  fomenta- 
tions and  poultices,  are  more  or  less  useful.  (See  Ostitis.)  When 
matter  forms,  and  is  confined  under  the  periosteum,  it  should  be 
evacuated  early,  by  means  of  a  deep  and  free  incision. 

When  the  disease  has  reached  the  second  stage,  or  that  in  which 
the  sequestrum  has  been  formed,  yet  remains  adherent  to  the  living 
portion  of  bone,  the  process  of  absorption  or  of  exfoliation  may  be 
aided  and  quickened  by  the  administration  of  Symphytum  officinale,  or 
by  Silieea,  Phosphorus,  Sulphur,  and  Calcarea.  These  remedies,  espe- 
cially the  four  latter,  materially  serve,  moreover,  to  lessen  the  ten- 
dency to  renewed  inflammatory  attacks  and  their  sequelse,  as  also  to 
mitigate  any  undue  severity  in  the  constitutional  disturbance  which 
is  so  prone  to  set  in  during  this  stage  of  the  affection.  When,  not- 
withstanding all  our  efforts,  the  health  of  the  patient  begins  to  be 
seriously  injured  by  the  pain,  profuse  discharge,  and  hectic  fever,  an 
operation  for  the  removal  of  the  sequestrum,  or  even  amputation  of 
the  affected  limb,  if  the  necrosis  be  extensive,  becomes  necessary. 
But  as  long  as  the  health  remains  tolerably  good,  we  should  abstain 
from  any  harsh  interference  with  the  operations  of  nature,  and 
endeavour  to  forward  her  efforts  by  judicious  medical  treatment. 
The  principal  medicines  by  means  of  which  this  commendable  aim  is 
most  likely  to  be  promoted  are  Sulphur,  Calcarea,  Silieea,  Lycopodium, 
&c.  These  remedies  are  equally  applicable,  whether  the  disease  may 
have  arisen  from  the  effects  of  external  injury,  or  originated  in 
internal  causes — such  as  Scorbutus,  Scrofula,  Syphilis,  or  the  abuse 
of  mercury,  which  have  affected  the  bones  through  the  medium  of 
the  constitution,  or  has  proceeded  from  a  debilitated  state  of  the 
system  resulting  from  severe  febrile  disturbance.  Sulphur  is  chiefly 
required  when  necrosis  occurs  in  persons  of  lymphatic  or  bilious 
temperament ;  also  in  those  who  are  disposed  to  eruptions,  enlarge- 
ment of  the  glands,  hemorrhoids  and  constipation.  Calcarea  may 
generally  be  exhibited  with  advantage  after  the  previous  employment 
of  Sulphur.  Silieea  is,  if  anything,  still  more  frequently  required 
than  either  of  the  two  preceding  remedies,  when  the  sequestrum  is 
completely  formed,  but  is  still  firmly  attached  to  the  living  part 
of  the  bone  (second  stage) ;  or  when  it  is  loose  (third  stage),  and 
there  is  an  excessive  discharge  from  the  fistulous  openings  consisting 
of  pus  and  ichor;  further,  when  there  is  a  considerable  degree  of 
nervous    excitement,   and  the  sleep  is   restless   and    unrefreshing. 


612  DISEASES  OF  PARTICULAR  ORGANS  AND  REGIONS. 

Lycopodium  is  often  useful  when  the  matter  discharged  is  very  copious, 
thick,  and  lemon-coloured.  In  other  cases  Assafodida,  Acid.  nitricum, 
Phosphorus,  Ruta,  or  Mezereum  may  be  required.  The  alternate  use  of 
Sulphur  and  Calcarea,  Silicea  and  Phosphorus  ;  or  of  these  four  in  rotation 
at  intervals  of  from  six  to  eight  or  ten  days  is  sometimes  beneficial. 

Suppuration  of  the  spongy  texture  is  to  be  treated  at  the  beginning 
of  the  disease  in  the  same  manner  as  has  been  described  for  ostitis ; 
and  on  the  bursting  of  the  abscess,  those  remedies  which  have  been 
noticed  under  caries  and  necrosis  must  be  resorted  to.  In  exostosis, 
or  the  growth  of  a  bony  tumor  from  the  surface  of  a  bone, — Sulphur, 
Calcarea,  Silicea,  Phosphorus,  Assafcetida,  Dulcamara,  Mezereum,  and 
Mercurius  have  chiefly  been  recommended.  And  in  Tophus,  or  the 
formation  of  a  soft  swelling  on  a  bone,  Bella.,  Merc,  Phosph.,  Acid, 
nitr.,  Sulph.,  Calc,  Assa.,  &c. 


RICKETS. 

Rachitis. 

This  malady  almost  invariably  begins  to  show  itself  at  the  tender 
age  of  from  one  to  two  years,  and  is  distinguished  by  great  develop- 
ment of  head,  abnormally  prominent  forehead,  projecting  sternum, 
flattened  ribs,  enlarged  abdomen,  with  emaciation  of  the  extremities, 
and  extreme  general  debility.  As  the  disease  progresses,  the  muscles 
become  more  flaccid,  the  epiphyses  of  the  limbs  increase  in  size,  the 
bones  and  dorsal  spine  become  more  or  less  distorted,  the  bowels 
relaxed  and  the  motions  frequent ;  and  frequently,  if  the  disease  be 
not  arrested,  slow  fever,  with  cough,  oppressed  breathing  and  atrophy 
supervene,  and  a  fatal  termination  results. 

Therapeutics.  The  remedies  which  have  hitherto  been  em- 
ployed with  the  greatest  success  in  the  treatment  of  this  distressing 
affection  by  homoeopathists  are :  Belladonna,  Mercurius,  Arsenicum, 
Sulphur,  Calcarea,  Silicea;  also,  Assafoetida,  Acidum phosph,,  Phosphorus, 
Baryta  muriatica,  Staphysagria,  Lycopodium,  Acidum  nitric,  Mezereum, 
Petroleum,  and  Rhus.  (See  Atrophy,  Hydrocephalus,  and 
Scrofula.) 


CASUALTIES. 


CONCUSSION,  BRUISES,  SPRAINS  OR  STRAINS,  WOUNDS,  DISLOCATIONS, 

AND  FRACTURES. 

In  Concussion  of  the  brain,  (which  may  arise  from  a  violent  shak- 
ing of  the  brain  or  of  the  whole  body,  without  any  direct  violence 
having  been  offered,  such  as  a  severe  blow  or  fall  on  the  head),  the 
symptoms  vary,  according  to  the  degree  of  injury  which  the  brain  has 
sustained.  When  the  concussion  is  very  severe,  there  is  immediate 
deprivation  of  sense  and  power  of  motion,  and  death  is  the  general 
result ;  but  when  slight,  a  temporary  stunning  or  confusion,  with 
more  or  less  headache,  is  produced,  followed  by  increased  action  of 
the  pulse,  vertigo  and  sickness.  When,  on  the  other  hand,  the  vio- 
lence done  is  greater  than  in  the  latter  instance,  though  not  so  severe 
as  to  cause  the  fatal  termination  alluded  to  in  the  former,  the  patient 
is  rendered  insensible  and  incapable  of  movement;  his  limbs  become 
cold ;  the  pulse  weak,  slow,  and  intermittent ;  the  respiration  labo- 
rious, but  usually  without  stertor.  (This  has  been  denominated  the 
first  stage  of  concussion) .  As  the  patient  begins  to  recover  from  this 
condition,  the  pulse  and  respiration  improve,  and  warmth  begins  to 
be  felt  in  the  extremities ;  the  sensibility  to  touch  then  returns,  and 
the  contents  of  the  stomach  are  in  most  cases  rejected ;  still  he  con- 
tinues to  remain  in  a  dull,  confused  state,  and  inattentive  to,  or  almost 
unconscious  of,  slight  external  impression  {second  stage).  On  the 
gradual  subsidence  of  the  first  effects  of  the  concussion,  the  patient 
becomes  enabled  to  respond  to  questions  spoken  in  a  loud  tone. 
When,  however,  the  stupor  has  considerably  or  entirely  abated, 
inflammation  of  the  brain,  of  an  active  character,  will,  in  many  cases, 
then  begin  to  develop  itself  {third  stage),  rwith  all  its  wonted  symp- 
toms (see  Phrenitis),  and  if  not  checked,  suppuration  or  effusion 
within  the  head,  preceded  by  rigors,  will  result. 


614  CASUALTIES. 

Therapeutics.  In  all  cases  of  injury  arising  from  external  violence., 
Arnica  is  an  invaluable  remedy,  and  its  timely  administration  in  cases 
of  concussion  of  the  brain,  will  in  most  instances,  if  the  injury  be  not 
very  severe,  suffice  to  remove  all  traces  and  evil  consequences  of  such 
misfortunes.*  We  may  administer  internally  two  globules  in  a  tea- 
spoonful  of  water ;  and,  if  there  be  an  external  wound,  we  may  bathe 
the  injured  part  with  a  lotion,  in  the  proportion  of  a  few  drops  of  the 
Tincture  of  Arnica  to  an  ounce  or  about  two  tablespoonfuls  of  water, 
twice  or  thrice  a  day ;  should  the  swelling,  pains,  and  other  symptoms 
increase,  after  one  or  two  applications,  wre  must  discontinue  the  lotion, 
but  shall  almost  always  find  a  marked  improvement  follow  such 
aggravation. 

When,  however,  the  contusion  has  been  serious,  and  extreme  rest- 
lessness or  jactitation,  and  irritability  of  temper,  with  sensibility  of  the 
eyes  to  light,  small  quick  pulse,  delirium,  or  subsequently  rigors,  &c, 
supervene,  the  same  treatment  must  be  pursued  as  that  described 
under  Inflammation  of  the  Brain,  and  also  Hydrocephalus, 
which  see.f  After  an  injury  to  the  head,  particularly  if  it  has  been 
of  a  somewhat  severe  character,  the  patient  ought  not  to  be  allowed 
to  partake  of  any  stimulating  liquids,  such  as  wine,  spirits,  &c,  until 
at  least  three  or  four  weeks  have  elapsed,  even  although  he  may 
appear  to  have  entirely  recovered  from  the  effects  of  the  accident ;  he 
ought  likewise  to  be  kept  quiet,  and  not  be  permitted  to  expose  him- 
self to  excitement  of  any  kind,  otherwise  the  most  serious  conse* 
quences  may  result.  When  the  chest  has  been  injured  by  a  contusion 
or  violent  concussion,  &c,  and  soreness,  or  a  sensation  as  if  from 
incipient  suppuration,  with  heat  and  throbbing,  is  experienced  in 
some  particular  spot;  fever,  or  alternate  chilliness  and  heat  followed 
by  fever,  which  becomes  aggravated  in  the  evening ;  sleeplessness  or 
disturbed  sleep,  with  general  heat,  and  sometimes  perspiration  towards 
morning ;  short  dry  cough  which  increases  the  pain,  or  cough  with 
spitting  of  blood ;  further,  when  the  pain  in  the  chest  is  rendered 
more  acute  by  taking  a  full  inspiration,  laughing  or  sneezing,  or  when 
pricking  pains  or  a  sensation  of  fulness  or  pressure,  as  if  caused  by 

*  In  simple  irritation  of  the  brain,  Arnica  rarely  fails  to  act  beneficially.  In  some  cases, 
Cicuta  virosa  is  serviceable. 

f  In  fracture  of  the  cranium  the  same  treatment  must  be  pursued,  but  when  compression 
of  the  brain  takes  place  attended  with  its  usual  concomitants,  such  as  stupor,  stertorous 
breathing,  &c,  from  the  effects  of  a  depressed  portion  of  bone,  the  trephine  must  be  employed 
if  the  symptoms  continue  unabated,  notwithstanding  the  use  of  the  medicines  indicated. 


CONCUSSION.  SPRAINS.  615 

extravasated  blood,  is  experienced,  together  with  a  feeling  of  constric- 
tion that  obstructs  the  freedom  of  respiration, — it  will  be  necessary  to 
have  immediate  recourse  to  Arnica  and  Aconitum  alternately,  at  inter- 
vals of  from  three  to  six  hours,  until  an  improvement  in  the  symptoms 
becomes  manifest ;  but  should  a  degree  of  fever  continue  after  the 
exhibition  of  several  closes  of  these  remedies,  attended  with  a  sensa- 
tion as  if  there  were  an  internal  excoriation  or  wound,  Pulsatilla 
should  be  given.  In  the  event  of  a  continuance  or  even  an  increase 
of  cough,  with  expectoration  of  thick,  yellow  mucus  occasionally 
streaked  with  blood,  Mercurius  should  be  prescribed ;  if,  on  the  other 
hand,  the  expectoration  has  a  sweetish  t&ste,  and  is  accompanied  by 
difficulty  of  breathing,  Nux  v.  is  to  be  preferred.  When  a  degree  of 
delicacy  of  chest  remains  behind,  after  the  employment  of  any  of  the 
preceding  medicines,  with  tendency  to  suffer  from  shortness  of  breath, 
and  a  dry  short  cough,  combined  with  paleness  of  the  face,  impaired 
appetite,  and  restless,  unrefreshing  sleep,  Cinchona  has  been  strongly 
recommended.  In  other  cases,  especially  those  which  have  been 
neglected,  wThere  we  have  reason  to  apprehend  the  development  of 
Phthisis  pulmonalis,  the  employment  of  Stannum,  Acidum  nltricum, 
Silicea,  and  Kali  <?.,  or  Phosphorus,  Sulphw,  Calcarea,  and  Lycopodium, 
may  yet  enable  us  to  arrest  the  progress  of  that  ruthless  malady. 

The  effects  of  a  shock  to  the  nervous  system,  with  pains  in  the 
limbs,  &c,  from  stumbling  or  making  a  false  step,  are  generally 
relieved  by  Bryonia  or  Pulsatilla.  When  the  accident  has  been 
accompanied  with  fright,  Opium  may  be  prescribed  in  the  first  instance, 
Aconitum  where  there  is  syncope ;  and  Chamomilla  when,  from  extreme 
pain,  convulsions  ensue.*  But  in  almost  all  such  cases,  Arnica  may 
be  employed  with  advantage,  either  subsequently  or  at  the  commence- 
ment ;  in  the  event  of  headache  resulting  from  a  contusion  or  from 
stumbling,  and  Arnica  not  being  found  to  afford  much  relief,  Bella- 
donna may  be  given  ;t  the  patient  should  at  the  same  time  remain 
quiet,  and  avoid  any  exertion,  whether  of  the  body  or  mind,  until  the 
pain  is  removed. 

Sprains.  In  the  treatment  of  these  troublesome  casualties,  at  the 
commencement,  prescribe  a  lotion  of  Arnica,  when  there  is  much 
tumefaction  and  redness,  with  great  pain  on  the  slightest  movement- 

*  Ignatia  has  also  been  recommended  in  the  event  of  convulsions ;  and  Coffea  when 
uncontrollable  agitation  and  agonizing  jactitation  result. 

t  Cocculus,  Cicuta,  or  Acid,  phosphoricum,  may  be  required  to  remove  prolonged  head- 
ache arising  from  the  above-named  causes.    (See  also  Cephalalgia.) 


616  CASUALTIES. 

After  the  employment  of  Arnica,  we  may  in  like  manner  have  recourse 
to  Rhus  toxicodendron,*  which  is,  properly  speaking,  more  spe- 
cific to  this  description  of  external  injury,  and  is  often  of  speedy 
efficacy,  even  in  cases  of  some  standing,  the  remedy  should  also  be 
taken  internally,.  If  severe  pain  continue,  notwithstanding  the  employ- 
ment of  Arnica  and  Rhus,  the  following  remedies  have  been  recom- 
mended:  Bryonia,  Ammonium  c,  and  Ruta,  and  in  some  instances, 
Belladonna,  Pulsatilla,  Nux  v.,  Agnus,  or  Silicea. 

Strains.  When  pricking  or  other  pains  are  experienced  in  the 
back,  &c,  after  a  strain  caused  by  any  powerful  or  sudden  exertion, 
such  as  lifting  a  heavy  weight,  or  throwing  up  a  window,  with  aggrava- 
tion from  the  slightest  movement  of  the  arms  or  trunk,  Bryonia  should 
be  exhibited,  and  succeeded  by  Sulphur,  if  only  partial  relief  is 
obtained.  When  headache  results  from  a  similar  source,  or  when 
the  pains  are  confined  to  the  extremities,  or  if  at  all  in  the  back  or 
loins,  are  equally,  if  not  more  severe,  during  rest  as  well  as  on  move- 
ment, Rhus  may  be  prescribed,  followed  in  turn  by  Calcarea,  if  the 
sufferings  remain  almost  unmitigated.  When  sickness  and  great  pain 
in  the  abdomen  are  produced  by  the  effects  of  a  strain,  Veratmm  has 
been  recommended  as  being  speedily  serviceable. 

Wounds  are  divided  into  incised,  lacerated,  contused,  punctured, 
poisoned^  and  gunshot  wounds. 

By  an  incised  wound,  is  meant  one  which  has  been  produced  by  a 
sharp  instrument,  as  a  sword,  knife,  &c,  and  is  not  accompanied  with 
any  contusion  or  laceration.  Incised  wounds,  although  more  liable 
tp  be  attended  with  a  greater  degree  of  hemorrhage,  are,  generally 
speakings  the  least  dangerous  and  the  most  easily  healed. 

Lacerated  wounds  are  those  in  which  the  muscular  fibres,  instead  of 
being  divided  by  a  sharp  cutting  instrument,  have  been  torn  asunder 
with  some  violence;  the  edges,  in  place  of  being  even  and  regular,  are 
jagged  and  unequal.  They  are  commonly  attended  with  little  or  no 
bleeding,  rarely  heal  without  suppurating,  and  are  frequently  succeeded 
by  violent  inflammation. 

*  When  an  individual  muscle  has  been  injured  by  the  effects  of  a  violent  strain,  Rhus 
will  more  readily  restore  its  tone  and  remove  the  pain  than  any  other  remedy.  A  dose  may 
be  prescribed  thrice  a  day,  and  locally  Tr.  Rh.,  gtt.  xv — xx,  in  aq.  libr.,  as  a  lotion.  Fre- 
quently, every  symptom  is  removed  after  a  few  hours ;  but  in  bad  constitutions,  many 
troublesome  sequelae  occasionally  arise,  against  which  Sepia  is  often  useful.  (Goullon,  Gr.  u. 
St.  Arch.,  xix,  3,  12/) 


WOUNDS.  617 

The  terms  contused  wounds,  or  bruises,  are  applied  to  those  injuries 
which  are  occasioned  by  some  blunt  instrument,  or  hard  blunt  surface, 
being  brought  in  violent  collision  with  a  part  of  the  body.  When 
severe,  they  are  dangerous,  from  being  prone  to  terminate  in  morti- 
fication and  sloughing. 

Punctured  wounds  are  those  which  have  been  caused  by  pointed 
instruments;  they  partake  more  of  the  nature  of  lacerated  than 
incised  wounds,  and  are  dangerous  from  the  great  depth  to  which 
they  frequently  penetrate,  and  the  serious  consequences  they  often 
entail,  by  occasioning  violent  inflammation  of  the  fascia,  and  tetanus. 

Gunshot  wounds  partake  of  the  character  of  lacerated  and  contused 
wounds. 

For  poisoned  wounds,  see  Hydrophobia. 

Therapeutics.  In  the  treatment  of  wounds  of  all  kinds,  the  first 
object  is  to  arrest  the  hemorrhage.  This  is  to  be  done  by  means  of 
the  tourniquet,  by  compression,  by  the  ligature,  by  cold  water  or  ice, 
and  astringents,  &c,  according  to  the  degree  and  source  of  the  dis- 
charge. 

Wounds  of  the  arteries  are,  for  the  most  part,  the  most  serious : 
they  are  to  be  distinguished  by  the  bright  colour  of  the  blood,  which 
moreover  issues  very  rapidly  and  in  jets ;  while  that  from  a  vein  flows 
in  a  smooth,  uninterrupted  stream,  and  has  a  dark  or  deep  purple 
hue. 

When  the  injured  vessels  are  of  a  small  size,  they  spontaneously 
cease  to  bleed,  or  do  so,  at  all  events,  as  soon  as  the  wound  is  dressed ; 
but  when  the  hemorrhage  is  considerable,  one  or  more  of  the  above- 
mentioned  arresting  measures  require  to  be  immediately  resorted  to. 

Bleeding  from  wounds,  &c.',  in  the  mouth,  sometimes  requires  the 
application  of  styptics,  such  as  alcohol,  kreasote  water,  &c.  The  same 
may  be  said  of  slight  superficial  wounds,  as  also  of  fungous  tumours, 
and  other  diseased  surfaces,  when  cold  water  fails  to  answer  the  pur- 
pose. Arnica,  Diadema,  and  Phosphorus,  internally  and  externally,  have 
likewise  been  strongly  recommended  in  such  cases. 

Copious  hemorrhage  after  the  extraction  of  a  tooth  is  usually  readily 
suppressed,  by  pushing  a  compress  of  lint  into  the  hollow  space  left ; 
or  by  the  aid  of  styptics,  and  the  medicines  above  mentioned,  when 
requisite.  A  simple,  and  sometimes  extremely  efficacious  mode  of 
checking  this  current  of  blood  is  by  replacing  the  extracted  tooth, 
and  keeping  it  in  its  former  position,  until  the  risk  of  further  hemor- 
rhage is  obviated. 


618  CASUALTIES. 

When  we  find  severe  syncope,  with  deadly  paleness  of  the  face,  or 
when  the  countenance  assumes  a  livid  appearance,  and  subultus  ten- 
dinum  and  other  signs  of  extreme  exhaustion  set  in  from  excessive 
loss  of  blood,  Cinchona  ought  to  be  prescribed ;  and  if  the  patient 
should  not  exhibit  any  indications  of  rallying,  a  little  wine  may  be 
given,  and  subsequently  Arnica  ;  but  if  the  stimulating  effects  of  the 
wine  prove  only  of  temporary  service,  another  dose  of  Cinchona  must 
previously  be  had  recourse  to. 

The  next  step  to  be  taken  in  wounds  of  every  description,  after  the 
hemorrhage  is  stopped,  is  to  remove  all  extraneous  matter,  as  sand, 
fragments  of  glass,  splinters,  shot,  rags,  &c. ;  then  relax  the  muscles 
so  that  the  wound  may  not  gape ;  finally,  to  place  the  lips  of  the 
wound  in  accurate  contact,  and  keep  them  so  by  bandages,  plasters, 
sutures,  &c.  Bandages  are  usually  indispensable  in  deep,  and  even 
in  small,  superficial,  incised  wounds,  but  care  must  be  taken  not  to 
apply  them  too  tight,  nor  when  there  is  excessive  inflammation. 

Sutures  are  generally  necessary  in  wounds  of  the  face,  or  abdomen, 
and  sometimes  of  the  hands,  and  in  old  people  generally.  In  the  young 
and  vigorous  they  are  seldom  called  for,  and  are  even  improper  and 
hurtful  when  the  patient  is  of  an  irritable  habit  of  body.  Strips  of  ad- 
hesive plaster,— cut  narrow  in  the  centre  or  portion  which  is  to  cross  the 
wound,  and  sufficiently  long  to  retain  their  hold  as  firmly  as  possible, 
and  act  with  the  required  compressive  power, — form,  in  the  majority 
of  incised  wounds,  the  most  frequently  useful  means  of  bringing  the 
sides  into  close  approximation  and  effecting  adhesion.  It  sometimes 
happens,  however,  that  even  incised  wounds,  particularly  when  deep 
and  of  considerable  magnitude,  terminate  in  suppuration;  it  is  con- 
sequently necessary  to  leave  intervening  spaces  between  the  strips  of 
plaster,  to  admit  of  the  exit  of  the  matter  in  such  an  event.  Again, 
when  it  is  found  impracticable  to  cleanse  the  wound  of  all  foreign 
substances,  it  ought  to  be  only  lightly,  and  so  to  speak,  incompletely 
dressed,  as  it  will  be  necessary  to  renew  the  dressings  repeatedly.  In 
some  cases  it  is  necessary  to  dilate  the  wound,  to  facilitate  the  abstrac- 
tion of  a  splinter,  &c. 

With  regard  to  the  constitutional  treatment  of  wounds  of  all  kinds, 
we  should  commence  with  the  administration  of  Arnica^  of  which  a 
few  globules  should  be  given,  as  soon  as  the  patient  has  been  made 
as  comfortable  as  circumstances  will  admit.    The  patient  should  at 

*  See  Dr.  Kaser's  remarks  on  the  employment  of  Calendula  officinalis,  at  the  end  of  this 
chapter. 


WOUNDS.  619 

the  same  time  be  kept  cool,  free  from  anxiety  or  exertion,  and  as 
quiet  as  possible.  He  should  live  abstemiously,  avoid  everything 
of  a  heating  nature,  and  drink  cold  water.  If  he  be  robust  and 
strong,  and  sympathetic  fever  run  high,  a  dose  of  Aconite  should  be 
prescribed;  followed,  in  the  course  of  from  three  to  six  hours,  by 
Arnica,  and  so  on  alternately  as  long  as  may  be  found  requisite ;  in 
favorable  cases  one  dose  of  each  of  these  medicines  is  often  found 
sufficient.  The  local  application,  in  the  first  instance,  if  required  by 
excess  of  pain,  heat,  and  swelling,  should  consist  simply  of  lint  dipped 
in  cold  water,  and  frequently  remoistened. 

Lacerated  wounds,  after  having  been  carefully  cleansed,  should  have 
all  the  parts,  that  will  admit  of  the  process,  closely  approximated  and 
retained  in  their  place  by  means  of  plasters  and  an  appropriate  posi- 
tion of  the  body  or  limb,  for,  the  purpose  of  promoting  union  by  the 
first  intention.  Should  the  wound  become  inflamed,  attended  with 
much  pain  and  swelling,  it  may  be  dressed  with  lint  dipped  in  cold 
water,  which  should  be  frequently  renewed.  If,  on  the  other  hand, 
copious  suppuration  ensue,  and  the  pain  be  very  severe,  the  cold 
water  must  be  discontinued,  and  Chamomilla  exhibited,  followed  by 
Hepar  s. ;  and  should  these  remedies  fail  to  bring  on  an  early  healing 
action,  Silicea  will  generally  answer,  or  Silicea  and  Sulpkur  in  alterna- 
tion, to  promote  granulation.     (See  Ulcers.) 

In  contused  wounds  (or  bruises)  Arnica  must  be  given  internally, 
and  cold  water  applied  externally,  in  the  first  instance.  When  there 
is  considerable  extravasation  of  blood,  Arnica*  should  be  applied  as  a 


*  It  has  been  already  remarked  that  this  useful  medicament,  when  applied  as  a  lotion  to 
wounds,  should  always  be  discontinued  whenever  any  aggravation  of  the  pains,  &c,  is  expe- 
rienced; and  I  take  the  opportunity  to  repeat  here,  that  it  ought  to  be  employed  with 
caution  in  cases  occurring  in  persons  of  what  is  ordinarily  designated  an  inflammatory  habit, 
or  who  have  very  irritable  skins,  and  are  liable  to  be  affected  with  erysipelas ;  in  such 
instances  the  tincture  should  invariably  be  diluted  with  a  larger  proportion  of  water  than 
is  recommended  in  various  parts  of  this  work,  and  if  that  fail  to  prevent  the  occurrence  of 
medicinal  aggravation,  in  the  form  of  greatly  increased  pain,  redness  and  inflammation  in 
fhe  injured  parts,  and  other  pathogenetic  symptoms  of  Arnica,  as  pains  from  contusion  or 
dislocation  in  all  the  limbs,  miliary,  papular,  or  pustular  eruptions,etc, — Helianthus  annus  may 
be  used  as  a  substitute  in  contusions,  and  Aqua  calendula  officinalis  in  wounds  of  all  kinds. 
In  recent  contusions  of  glandular  organs,  such  as  the  testes,  Arnica  is  the  best  remedy ;  but 
when  induration  has  resulted,  Conium  is  of  greater  efficacy.  When  the  mammary  gland  is 
the  seat  of  injury,  Aconite  is  frequently  required  in  preference  to  Arnica,  as  is  generally  the 
case  in  wounds  or  contusions  of  any  part  when  they  are  followed  by  severe  or  extensive 
inflammation.  If  suppuration  threatens,  in  a  contused  mamma,  Phosphorus  or  Acidum 
phosph.  should  be  employed.    If  induration  has  taken  place,  Conium  is  commonly  of  greater 


620  CASUALTIES, 

lotion,  of  the  strength  of  about  one  part  of  the  tincture  in  ten  of 
water,  to  stimulate  absorption,  and  otherwise  forward  the  cure.  In 
the  event  of  an  abscess  resulting  from  the  effects  of  a  contusion,  see 
that  article. 

When  the  joints,*  synovial  membranes,  or  tendons  are  injured  by 
a  contusion,  Rhus  has  been  particularly  recommended  :  in  some  cases 
Silicea  will  be  found  of  great  utility,  as  we  can  testify  from  experience. 
If  the  periosteum  be  affected,  Ruta  is  said  to  be  useful ;  we  wTould, 
however,  recommend  an  incision  to  be  made  in  the  membrane,  if 
ecchymosed  blood  or  matter  is  evidently  pent  up  beneath  it,  and  the 
patient's  sufferings  are  great ;  after  which  the  treatment-to  be  pursued 
must  be  the  same  as  described  for  open  abscesses.  When  a  bruise 
or  contusion  is  so  violent  as  to  squeeze  the  limb  nearly  flat,  or  other- 
wise disfigure  it,  cold  water  ought  to  be  constantly  applied,  and 
Arnica  prescribed  internally.  But  if  gangrene  threatens,  Cinchona 
must  be  given,  and  when  the  skin  has  assumed  a  livid  and  black  ap- 
pearance, amputation  may  still  be  avoided,  and  life  and  limb  saved, 
by  having  recourse  to  Lachesis  and  Arsenicum  alternately,  in  frequently 
repeated  doses.  In  the  greater  number  of  such  unfortunate  cases, 
however,  amputation  becomes  imperative,  and  ought  to  be  performed 
without  hesitation,  when  it  becomes  evident  that  the  patient  will  fall 
a  sacrifice  to  further  delay.     When  amputation  has  been  found  neces- 

and  more  speedy  efficacy  than  any  other  remedy.  In  wounds  of  the  eye,  Aconite,  as  has 
elsewhere  been  observed  (art.  Ophthalmia)  is  the  specific  medicament.  In  superficial  con- 
tusions of  the  trunk  or  limbs,  and  in  those  of  long  duration,  Acidum  sulph.  has  repeatedly 
been  used,  externally  and  internally,  with  much  advantage. 

*  In  cases  of  swelling,  with  considerable  pain,  stiffness,  or  inflexibility  of  the  knee,  from 
the  effects  of  kneeling,  to  which  housemaids  (hence  the  name  of  Housemaid's  knee)  and 
others,  from  the  nature  of  their  occupations,  are  liable — and  which  affection,  it  may  be 
added,  consists  of  a  degree  of  inflammation  and  consequent  thickening  of  the  bursa  mucosa, 
situated  between  the  patella  and  the  skin,  attended  with  increased  secretion  of  the  slippery 
lubricating  fluid  contained  in  the  sac, — Silicea,  either  administered  daily,  or  at  intervals  of 
four  to  eight  days  in  susceptible  habits,  is  a  most  important  and  eminently  successful 
remedy. 

The  same  medicament  is  equally  efficacious  in  similar  swellings  in  other  parts,  such  as  the 
ball  of  the  great  toe  (where  the  tumefaction  is  commonly  known  by  the  name  of  a  bunion), 
or  the  joints  of  the  fingers,  and  indeed  in  most  of  the  situations  where  tendons  play : 
the  use  of  these  little  sacs,  or  burses  mucosae,  being  to  facilitate  the  action  or  play  of  the 
muscles. 

During  the  treatment  of  these  swellings,  it  is  very  necessary  that  the  patient  should  at 
the  same  time  be  careful  to  avoid  pressure  on  the  affected  part,  and  that  he  should  walk 
about  as  little  as  possible.  In  the  case  of  a  bunion,  when  there  is  active  inflammation, 
his  own  suffering  will  sufficiently  remind  him  of  the  necessity  of  these  precautions. 


WOUNDS.  621 

sary,  the  stump  ought  to  be  dressed  with  lint  dipped  in  cold  water, 
and  Arnica  should  be  given  internally ;  subsequently  the  said  medi- 
cine maybe  employed  in  alternation  with  Aconitum,  if  required  by  the 
accession  of  traumatic  fever,  Hepar,  Silicea,  and  Sulphur  may  also 
be  required  at  the  ensuing  stages  in  the  healing  of  the  stump.  Sub- 
sequent trials  of  Calendula  officinalis,  as  recommended  by  Dr.  Thorer, 
may  confirm  his  opinion  as  to  its  superiority  over  all  other  remedies 
in  severe  wounds,  or  after  important  surgical  operations,  where  ex- 
tensive suppuration  is  to  be  apprehended.  (See  Ulcer-s,  for  indi- 
cations for  the  employment  of  these  and  other  remedies.) 

In  the  case  of  punctured  wounds,  the  treatment  to  be  followed  is 
the  same  as  that  described  for  wounds  in  general,  but  unless  com- 
pression, by  means  of  adhesive  plaster  or  a  bandage,  can  be  brought 
to  bear  against  their  entire  extent,  the  cure  by  the  first  intention 
must  not  be  attempted.* 

When  suppuration  ensues,  Mercurius  may  be  prescribed,  followed 
by  Hepar  s.,  and  then  Silicea,  if  required.  Chamo?mllas  Belladonna,  and 
Rhus  may  be  found  serviceable  in  the  event  of  excessive  local  inflam- 
mation ;  the  two  latter  particularly,  if  the  inflammation  partake  of 
an  erysipelatous  character.  (See  Erysipelas.)  When  spasmodic 
twitchings  make  their  appearance,  Oicuta  is  frequently  serviceable; 
but  Arnica  will  generally  be  found  sufficient  to  subdue  these  symp- 
toms when  timely  administered ;  when  the  constitutional  disturbance 
is  severe,  Aconitum  may  be  alternated  with  Arnica ;  and  when  the 
wound  arises  from  violent  inflammation  of  the  fascia,  a  transverse 
incision  may  in  some  instances  be  necessary ;  in  which  event  a  dose  of 
Arnica  must  be  prescribed  almost  immediately  afterwards. 

If  tetanus  supervene,  Arnica  must  be  employed,  and  followed,  if 
required,  by  Angustura  or  Cocculus,  &c.     (See  Tetanus.) 

Gunshot  wounds  must  be  treated  by  the  exhibition  of  Arnica  inter- 
nally, and  cold  water  constantly  applied  by  means  of  lint,  externally. 
In  some  cases  it  may  be  found  advantageous  to  apply  a  very  weak 
lotion  of  Arnica,  in  preference  to  water  simply,  at  the  commencement. 
When  splinters  of  bone,  a  ball,  &c,  are  lodged  in  the  wound,  they 
ought  to  be  extracted  with  as  little  irritation  as  possible,  if  they  press 


*  In  punctured  wounds  of  the  abdomen  Aconitum  should  be  given  as  soon  as  possible,  in 
order  to  prevent  the  development  of  active  inflammation,  which  is  so  prone  to  follow  in 
such  cases.  Belladonna  is  generally  required  after  Aconit,,  when  symptoms  of  peritonitis 
have  already  made  their  appearance.     (See  also  Peritonitis  and  Enteritis.) 


622  CASUALTIES. 

on  some  important  viscera,  &c. ;  but  if  not,  they  may  be  allowed  to 
remain,  particularly  when  deeply  seated  or  difficult  to  be  found,  until 
loosened  by  suppuration,  which  process  will  be  materially  forwarded 
by  the  administration  of  Silicea.  In  other  cases  Hepar  s.  and  SulpL 
may  afford  valuable  aid.  In  the  event  of  fever,  gangrene,  &c,  see 
Contused  Wounds. 

When  a  joint  is  greatly  injured,  or  much  of  the  soft  parts  together 
with  the  blood-vessels  and  nerves  of  importance  are  carried  away  by 
a  gunshot  wound,  the  bone  remaining  entire ;— when  there  is  a  frac- 
ture of  a  bone  with  destruction  of  the  soft  parts  adjacent;  when  the 
bone  is  shattered,  and  the  principal  vessels  lacerated  or  ruptured — 
or  when  a  limb  is  completely  shot  or  torn  off,  or  other  serious  injury 
done,  which  renders  the  prospect  of  saving  the  limb  hopeless,  ampu- 
tation should  be  performed.* 

It  may  be  added  that  Staphysagria  has  been  recommended  as  a 
useful  remedy  in  severe  incised  wounds ;  and  Aconitum,  Cicuta,  or 
Acid.  nitr.  in  addition  to  Silicea  and  Hepar  s.3  in  wounds  from  splin- 
ters, &c.  (For  poisoned  wounds,  the  treatment  will  be  found  under 
Hydrophobia.) 

Dr.  Thorer,  of  Gorlitz,f  strongly  recommends  Calendula  offi- 
cinalis in  preference  to  Arnica,  in  wounds  of  every  description,  but 
especially  incised,  punctured,  or  lacerated  wounds,  and  those  with 
considerable  loss  of  substance.  The  sphere  of  the  latter  as  a  trau- 
matic remedy  he  confines  to  contusions,  sprains,  bruises  without 
abrasion  of  the  surface,  or  laceration  of  the  soft  parts.  Dr.  Thorer 
speaks,  moreover,  in  favorable  terms  of  the  effect  which  Calendula 
appears  to  exercise  over  the  process  of  granulation  and  cicatrization. 
Very  frequently,  even  after  amputations,  the  cure,  under  the  employ- 
ment of  this  remedy,  was  effected  by  the  first  intention,  and  in  almost 
every  instance  where  it  was  impossible  to  avoid  suppuration,  the 
extent  to  which  it  occurred  was  comparatively  insignificant.  He  em- 
ployed two  different  preparations  of  this  remedy  as  lotions,  the  one, 


*  "After  amputations,  extirpations,  and  other  surgical  operations,  I  have  invariably 
derived  the  most  important  service  from  the  employment  of  Aconitum.  In  most  instances, 
a  complete  cessation  of  pain  took  place  three  hours  after  its  administration;  traumatic 
fever  never  supervened,  and  the  patients  almost  always  fell  into  a  placid  and  refreshing 
slumber ;  but  rarely  was  it  found  necessary  to  have  recourse  to  Opium,  and  that  only  when 
.startings  from  sleep  took  place  from  local  or  general  convulsive  jerkings  or  twitchings." — 
Dr.Wurzler.    Allg.  Horn.  Zeit.,  No.  i,  21  Band. 

f  Neues  Arch.,  dritter  Band,  erster  Heft. 


wounds.  62  B 

to  which  he  gave  the  name  of  Aqua  Calendula  Officinalis,  he  prepared 
as  follows : 

"1  filled  one  third  of  a  clean  bottle  with  the  petals  or  leaves  of  the 
flowers,  the  remaining  two -thirds  with  fresh,  pure  spring  water,  corked 
it  well,  and  exposed  it  for  two  to  three  days  to  the  warm  rays  of  the 
sun.  The  water  was,  by  this  process,  rendered  slightly  aromatic, 
and  having  been  poured  off  from  the  leaves,  it  was  put  into  a  bottle, 
well  sealed  up  like  wine  bottles,  then  immediately  placed  in  the  lower 
temperature  of  the  cellar.  Whilst  the  bottle  with  the  mixture  of  the 
leaves  and  water  is  exposed  to  the  higher  temperature  of  the  sun  it 
should  be  narrowly  watched,  and  the  moment  that  any  signs  of  inci- 
pient fermentation  make  their  appearance,  measures  must  be  taken 
to  arrest  it.  The  second  preparation  was  a  Spiritus  Calendula,  for 
which  I  employed  the  same  quantity  of  the  leaves  of  the  flower  as  in 
the  preceding  instance,  and  pure  rectified  spirits  of  wine  in  place  of 
the  water.  I  employed  the  latter  preparation  only  on  one  occasion, 
very  much  diluted,  in  order  that  the  spirit  of  wine  might  not  exercise 
a  detrimental  influence  on  the  injured  parts.  Its  effect  was  equally 
beneficial/' 

We  give  the  following  cases  as  instances  in  which  Dr.  Thorer 
applied  Calendula  as  a  lotio  vulneraria  homoeopathica  with  success. 

"1.  R.  K.  had  the  under  lip  much  bruised  and  lacerated  from  the 
kick  of  a  horse.  The  lips  of  the  wound  were  brought  into  approxi- 
mation, and  retained  there  by  means  of  a  strip  of  adhesive  plaster. 
In  addition  to  this,  the  patient  wTas  furnished  with  a  phial  containing 
Aqua  calendula  and  desired  to  keep  the  wound  covered  with  a  com- 
press saturated  with  the  lotion.  Already,  after  an  interval  of  three 
days,  healthy  cicatrization  began  to  set  in,  without  suppuration.  The 
process  of  healing  went  on  quickly  and  uninterruptedly  per  primam 
intentionem,  and  the  scar  of  the  divided  lip  is  now  scarcely  perceptible. 

6i  2.  M.  A.  had  the  misfortune  to  fall  down  a  flight  of  stairs,  and  in 
addition  to  several  contusions  on  the  chest,  two  extensive  wounds 
were  inflicted,  one  on  the  forehead,  and  the  other  along  the  ridge  and 
at  the  point  of  the  nose,  producing  great  disfiguration.  In  this  case, 
also,  the  healing  process  proceeded  most  rapidly  and  favorably,  with- 
out suppuration,  and  without  leaving  any  disfigurement,  such  as  a 
wound  of  so  severe  a  character  might  reasonably  have  led  me  to 
anticipate. 

"  3.  This  case  was  of  infinitely  greater  importance  than  the  above, 


624  CASUALTIES. 

Floder,  a  boy,  16  years  of  age,  while  engaged  at  His  occupation  in  a 
cloth  manufactory,  had  the  misfortune  to  become  entangled  in  the 
machinery;  in  consequence  of  which,  the  following  injuries  were 
sustained: 

cc  1.  Compound  fracture  of  the  left  arm,  the  sharp  extremities  of 
the  broken  bone  protruding  through  the  integuments. 

"  2.  A  deep  wound  at  the  bend  of  the  elbow. 

"  3.  The  bones  of  the  left  forearm  completely  stripped  of  their 
muscles,  and  laid  bare  to  the  extent  of  six  inches. 

"  4.  The  hand  torn  off,  being  only  kept  adhering  to  the  stump  by 
a  slip  of  skin. 

"  5.  The  skin  and  portions  of  the  muscles  of  the  exterior  surface  of 
the  right  leg  were  torn  off,  leaving  a  large  and  deep  wound  extending 
down  to  the  bone. 

"  6,  Face  and  chest  severely  contused,  and  exhibiting  many  small 
flesh  wounds. 

"  The  unfortunate  patient  was  reduced  to  a  state  of  extreme  exhaus- 
tion by  loss  of  blood  and  excessive  suffering ;  amputation  of  the  left 
upper  arm  was  nevertheless  rendered  imperative,  and  was  accordingly 
performed.  Compresses,  saturated  with  Aqua  calendula,  were  applied  to 
the  exposed  lacerated  muscles  of  the  right  leg,  up  to  the  period  of  the 
recovery  of  the  patient,  and  it  was  striking  to  observe  how  dry,  and 
without  suppuration,  incarnation  proceeded  in  the  parts  to  which  the 
Calendula  was  applied,  in  comparison  with  the  extensive  suppuration 
and  slow  curative  process  which  took  place  in  the  stump  of  the  am- 
putated arm,  treated  according  to  the  ordinary  surgical  rules.  I  was 
not  at  the  time  aware  of  the  peculiar  properties  of  Calendula,  but  in 
consequence  of  the  striking  beneficial  effects  which  it  produced  on  the 
injured  lower  extremity  of  the  patient,  I  subsequently  applied  it  to 
the  wound  of  the  stump,  and  was  gratified  by  the  peculiarly  favorable 
granulation  which  soon  ensued  there  likewise.  All  the  wounds  hence- 
forward filled  up  and  healed  in  so  satisfactory  a  manner,  that  it  was 
scarcely  possible  to  conceive  that  they  could  have  been  of  so  serious 
a  character,  and  attended  with  such  loss  of  substance  as  they  in 
reality  were.  The- patient  was  restored  to  perfect  health,  and  I  have 
no  hesitation  in  attributing  his  recovery  to  the  very  favorable  process 
of  granulation  and  cicatrization  which  took  place  under  the  employ- 
ment of  the  Aqua  calendula. 

"  4.  C.  in  G.  lost  his  footing  when  in  his  mill,  and  had  the  third 


wounds.  625 

phalanx  of  the  left  index-finger,  the  second  and  third  phalanx  of  the 
ring-finger,  and  the  flesh  of  the  point  of  the  middle  finger  torn  off. 
A  small  portion  of  the  bone  of  the  second  phalanx  of  the  ring- 
finger  remained,  but  was  entirely  bared  and  exposed ;  the  patient  was 
desirous  that  this  remnant  of  bone  should  be  removed.  I  refrained 
from  doing  so,  however,  in  the  hope  that  it  might  become  covered 
by  means  of  favorable  granulation.  And  so  the  result  proved.  After 
the  hemorrhage  had  been  arrested  by  the  application  of  cold-water 
dressings,  Aqua  calendula  was  employed,  two  days  from  the  occur- 
rence of  the  accident.  The  wounds  thereupon  assumed  a  drier  aspect, 
incarnation  went  on  uninterruptedly,  and  a  perfect  cure  was  rapidly 
accomplished.  On  the  ring-finger  alone,  a  very  minute  exfoliation 
came  off  from  the  exposed  bone. 

"  Mr.  Surgeon  Schulze,  to  whom  I  had  recommended  the  Calendula 
as  a  remedy  in  wounds,  and  who  had  employed  it  extensively  with 
much  satisfaction  to  himself  for  the  past  two  years,  recently  favoured 
me  with  the  following  cases,  amongst  others,  in  which  he  had  used 
it  with  success. 

Ci  5.  A  labourer  received  a  comminuted  fracture  of  the  right  index- 
finger,  wThile  engaged  in  lifting  a  heavy  stone.  The  splintered  and 
more  or  less  loose  pieces  of  bone  were  removed,  and  the  Aqua  calen- 
dula applied  as  a  lotion.  The  cure  followed  rapidly,  and  without  any 
particular  suppuration. 

"  6.  A  miller's  apprentice  had  two  of  his  fingers  so  completely 
crushed  that,  as  in  the  foregoing  case,  it  was  necessary  to  remove  the 
shattered  particles  of  bone.  The  Calendula  effected  an  equally  rapid 
cure,  with  a  very  trivial  degree  of  suppuration. 

"7.  In  a  case  of  complicated  fracture  of  the  leg,  with  a  wound  nine 
inches  in  length,  from  which  the  tibia  was  laid  bare,  Arnica,  largely 
diluted,  was  employed  for  a  few  days,  in  consequence  of  the  accom- 
panying extensive  sugillation.  The  Calendula  wTas  then  brought  into 
requisition,  and  produced  a  speedy  cure  without  extensive  sup- 
puration. 

"  I  could  quote  a  multitude  of  other  cases  in  which  the  Calendula 
alone  was  employed,  and  with  singularly  successful  and  satisfactory 
results;  but  I  shall  content  myself  with  adding,  that  in  all  in- 
stances in  which  there  is  extensive  loss  of  substance,  and  where  it  is 
found  impracticable  to  bring  and  retain  the  lips  of  a  wound  to- 
gether by  means  of  adhesive  plaster,  &c,  1  consider  the  Calendula  to 
be  the  best  aqua  vulneraria.  It  has  long  been  occasionally  employed 
by  the  lower  orders  in  the  form  of  an  ointment,   made   of  fresh 

40 


626  CASUALTIES. 

butter,  mixed  up  with  the  ground  or  powdered  leaves  of  the  flower, 
and  sometimes,  though  rarely,  in  the  form  of  infusion,  and  taken 
internally.  Its  Jiommopathicity  in  wounds,  as  well  as  several  other 
affections,  has  moreover  been  demonstrated  and  confirmed  by  the 
provings  of  Dr.  Franz."* 

Dr.  Thorer  concludes  his  remarks  by  expressing  the  hope  that 
his  statement,  in  respect  to  the  properties  of  Calendula,  as  a  remedy 
in  wounds,  may  have  the  effect  of  calling  the  attention  of  surgeons  to 
it ;  and  that  if  their  observations  tend  to  confirm  its  healing  proper- 
ties in  recent  wounds,  attended  or  not  with  loss  of  substance,  the 
Chimrgia  Homceopathica  will  possess  a  new  remedy  which  presents 
the  advantage  of  causing  very  slight  suppuration,  a  circumstance  of 
no  mean  importance  in  the  treatment  of  extensive  wounds,  where  there 
is  often  exhausting  suppuration,  lasting  a  long  time,  and  severely 
taxing  the  strength  of  the  patient. 

Dislocations.  Luxations.  Violent  pain,  swelling,  distortion 
of  the  joints,  loss  of  motion,  with  an  alteration  in  the  shape,  length, 
and  direction  of  the  limb,  characterise  the  existence  of  this  species 
of  injury. 

Therapeutics.  The  reduction  of  a  luxation  ought  to  be  effected 
as  soon  as  possible  by  the  surgeon.  When  there  is  excessive  pain 
and  inflammation,  a  dose  of  Arnica  ought  to  be  given,  followed  by 
Aconitum  in  an  hour  or  two,  if  the  pain  continue  violent,  and  the 
inflammatory  symptoms  active.  Cold  water,  or  weak  Amicated  water, 
(one  part  of  the  tincture  in  ten  of  wrater)  should  be  applied  locally* 
When  the  luxation  is  reduced,  the  same  treatment  may  be  pursued 
if  called  for ;  and  the  usual  beneficial  mechanical  measures  employed. 
In  compound  luxations,  the  same  treatment  must  be  pursued  in  the 
first  instance  as  above  described ;  and  the  wound  treated  so  that  it 
may  be  healed  if  possible  by  the  first  intention.     (See  Wounds.) 

Fractures.  The  symptoms  of  fracture  are  pain,  swelling, 
deformity,  and  sometimes  shortening  of  the  limb  ;  loss  of  power, 
with  preternatural  mobility,  when  wTe  attempt  to  bend  the  limb,  and 
crepitation  on  rubbing  the  broken  surfaces  of  bone  together. 

Fractures  are  divided  into  transverse,  oblique,  and  longitudinal ; 
and  also  into  simple,  compound,  complicated,  and  comminuted.     By 

*  Arch.,  Bd.  17,  Heft  3. 


FRACTURES.  627 

a  simple  fracture  is  understood  one  in  TOhich  the  bone  is  broken,  with- 
out there  being  at  the  same  time  a  wound  of  the  soft  parts.  A 
compound  fracture  consists,  not  only  of  a  solution  in  the  continuity  of 
the  bone,  but  also  in  the  coexistence  of  an  external  wound,  caused 
by  the  protrusion  of  the  extremity  of  one  or  both  fragments  of  the 
bone  through  the  integuments.  Again,  a  fracture  is  termed  compli- 
cated, when  it  is  attended  with  a  wound  of  a  large  artery,  extensive 
laceration  of  the  soft  parts,  or  with  dislocation  of  a  joint.  Lastly,  it 
is  designated  comminuted,  when  the  bone  is  broken  into  several  pieces. 

Therapeutics.  As  soon  as  a  limb  is  discovered  to  be  fractured, 
the  patient  ought  to  be  placed  on  a  litter  of  any  kind  which  happens 
to  be  at  hand,  such  as  a  board  or  shutter,  and  removed  to  some 
neighbouring  place  of  shelter,  or  to  his  own  abode  if  it  be  not  far 
distant.  Great  care  and  gentleness  ought  to  be  exercised  in  lifting 
and  transporting  the  patient  from  one  place  to  another ;  otherwise  a 
fracture,  originally  of  the  simple  kind,  is  liable  to  be  converted  into  a 
compound  or  at  all  events  into  a  complicated  one,  from  laceration  of 
the  soft  parts,  &c.  by  the  serrated  extremities  of  the  fractured  bone, 
whereby  the  probabilities  of  recovery  will  be  rendered  much  more 
unfavorable,  particularly  if  the  accident  has  happened  to  a  debilitated 
or  aged  individual.  In  the  case  of  a  simple  fracture,  the  reduction 
should  be  immediately  effected.  When  that  is  accomplished,  a  dose 
of  Arnica  should  be  administered,  for  the  double  purpose  of  prevent- 
ing the  invasion  of  undue  inflammation,  and  of  promoting  the 
reunion  of  the  fracture.  Bymphitum  officinale  has  also  been  most 
favorably  spoken  of  as  being  extremely  valuable  in  facilitating  the 
last-named  important  object.*  Those  who  have  had  ample  oppor- 
tunities of  testing  the  virtues  of  these  remedies,  and  the  homoeo- 
pathic treatment  generally,  in  cases  of  fracture,  unhesitatingly  de- 
clare that  the  patients  are  thereby  enabled  to  regain  the  use  of  their 
limbs,  and  to  be  discharged  with  safety  from  the  hands  of  the  surgeon 
at  an  earlier  period  than  when  treated  according  to  the  old  method ; 
and  further,  that  the  formation  of  false  joints  is  less  liable  to  occur 
tinder  the  new  mode  of  treatment. 

In  fracture  complicated  with  a  wounded  artery,  or  with  a  dislocated 
joint,  the  artery  should  be  ligatured,  and  the  luxation  reduced  before 
the  bone  is  set. 

*  Ruta  has  likewise  been  mentioned  as  useful  in  some  cases. 


628  CASUALTIES. 

In  compound  fracture,  the  protruded  extremities  of  the  bone 
should  be  restored  to  their  natural  position  as  soon  as  possible,  the 
limb  supplied  with  splints,  &c,  and  the  external  wound  attempted  to 
be  healed  by  the  first  intention.  Consecutive  inflammation  and  con- 
stitutional disturbance  must  be  suppressed  by  the  measures  alluded 
to  in  the  treatment  of  wounds. 

It  is  foreign  to  our  purpose  to  occupy  further  space,  by  entering 
into  a  description  of  the  means  to  be  adopted,  in  the  reduction  of 
the  various  specific  fractures  which  are  liable  to  be  encountered  in 
different  parts  of  the  body  :  such  a  proceeding  would  come  more 
within  the  province  of  a  purely  surgical  work.  Let  it  suffice,  there- 
fore, to  remark,  in  closing  these  observations,  that  in  all  cases, 
the  same  medical  treatment  is  to  be  pursued,  as  we  have  already 
prescribed  for  that  of  contusions,  wounds,  and  fractures  in  general. 
Finally,  it  may  be  stated,  that  from  the  great  success  which  has 
attended  the  homoeopathic  practice,  as  employed  by  continental 
surgeons,  in  the  treatment  of  those  numerous  and  serious  diseases 
which  are  usually  considered  of  a  surgical  character,  it  is  earnestly  to 
be  hoped  that  their  colleagues  in  this  country  may  be  induced  to 
emulate  their  example,  and  thereby  become  enabled  to  raise  their 
important  branch  of  the  profession  to  a  still  higher  standing  than  it 
already,  in  many  respects,  has  attained. 


BURNS  AND  SCALDS. 


Burns  have  generally  been  divided  by  most  authors  into  three 
kinds : — First,  those  which  only  excite  an  inflammation  of  the  skin, 
accompanied  or  not  with  vesication  ;  second,  those  which  injure 
the  vitality  of  the  cutis,  inducing  separation  of  the  cuticle  and  suppu- 
ration of  the  dermal  surface ;  third,  those  in  which  the  vitality  of  the 
integuments  is  either  at  once  destroyed  or  so  seriously  affected  that 
sloughing  ensues.  The  amount  of  danger  from  the  effects  of  a  burn 
depends  upon  several  conditions.  A  scald  or  burn  of  great  extent 
frequently  proves  fatal  immediately  or  after  the  lapse  of  a  few  hours, 
the  patient  never  rallying  from  the  collapse.  The  extent  and  depth 
of  the  burn,  wherever  its  seat  may  be,  together  with  the  age,  tempe- 


BURNS  AND  SCALDS.  629 

rament,  and  habit  of  body  of  the  patient,  determine  the  degree  of 
danger  to  be  apprehended. 

Therapeutics.  In  slight  burns  or  scalds  the  injured  part  should 
be  held  for  a  couple  of  minutes  to  the  fire;  a  temporary  increase  of 
pain  will  be  amply  repaid  by  the  prevention  of  future  suffering  and 
annoyance.  The  application  of  Arnica  is  of  speedy  service  in  super- 
ficial burns.  When  the  pain  is  excruciating,  Carlo  v.  often  relieves, 
and  failing  it  Coffea.  If,  however,  the  injury  be  more  severe,  the 
affected  part  may  be  dressed  with  heated  alcohol,  or  oil  of  turpentine, 
taking  care  to  keep  the  surface  continually  moist,  and  well  protected 
from  the  external  air. 

The  application  of  raw  cotton  to  the  part,  is  frequently  found  very 
efficacious,  particularly  when  the  injury  presents  a  large  surface ; 
having  previously  punctured  any  blisters  that  may  have  arisen,  and 
bathed  the  sore  with  tepid  water,  cover  it  with  carded  cotton  or  wad- 
ding, in  three  layers ;  when  suppuration  sets  in,  remove  the  upper 
layer  only,  and  substitute  fresh.  At  the  same  time  we  may  prescribe 
Hepar  sulphuris,  a  grain  to  an  ounce  of  water,  a  dessert-spoonful 
every  twelve  hours.  China  is  sometimes  serviceable  after  Hepar,  when 
the  discharge  has  been  excessive. 

Soap,  a  remedy  generally  at  hand,  is  extremely  serviceable  in 
burns,  where  not  only  the  cuticle,  but  the  true  skin  has  been  de- 
stroyed :  pure  white  or  curd  soap  is  the  best  for  this  purpose. 

Its  application  will,  as  in  the  instance  of  dry  heat,  &c.  at  first 
increase  the  pain;  but  this  temporary  inconvenience  will  be  super- 
seded by  a  marked  amelioration  ;  after  a  lapse  of  about  twenty-four 
hours,  the  plaster  may  be  gently  removed,  and  a  fresh  one  substi- 
tuted ;  generally  speaking,  however,  we  must  be  guided  by  the 
feelings  of  the  patient,  and  renew  it  as  often  as  a  return  of  pain  is 
complained  of;  and  so  continue  until  the  injury  is  completely 
healed.* 


*  "  When  erythema  alone  results  from  a  burn,  warm  alcohol,  oil  of  turpentine,  or  radiated 
heat  are  the  most  appropriate  applications.  When  the  epidermis  is  destroyed,  the  principal 
object  to  be  kept  in  view,  in  order  to  facilitate  the  cure,  is  to  protect  the  injured  part  from 
the  atmospheric  air,  and  from  any  other  irritation  or  pressure.  The  best  mode  of  effecting 
this  is  by  covering  the  affected  surface  with  thick  layers  of  carded  cotton,  having  previously 
opened  the  blisters  with  the  point  of  a  needle,  and  bathed  the  part  with  tepid  water.  Pen- 
cilling with  white  of  egg,  which  has  been  beat  into  a  froth,  is  sometimes  attended  with 
beneficial  results.     Should  the  cotton  have  become  hard  and  inflexible,  like  a  coat  of  mail, 


630  CASUALTIES. 

Aconitum  is  essential  in  the  event  of  extensive  inflammation, 
with  considerable  fever ;  or  when  the  system  has  received  a  severe 
shock  from  fright  at  the  time  of  the  injury.  Opium  is  also  of  use 
under  the  latter  circumstances. 

Urtica  urens  has  recently  come  into  repute  as  a  valuable  re- 
medy in  burns.  The  mode  of  application  recommended  consists  in 
applying  linen  cloths,  saturated  with  the  mother  tincture,  to  the 
injured  part ;  and  in  severe  cases,  a  drop  of  the  tincture  may  be 
taken  internally  also,  either  in  a  little  water,  or  on  a  piece  of  lump 
sugar. 

Kreasote  water  has  likewise  been  recommended  as  a  lotion  in 
burns  of  all  kinds,  either  at  the  commencement  or  subsequently,  to 
induce  healthy  granulation  and  cicatrization.  Crocus  sativus  (applied 
externally)  has  also  been  favorably  spoken  of  as  most  serviceable  for 
the  latter  purpose,  in  burns  or  wounds  with  considerable  loss  of  sub- 
stance, and  disposition  to  mortification  and  sloughing.  It  is  pro- 
bable that  Calendula  officin.  may  prove  useful  in  similar  cases.  (See 
also  Ulcers.)  Arsenicum,,  and  sometimes  Acid,  nitric,  favor  the 
sloughing  of  eschars. 


FATIGUE. 

When  a  feeling  of  contusion  is  experienced  in  all  the  limbs,  Arnica 
will  generally  be  found  the  most  appropriate  remedy  to  afford  relief. 

Pains  in  the  joints,  &c,  arising  from  lifting  heavy  weights,  or  from 
violent  physical  exertion  of  any  kind,  are  usually  speedily  removed 
by  Rhus  toxicodendron. 

Cinchona  will  frequently  assist  in  renovating  the  strength,  when 
there  has  been  profuse  perspiration. 

Veratrum,  when  tendency  to  fainting  ensues  from  the  effects 
of  extreme  fatigue ;  and 

Coffea,  when  abstinence  from  food,  combined  with  violent  exer- 
cise, has  produced  a  state  of  exhaustion. 

Coccultjs,  when  fatigue  occurs  after  the  most  trivial  exertion 

in  which  case  some  effluvium  is  also  more  or  less  perceptible,  it  may  be  moistened  once  a 
day  with  largely  diluted  kreasote  water.  If  the  dermis  be  also  injured,  it  cannot  be  healed 
without  suppuration ;  in  such  cases  thick  warm  soap  lather  or  paste  is  the  best  external 
remedy." — (Kurtz.  Allg.  Horn.  Zeit.  xxvi,  368.) 


OVERHEATING.  631 

either  of  body  or   mind.       (Veratrum  and  Calcarea  are  sometimes 
necessary  when  Cocculus  does  not  give  much  relief.) 

In  fatigue  from  long  watching  Cocculus  is  the  most  generally  useful 
medicament ;  but  Nux  v.,  Ipecac,  Puis.,  and  Carlo  v.  are  also  of  service 
occasionally.  Aconitum  is  a  valuable  remedy  when  dyspnoea,  with 
palpitation  of  the  heart,  pain  in  the  side,  or  aching  in  the  extremities, 
arises  from  running  a  short  distance,  or  even  from  walking  quickly, 
(Bryonia  is  sometimes  necessary  when  these  symptoms  continue  not- 
withstanding the  employment  of  Aconitum.  At  other  times  Arnica 
will  be  found  more  efficacious,  particularly  when  the  pain  resembles 
what  is  termed  a  stitch  in  the  side.  Ranunculus  bulbosus  is  also  very 
useful  in  the  latter  case.) 


OVERHEATING.     EXPOSURE  TO  HEAT. 

When  heat  in  the  head  and  flushing  of  the  face  have  arisen  from 
over-exertion  in  hot  weather,  care  should  be  taken  not  to  drink  cold 
water  until  a  sufficient  time  has  elapsed  to  admit  of  a  diminution  of 
the  temperature  of  the  body.  The  early  employment  of  Aconitum  in 
such  cases  affords  speedy  relief,  and  acts  as  a  preventive  to  any 
ulterior  troublesome  consequences.  Violent  headache,  with  con- 
gestion, fever,  vomiting,  sleeplessness,  great  anguish  or  despair,  and 
a  sense  of  weight  at  the  forehead  on  bending  forward,  or  on  stooping, 
as  if  the  contents  of  the  cranium  would  burst  forward  out  of  their 
containing  cavity,  Belladonna  should  be  given,  and  repeated  from  six, 
twelve,  or  twenty-four  hours,  if  required,  shortening  or  lengthening 
the  interval  according  to  circumstances.  Bryonia  may  be  selected  in 
preference  to  Bella.,  w7here  there  is  ill-humour  and  apprehension  of 
some  future  misfortune.  When  headache  with  loss  of  appetite,  a 
degree  of  fever  wdth  thirst,  or  diarrhoea  is  brought  on  by  expo- 
sure either  to  the  rays  of  the  sun  or  to  the  heat  of  the  fire 
during  any  exertion,  Bryonia  is  again  the  most  useful  remedy  in  most 
instances.  If  nausea  is  the  only  or  principal  symptom  which  is 
produced  by  exposure  to  heat,  Silicea  wrill  generally  be  found  the 
more  efficacious  medicament  in.  removing  the  said  susceptibility. 
Against  headache  from  over-heating,  with  weight  over  the  orbits 
and  pain  in  the  ball  of  the  eye  on  looking  intently  at  any  object, 
Carlo  v.,  usually  affords  speedy  relief. 


632  CASUALTIES. 


STINGS  OF  INSECTS. 


The  severe  pain  and  febrile  irritation  which  sometimes  ensue  from 
the  stings  of  insects,  such  as  bees,  wasps,  &c.  is  frequently  speedily 
alleviated  by  the  olfaction  of  spirits  of  Camphor.  Should,  however, 
considerable  inflammation  with  swelling  supervene,  Aconitnm  should 
be  administered,  and  subsequently  Arnica,  internally  and  externally, 
as  described  under  Wounds.  Should  the  tongue  or  any  part  of  the 
mouth  be  the  part  where  the  sting  has  been  inflicted — as  occasionally 
happens  to  children  when  biting  a  piece  out  of  an  apple  or  pear,  &c, 
into  which  a  wasp  may  have  greedily  inserted  itself — the  mouth 
ought  to  be  rinsed  with  diluted  Arnica  tincture  ;  and  should  that  not 
suffice,  Belladonna  should  be  prescribed.  In  some  instances  it  will 
be  found  necessary  to  have  recourse  to  Mercurius  after  Belladonna. 

The  bites  or  stings  of  gnats  require  an  Arnica  lotion  ;  lemon-juice 
will  likewise  be  found  useful  in  relieving  the  pain  and  itching  caused 
thereby. 

Immediate  relief,  when  a  person  has  been  severely  stung  by  net- 
tles, will  often  be  found  by  the  application  of  a  lotion  of  Arnica,  pre- 
pared according  to  the  formula  given  under  Bruises. 


SEA-SICKNESS. 

Therapeutics.  The  medicaments  found  most  useful  in  the 
treatment  of  this  distressing  and  painful  malady  are  Nux  vomica, 
Cocculus,  Tabacum,  Arsenicum,  and  Ipecacuanha. 

Nux  vomica  should  be  taken  fasting,  from  six  to  twelve  hours 
before  embarkation ;  this  precaution  will,  in  some  cases,  prove  suffi- 
cient to  ward  off  the  attack.  {Nux  v.,  and  Arsenicum  alternately  every 
hour  or  so,  at  the  commencement  of  the  voyage,  or  oftener  should  a 
degree  of  nausea  have  already  come  on,  frequently  ward  off  the  sick- 
ness, or  at  all  events  afford  great  relief.  As  soon  as  decided  improve- 
ment is  experienced,  the  remedies  must  be  discontinued,  or  taken  at 
much  longer  intervals.) 

Should,  however,  a  feeling  of  giddiness,  or  a  sensation  of  emptiness 
in  the  head  be  experienced,  shortly  after  going  on  board,  attended 


APPARENT  DEATH.  633 

with  headache,  nausea,  and  inclination  to  vomit/ as  the  motion  of  the 
vessel  increases,  which  is  aggravated  by  standing  erect,  Cocculus 
may  be  had  recourse  to,  and  repeated  every  one,  two,  or  three  hours, 
as  those  symptoms  recur.  (This  remedy  has  also  been  found  useful 
in  sickness  arising  from  travelling  in  a  carriage.) 

Tabacum.  Excessive  giddiness,  attended  with  distressing  nausea, 
headache,  and  deadly  paleness  of  the  face;  or  nausea,  with  sickness,  or  a 
sensation  of  burning  in  the  stomach,  renewed  by  the  slightest  movement 
of  the  head  or  body,  This  remedy  is  further  indicated,  when  the 
symptoms  are  somewhat  relieved  by  exposure  to  the  fresh  air. 

Arsenicum  is  useful  when  the  sickness  becomes  excessive,  and  is 
attended  with  a  feeling  of  utter  prostration  and  helplessness,  violent 
retching,  burning  sensation  in  the  throat,  and  the  other  severe  con- 
comitants of  this  malady.  It  should  be  administered  between  the 
paroxysms,  and  will  rarely  fail  of  relief.  This  medicine  may  be 
followed  by  Tabacum  or  Cocculus,  to  dissipate  the  symptoms  of  nausea 
and  swimming  in  the  head  that  may  supervene. 

Ipecacuanha  is  serviceable  in  attacks  of  vomiting  unattended  with 
great  prostration  of  strength  given  under  Arsenicum.  Of  course,  in 
order  to  avoid  interfering  with  the  action  of  the  medicines,  the  homoeo- 
pathic regimen  should  be  carefully  observed  during  the  period  of  their 
administration. 

Petroleum,*  Silicea,  and  Therideon,  from  the  close  analogy 
of  their  pathogenetic  symptoms  to  those  of  the  ordinary  forms  of  this 
distressing  malady,  deserve  a  trial. 


apparent  death. 

Asphyxia, 

Apparent  Death.  Asphyxia.  In  every  instance  where  an 
individual  has  to  all  appearance  suddenly  expired  from  external 
causes,  animation  may  only  be  suspended ;  there  are  many  cases,  of 

*  "  I  have  found  that  Petroleum  is  the  best  specific  for  sea-sickness.  It  has  become 
quite  a  celebrated  remedy  among  those  who  travel  on  the  lakes.  As  soon  as  the  nausea, 
swimming  in  the  head,  etc.,  sets  in  the  patient  takes  three  or  four  pellets,  6  upon  the 
tongue,  and  the  symptoms  disappear  almost  instantaneously,  without  ever  returning.  I 
know  that  numbers  have  been  relieved  by  Petroleum,  and  that  it  has  so  far  failed  only  in 
one  instance." — (Dr.  D.  Chase,  Homceop.  Examr.  Vol.  iv,  No.  2.) 


634  CASUALTIES. 

course,  where  sudden  death  is  no  mere  suspension  of  animation,  but 
there  are  others  where  apparent  death  is  far  from  uncommon ;  in  all 
cases,  therefore,  where  there  is  the  least  uncertainty,  care  should  be 
taken  to  do  nothing  that  may  cause  death,  and  interment  should  be 
avoided  until  certain  signs  of  putrefaction  set  in.^ 

Apparent  death  from  hunger.  Give  small  injections  of  warm  milk 
repeatedly ;  great  care  must  be  taken  to  give  the  food  when  the 
patient  begins  to  rally,  in  the  smallest  possible  quantity  at  a  time. 
Milk  may  be  given  drop  by  drop,  and  gradually  increased  to  a  tea- 
spoonful,  and  after  some  interval  a  small  quantity  of  beef  tea  and  a 
few  drops  of  wine.  After  a  sound  sleep  has  succeeded,  but  not  till 
then,  a  small  meal  may  be  given ;  but  it .  is  best  that  the  patient 
should  eat  little  at  a  time,  but  often,  so  that  he  may  gradually  return 
to  his  natural  mode  of  living.  It  must  be  borne  in  mind,  that  in  all 
persons  suffering  from  starvation,  eating  too  much  and  too  quickly, 
is  in  the  highest  degree  dangerous. 

Apparent  death  from  a  fall.  Place  the  patient  cautiously  on  a  bed, 
with  his  head  high,  in  a  place  where  he  can  remain  quiet ;  put  a  few 
globules  of  Arnica  on  his  tongue,  and  wait  till  a  medical  man  visits 
him  to  see  if  there  is  any  fracture,  or  whether  there  are  still  signs  of 
life ;  bleeding  may  be  here  sometimes  of  benefit,  but  it  requires  great 
caution.  Arnica  may  be  repeated,  and  also  administered  in  injec- 
tions. If  the  patient  has  been  bled,  give  China;  but  it  is  obvious  that 
if  much  blood  has  been  lost  by  the  fall  or  wound,  venesection  would 
be  injurious. 

Apparent  death  from  suffocation,  (hanging,  pressure,  chohing.)  Remove 
all  tight  clothing.  Put  the  patient  in  a  proper  position,  the  head  and 
neck  rather  high,  the  neck  quite  easy,  not  bent  forward.  Begin  by 
rubbing  gently  but  constantly  with  clothes,  give  an  injection  of  a  dozen 
or  two  globules,  or  a  drop  of  Opium,  dissolved  in  a  half  pint  of  water, 
and  injected  slowly.  This  may  be  repeated  every  quarter  of  an  hour, 
whilst  the  ribs  are  being  rubbed  gently.  Hold  from  time  to  time  a 
mirror  before  the  mouth,  to  see  if  the  breath  dims  it ;  open  the  eyelids, 
and  see  if  the  eyes  contract ;  put  warm  clothes  on  ;  hot  stones  wrapped 
in  blankets  to  the  feet,  between  the  thighs,  to  the  sides,  neck,  and 

*  The  subjoined  directions  have  chiefly  been  taken  from  Hering's-  Hausarzt. 


APPARENT  DEATH.  635 

shoulders.  If  in  an  hour  no  change  is  produced,  take  a  bitter  almond, 
pound  it  fine,  mix  it  in  a  pint  of  water,  put  a  few  drops  into  the 
mouth,  or  into  the  nose,  and  give" the  rest  in  injections. 

Apparent  death  from  lightning.  The  body  should  be  immediately 
removed  into  a  current  of  cool  fresh  air ;  and  cold  water  dashed  fre- 
quently on  the  neck,  face  and  breast.  If  the  body  be  cold,  warmth 
with  friction  must  be  employed  in  the  same  manner  as  recommended 
for  the  drowned  in  the*next  article  ;  as  well  as  the  means  therein  pre- 
scribed for  inflating  the  lungs.  A  few  globules  of  Nux  vomica  may  be 
put  upon  the  tongue,  and  repeated  in  half  an  hour,  when,  if  no  effect 
is  produced,  a  little  Nux  vomica  in  water  rubbed  on  the  neck,  and 
some  injected,  may  be  of  service.  It  has  also  been  recommended  to 
place  the  patient  in  a  half-sitting,  half-recumbent  posture,  and  to 
cover  him  over  with  newly-excavated  earth  (leaving  the  face  alone 
exposed,  which  should  be  turned  towards  the  sun,  until  the  first  signs 
of  returning  animation  become  apparent,  after  which  Nux  v.  is  to  be 
had  recourse  to,  as  above  directed. 

Apparent  death  from  drowning.  Observe  the  following  cautions: 
1,  lose  no  time  ;  2,  avoid  all  rough  usage ;  3,  never  hold  up  the  body 
by  the  feet ;  4,  do  not  roll  the  body  on  casks ;  5,  do  not  rub  the  body 
with  salts  or  spirits ;  6,  do  not  inject  smoke  or  infusion  of  tobacco, 
though  clysters  of  warm  water  and  salt,  or  spirits  and  water  may  be 
used,  and  the  following  means  should  not  be  delayed : — 

1.  Convey  the  body  carefully  with  the  head  and  shoulders  in  a 
raised  position  to  the  nearest  house. 

2.  Strip  the  body  and  rub  it :  then  wrap  it  in  hot  blankets,  and 
place  it  in  a  warm  bed  in  a  warm  room,  or  in  warm  sand  or  ashes. 

3.  Wipe  and  cleanse  the  throat,  mouth,  and  nostrils. 

4.  If  the  foregoing  measures  produce  no  reaction,  administer  a  few 
globules  of  Lachesis  on  the  tongue,  and  in  injections,  and  resume  the 
rubbing.  Solatium  mamosum  has  also  been  recommended,  and  may 
be  tried  after  Zachesisi  when  that  remedy  fails  to  do  any  good. 

5.  Again,  should  our  efforts  still  fail,  or  should  the  medicines 
quoted  not  be  at  hand,  we  may,  in  order  to  restore  the  natural  heat 
of  the  body,  move  a  heated,  covered  warming-pan,  over  the  back  and 
spine ;— place  bottles,  or  bladders  filled  with  hot  water,  or  hot  bricks, 
to  the  pit  of  the  stomach,  the  armpits,  between  the  thighs,  and  to  the 
soles  of  the  feet ; — put  the  body  in  a  warm  bath,  in  the  sun,  or  at  a 


636  CASUALTIES. 

proper  distance  from  the  fire  :  use  friction  with  hot  flannels,  flour  of 
mustard,  or  other  stimulants ;  rub  the  body  briskly  with  the  hand, 
and  at  the  same  time  not  suspend  the  employment  of  other  means. 

To  restore  breathing,  introduce  the  pipe  of  a- common  bellows  into 
one  nostril,  carefully  closing  the  other  and  also  the  mouth,  at  the 
same  time  drawing  downwards,  and  gently  pushing  backwards,  the 
upper  part  of  the  windpipe,  to  allow  a  more  free  admission  of  air ; 
blow  the  bellows  gently  in  order  to  inflate  the  lungs  till  the  chest  be 
a  little  raised,  the  mouth  and  nostrils  should  then  be  set  free,  and  a 
moderate  pressure  made  with  the  hand  upon  the  chest ;  continue  this 
process  until  signs  of  life  appear. 

6.  Electricity,  or  a  stream  of  galvanism  passed  through  the  chest, 
promises  to  be  of  great  service. 

7.  Apply  pungent  salts,  as  sal  volatile  or  spirits  of  hartshorn,  to 
the  nostrils. 

These  means  should  be  persisted  in  for  several  hours,  and  till  there 
are  evident  signs  of  death. 

When  the  patient  shows  signs  of  life,  and  can  swallow,  small  quan- 
tities of  warm  wine,  or  spirits  and  water  may  be  taken ;  but  till  then, 
nothing  should  even  be  poured  down  the  throat,  either  by  a  flexible 
tube  or  otherwise.  At  this  period  the  patient  should  never  be  left 
alone,  as  some  have  been  lost  for  want  of  care  who  might  otherwise 
have  been  saved. 

Apparent  death  from  leing  frozen.  When  an  individual  is  found  in  a 
state  of  frost-bitten  asphyxy,  arising  from  exposure  to  intense  cold,  he 
should  be  removed  with  great  gentleness  and  caution,  to  guard  against 
any  injury,  as  fracture,  etc.,  to  a  place  of  shelter,  such  as  a  barn  or 
unheated  apartment,  since  even  a  moderate  degree  of  heat  might  anni- 
hilate all  hope  of  restoring  animation ;  at  the  same  time  the  patient 
ought  to  be  protected  from  the  slightest  draught. 

He  should  then,  especially  if  the  limbs  have  become  stiffened  by 
the  frost,  be  covered  over  with  snow  to  the  height  of  several  inches, 
the  mouth  and  nostrils  alone  being  left  free. 

The  patient  ought  to  be  put  into  such  a  position  that  the  melted 
snow  may  run  off  readily,  and  its  place  be  supplied  by  fresh.  When 
there  is  no  snow  a  cold  bath,  the  temperature  of  which  has  been 
reduced  by  ice,  (or  a  bath  of  cold  sea  or  salted  water),  may  be  substi- 
tuted, and  the  body  immersed  therein  for  a  few  minutes. 

The  process  of  thawing  is  by  these  means  to  be  effected,  and  when 


HYDROPHOBIA.  637 

every  part  has  lost  its  rigidity*,  the  patient  should  be  undressed  by 
degrees,  or  the  clothes  cut  from  the  body,  if  requisite.  As  the  mus- 
cular or  soft  parts  become  pliable,  they  may  be  rubbed  with  snow 
until  they  become  red;  or  the  body  should  be  wiped  perfectly  dry,  if 
snow  is  not  to  be  had,  placed  in  flannel,  in  a  modetately  warm  room, 
and  rubbed  with  the  warm  hands  of  several  parties  simultaneously. 

In  the  event  of  no  signs  of  returning  animation  declaring  them- 
selves soon  after  the  foregoing  treatment,  small  injections  containing 
Camphor  may  be  administered  every  quarter  of  an  hour.  As  soon  as 
any  symptoms  of  approaching  restoration  become  perceptible,  small 
injections  of  lukewarm  black  coffee  (coffee  without  milk)  maybe  thrown 
up  ;  and  as  soon  as  the  patient  is  able  to  swallow,  a  little  coffee  may 
be  given,  in  the  quantity  of  a  teaspoonful  at  a  time. 

The  measures  above  detailed  ought  to  be  persevered  in  for  several 
hours.  Against  the  excessive  pain  which  is  generally  experienced 
when  life  is  restored,  Carlo  v.  should  be  prescribed  in  repeated  doses, 
and  if  it  fails  to  relieve  the  sufferings,  Arsenicum  may  be  given.  The 
party  rescued  must  avoid  subjecting  himself  to  the  heat  of  the  fire  or 
stove  for  a  considerable  length  of  time  after  his  recovery,  as  serious 
consecutive  ailment,  and  particularly  disease  of  the  bones,  is  liable  to 
result  therefrom. 

Apparent  death  from  noxious  vapours.  The  treatment  consists  in  re- 
moving the  body  into  a  cool,  fresh  current  of  air ;  dashing  frequently 
cold  water  on  the  neck,  face  and  breast ;  if  the  body  be  cold,  applying 
warmth,  &c.,  as  above  recommended  to  the  drowned ;  inflation  of  the 
lungs ;  early  and  judicious  application  of  electricity  or  galvanism ; — 
after  life  has  been  restored  Op.  or  Aeon,  may  be  given  with  advantage. 


HYDROPHOBIA. 

It  is  acknowledged  that  no  allopathic  cure  has  hitherto  been  ound 
for  this  disease,  when  fully  established.  The  plans  of  treatment, 
which  are  reported  to  have  been  successful  in  some  few  instances, 
have  generally  failed  in  all  others ;  thus  rendering  it  probable  that  in 
these  supposititious  cases  of  success,  the  persons  bitten  might  have 
escaped  without  any  treatment  whatever*     But  it  is  not  to  my  pur- 


638  CASUALTIES. 

pose  to  enter  into  the  multitude  of  ineffectual  remedies  which  have 
been  recommended  by  the  Allopathists. 

Hydrophobia  is  a  disease  which  arises  in  consequence  of  the  bite 
of  a  rabid  animal,  and  sometimes  spontaneously,  particularly  in  the 
course  of  some  other  disease ;  in  which  form  it  is  known  under  the 
term  of  symptomatic  hydrophobia. 

Ere  proceeding  to  the  homoeopathic  treatment,  a  few  remarks 
descriptive  of  the  disease  as  it  appears  in  the  human  subject,  may  not 
be  misplaced.  The  first  symptoms  that  show  themselves  in  a  person 
who  has  been  bitten,  are  usually,  general  uneasiness,  anxiety,  and 
disturbed  sleep ;  the  eyes  are  glassy,  inflamed,  and  sensitive  to  light ; 
there  are  also  ringing  in  the  ears,  giddiness,  and  paleness  of  counte- 
nance;  frequent  paroxysms  of  chilliness  ;  oppressed  respiration,  and 
quickness  of  pulse,  which  latter  is  usually  at  the  same  time  small, 
contracted,  and  irregular;  and  loss  of  appetite.  These  symptoms 
generally  come  on  at  some  indefinite  period,  occasionally  after  the 
bitten  part  seems  quite  well.  In  the  second  or  convulsive  stage,  the 
wound,  which  may  have  already  become  completely  cicatrized  or 
healed,  begins  to  assume  a  somewhat  inflamed  appearance,  and  a 
slight  pain  and  heat,  now  and  then  attended  with  itching,  is  expe- 
rienced in  it.  It  now  breaks  out  afresh,  and  an  ulcer,  with  elevated 
margins  of  proud  flesh,  which  secretes  a  dark  coloured  and  offensive 
discharge,  is  subsequently  formed;  and  wandering,  drawing,  and 
shooting  pains  from  the  lacerated  part  upwards  towards  the  throat, 
present  themselves.  These  symptoms,  with  the  state  of  testiness  and 
anxiety,  increase  daily ;  and  the  patient  complains  of  a  state  of  confu- 
sion in  the  head,  or  giddiness,  with  sparks  before  the  eyes ;  is  afflicted 
with  sudden  startings,  spasms,  sighing,  and  is  fond  of  solitude ;  the 
pulse  is  small,  irregular,  and  intermittent;  the  breathing  laborious  and 
uneasy ;  the  skin  cold  and  dry,  and  general  chilliness,  especially  in 
the  extremities,  is  complained  of ;  then  hiccough,  colic,  and  palpita- 
tion come  on ;  the  patient  looks  wild,  and  the  eyes  have  a  fixed, 
glassy,  and  sJdning  appearance ;  the  act  of  deglutition  is  impeded  by 
a  sense  of  pressure  in  the  gullet,  which  occasionally  renders  every 
attempt  to  swallow  liquids  impracticable ;  convulsions  also  take  place 
in  the  muscles  of  the  face  or  neck.  In  this  stage,  however,  the  deglu- 
tition of  any  solid  substance  is  performed  with  tolerable  ease.  In 
ordinary  cases  the  sufferer  remains  affected  in  the  above  manner  for 
a  few  days,  after  which,  the  disease  passes  into*  the  JuycH/rophobic  stage, 


HYDROPHOBIA.  639 

in  which  it  is  utterly  impossible  for  him  to  swallow  the  smallest  drop 
of  liquid ;  and  the  moment  that  any  fluid,  especially  water,  is  brought 
in  contact  with  the  lips,  it  occasions  the  individual  to  start  back  with 
dread  and  horror,  although  he  may,  at  the  same  time,  suffer  the  most 
excessive  thirst ;  even  the  sight  of  water,  or  the  very  noise  produced 
by  pouring  it  from  one  vessel  into  another,  in  fact,  anything  that 
tends  to  remind  him  of  that  fluid,  produces  indescribable  anxiety, 
uneasiness,  convulsions,  and  even  furious  paroxysms  of  madness ;  he 
dreads  even  to  swallow  his  own  saliva,  and  is  constantly  spitting ; 
vomiting  of  bilious  matter  soon  comes  on,  succeeded  by  intense  fever, 
great  thirst,  dryness  and  roughness  of  the  tongue,  hoarseness,  and  fits 
of  delirium  or  madness,  with  disposition  to  bite  and  tear  everything 
within  reach,  followed  at  intervals  by  convulsive  spasms.  These 
attacks  commonly  last  for  a  quarter  or  half  an  hour,  and  at  their 
expiration,  the  patient  is  restored  to  reason,  but  remains  in  a  state  of 
great  despondency;  finally,  the  paroxysms  come  on  more  violently 
and  frequently,  and  in  some  instances  a  fit  of  furious  delirium  closes 
the  frightful  scene ;  in  others,  nature  sinks  exhausted  after  a  severe 
attack  of  convulsions.  The  disease  may  be  communicated  to  the 
human  subject,  from  the  bites  of  cats,  and  other  animals  not  of 
the  canine  race,  which  have  been  previously  inoculated  with  the 
virus. 

It  may  be  remarked  in  this  place,  that  the  best  and  most  expe- 
rienced of  our  writers  upon  this  subject,  consider  the  human  species 
as  the  least  susceptible  of  contagion  from  the  hydrophobic  virus; 
scarcely  one  out  of  twenty,  or  even  thirty,  of  those  actually  bitten  by 
an  animal  in  a  state  of  rabies,  suffering  from  its  effects.  I  cbnsider 
it  my  duty,  while  making  this  statement,  which  I  hope  may  prove  a 
means  of  relieving  the  minds  of  many  from  painful  apprehensions,  to 
enforce,  at  the  same  time  the  necessity  of  taking  those  precautions, 
which  are  about  to  be  pointed  out,  against  the  danger. 

It  may  also  be  added,  before  proceeding  to  the  treatment  of  the 
malady,  that  the  possibility  of  the  poison  being  communicated  through 
the  medium  of  the  epithelium  is  exceedingly  questionable;  but 
scarcely  a  doubt  exists  of  the  incapacity  of  the  cuticle  to  absorb  it. 
As  many  have  been  made  wretched  from  having  allowed  a  dog,  which 
has  afterwards  shown  symptoms  of  rabies,  to  lick  their  hands,  it  may 
be  stated  with  confidence  that  if  no  abrasion  of  surface  exists,  there  is 
not  the  slightest  danger. 

In  the  homoeopathic  treatment  of  this  disease,  and  its  prevention, 


640  CASUALTIES. 

the  following  are  the  principal  remedies  employed :  Belladonna,  Lachesis. 
Hyoscyamus,  Stramonium,  and  CantharidesJ* 

*  The  use  of  dry  or  radiating  heat  in  this  disease,  and  in  envenomed  wounds  by  snakes, 
&c.,  is  recommended  by  Dr.  Hering,  of  America,  whose  directions  for  the  treatment  of 
envenomed  wounds  in  general,  are  as  follows : 

Envenomed  wounds.  The  best  domestic  remedy  against  the  bites  of  venomous  serpents, 
mad  dogs,  &c,  is  radiating  heat.  This  should  be  done  by  the  readiest  means  at  hand, — 
a  red-hot  iron  or  live  coal,  or  even  a  lighted  cigar,  for  instance,  must  be  placed  as  near  the 
wound  as  possible,  without,  however,  burning  the  skin,  or  causing  too  sharp  pain ;  but 
care  must  be  taken  to  have  another  instrument  ready  in  the  fire  so  as  never  to  allow 
the  heat  to  lose  its  intensity.  It  is  essential  also  that  the  heat  should  not  exercise 
its  influence  over  too  large  a  surface,  but  only  on  the  wound  and  the  parts  adjacent- 
If  oil  or  grease  can  be  readily  procured,  it  may  be  applied  round  the  wound,  and  this 
operation  should  be  repeated  as  often  as  the  skin  becomes  dry ;  soap,  or  even  saliva 
may  be  employed,  where  oil  or  grease  cannot  be  obtained.  Whatever  is  discharged  in 
any  way  from  the  wound  ought  to  be  carefully  removed.  The  application  of  burning 
heat  should  be  continued  in  this  manner,  till  the  patient  begins  to  shiver  and  to  stretch 
himself;  if  this  takes  place  at  the  end  of  a  few  minutes,  it  will  be  better  to  keep  up 
the  action  of  the  heat  upon  the  wound  for  an  hour,  or  until  the  affections  produced  by 
the  venom  are  observed  to  diminish. 

Internal  medicines  must  be  judiciously  administered  at  the  same  time.  In  the  case  of  a 
Bite  from  a  Serpent,  it  will  be  advisable  to  take  from  time  to  time  a  gulp  of  salt  and 
water,  or  a  pinch  of  kitchen  salt,  or  of  gunpowder,  or  else  some  pieces  of  garlic. 

If,  notwithstanding  this,  bad  effects  manifest  themselves,  a  spoonful  of  wine  or  brandy, 
administered  every  two  or  three  minutes,  will  be  the  most  suitable  remedy ;  and  this 
should  be  continued  till  the  sufferings  are  relieved,  and  repeated  as  often  as  they  are 
renewed. 

If  the  shooting  pains  are  aggravated,  and  proceed  from  the  wound  towards  the  heart,  and 
if  the  wound  becomes  blueish,  marbled,  or  swollen,  with  vomiting,  vertigo,  and  fainting, 
the  best  medicine  is  Arsenicum.  It  should  be  administered  in  a  dose  of  three  globules  in 
a  tablespoonful  of  water ;  and  if  after  this  has  been  taken,  the  sufferings  are  still  aggra- 
vated, the  dose  should  be  repeated  at  the  end  of  half  an  hour ;  but  if,  on  the  contrary, 
the  state  remains  the  same,  it  should  not  be  repeated  till  the  end  of  two  or  three  hours ;  if 
there  is  an  amelioration,  a  new  aggravation  must  be  waited  for,  and  the  dose  ought  not 
to  be  repeated  before  its  appearance. 

In  cases  in  which  Ars.  exercises  no  influence,  though  repeated  several  times,  recourse 
must  be  had  to  Bell.;  Sen.  also  frequently  proves  efficacious. 

Against  chronic  affections  arising  from  the  bite  of  a  serpent,  Phos.  ac.  and  Merc,  will 
generally  be  most  beneficial. 

For  the  treatment  of  persons  bitten  by  a  mad  dog,  after  the  application  of  dry  heat,  as 
directed  and  described  above — see  Hydrophobia,  p.  641.) 

If  morbid  affections  or  ulcerations  exhibit  themselves,  in  consequence  of  a  bite  from  a 
rabid  man  or  animal,  Hydrophobine,  administered  in  homoeopathic  doses,  will  often  render 
essential  service. 

For  wounds  that  are  envenomed  by  the  introduction  of  animal  substances  in  a  state  of 
putrefaction,  or  of  pus  from  the  ulcer  of  a  diseased  man  or  animal,  Ars.  is  generally  the  best 
medicine. 

Lastly,  as  a  Preventive  against  bad  effects,  when  obliged  to  touch  morbid  animal  sub- 


HYDROPHOBIA.  641 

Belladonna.  HAHNEMANN  states,  in  the  introductory  arti- 
cle to  Belladonna,  in  his  Materia  Medica  Pura,  that  he  considers  the 
smallest  dose  of  that  medicine,  repeated  every  three  or  four  days,  to 
be  the  most  certain  preventive  against  Hydrophobia;  and  when  we  refer  to 
the  pathogenetic  effects  of  Belladonna,  described  in  the  aforesaid  work, 
it  is  impossible  not  to  be  struck  with  the  great  resemblance  which 
many  of  them  bear  to  the  symptoms  of  this  malady ;  and  it  is  from 
this  circumstance,  according  to  the  great  law  of  Nature,  on  which 
Hahnemann's  doctrine  of  similia  similihus  is  founded,*  that  this 
medicine  is  found  to  be  both  a  prophylatic  and  curative  remedy. 

These  precautions  taken,  the  patient  may  be  allowed  to  pursue  his 
usual  occupation,  those  around  him  being  careful  to  avoid  making 
any  allusion  which  may  tend  to  remind  him  of  his  misfortune. 
Belladonna,  in  the  same  dose,  should  be  repeated  on  the  third  or 
fourth  day,  and  subsequently  at  longer  intervals.  The  effect  of  each 
exhibition  should  be  attentively  watched,  and  care  taken  that  a  fresh 
one  be  not  given,  as  long  as  any  symptoms  of  the  action  of  the  pre- 
vious dose  are  perceptible. 

Lachesis  may  generally  be  given  as  soon  as  convulsions  set  in. 


stances,  envenomed  wounds,  or  ulcers  of  men  and  animals,  under  the  influence  of  contagious 
diseases,  the  best  method  that  can  be  pursued  is  the  application  of  dry,  burning  heat,  at  a 
distance.  To  effect  this  purpose,  it  will  be  sufficient  to  expose  the  hands  for  five  or  ten 
minutes  to  the  greatest  heat  that  can  be  borne ;  and  after  this,  it  will  be  proper  to  wash 
them  with  soap. 

The  use  of  Chlorine  and  muriatic  acid,  in  similar  cases,  is  well  known. 

Hydrophobia.  Apply  distant  or  radiated  heat  to  the  recent  wound,  as  described  under 
"  Envenomed  Wounds,"  or  until  shudderings  appear ;  and  continue  this  practice  three  or 
four  times  a  day,  until  the  wound  is  healed,  without  leaving  a  coloured  cicatrix. 

At  the  same  time  the  patient  should  take,  every  five  or  seven  days,  or  as  often  as  the 
aggravation  of  the  wound  requires  it,  one  dose  of  Bell,  or  Lach.  or  of  Hydrophobine,  till 
the  cure  is  completed. 

If,  at  the  end  of  seven  or  eight  days,  a  small  vesicle  shows  itself  under  the  tongue,  with 
feverish  symptoms,  it  will  be  necessary  to  open  it  with  a  lancet  or  sharp-pointed  scissors 
and  to  rinse  the  mouth  with  salt  and  water. 

If  the  raging  state  has  commenced,  before  assistance  can  be  procured  for  the  patient, 
the  medicines  that  ought  to  be  administered,  are  especially,  Bell,  or  Lach. ;  or  else  again, 
Canth.,  Hyos.,  Merc,  or  also  Stram.  or  Verat.,  according  to  symptoms,  &c.  (See  the  indi- 
cations above  given  for  Belladonna,  Lachesis,  Hyoscyamus,  Stramonium,  and  Cantharides.) 

*  The  curing  of  a  disease  by  the  administration  of  a  remedy  which  has  been  found  to 
possess  the  property  of  producing  a  train  of  symptoms  in  a  healthy  person,  similar  to  those 
observed  in  the  disease 

41 


642  CASUALTIES. 

Dose.  A  few  globules  repeated  every  two  or  three  hours,  or  at  every 
return  of  the  convulsions,  until  benefit  result,  or  decided  symptoms  of 
medicinal  action  make  their  appearance ;  but  should  this  remedy  appear 
to  exert  no  perceptible  influence  in  checking  the  progress  of  the  malady 
we  must  again  have  recourse  to 

Belladonna^  particularly  when  the  following  characteristics  are 
present :  drowsiness,  with  constant  but  useless  efforts  to  sleep,  chiefly 
in  consequence  of  excessive  anguish  and  great  agitation :  sense  of 
burning ;  great  burning  in  the  throat,  with  accumulation  of  frothy  mucus 
in  the  mouth  or  throat,  frequent  desire  for  drinks,  which  are  imme- 
diately pushed  aside  when  presented,  or  a  suffocating  or  constricting 
sensation  in  the  throat  on  attempting  to  perform  the  act  of  deglutition,  or 
complete  incapacity  to  swallow,  with  glowing  redness  and  bloated 
appearance  of  the  face  ;  pupils  immoveable,  and  generally  dilated ; 
great  dread ;  occasional  desire  to  strike,  spit  at,  bite,  or  tear  every- 
thing ;  inclination  to  run  away ;  continual  tossing  about ;  and  great 
physical  activity,  with  twitching  in  various  muscles,  especially  those 
of  the  face :  ungovernable  fury,  with  foaming  at  the  mouth ;  and 
tetanic  convulsions. 

Dose.  A  few  globules  to  be  placed  on  the  tongue  at  every  threatening 
of  a  return  of  the  convulsions,  but  with  the  same  precaution  as  enjoined 
under  Lachesis. 

Hyoscyamus  is  more  particularly  indicated  either  before  or  after 
Belladonna,  when  the  convtdsions  are  severe  and  of  long  dtiration ;  wrhere 
there  is  not  so  much  inclination  to  bite  or  spit,  but  a  desire  to  injure 
those  that  stand  around,  in  some  manner  or  other.  The  spasms  in 
the  throat  are  not  so  violent,  but  great  dryness  and  burning  are  com- 
plained of,  attended  with  a  sense  of  shooting  or  pricking,  which 
causes  a  difficulty  in  swallowing,  resembling  a  sensation  of  constric- 
tion in  the  throat,  and  threatening  to  produce  suffocation  on  attempt- 
ing to  satisfy  the  thirst ;  dread  of  liquids  in  consequence  of  the  pain 
and  difficulty  that  is  experienced  in  deglutition,  with  ejection  of  the 
saliva  for  the  same  reason ;  excessive  convulsions,  with  loss  of  consciousness 
come  on  soon  after  the  distressing  act  of  swallowing  has  been  performed. 
There  is,  moreover,  foaming  at  the  mouth,  with  constant  raving; 
sometimes  the  patient  seems  wrapped  up  in  his  own  thoughts ;  or  is 
full  of  fear,  and  inclined  to  run  away  from  the  house,  being  afflicted 
with  a  sort  of  Anthropophohia  ;  there  are  also  attacks  of  excessive  fury, 


HYDROPHOBIA.  643 

attended  with  apparently  supernatural  physical  power ;  or  excessive 
anguish  and  fear,  alternating  with  fits  of  trembling  and  convulsions ; 
the  individual  exhibits  a  peculiar  dread  of  being  bitten  by  animals ; 
the  pupils  are  dilated ;  sleep  is  much  disturbed  by  great  nervous  excite- 
ment ;  starts,  and  agonizing  dreams. 

Dose.     Same  as  Belladonna. 

Stramonium  is  chiefly  indicated  in  this  disease,  when  we  observe 
severe  convulsions  taking  place  whenever  the  eye  becomes  fixed  on  brilliant 
objects,  or  on  whatever  tends  to  remind  the  patient  of  water ;  great 
thirst ;  dryness  of  the  mouth  and  throat,  with  hoiror  of  water  and  all 
liquids;  spasmodic  constriction  in  the  gullet,  with  foaming  at  the 
mouth,  and  frequent  spitting ;  mania,  with  great  loquacity  and  ges- 
ticulations; fits  of  laughter  and  singing,  sometimes  alternately  with 
acute  fits  of  passions  and  moaning ;  the  convulsions,  when  severe, 
are  generally  attended  with  ungovernable  fury,  restless,  agitated  sleep, 
sudden  shrieks,  and  starting  up  with  wild  gestures ;  insensible  and 
dilated  pupils  ;  and  great  disposition  to  bite  or  tear  everything  with 
the  teeth. 

Dose.     Same  as  Belladonna. 

Cantharides.  This  medicine  also  posesses  various  pathogenetic 
properties,  wrhich  bear  a  close  resemblance  to  the  symptoms  that  are 
met  with  in  many  cases  of  this  disorder,*  and  should  be  selected  in 
preference  to  any  of  the  foregoing  remedies  when  we  meet  with  the 
following  indications :  great  dryness  and  burning  in  the  mouth  and 
throat,  much  aggravated  on  attempting  to  swallow ;  paroxysms  of  fury, 
alternating  with  convulsions,  which  are  renewed  by  any  pressure  on 
the  throat  or  abdomen,  and  also  by  the  sight  of  water ;  fiery  redness 
and  sparkling  of  the  eyes,  which  become  prominent  and  frightfully 
convulsed  ;  spasms  in  the  throat,  excited  by  the  pain  produced  by  the 


*  Drs.  Hartlaub  and  Trinks  consider  Cantharides  to  be  the  most  certain  prophylactic 
against  hydrophobia,  when  administered  early  ;  they  recommend  a  drop  to  be  given  every 
three  or  four  days,  and  are  of  opinion  that  the  virus  is  not  eradicated  as  long  as  the 
cicatrized  wound  presents  a  livid  hue,  and  is  attended  with  induration,  but  affirm  the 
danger  to  be  over  as  soon  as  the  part  assumes  a  healthy  and  natural  appearance.  (Vide 
Hartlaub  and  Trinks,  R.  A.  M.  L.,  vol.  i,  p.  173.) 


644  CASUALTIES. 

act  of  swallowing^  especially  fluids  ;  continual  burning,  titillation  and 
other  irritating  sensations  in  the  lower  part  of  the  abdomen,  &c. 

Dose.     Same  as  Belladonna. 

We  have  now  enumerated  and  described  the  characteristic  indica- 
tions for  the  principal  Homoeopathic  remedies,  which  have  been  suc- 
cessfully employed  against  Hydrophobia;*  others  have  also  been 
strongly  recommended,  but  those  mentioned  have  repeatedly  proved 
sufficient,  when  administered  early,  and  exclusively  adhered  to  through- 
out the  course  of  the  disease.  Belladonna  has  frequently  been  tried 
by  the  Allopathists,  but  the  cases  in  which  it  seemed  to  fail,  were 
evidently  attributable  to  the  improper  manner  in  which  it  was  administered. 
We  shall  not  treat  of  the  several  remedies  which  have  from  time  to 
appeared,  and  have,  by  their  inventors,  been  highly  eulogised,  as  time 
and  experience  alone  will  prove  whether  they  possess  any  virtue  or 
not. 


MENTAL  EMOTIONS. 

We  shall  conclude  this  part  of  the  work  with  the  consideration  of 
those  particular  Mental  Emotions,  which  exercise  so  great  a  control 
over  the  human  organism,  among  which,  fright,  passion,  or  anger, 
and  concentrated  grief,  are  the  most  prominent  and  continually 
recurring. 

Therapeutics.  The  remedies  found  most  serviceable  for  derange- 
ments of  the  system,  arising  from  the  above-mentioned  causes,  are, 
Opium,  Aconitum,  Pulsatilla,  Belladonna,  Ignatia  amara,  Chamomilla, 
Nux  vomica,  Staphysagria,  Arsenicum  album,  Bryonia,  Sec. 

Opium  : — when  the  sufferer  has  been  exposed  to  sudden  fright,  with 
terror,  horror,  or  fear,  is  generally  efficacious,  if  administered  im- 
mediately, in  restoring  the  patient,  and  obviating  any  evil  conse- 
quences, such  as  convulsive  fits,  swooning,  lethargic  sleep,  involun- 
tary evacuations,  diarrhoea,  &c.     (When  Opium  is  not  sufficient  to 

*  Vide  Hartmann's  Therapie  acut.  Krank,  vol.  ii,  p.  77,  2d  ed. 


MENTAL  EMOTIONS.  645 

remedy  the  mischief,  Aconitum  may  be  administered,  or  Aconitum  and 
Opium  alternately.  In  some  case  Ignatia  will  answer  better  than 
Aconitum,  especially  when  the  convulsions  continue  :  Belladonna  or 
Hyoscyamus,  and  Veratrum,  are  also  serviceable,  when  none  of  the  other 
remedies  are  sufficient  to  remove  all  the  effects.  Causticum  is  a  useful 
remedy  when  a  constant  dread  haunts  the  child  after  a  previous  fright, 
Sec.)     See  also  Samb. 

Aconitum  is  the  appropriate  remedy,  when  the  system  is  labour- 
ing under  the  joint  influence  of  fright  and  passion :  and  especially 
when  there  is  headache,  feverishness,  heat  in  the  face  and  head  (con- 
gestion) ;  fear. 

Pulsatilla,  in  cases  of  fright,  fear,  or  timidity,  particularly 
when  accompanied  with  an  effect  upon  the  stomach  and  bowels,  as 
also  heat  of  the  body,  with  coldness  of  the  extremities ;  or  passion, 
in  people  of  generally  mild  temper  ;  it  is  also  suitable  for  highly  sen- 
sitive persons. 

Belladonna.  Two  globules,  when  there  is  particular  liability 
to  be  startled  by  trifles,  or  extreme  general  nervous  excitement,  after 
a  fright,  &c. 

Ignatia  : — Where  the  cause  is  gnawing,  inward  grief.  Acid.phosph. 
and  Staphysagria  are  sometimes  requisite  after  Ignatia. 

Chamomilla  : — Where  suffering  has  arisen  from  vexation  or  a  dis- 
position to  irritability  ;  or  great  anguish  and  mental  depression,  are 
present. 

Nux  vomica.  Suffering  arising  from  a  sudden  fit,  or  outbreak  of 
passion  or  rage. 

Staphysagria.     Anger  and  vexation,  arising  from  just  cause. 

Arsenicum  is  useful  where  passion  is  followed  by  great  weakness 
and  dangerous  prostration  of  the  vital  powers. 

Bryonia  is  indicatedNvhere  a  fit  of  passion  is  followed  by  coldness 
and  shivering  over  the  whole  body,  great  irascibility,  want  of  appetite, 
nausea,  vomiting,  and  bilious  sufferings. 

Colocynth  : — when  indignation  accompanies  the  above  described 
effects  of  a  fit  of  anger. 

Against  the  injurious  effects  which  occasionally  result  after  excessive 
joy,  such  as  headache,  trembling,  and  tendency  to  fainting,  Coffea  is 
the  most  useful  remedy.  But  when  the  consequences  are  more  serious, 
and  violent  headache,  with  congestion  to  the  head,  frequent  vomiting, 
diarrhoea,  swooning,  &c,  result,  Opium  must  be  given. 

Hyoscyamus  is  a  serviceable  remedy  against  any  injurious  con- 


646  CASUALTIES. 

sequences  arising  from  jealousy,  or  disappointed  love.  In  the  latter 
instance  Ignatia  and  Acid,  johosphoricum  are  also  beneficial. 

Against  the  effects  of  mortification  or  wounded  vanity  or  self-esteem, 
Colocynth,  Ignatia,  Staphysagria,  Pulsatilla,  Plalina,  or  Belladonna  have 
proved  useful. 

Sambucus  : — When  oppression  at  the  chest,  with  stertorous  breath, 
has  ensued  in  consequence  of  a  fear  or  fright,  and  failed  to  yield  to 
the  employment  of  Opium. 


END  OF  PART  I, 


PART  II. 


TREATMENT    OF    FEMALES, 


THEIR  PECULIAR  AFFECTIONS. 


PART  II. 


TREATMENT  OF  FEMALES,  AND  OE  THEIR 
PECULIAR  AEEECTIONS. 


CHLOROSIS. 


This  complaint  generally  declares  itself  in  young  females  about 
their  fourteenth  year.  Its  proximate  cause  is  an  obstruction  of  the 
first  menstruation  ;  a  disease  very  similar  may  be  produced  by  great 
loss  of  blood. 

Diagnosis.  Pale/ blanched  complexion  and  lips  (sometimes  with 
flushes  of  heat  and  redness) ;  cantm  carotidum  ;  a  depravity  of  appetite, 
a  longing  after  innutritious  substances,  such  as  chalk,  &c,  and  a 
general  languor  both  mental  and  physical ;  the  patient  complains 
of  weariness,  lassitude,  and  debility,  and  becomes  emaciated;  the 
lower  extremities  frequently  assume  an  cedematous  appearance,  gene- 
rally attended  with  cold  in  those  parts,  and  headache  with  flatulent 
distension  of  the  abdomen,  particularly  after  meals,  and  in  the  evening; 
bowels  irregularly  confined,  sometimes  at  a  later  period  very  easily 
irritated  and  relaxed ;  a  harsh,  harassing  cough,  occasionally  with 
periodical  expectoration  of  dark-coloured  coagulated  blood,  and  hur- 
ried respiration,  frequently  declares  itself,  if  the  affection  has  been 
allowed  to  proceed  unchecked ;  and  to  an  experienced  eye  the  sufferer 
appears  to  be  on  the  verge,  or  even  passing  through  the  different 
stages  of  a  decline,  the  disease  appearing  to  stand  in  closer  relation 


650  TREATMENT  OF  FEMALES, 

to  the  functions  of  the  stomach  and  lungs  than  to  those  of  the  uterus, 
as  indeed  it  virtually  does,  in  the  generality  of  cases. 

Therapeutics.  The  medicines  which  have  hitherto  been  found 
most  useful  in  ordinary  cases  of  this  affection  are,  Pulsatilla,  Sepia, 
Bryonia,  Sulphur,  Natrum  muriaticum,  Calcarea  carbonica,  Ferrum,  By co- 
podium,  and  Plumbum. 

Pulsatilla  is,  together  with  Bryonia,  Sulph.,  By  cop.,  &c,  peculiarly 
efficacious  in  emansio  mensmm,  when  the  complaint  seems  to  have  been 
excited  by  and  is  intimately  connected  with  deranged  digestion,  and 
when  it  is  accompanied  by  frequent  attacks  of  semilateral  headache, 
with  shooting  pains,  extending  to  the  head  and  teeth,  sometimes  shifting 
suddenly  to  the  other  side  ;  also  when  we  observe  aching  in  the  forehead, 
with  pressure  at  the  crown  of  the  head,  and  sallow  complexion;  difficulty 
of  breathing,  and  sense  of  suffocation  after  the  slightest  mo  vement;  palpi- 
tation of  the  heart;  coldness  of  the  hands  and  feet,  often  changing  to  sudden 
heat ;  disposition  to  diarrhoea  and  leucorrhoea  ;  pains  in  the  loins ;  sensa- 
tion of  weight  in  the  abdomen;  almost  constant  chilliness  and  shivering; 
spasms  in  the  stomach,  with  nausea,  inclination  to  vomit,  and  vomiting  ; 
periodical  expectoration  of  dark,  coagulated  blood;  hunger,  with 
repugnance  to  food,  or  want  of  appetite  with  dislike  to  food ;  swelling 
of  the  feet  and  ankles,  great  fatigue,  especially  in  the  legs.  This 
medicine  is  peculiarly  adapted  to  females  of  mild  or  phlegmatic  dis- 
position, disposed  to  sadness  and  tears. 

Graphites,  when  there  is  retention  of  the  period  with  congestion 
of  the  vessels  of  the  head  and  chest ;  dark  red  flushing  of  the  face, 
oppression  at  the  chest ;  and  a  feeling  of  anxiety  w7hen  in  the  recum- 
bent posture.  Graphites  is,  moreover,  one  of  the  most  important 
remedies  in  scanty,  insufficient  menstruation.  Belladonna  is  often  called 
for  when  the  congestion  of  the  head  and  chest  is  of  an  active  cha- 
rater,  and  accompanied  with  violent  throbbing  of  the  carotids. 

Sepia  is  also  a  very  valuable  remedy  in  this  affection,  when  many 
of  the  above  symptoms  are  present,  with,  at  the  same  time,  hysteri- 
cal megrims  ;  complexion  sallow,  with  dark-coloured  spots  ;  frequent  colic 
and  pain  as  if  arising  from  bruises  in  the  limbs.  It  may,  when  the 
above  symptoms  declare  themselves,  advantageously  follow  Pulsatilla; 
if  the  latter  have  failed  to  relieve,  which  it  generally  does,  if  the 
pathognomonic  sign  of  chlorosis,  denominated  cantus  carotidum,  be 
absent. 

Bryonia  : — Frequent  congestion  in.  the  head  or  chest ;  bleeding  at 


CHLOROSIS.  651 

the  nose ;  dry  cough ;  coldness  and  frequent  shivering,  sometimes 
alternated  with  dry  and  burning  heat ;  constipation  or  colic ;  bitter 
taste  in  the  mouth,  tongue  coated,  yellow  ;  sense  of  pressure  in  the 
stomach  as  if  from  a  stone  ;  irascibility. 

Sulphur  is  more  particularly  indicated  when  there  is pressive  and 
tensive  pain  in  the  back  of  the  head,  extending  to  the  nape  of  the  neck ; 
or,  pulsative  pain  in  the  head,  with  determination  of  blood ;  humming 
in  the  head;  pimples  on  the  forehead  and  rotmd  the  month ;  pale  and 
sickly  complexion,  with  red  spots  on  the  cheeks  ;  voracious  appetite ; 
general  emaciation ;  sour  and  burning  eructations ;  pressive  fulness 
and  heaviness  in  the  stomach  under  the  lower  ribs  and  in  the  abdomen;  bowels 
irregular ;  difficulty  of  breathing  ;  pain  in  the  loins  and  fainting  ; 
excessive  fatigue,  especially  in  the  legs,  with  great  depression  after  talking  ; 
great  tendency  to  take  cold;  irritability,  and  inclination  to  be  angry;  or 
sadness  and  melancholy,  with  frequent  weeping. 

Calcarea  carb.  is  often  of  the  most  striking  benefit  in  chlorosis. 
Sometimes  a  complete  cure  is  effected  by  it  alone,  even  in  the  worst 
cases,  with  oedema  of  the  extremities,  and  extreme  dyspnoea.  Occa- 
sionally it  is  found  necessary  to  follow  up  the  treatment,  on  the  dis- 
appearance of  the  more  important  symptoms  under  the  employment  of 
Gale,  with  Ferrum  carb.  in  repeated  doses,  in  order  to  prevent  a  relapse. 
Ferrum  is  especially  required  when  the  pale  and  sickly  hue  of  the  face 
continues,  as  it  frequently  does,  notwithstanding  the  previous  use  of 
Calc.  When  Ferrum  is  employed  at  the  commencement  of  the  treat- 
ment, it  has  been  found  to  aggravate  the  anxiety,  cough,  and  other 
pectoral  symptoms.  Where  there  is  a  complication  with  tubercular 
diathesis,  accompanied  by  cough,  &c,  coeval  with  the  first  appear- 
ance of  chlorosis,  Sulphur  and  Calcarea  often  prove  highly  beneficial 
in  alternation.*  In  the  generality  of  cases,  during  the  employment 
of  Calcarea,  a  dose  of  Lycopodium  is  required  when  there  is  obstinate 
constipation  and  extreme  languor,  or  Sepia  when  oppressive  headache 
is  complained  of.f  Sometimes  the  menses  do  not  appear  for  some 
time  afterwards,  although  the  general  health  may  have  been  thoroughly 
renovated  by  the  remedies  prescribed. 

Valeriana  has  been  found  of  great  service  in  daily  repeated 
doses,  when  a  feeling  of  constriction  was  experienced  in  the  gullet  or 
chest,  accompanied  with  signs  of  threatened  suffocation,  and  followed 
by  frequent  yawning,  as  soon  as  the  patient  sat  down  to  dinner. 

*  Allg.  Horn.  Zeit.,  Gr.  u.  St.  Arch,  xx,  3,  58. 
t  Arch,  xx,  3,  58. 


652  TREATMENT  OF  FEMALES. 

Natrum  muriatic um  is  a  most  valuable  remedy  in  many  obsti- 
nate cases  of  chlorosis  with  habitual  constipation. 

Plumbum  aceticum  has  repeatedly  been  found  useful  in  inveterate 
cases  with  dyspnoea,  oedema,  and  anasarca,  but  no  organic  disease 
either  in  the  chest  or  abdomen.  Ammonium  c,  Phosphorus,  Conium, 
Lycopodium,  Kali,  China,  Ignatia,  Aurum,  Acid,  nitricum,  &c,  have  also 
been  advantageously  employed  in  chlorosis. 

In  enlargement  of  the  abdomen,  occurring  in  young  girls  at  the  critical 
age,  Lachesis  has  been  employed  with  success. 


AMENORRHEA. 

Suppressio  Mensium. 

Suppression  of  the  menses  occasionally  takes  place  suddenly  from 
some  accidental  cause,  such  as  exposure  to  cold,  powerful  mental 
emotions,  &c.  In  other  instances  the  suppression  is  symptomatic  of 
some  other  disease,  either  organic  or .  functional,  and  can  only  be 
removed  by  the  cure  of  the  primary  malady.  It  is  of  the  former 
that  we  here  propose  to  treat. 

When  a  suppression  takes  place  from  the  sudden  effects  of  a  chill, 
we  may  have  recourse  to  Pulsatilla,  wThen  the  symptoms  generally 
correspond  to  those  of  that  remedy,  as  detailed  under  Chlorosis.  In 
other  cases  arising  from  this  cause,  Nux  moschata,  Dulcamara,  Sepia, 
or  Sulphur  may  be  necessary.  (See  Chlorosis  for  indications  for 
Stilph.  and  Sep.,  which  are  remedies  of  great  service  in  a  large  number 
of  cases,  when  the  affection  has  become  chronic.) 

When  a  sudden  fright  has  given  rise  to  the  affection, Aconitum 
should  be  immediately  administered,  followed  by  Lycopodium,  Opium, 
or  Veratrum,  if  the  bad  consequences  which  frequently  result  do  not 
yield,  or  if  only  partial  relief  is  obtained  from  the  employment  of 
Aconitum.     (See  Mental  Emotions,  Parts  I  and  II.) 

In  chronic  cases  occurring  in  weak  or  debilitated  individuals,  in 
addition  to  Sulphur  and  Sepia,  the  following  remedies  are  useful : 
Natmm  m.,  Conium,  Arsenicum,  Cinchona,  Graphites,  Iodium.  Whilst 
in  those  which  occur  in  plethoric  subjects,  whether  of  a  chronic  or* 
recent   description,  Aconitum,  Belladonna,  Sulphur,  Bryonia,  Nux  v., 


MENORRHAGIA.  653 

Sabina,  Opium,  Platina,  &c,  will  generally  be  found  the  most 
serviceable.  When  there  is  not  a  complete  suppression,  but  the 
menstrual  discharge  is  scanty  and  insufficient,  Graphites,  Kali,  Conium, 
Natrum  m.,  Phosphorus,  Pulsatilla,  Sulphur,  Lycopodium,  Magnesia,  Silicea, 
Veratrum,  or  Zincum,  are  the  most  important  remedies. 


MENSTRUATIO  NIMIA.    MENORRHAGIA. 

The  quantity  of  the  menstrual  discharge  varies  a  good  deal  in 
different  women.  Considerable  influence  is  for  the  most  part  exerted 
by  climate,  constitution,  and  the  manner  of  living.  The  duration  of 
the  discharge  and  the  period  of  return  are  also  variable.  In  some 
women  it  continues  from  four  to  ten  days,  in  others  it  lasts  only  a 
few  hours ;  from  three  to  six  days  is,  however,  the  most  usual  period. 
The  regularity  is  in  many,  exact  to  a  day,  or  even  an  hour,  while  in 
others  a  variation  of  several  days  is  a  usual  occurrence,  without  the 
slightest  disturbance  to  the  general  health  resulting  therefrom. 
When  the  discharge  is  excessive,  and  attended  with  pains  in  the 
back,  loins,  and  abdomen,  resembling  those  of  labour^  it  becomes 
necessary  to  prescribe  remedies  calculated  to  arrest  it,  and  to  correct 
the  tendency  thereto.  Amongst  these  the  following  are  of  great 
utility :  Ipecacuanha,  Crocus,  Sahina,  Cinchona,  Nux  v.,  Chamomilla, 
Platina,  Sulphur,  Calcarea,  &c. 

Ipecacuanha  is  one  of  the  more  generally  useful  medicaments 
in  severe  cases  of  this  derangement,  as  well  as  in  flooding  after  labour, 
and  may,  in  most  instances  be  administered  first,  unless  there  are 
strong  indications  for  a  preference  being  given  to  any  of  the  others. 

Crocus  is  more  especially  called  for  when  the  discharge  is  of  a 
dark  colour,  viscid,  and  very  copious ;  and  the  menses  have  appeared 
before  the  usual  time. 

Sab  in  a,  when  the  discharge  is  excessive,  of  a  bright  colour,  and 
occurs  in  plethoric  females  who  are  prone  to  miscarry ;  rheumatic 
pains  in  the  head  and  limbs ;  great  weakness ;  pains  in  the  loins 
similar  to  those  of  labour. 

Cinchona  is  of  considerable  utility  after  the  previous  employment 
of  either  of  the  foregoing,  and  in  all  cases  were  there  is  great  debility 
in  consequence  of  a  more  copious  menstrual  discharge  than  natural. 

Nux  v.  when  the  discharge  is  of  too  frequent  occurrence,  too 


654  TREATMENT  OE  FEMALES. 

profuse,  and  of  too  long  duration ;  and  when  it  commonly  stops  for 
a  day  or  so  and  then  returns,  attended  with  spasms  in  the  abdomen ; 
sometimes  nausea  and  fainting,  especially  in  the  morning ;  pains  in 
the  limbs ;  restlessness ;  irascibility.  Nux  v.  'is  especially  serviceable 
when  the  above  symptoms  occur  in  females  who  are  addicted  to  the 
daily  or  frequent  use  of  coffee,  liqueurs,  and  other  stimulants. 

Chamomilla  is  frequently  useful  after  Nux  v.,  but  particularly 
when  there  is  a  discharge  of  dark,  clotted  blood,  with  severe  colic, 
or  pains  like  those  of  labour ;  great  thirst ;  paleness  of  the  face,  and 
coldness  of  the  limbs. 

Ignatia  is  of  considerable  service  when  the  derangement  happens 
in  hysterical  females. 

Platina.  Pre  tern  atur  ally  increased  menstrual  discharge,  with 
painful  bearing-down  pains,  and  venereal  orgasm;  thick,  dark-coloured 
menstrual  blood;  great  excitability. 

Veratrum.  Too  early  or  too  copious  menstrual  discharge, 
always  attended  with  diarrhoea. 

Kreosotum  has  been  found  of  great  service  in  metrorrhagia, 
■where  the  discharge  was  excessive,  dark-coloured,  frequently  in  large 
clots,  and  very  offensive.  The  cervix  uteri  and  uterus  itself  being, 
at  the  same  time,  swollen  and  very  sensitive ;  and  the  accompanying 
pains  of  a  severe  burning  or  corroding  description. 

Sulphur  administered  thrice  during  the  intervals,  allowing  ten 
or  twelve  days  to  elapse  between  the  second  and  third  doses,  and 
followed  by  Calcarea,  in  the  same  manner,  has  frequently  been  found 
successful  when  any  of  the  previous  remedies  had  afforded  but 
temporary  relief.  In  other  cases,  Belladonna,  Cortex  mali  granati  (often 
where  Sabina,  Bella.,  and  other  remedies  fail),  Bryonia,  Bycopod., 
Natrum  m.,  Magnesia  m.,  Sepia,  Silicea,  or  Phosphorus,  &c,  may  be 
useful.  In  menorrhagia  occurring  at  the  change  of  life,  and  coming 
on  in  daily  paroxysms  for  eight,  ten,  fourteen  days,  and  then  ceasing 
for  a  time,  after  which  the  discharge  broke  out  anew,  Laurocerasus 
has  been  found  of  great  efficacy.  The  blood  was  dark-coloured,  and 
frequently  in  large  coagula.* 


*  Allg.  Horn.  Zeit.,  vol.  xxxi. 


HYSTERICS.  655 


DYSMENORRHEA. 


In  painful  and  difficult  menstruation,  or  menstrual  colic,  the  most 
important  remedies  are  the  same  as  those  enumerated  under  Menor- 
rhagia and  Chlorosis,  but  particularly  Chamomilla,  Pulsatillas 
Bella.,  Nux,  Coffea,  Sulph.,  and  Calc,  &c.  When  the  disorder  occurs 
with  great  vehemence  at  the  critical  age  [tour  d'age)  Laches  is  is  of 
invaluable  assistance,  and  particularly  when  diarrhoea,  attended  wTith 
almost  insupportable  tormina,  usually  sets  in  before  and  after  the 
menstrual  period.*  The  following  are  likewise  of  considerable  utility 
against  the  sufferings  which  are  often  experienced  at  the  critical  age : 
Pulsatilla,  Sepia,  Sulphur,  Cocculus,  Rtita,  Conium.  Against  uterine 
spasms,  Coccuhis,  Pulsatilla,  Ignatia,  Platina,  Cuprum,  form  the  most 
valuable  remedial  agents;  but  in  some  instances  Nux  v.,  Cinchona, 
Sulphur,  Graphites,  Conium,  or  Natrum  m.,  &c,  may  be  more  ap- 
propriate. 


HYSTERICS. 

Hysteria.     Passio  Hysterica. 

This  disease  appears  in  paroxysms,  is  preceded  generally  by  de- 
pression of  spirits,  anxiety,  effusion  of  tears,  dyspnoea,  nausea,  and 
palpitatio  cordis;  also  with  pain  in  the  left  side,  which  seems  to 
advance  upwards  till  it  gets  to  the  throat,  when  it  feels  as  if  a  ball 
were  lodged  there  (globus  hystericus) ;  if  it  advances  further,  there 
is  a  sense  of  suffocation,  stupor,  and  insensibility,  with  spasmodic 
clenching  of  the  jaws ;  the  trunk  of  the  body  is  moved  about,  and 
the  limbs  agitated ;  alternate  fits  of  laughing,  crying,  and  screaming ; 
incoherent  expressions ;  foaming  at  the  mouth ;  relief  ensues  gene- 
rally with  eructation,  and  frequent  sighing  and  sobbing,  followed  by 
a  sense  of  soreness  over  the  whole  body.  Hiccough  is  sometimes  a 
concomitant,  and  a  very  distressing  one,  in  hysteria.  These  are 
the  usual  symptoms  indicating  this  disease,  but  the  complaint  appears 

*  Against  flushes  of  heat  occurring  after  the  change  of  life,  Acidurn  sulphuricum  is  an 
excellent  remedy. 


656  TREATMENT  OF  FEMALES. 

in  a  great  variety  of  forms  ;  and  in  many  cases  the  patient  is  attacked 
with  a  violent  spasmodic  pain  in  the  back,  which  extends  from  the 
spine  to  the  sternum,  and  eventually  becomes  fixed  at  the  epigastric 
region,  and  is  often  so  intense  as  to  cause  clammy  perspiration,  a 
pale  cadaverous  countenance ;  coldness  of  the  extremities ;  and  a 
feeble,  thread-like,  or  scarcely  perceptible  pulse. 

Hysteric  affections  are  more  frequent  in  single  than  in  married  life, 
and  usually  occur  between  the  age  of  puberty  and  that  of  thirty-five, 
and  generally  about  the  period  of  menstruation. 

The  disorder  is  readily  excited  in  those  who  are  subject  to  it,  by 
sudden  mental  emotions.  Hysterics  have  also  been  known  to  arise 
from  sympathy  and  imitation. 

Women  of  delicate  habit,  and  of  extreme  nervous  sensibility,  are 
chiefly  prone  to  be  affected  with  hysteria,  and  are  predisposed  to  the 
attack  by  an  inactive  or  sedentary  life,  distress  of  mind,  suppression 
or  obstruction  of  the  periodical  illness,  excessive  depletion,  or  con- 
stant use  of  spare  or  unwholesome  diet. 

Females  of  a  nervous,  sanguine,  or  plethoric  temperament  are  chiefly 
liable  to  this  disease. 

The  best  medicines  against  hysterical  affections  are,  A%irum,  Bella., 
Cole,  Caust.,  Cocc,  Con.,  Crocus,  Ign.,  Lack.,  Mosch.,  N.  mosch.,  N.  vom., 
Phosph.,  Plat.,  Puis.,  Sepia,  Sil.,  Stram.,  Siilph.,  Verat.,  Valeriana,  Viola 
odorata,  &c. 

When  the  affection  arises  from  Chlorosis  or  Amenorrhcea,  see 
the  remedies  mentioned  under  these  headings. 

When  from  Menorrhagia,  see  that  article.—  Mental  Emotions, 
see  that  subject. 

When  the  attacks  are  attended  with  clenching  of  the  jaws,  or  ge- 
neral spasm,  coldness  of  the  extremities,  and  clammy  sweat,  particu- 
larly on  the  face  and  forehead,  Veratrum  is  a  valuable  remedy.  (See 
also  the  remedies  mentioned  under  Tetanus,  and  likewise  Lockjaw 
in  Infants.) 

When  violent,  spasmodic  hiccough  predominates ;  Nux  vomica,  Bel- 
ladonna, and  Stramonium  ; — or  Hyoscyamus,  Veratrum,  Ignatia,  Pulsa- 
tilla, Cicuta,  Bryonia,  and  Sulphur  will  be  found  the  most  frequently 
useful. 


INFLAMMATION  OF.  THE  OVARIES.  657 


INFLAMMATION  OF  THE  OVARIES. 

Ovaritis. 

Inflammation  of  the  ovaria  is  more  particularly  liable  to  occur  a 
short  time  after  delivery ;  but  the  affection  may  arise  at  other  times,, 
and  particularly  in  highly  excitable  females  who  are  addicted  to  per- 
nicious habits,  such  as  venereal  excesses,  onanism,  or  to  over-indul- 
gence in  spirituous  liquors.  The  signs  by  which  the  disorder  is  to 
be  recognised  consist  in  pain  in  the  ovarian  region,  sometimes  of  a 
severe  shooting,  pulsating  character,  which  is  occasionally,  however, 
only  experienced  under  the  influence  of  external  pressure  over  the 
part.  After  a  careful  examination,  per  vaginam  aut  rectum  when 
necessary,  a  small,  hard,  circumscribed  swelling  is  detected.  In 
combination  with  these  symptoms,  a  constant  itching  is  frequently 
complained  of  in  the  internal  organs  of  generation,  also  gastric  dis- 
turbance, headache,  constipation,  diminished  secretion  of  urine,  fever, 
frequently  of  an  active,  inflammatory  type,  and  derangement  of  the 
entire  nervous  system.  But  it  is  chiefly  in  the  subacute  or  chronic 
form  that  the  inflammation  is  encountered ;  coming  on  gradually  and 
insidiously,  materially  implicating  the  nervous  system,  and  often 
occurring  in  association  with  a  species  of  nymphomania. 

Therapeutics.  In  phlegmonous  inflammation  of  the  ovarium, 
attended  with  a  high  degree  of  fever  and  shooting  pain,  a  few  doses 
of  Aconitum  are  necessary,  after  which  we  must  select  another  remedy 
to  meet  the  remaining  local  symptoms  ;  being  guided  in  our  choice 
by  the  exciting  cause  of  the  malady,  where  known,  as  well  as  by  the 
particular  nature  of  the  pain,  or  the  circumstances  under  which  it  be- 
comes aggravated,  &c.  &c. 

When  the  pain  in  the  affected  parts  is  increased  by  movement, 
Bryonia  is,  generally  speaking,  the  most  efficacious  remedy,  and  when, 
on  the  other  hand,  movement  somewhat  relieves,  whereas  rest  is  only 
productive  of  aggravation, — Rhus  will  rarely  fail  to  produce  consider- 
able relief,  if  not  a  radical  cure.  Should  the  pains  be  so  violent  as  to 
cause  the  patient  to  toss  about  with  agony,  and  continually  shift  the 
position  of  the  feet,  from  experiencing  some  slight  temporary  allevia- 

42 


658  TREATMENT  OF  FEMALES. 

tion  of  the  sufferings  by  so  doing,  they  will  commonly  yield  to  the 
use  of  Arsenicum  or  Colocynth. 

In  cases  where  the  disease  has  gradually  arisen  from  the  habitual 
use  of  spirituous  liquors,  material  service  will  commonly  be  derived 
from  the  employment  of  Nux  vomica ;  but  where  there  is  reason  to 
apprehend  that  the  inflammation  has  terminated  in  suppuration, 
Lachesis  will  be  more  appropriate,  and  subsequently  Staphysagria,  Mer- 
curius,  or  Hepar  s. 

In  the  event  of  excess  in  venery  or  onanism  having  given  rise  to 
the  disorder,  Cinchona  may  be  employed  with  advantage.  Nuoo  v. 
and  Staphysagria  are  also  calculated  to  be  of  assistance  in  similar  cases. 
Ignatia,  Staphysagria,  and  Acidum  phosphoricum  have  been  recommended 
where  unrequited  love  and  consequent  perpetual  dwelling  of  the 
imagination  on  sensual  subjects  has  proved  the  originating  cause. 
In  those  cases  where  the  affection  is  accompanied  with  a  continual 
prurient  irritation  in  the  internal  genital  organs,  and  where  nympho- 
mania has  thereby  been  developed,  where,  moreover,  the  local  pain 
which  is  commonly  experienced  changes  to  a  beaten  or  bruised  feeling 
on  the  application  of  external  pressure,  and  the  patient  is  affected 
with  anxious  oppression  at  the  chest,  palpitation  at  the  heart,  pricking 
in  the  forehead,  together  with  alternate  fits  of  elevation  and  depres- 
sion of  spirits,  Platina  is  often  capable  of  effecting  a  radical  cure. 
Belladonna  may  be  beneficially  employed  where  there  is  no  nympho- 
mania, or  internal  itching,  but  the  symptoms  otherwise  analogous  to 
those  above  given.  It  rarely  happens  that  a  cure  is  to  obtained  from 
the  employment  of  one  remedy  alone ;  it  therefore  becomes  requisite 
to  select  others  which  seem  appropriate  to  meet  the  remaining  symp- 
toms, when  we  have  derived  all  the  assistance  that  the  remedy  first 
selected  seems  capable  of  accomplishing.  Ambra.,  Cantharides,  Ptdsa- 
tilla,  and  Antim.  crudum  have  also  been  named  as  likely  to  prove  of 
efficacy  in  ovarian  inflammation. 

In  ovarian  induration,  ulceration,  or  dropsy,  &c. :  Lachesis,  Pla- 
tina, Belladonna,  China,  Cantharides,  Calcarea  carbonica,  &c,  have  been 
found  more  or  less  successful,  according. to  the  state  of  the  constitu- 
tion and  the  stage  of  the  disease.  But  in  the  great  majority  of  cases 
which  have  been  of  long  duration,  or  in  which  the  tumour  has  attained 
a  large  size,  all  that  can  be  done  is  to  endeavour  to  afford  as  much 
palliative  relief  as  the  circumstances  will  admit  of  by  means  of  such 
remedies  as  Aconitum,  Belladonna,  Bryonia,  Arsenicum,  Prunus  spinosa, 
China,  Sepia,  Lycopodium,  Kali  c,  Merc*,  Sulphur,  Cannabis,  Graph.,  Hep., 


INFLAMMATION  OF  THE  OVARIES.  659 

Sil.,  &c.  It  often  happens  that  ovarian  diseases  are  not  detected 
until  they  excite  peritoneal  inflammation  or  other  disturbances  in  ad- 
jacent parts,  by  the  pressure  arising  from  their  increasing  bulk. 
Their  progress  is  sometimes  very  rapid,  but  frequently  it  is  slow, 
even  for  a  succession  of  years.  A  sudden  and  inexplicable  invasion  of 
dangerous  activity  in  cases  which  had  long  been  in  a  dormant  state 
is  not  of  rare  occurrence. 


INFLAMMATION  OF  THE  LABIA  MAJORA  AND  VAGINA. 

This  inflammation  develops  a  painful,  burning,  red,  hard,  dry,  and 
very  sensitive  swelling  of  the  labia  pudendi.  It  chiefly  occurs  in  new 
married  females  after  the  rupture  of  the  hymen,  and  especially  when 
the  orifice  of  the  vagina  is  of  small  size ;  in  which  latter  case,  more- 
over, the  sheath  itself  becomes  implicated  in  the  swelling,  and  is 
consequently  productive  of  considerable  impediment  to  locomotion, 
or  even  the  assumption  of  a  sitting  posture.  Difficult  and  tedious 
labours  also  form  a  not  unfrequent  source  of  the  inflammation.  The 
inflammation,  when  arising  from  the  above  cases,  yields  very  speedily 
to  the  application  of  a  lotion  of  Arnica  (one  part  of  the  tincture  in 
ten  of  water).  When  traumatic  fever  results,  which  is  prone  to 
happen  in  neglected  cases,  the  internal  administration  of  Arnica  be- 
comes requisite ;  but  should  the  fever  partake  of  an  inflammatory 
type  Aconitum  must  be  resorted  to. 

If  the  inflammation  and  tumefaction  partake  of  a  lymphatic  cha- 
racter, and  is  attended  with  considerable  induration,  Mercurius  forms 
the  specific  remedy.  On  the  other  hand,  when  an  erysipelatous 
swelling  and  inflammation  affects  the  labia,  accompanied  with  burning 
pain,  and  an  internal  feeling  of  fulness,  tension,  and  bearing  down  is 
complained  of,  Belladonna  is  to  be  preferred^  from  whatever  cause  the 
disorder  may  have  arisen.  Should  there  be  only  an  internal  swelling 
of  the  vagina,  somewhat  analogous  to  a  partial  prolapsus,  attended 
with  burning,  pricking  pains,  increased  by  external  pressure,  Nunc  v. 
will  give  the  required  relief. 

In  the  event  of  a  termination  of  the  inflammation  in  ulceration, 
Arsenicum  and  Sulphur  are  the  remedies  most  likely  to  be  required* 


OBSERVATIONS  ON  PREGNANCY. 


This  period  may  be  looked  upon  as  one  of  the  most  interesting- 
eras  of  a  woman^s  life.  She  is  now  no  longer  acting  for  herself  alone, 
but  becomes  invested  with  a  new  and  serious  responsibility,  and 
upon  some  of  the  most  apparently  trifling  of  her  actions  may  depend 
the  future  health  and  happiness  of  a  being  bound  to  her  by  the 
fondest  ties. 

From  the  mass  of  evidence  collected  by  careful  observers  of  the 
operations  of  Nature,  we  are  warranted  in  drawing  the  conclusion 
that  the  actions  of  the  mother  exercise  a  great  influence  over,  not 
only  the  constitutional  and  physical,  but  also  the  mental  organization 
of  her  offspring.  Keeping  this  fact  in  view,  we  shall  endeavour  to 
point  out  the  course  that  mothers,  who  prefer  the  welfare  of  their 
future  offspring  to  their  own  indulgence,  should  pursue,  and  from 
which  they  will  derive  a  double  benefit, — an  improvement  in  their 
own  health,  with  exemption  from  suffering,  and  the  delight  of  seeing 
their  children  pass  safely  through  the  anxious  period  of  infancy; 
whilst  in  after  life  beholding  them  flourishing  around  them,  in  the  full 
enjoyment  of  health  and  vigour,  they  will  reap  the  additional  rich 
reward  of  a  slight  temporary  self-denial,  in  the  delightful  conscious- 
ness of  having  performed  their  duty. 

The  leading  causes  of  a  weak  and  sickly  offspring  are,  ill  health,  or 
constitutional  taint  of  both  or  either  of  the  parents ;  very  early  or 
late  marriages ;  great  inequality  between  the  ages  of  the  parents ; 
errors  in  dress,  diet,  and  general  habits  of  life;  and  lastly,  powerful 
mental  emotions. 

Medicine,  under  the  present  enlightened  system,  possesses  power 
considerably  to  obviate  the  first  of  these  causes,  not  only  by  materially 
modifying  or  destroying  the  hereditary  taint  in  the  parents,  but  also 


OBSERVATIONS  ON  PREGNANCY.  661 

by  nipping  it  in  the  bud  when  transmitted  to  the  infant.  Whilst 
upon  this  subject^  we  may  remark,  that  in  many  families  hereditary 
diseases  are  fostered,  and  even  exacerbated  in  virulence  by  inter- 
marriages between  their  different  members,  sometimes  disappearing 
in  one  generation,  and  again  declaring  themselves  in  the  next ;  but 
when  the  habits  or  mode  of  life  of  communities  become  more  adapted 
to  the  natural  law,  and  Homoeopathy,  as  it  must  do  eventually,  com- 
pletely supersedes  the  present  system  of  medicine,  we  may  safely 
calculate  upon  the  gradual  extinction  of  all  hereditary  diseases  ;  and 
so  far,  at  least,  children  will  not  have  to  suffer  for  the  faults  and  follies 
of  their  progenitors. 

Females  should  seldom,  at  least  in  this  country,  enter  into  the 
marriage  bond  before  their  twenty-first  or  twenty-second  year ;  prior 
to  that  period,  their  organization  is  scarcely  ever  fully  developed ; 
those  who  marry  at  sixteen  or  eighteen  years  of  age  incur  the  risk  of 
a  severe  after-suffering  themselves,  and  also  of  giving  birth  to  weak 
and  delicate  children.  How  very  often  we  see  the  first  children  of 
such  marriages  perish  in  infancy,  or  after  contending  through  a  child- 
hood of  continued  delicacy,  sink  into  a  premature  grave.  Women 
who  marry  late  in  life  incur  considerable  personal  risk  and  severe 
suffering  in  giving  birth  to  children,  and  the  offspring  is  seldom 
healthy. 

The  children  of  old  men,  although  by  a  young  wife,  are  very  often 
extremely  delicate  and  susceptible  to  illness ;  they  not  unfrequently 
precede  their  father  to  the  grave,  or  linger  but  to  drag  on  a  miserable 
and  wearisome  existence. 

In  concluding  these  observations,  we  may  remark  that  so  far  is  the 
period  of  pregnancy  from  being  destined  for  one  of  suffering  or 
danger,  that  Nature  has  taken  every  precaution  for  the  protection  of 
the  female  and  her  future  offspring.  While  pregnancy  runs  its 
equable  and  uniform  course,  the  expectant  mother  enjoys  an  almost 
complete  exemption  from  the  power  of  epidemic  or  infectious  diseases, 
and  even  chronic  complaints  are  frequently  suspended ;  in  fact,  with 
,  the  exception  of  some  slight  morning  sickness,  and  occasional  trifling- 
uneasiness,  a  well- constituted  organism  should  enjoy  as  good  health 
during  pregnancy  as  at  any  other  time;  and  many  women  pass 
through  this  period,  and  give  birth  to  vigorous  children,  without  even 
the  most  trifling  inconvenience. 

Though,  as  we  have  said,  Nature  seems  during  this  period  to  adopt 
every  possible  precaution  for  the  health  and  preservation  of  the  parent 


662  OBSERVATIONS  ON  PREGNANCY. 

and  her  future  offspring,  yet  are  her  wise  arrangements,  in  too  many- 
instances,  rendered  nugatory  by  a  direct  contravention  of  her  laws. 
The  expectant  mother  should  therefore  bear  in  mind,  that  the  duty 
of  leading  a  regular  and  systematic  course,  so  essential  to  every 
individual,  devolves  upon  her  with  double  force,  since  every  neglect 
or  breach  of  these  ordinances  of  Nature  upon  her  part,  is  frequently 
visited  with  fearful  energy  upon  her  yet  unborn  infant. 


AIR  AND  EXERCISE. 

Nothing  tends  more  to  the  preservation  of  health  than  a  proper 
attention  to  these  two  important  points,  and  yet,  unfortunately,  there 
are  perhaps  few  more  completely  lost  sight  of.  Neither  air  nor  exercise 
is  individually  sufficient,  and  females  of  the  more  opulent  classes  in 
this  country,  w7ho  merely  take  the  air  in  their  carriages,  and  shun  the 
slightest  physical  exertion,  from  long-continued  habits  of  acquired 
indolence,  and  who  feel  any  attempt  of  the  kind  at  this  period  at- 
tended with  increased  inconvenience,  can  scarcely  expect  to  enjoy  the 
benefit  that  Nature  has  annexed  to  the  observance  of  her  laws,  in  a 
course  of  pregnancy  free  from  suffering,  and  the  production  of  a  fully- 
developed  and  healthy  offspring. 

During  this  epoch,  therefore,  passive  or  carriage  exercise  is  not 
sufficient ;  walking  brings  not  only  the  physical,  but  the  whole  of 
the  organic  muscles  into  play,  and  communicates  the  increasing 
vigour  of  the  mother  to  her  offspring ;  whilst,  on  the  contrary,  con- 
tinual passive  exercise  in  a  carriage  has  been  found  particularly  inju- 
rious during,  and  towards  the  end  of  the  second  period  of  pregnancy, 
and  is  frequently  the  cause  of  premature  and  abnormal  births ;  exer- 
cise on  horseback,  even  without  taking  into  consideration  the  risk  of 
fright  or  accident  to  the  rider,  and  the  fearful  consequences  that  may 
thence  result,  is  still  more  objectionable  for  many  reasons. 

A  second  class,  that  of  thrifty  housewives,  take  a  great  deal  of  ex- 
ercise, yet  without  a  corresponding  benefit^  from  their  work  occupy- 
ing them  wholly  in-doors ;  this  is  a  strong  proof  of  the  inutility  of 
exercise  in  itself,  unless  combined  with  pure  air.  Moreover,  many  of 
these  women,  either  from  too  great  activity  of  temperament,  or  coerced 
by  hard  necessity,  frequently  over-fatigue  themselves,  go  to  bed  late, 


CLOTHING.  663 

rise  early  and  sometimes  unrefreshed,  and  thus  in  a  manner  deaden 
the  energies  of  the  organic  powers,  to  their  own  injury,  and  that  of 
the  unborn  child. 

A  third  class  of  females  injure  their  health,  and  frequently  induce 
miscarriage,  through  their  excessive  levity  and  thoughtlessness,  by 
unrestrained  indulgence  in  active  exercise,  riding  on  horseback,  danc- 
ing, &c.  A  female  ought  to  recollect  that,  if  through  her  own  folly 
she  has  brought  on  miscarriage,  the  greatest  possible  care  is  necessary 
to  prevent  its  recurrence ;  that  a  second  attack  increases  her  liability 
in  future;  and  that  she  who  has  suffered  twice  or  thrice  from  this 
misfortune,  even  when  she  escapes  it,  rarely  attains  her  full  time. 
Furthermore,  continued  casualties  of  this  nature  not  unfrequently 
terminate  in  premature  death,  from  that  serious  and  painful  disease, 
uterine  cancer. 

The  best  exercise,  therefore,  for  a  female  during  this  epoch,  is 
walking  every  day  (when  the  weather  permits)  in  the  open  air.  In 
order  to  prove  beneficial,  and  not  to  interfere  with  the  process  of 
digestion,  exercise  ought  to  be  taken  two  or  three  hours  after  a  mode- 
rate meal,  about  mid-day,  or  in  the  afternoon,  except  during  hot 
weather,  when  the  evening  may  be  preferred,  care  being  taken  to 
avoid  the  night  damps,  by  not  remaining  out  too  late. 


CLOTHING. 

The  dress  of  the  female  should  of  course  be  suited  to  the  season, 
and  if  she  pass  from  a  warm  into  a  cold  atmosphere,  she  ought  to 
have  her  neck  and  throat  well  protected,  so  as  to  avoid  any  risk  of 
taking  cold.  But  a  point  of  far  greater  importance  is  the  adaptation 
of  her  clothing  to  her  form,  so  as  to  preclude  all  unnecessary  pressure 
upon  any  part  of  the  frame,  calculated  to  interfere  with  the  functions 
of  those  important  organs,  which  are  destined  for  the  birth  and 
nourishment  of  the  infant ;  tight  lacing  therefore,  at  all  times  most 
objectionable,  is  particularly  so  during  this  period,  inasmuch  as  it 
cramps  the  natural  action  of  the  body,  and  bearing  directly  upon  the 
abdominal  muscles,  the  blood-vessels,  lymphatics,  and  the  whole 
intestinal  economy,  produces  narrowness  of  the  chest,  disturbed  cir- 
culation, and  induration  or  other  derangements  of  the  liver,  and 
exercises  a  most  baneful  effect  upon  the  breasts  and  uterus.     We 


664  OBSERVATIONS  ON  PREGNANCY. 

should  bear  in  mind  that  a  pressure  upon  these  organs  during  de- 
velopment, takes  place  in  direct  contravention  of  the  operations  of 
nature.  Females,  in  their  efforts  to  preserve  the  elegance  of  their 
shape  during  pregnancy,  are  little  aware  that  the  constringing  force 
thus  exercised  upon  the  abdominal  muscles,  destroys  their  elasticity, 
prevents  a  proper  retraction  after  parturition,  and  thus  proves  one 
of  the  most  common  causes  of  permanent  abdominal  deformity. 
Moreover,  to  the  culpable  vanity  of  their  mothers,  in  this  and  other 
respects,  many,  it  is  probable,  owe  their  club-feet  and  other  mal- 
formations ;  and  in  addition  to  these  evils,  this  practice  not  unfre- 
quently  deranges  the  position  of  the  foetus, — a  displacement  which, 
together  with  the  consequent  want  of  energy  in  the  muscles  and  the 
parts  concerned,  generally  brings  on  protracted  and  dangerous  labours. 
Besides  this,  continual  pressure  on  the  uterus  is  liable  to  produce 
premature  labours.  To  tight  lacing  also  may  be  attributed  the 
difficulty  many  women  of  the  present  day  experience  in  suckling 
their  offspring,  from  the  incipient  process  required  for  the  subsequent 
secretion  of  milk  being  deranged  by  the  unnatural  pressure  on  the 
beautifully  constructed  mechanism  of  the  mammae ;  from  this  also 
sometimes  those  dangerous  indications,  cancers  and  other  affections 
of  the  breast,  and  also  retraction  and  diminution  of  the  nipple,  from 
which  the  act  of  suckling  is  rendered  difficult,  and  in  some  cases 
impracticable. 

Young  girls  of  seventeen  or  eighteen  are  frequently  found  with 
pendulous  breasts,  owing  to  the  artificial  support  having  usurped 
the  office  of  the  muscles,  intended  by  Nature  for  that  purpose,  and 
throwing  them  out  of  employment. 

Garters  too  tightly  bound  are  generally  injurious,  more  par- 
ticularly to  pregnant  females,  for  the  pressure,  thereby  exercised 
upon  the  blood-vessels,  encourages  the  development  of  varicose 
vessels  in  the  inferior  extremities  (to  which  affection  the  system  is 
already  sufficiently  predisposed),  which,  in  many  instances,  become 
exceedingly  painful  and  troublesome. 


DIET.       HABITS.  665 


DIET. 


The  greatest  simplicity  should  regulate  the  diet  of  the  pregnant 
female ;  she  should  avoid  taking  too  great  a  quantity  of  nourishment, 
because  any  excess  in  this  respect,  besides  causing  dyspepsia 
and  general  uneasiness,  has  a  bad  mechanical  effect  upon  the  future 
offspring ;  and,  moreover,  the  foetus  shares  in  the  derangements  of 
the  mother. 

Much  depends  upon  the  quality  of  her  food ;  nothing  should  be 
taken  that  is  not  of  a  simply  nutritive  nature,  and  everything  pos- 
sessing a  medicinal  property  avoided.  Coffee  and  strong  tea  should 
be  laid  aside.  Wine,  liquors,  beer,  and  other  stimulating  beverages 
are  also  injurious.  If,  however,  the  female  has  been  long  habituated 
to  wine,  it  may  be  taken,  if  of  good  quality,  in  extreme  moderation, 
and  diluted  with  water  ;  but  it  will  be  far  better  if  stimulants  of  every 
hind  are  altogether  avoided;  indeed,  the  usual  homoeopathic  diet  (for 
which  see  the  article  Regimen)  should  be  adopted  as  closely  as 
possible  during  pregnancy. 


EMPLOYMENT  OF  THE  MIND  AND  HABITS  DURING  PREGNANCY. 

It  is  not  sufficient  that  the  body  may  be  in  perfect  health ;  the 
mind  must  also  be  kept  in  a  state  of  serenity.  An  easy  cheerfulness 
of  temper  is  essentially  useful  in  promoting  the  well-being  of  the 
unborn  infant.  Experience  has  presented  us  wdth  many  instances  in 
which  the  predominant  feeling  on  the  mind  of  the  mother  during 
pregnancy  has  influence  on  the  future  mental  organization  of  the 
child.  This  showrs  how  essential  it  is  for  females  to  keep  their  minds 
well  employed  during  this  period,  to  avoid  all  improper  meditation, 
and  dissipation,  and  to  abstain  from  reading  works  not  calculated  to 
improve  their  understanding.  Nothing  can  act  more  effectually 
against  the  future  mental  and  corporeal  health  of  the  unborn  infant 
than  an  oscillatory  state  of  intellect,  in  combination  with  physical 
indolence  on  the  part  of  the  mother  ;  the  late  hours,  turning  day  into 
night,  and  other  practices  of  fashionable  life,  injurious  as  they  are  to 
the  most  robust  constitutions,  are  doubly  reprehensible  on  the  part  of 
the  expectant  mother. 


666  OBSERVATIONS  ON  PREGNANCY. 


INFLUENCE  OF  EXTERNAL  OBJECTS  UPON  THE  UNBORN  INFANT. 


The  effect  of  any  unpleasant  or  unsightly  object  upon  the  ima- 
gination of  the  mother,  and  the  transmission  of  that  effect  to  the 
offspring,  evidenced  in  various  mental  or  physical  peculiarities  after 
birth,  is  a  theory  as  old  as  tradition  ;  without  entering  upon  the 
various  arguments  brought  forward  both  for  and  against  it,  we  would 
simply  advise  females  to  keep  as  much  as  possible  out  of  the  way  of 
such  objects,  to  preserve  both  body  and  mind  in  a  state  of  health, 
which  will  lessen  every  fear  of  being  affected  by  such  occurrences  ; 
and  endeavour,  as  constantly  as  possible,  to  direct  their  attention  to 
pleasing  subjects ;  as  it  must  be  perfectly  evident  that  brooding  over 
such  unpleasant  impressions  can  scarcely  fail  of  being  both  physically 
and  mentally  injurious. 


MENTAL  EMOTIONS. 

This  subject  has  been  already  treated  of  in  Part  I,  to  which  the 
reader  is  referred,  as  the  remedies  there  mentioned  are  equally  appli- 
cable to  affections  arising  from  these  sources  in  either  sex. 

A  not  unfrequent  symptom  during  pregnancy  is  great  despond- 
ency of  mind,  and  uneasiness  about  the  future;  some  females, 
whose  spirits  are  generally  good  at  other  times,  suffer  much  from 
this  affection  during  this  period ;  and  in  others,  we  find  the  same 
feeling  and  excessive  low  spirits,  during  the  time  of  nursing ;  this 
symptom,  however,  is  not  permanent,  and  when  it  commences  early 
in  gestation,  usually  disappears  before  delivery,  without  material 
injury  to  the  general  health. 

Therapeutics.  As  this  affection  is  apt  to  create  some  uneasi- 
ness, both  to  the  sufferer  herself  and  her  friends,  we  have  thought  it 
advisable  to  mention  it,  and  at  the  same  time  to  point  out  remedies 
which  will  frequently  be  found  efficacious. 


MENTAL  EMOTIONS.  667 

Such  are  Aconitum,  Bryonia  alba,  Nux  vomica,  Natrum  muriaticum, 
Phosphorus,  Calcarea  carbonica,  and  Cinchona. 

Aconitum  : — If  the  state  of  despondency  is  preceded  by  one  of 
excitement^  marked  by  heat  of  skin  and  frequency  of  pulse,  attended 
with  apprehension  and  presentiment  of  approaching  death.* 

Bryonia: — Great  inquieUide  and  fear  of  the  future,  attended  with 
irascibility  and  derangement  of  the  digestive  functions. 

Nux  vomica: — Morning  sickness  and  melancholy,  with  great 
uneasiness,  impaired  appetite,  constipation,  fretfulness. 

Natrum  muriaticum  : — Melancholy,  with  weeping,  uneasiness 
about  the  future;  also  obstinate  cases  of  morning  sickness,  not 
yielding  to  Nux  vomica. 

When  the  affection  comes  on  during  lactation,  arising  from  an 
over-secretion  of  milk,  so  that  this  fluid  escapes  involuntarily,  and  is 
attended  with  great  emaciation,  melancholy,  and  apprehension  of  the 
future,  we  may  give  Phosphorus. 

Calcarea  is  also  efficacious  when  the  above  symptoms  present 
themselves,  and  more  particularly  so,  when  there  is  excessive  dejection 
with  great  lassihide. 

This  remedy  is  further  very  serviceable  when  there  is  suppression 
of  the  secretion,  and  also  excessive  obesity,  or  the  individual  is  of 
plethoric  habit.  Both  the  last-mentioned  remedies  are  also  valuable, 
when  there  is  a  disposition  to  consumption. 

When  there  is  lowness  of  spirits,  attended  with  dyspepsia,  which 
may  arise  from  the  energies  of  the  mother  being  too  severely  tasked 
in  the  nourishment  of  her  offspring,  either  from  keeping  the  child 
too  long  unweaned,  or  from  rearing  twins,  we  may  administer  Cin- 
chona. The  practitioner  will  further  find  occasion  to  select  the 
following  remedies  in  particular  cases :  Belladonna,  Pulsatilla,  Veratrum, 
Stramonium,  Platina,  Aurum,  Cuprum,  Lachesis,  and  Sulphur. 


*  In  the  treatment  of  pregnant  women  of  exalted  nervous  sensibility,  considerable  caution 
is  frequently  requisite  in  the  repetition  of  the  doses.  (See  also  the  rules  laid  down  for  the 
Repetition  of  the  Dose  in  ordinary  cases,  in  the  Introduction.) 


DERANGEMENTS  DURING  PREGNANCY. 


MENSTRUATION. 

Virtual  diseases  during  gestation  are  of  rare  occurrence,  but 
when  they  do  happen,  they  ought  to  be  treated  accordingly. 

A  continuance  of  menstruation  at  this  period  is  not  an  actual  dis- 
ease, but  rather  an  exception  to  the  general  course  of  nature ;  nor 
must  we  here  mistake  her  operation  for  an  indication  of  the  utility  of 
the  lancet,  for  neither  in  this,  nor  in  any  other  case,  can  the  artificial 
supply  the  place  of  natural  bleeding  ;  however,  when  the  female 
appears  to  suffer  from  the  continuance  of  the  menstrual  flux,  we 
must  call  in  the  assistance  of  medicaments,  among  which  the  prin- 
cipal are  Cocculus,  Phosphorus,  and  Platina. 

Cocculus.  A  sanguineous  mucous  discharge,  and  very  severe 
spasmodic  pains  in  the  lower  part  of  the  abdomen. 

Phosphorus.  Discharge  of  blood,  with  incisive  pains  in  the 
back,  and  occasionally  vomiting. 

Platina.  Discharge  very  profuse,  attended  with  a  severe  pain 
and  bearing  down.  (See  also  the  remedies  given  under  Dys- 
menorrhea and  Menstruatio  nimia.) 


MORNING  SICKNESS. 

Morning  sickness,  nausea,  vomiting,  and  heartburn,  are  the  most 
distressing  symptoms  attendant  on  the  course  of  pregnancy.  These 
troublesome  complaints  harass  women  most  upon  their  first  rising 
from  a  horizontal  position  in  bed.  They  generally  disappear  soon 
after  quickening,  but  sometimes  continue  during  the  whole  period. 


CONSTIPATION.  669 

The  numerous  palliative  remedies  recommended  by  allopathists — 
leeches,  cupping-glasses,  blisters,  aperients,  sedatives,  &c,  &c,  unfor- 
tunately too  often  fail  in  effecting  their  object ;  and  in  severe  cases, 
when  the  stomach  becomes  enfeebled,  the  hazardous  expedient  of 
artificially  produced  premature  labour  is  resorted  to. 

Therapeutics.  The  homoeopathic  treatment  of  this  derangement 
at  once  simple,  prompt,  and  efficacious,  has  in  almost  all  cases  been 
stamped  by  the  signet  of  success.  In  instances  free  from  complica- 
tion, with  a  tendency  to  relaxation  of  the  bowels,  Ipecacuanha  is 
generally  sufficient. 

Nux  vomica  : — When  there  is  nausea  or  vomiting  every  morning 
on  rising,  heartburn,  depraved  appetite,  or  craving  for  chalk,  earth, 
beer,  &c,  constipation,  and  irritability  of  temper. 

Arsenicum.  Excessive  vomiting  after  eating  or  drinking,  with 
attacks  of  fainting ;  great  weakness  and  emaciation. 

Pulsatilla.  Nausea  after  every  meal;  vomiting  of  ingesta, 
heartburn,  depraved  appetite,  or  longing  for  particular  articles,  such  as 
acids,  beer,  wine,  &c.  Disposition  peevish  and  sensitive,  though 
naturally  mild. 

Conium,  Acidum  nitricum,  Magnesia,  Phosjphorus,  Bryonia,  and  Lgcopo— 
dium,  &c,  will  also  be  found  useful  in  particular  cases. 

When  this  affection  shows  itself  in  a  mild  form,  we  may  leave  it  to 
Nature,  adopting  at  the  same  time  the  homoeopathic  rules  for  regimen, 
and  being  careful  not  to  overload  the  stomach.  In  severe  cases, 
depending  upon  a  plethoric  tendency,  Aconitwm  is  an  excellent  substi- 
tute for  the  venesection  recommended  by  the  old  school. 


CONSTIPATION. 

Constipation  is  a  very  common  attendant  upon  pregnancy,  and 
those  females  usually  suffer  most  from  it  who  are  naturally  of  a  costive 
habit ;  when  it  does  not  arise  from  a  mechanical  cause,  active  exercise 
in  the  open  air,  and  avoiding  indigestible  food,  coffee  and  other  stimu- 
lating liquids,  are  often  sufficient  to  remove  the  complaint,  or  at  all 
events  to  render  it  less  troublesome.  When  Nature  requires  further 
assistance  : — 

Nux  vomica  will  often  answer  the  purpose ;  if  after  the  completion 


670  DERANGEMENTS  DURING  PREGNANCY. 

of  its  action,  there  still  remains  some  inconvenience,  Ignatia  should 
be  given  as  an  immediate  remedy,  followed  by  a  Nux  vomica ;  in  other 
cases,  when  Nux  vomica  does  not  show  a  marked  improvement,  and 
the  temper  is  extremely  irritable,  Bryonia  will  sometimes  cure,  or  Opium 
globules,*  which  is  especially  indicated  to  follow  Nux  vomica  when 
there  appears  to  be  a  weight  in  the  stomach,  dryness  of  the  mouthy 
and  deep  flushing  of  the  face.  In  other  cases  Sepia,  Lycopodium, 
Alumina,  &c,  will  be  found  useful.     (See  Constipation,  Part  I.) 

Dysuria.  Pulsatilla,  Cocculus,  Nux  v.,  and  Acid,  pJiosphoricum,  as 
also  Sulphur,  and  Conium  are  the  remedies  which  are  of  the  greatest 
service  in  the  generality  of  cases  of  this  derangement  in  pregnant 
women. 


DIARRH(EA  DURING  PREGNANCY. 


See  Diarrhosa,  Part  I,  and  Diarrhoea  in  Lying-in-Women, 
in  this  division  of  the  work. 


FAINTING  AND  HYSTERIC  FITS. 

Many  delicate  and  nervous  females  are  frequently  attacked  with 
fainting  fits  during  pregnancy.  The  attack  generally  passes  over 
easily  and  without  deleterious  consequences.  Exercise  in  the  open 
air,  and  attention  to  the  rules  of  regimen,  are  the  best  safeguards 
against  the  affection ;  but  in  cases  where  these  are  insufficient,  and 
the  attacks  prove  distressing,  we  must  endeavour  to  ascertain  their 
origin.  If  the  fits  arise  from  tight  lacing,  warm  rooms,  or  any  other 
obvious  excitant,  the  simple  removal  of  the  cause  will  prove  sufficient ; 
should  the  sufferer  remain  long  insensible,  the  speediest  means  of 
revival  is  sprinkling  the  face  with  cold  water.  When  arising  from 
plethoric  habit,  returns  of  the  attack  may  be  prevented  by  Aconite, 
of  which  we  have  had  occasion  to  speak  several  times,  as  a  general 
regulator  of  the  circulation. 

*  See  page  144  for  additional  indications  for  the  employment  of  this  remedy. 


TOOTHACHE.  671 

Chamomile  a  : — When  the  fainting  is  excited  by  sudden  fits  of 
anger. 

Nux  vomica: — When  from  general  irritability  of  system,  and  con- 
sequent gastric  derangement. 

Belladonna  : — When  there  is  determination  of  blood  to  the  head, 
with  simultaneous  flushing  of  the  face  and  perceptibly  increased  action 
of  the  arterial  system.     (Alternately  with  Aconite  when  required.) 

Cinchona: — When  arising  from  general  weakness,  and  especially 
from  loss  of  blood. 

Pulsatilla.  General  excitability  and  disposition  to  hysteria, 
with  hypochondriasis,  and  great  general  susceptibility. 

Coffea.  Abdominal  spasms,  with  oppressed  respiration,  subsultus 
tendinum,  cold  perspiration,  and  uncontrollable  agitation  and  jactita- 
tion. When  the  symptoms  are  generally  preceded  by  a  pain,  which 
proceeds  upwards  from  the  lower  part  of  the  bowels,  on  the  left  side, 
into  the  stomach,  and  from  thence  into  the  throat,  where  it  creates  a 
disagreeable  and  suffocative  sensation,  as  if  a  ball  were  lodged  there, 
Lachesis,  JBelladonna,  Sepia,  and  Plumbum,  or  Ignatia,  Sulpfaor,  Ntix  v., 
Conium,  &c,  will  prove  useful,  a  preference  being  given  to  that 
remedy  which  corresponds  the  most  closely  to  the  whole  features  of 
the  case. 

Ignatia  : — When  the  patient  suffers  from  severe  headache,  as  if  a 
nail  were  driven  into  the  head;  sadness;  concealed  sorrow,  and 
sighing.     (See  Swooning.) 

Viola  odorata.  Constant  and  unassignable  inclination  to 
weep. 

Administration  of  the  above  remedies.  The  dose  as  prescribed 
repeated,  if  necessary,  every  two  or  four  days,  according  to  the 
urgency  of  the  symptoms,  until  relief  is  obtained,  or  another  remedy 
is  required. 


TOOTHACHE. 

This  is  a  frequent  affection  with  pregnant  women,  and  is  sometimes 
too  valuable  an  indication  of  some  taint  lurking  in  the  constitution, 
to  be  neglected ;  the  female  should,  as  soon  as  she  is  in  a  proper  state, 
put  herself  under  a  course  of  proper  treatment,  as  until  this  tendency 
is  eradicated,  no  remedies  can  prove  otherwise  than  palliative.     We 


672  DERANGEMENTS  DURING  PREGNANCY. 

must  particularly  caution  females  in  this  situation  against  having 
teeth  extracted,  as  the  affection  frequently  occurs  in  sound  teeth. 

Therapeutics.  To  relieve  the  sufferings,  the  following  medicines 
may  be  often  given  with  advantage:  Sepia,  Calcarea,  Alumina,  and 
Magnesia  carbonica. 

For  the  Administration  of  the  remedies,  see  Toothache, 
Part  I,  where,  moreover,  other  useful  remedies  will  be  found. 

Sepia  is  particularly  indicated  when  there  is  pulsative,  shooting, 
drawing  toothache,  with  pain,  extending  to  the  ears,  or  to  the  arms  and 
fingers,  excited  by  compressing  the  teeth,  or  by  cold  air,  and  attended 
with  impeded  respiration,  swelling  of  the  cheek,  and  enlargement  of 
the  submaxillary  glands. 

Calcare  a  : — When  the  toothache  is  excited  or  aggravated  by  cold  air, 
or  anything  hot  or  cold,  and  attended  with  painful  sensation  of  the  gums, 
and  pulsative  gnawing  or  shooting  pains,  which  are  aggravated  by  noise. 

Alumina  : — When  the  pains  are  excited  by  mastication,  or  in  the 
evening  in  bed,  and  when  they  are  of  a  tearing  nature,  extending  to 
the  cheek-bone,  temple,  and  forehead. 

Magnesia  carbonica: — Noctttrnal pains  'in  the  teeth,  insupportable 
when  lying  down,  and  compelling  the  patient  to  get  up  and  walk  ;  pains 
generally  boring,  burning,  drawing,  tearing,  and  resembling  those  of 
ulceration,  attended  with  swelling  of  the  cheek  on  the  side  affected ; 
throbbing  and  shooting  in  the  teeth  after  a  meal ;  pain  aggravated  by 
a  cold.  The  above  are  the  four  leading  medicines,  though  there  are 
others  which  may  be  called  for  by  peculiar  symptoms. 

Mezereum: — Continuous  dull  pains;  teeth  feeling  as  if  elongated; 
sensibility  to  the  touch. 

Coccionella  : — Pains  in  hollowr  teeth,  particularly  of  a  throbbing 
description.  {Cynips  rusarum  has  likewise  been  found  useful  in  similar 
cases.) 

Sarsaparilla  : — Rending  pains  in  the  teeth,  especially  in  the 
evening,  on  exposure  to  a  current  of  air. 

Carbo  v.  : — Gnawing,  pulsative  constriction,  or  dragging  pains, 
especially  in  hollow  teeth,  usually  increased  by  partaking  of  food  or 
drink,  whether  hot  or  cold.    (See  Toothache,  Part  I.) 

The  following  remedies  are  those  which  are  generally  of  the 
greatest  efficacy  when  the  pains  are  excited,  aggravated,  or  relieved 
under  the  circumstances  hereafter  mentioned: 


TOOTHACHE.  673 

Air  (toothache,  on  exposure  to)  cold :  Stop  A.,  Sep.,  Sil.,  Nux  v.,  Sass., 

Merc,  Hoscy. 
Air,  (diminution  of  pain  from)  cold  :   'Puis.,  Natrum  s. 

—  (aggravation  from  exposure  to)  damp  :  Nux  moscA.,  Rod.,  Bor. 

—  (aggravation  from  exposure  to)   the  evening :    Nux  moscA.,  Sass., 
Merc. 

Air,  (toothache  excited  or  aggravated  by  inhaling,  or  drawing  in) : 

Natr.  m.,  and  StapA. ;  or,  Nux  v.,  Alum.,  Mags.,  Mags.  arc.  ;  or  Alum.;, 

Bella.,  Sil.,  Spig.,  Clem.,  Sabina. 
Air  (toothache  in  the  open) :    Bella.,  Nux  v.,  SulpA.,  PAospA. ;  Con., 

Magn.  s.,  Ant.,  CAina. 
Air  (diminution  of,  or  exemption  from  pain  in  the  open)  :  BAus,  Con., 

Magn.  s.,  Nux  v. 

Bed  (aggravation  of  pain  in) :  CAam.,Merc.,  Puis.,  Acid.  sulpA.,  chiefly; 

but  also :  Ant.,  Alum.,  Ammon.  c,   GrapA.,  PAospA.,  Ac.  nitr.,  Kali, 

Sab. 
Bed  (diminution^  or  cessation  of  pain  in)  :  Lye,  Magn.  s. 

—  (diminution  or  cessation  of  pain  on  getting  out  of) :  Oleander, 
Sabina,  Antim.  crudum. 

Clenching,  or  compressing  the  teeth,  or  masticating  (aggravation 
from) :  Am.  c,  GrapA.,  ColcA.,  Sep.,  Hep.,  Petr.,  Tab.,  Guaj.,  Sab., 
PAospA.,  TAuja,  Veratr.,  StapA.,  SulpA.,  Alum.,  CAina,  Zinc,  BupA. 

Clenching  the  teeth,  amelioration  on  :   CincAona. 

Cold  substances  (aggravation  from  the  introduction  of,  into  the 
mouth) :  Merc,  SulpA.,  Spig. ;  Ant.,  TAuja,  Plumb.,  &c. 

Drinking  (cold  fluids,  aggravation  from)  :  Nux  v.,  SulpA.,  StapA., 
GrapA.,  Ac  mur.,  Bor.,  Nux  moscA.,  Merc,  chiefly  :  but  also,  CAam., 
Calc,  LacA.,  Puis.,  Carb.  a.,  Sass.,  Mags. 

Drinking  coffee  (aggravation  from) :  Nux  v.,  CAam. 

—  hot   fluids    (aggravation   from) :    Agnus,    CAam.,  Brosera, 
Nux  v.,  LacA. 

Drinking  tea  (aggravation  from) :  TAuja. 

—  wine  —  Nux  v. 

Eating  (aggravation  while):  Bella.,  Kali,  Lye,  Merc,  Natr.,  Mags, 
arc,  chiefly;  but  also,  Ant.,  Bry.,  Carb.  a.,  Cocc,  GrapA.,  Hep.,  Ign., 
Magn.  m.,  Puis.,  SulpA.,  TAuja,  &c. 

43 


674  DERANGEMENTS  DURING  PREGNANCY. 

Eating  (aggravation  after)  :  Bella.,  Cham.,  Lack.,  Nux  v.,  Staph., 
Sabin.,  Spiff.,  Mags.  arc. ;  or,  Ign.,  Graph.,  Magn.,  Natr.  m.,  China, 
Bryonia,  &c. 

Eating  cold  food  (aggravation  from) :  Conium. 

—  hot  food  —  Agn.,  Phosph.,  Sil. 
Evening  (aggravation  of  the  toothache  towards) : 

Hot  substances  (aggravation  from  the  introduction  of,  into  the 
mouth) :  Nux  v.,  Calc.  ;  Bryon.,  Carl,  v.,  Lack,  Sulph.,  Merc, 
Phosph.  Sec. 

Hot  substances  (mitigation  on  the  introduction  of,  into  the  mouth)  : 

Nux  mosch.,  Kali  h. 

Morning  (aggravation  of  suffering  in  the) :  Nux  v.,  Lack,  Phosph.; 
Tart. '  emet.,  Kali,  Kreos.,  Ban. 

Night  (aggravation  or  accession  of  the  toothache  during  the) :  Bella., 

Cham.,  Nux  v.,  Ars.,  Puis.,  Rhus,  Spig.,  Sulph.,  Staph.,  Merc,  Phosph., 
Magn.,  China,  Cyc,  Gran.,  Am.  c,  Sep.,  Rhod.,  Baryta  c  et  m.,  &c. 

Noise  (aggravation  of  pain  from) :   Calc.  c 

Noon,  in  the  after-,  Nux  v.,  Lach.,  Puis.,  Berh. 

Quotidian  toothache :  Diadema,  Tart.,  Sec. 

Reading,  Reflecting,  Meditating  (aggravation  from) :   Nux  vomica, 

Belladonna. 
Repose,  Rest,  Quietude  (aggravation  from) :  Magn. 
Room  (aggravation  in  a  warm)  :  Puis.,  Nux  v.,  Hepar  s. 

Posture  (aggravation  while  in  the  horizontal)  :  Clem, 

—  (aggravation  whilst  lying  on  the  affected  side) : 

Salt  food,  (toothache  increased  or  excited  by  partaking  of) :  Carl.  v. 
Smoke  (aggravation  from  tobacco)  :  Spig.,  Clem.,  Sabin. 

—     (mitigation  from  ditto)  : 
Speaking  (aggravation  while) :  Sepia. 
Sucking  the  teeth  (aggravation  or  accession  of  toothache  from) : 

Nux  mosch. 
Sweetmeats  (sugar,  &c,  aggravation  from) :  Natrum. 


TOOTHACHE.  675 

Tea  (aggravation  from) :  Thuja. 

Toothache,  with  extension  of  pain  to  the  arms  and  fingers:  Sepia, 

—  with  extension  of  the  pain  into  the  ears :  Merc,  Ars., 

Nux  v.,  Puis.,  Sulph.,  Sep.,  Cham.,  Natr.  m.,  &c. 
Toothache,  with  pains  extending  into  the  face:  Merc., Puis,,  Nux  v., 

Hyos.,  Sulph.,  Rhus,  Mez.,  &c. 
Toothache,  with  pains  extending  into  the  eyes :  Puis. 

—  with  pain  extending  into  the  head :  Ant.  c.,  Ars.,  Baryta  c, 
Hyos.,  Merc.,  Nux  v.,  Rhus,  Puis.,  Sulph.,  Cham.,  chiefly. 

Toothache,  with  pain  extending  to  the  neck :  Natr.  muriaticum. 

—  attended  with  coldness  in  the  ears  :  Lach., — with  gene- 
ral coldness,  Veratr.  alb. 

Toothache  attended  writh  dyspnoea  :  Sep.,  Puis. 

—  despair  :  Nux  v.,  Ars.,  Cham. 

—  with  great  irascibility :  Nux  v.,  Sep.,  Alum.,  Cham. 

—  with  extreme  agitation  or  anguish :  Coffea,  Clem.,  Spig., 
Ars.,  Magn.,  Mang.,  Natr.  s. 

Toothache,  with  paleness  of  the  face  :  Puis.,  Spig. 

—  redness  of  the  face  ;  CJiam.,  Veratr.,  Bella,  Nux. 

—  with  virulent  pulsation  in  all  the  arteries  :  Sepia. 

—  writh  whining,  or  plaintive  humour  :  Nux  v.,  Cham. 

—  with  salivation  :  Merc.,  JDaph.,  Phosph.,  Stront.,  chiefly. 

—  with  tendency  to  shivering :  Daphne  indica,  Lach.,  Merc, 
Puis.,  Sulph.,  JEup. 

Toothache,  with  tendency  to  sweating:  Daphne  indica. 

—  with  cold  sweat  on  the  forehead  :   Veratrum  album. 

—  with  tendency  to  syncope  :   Veratrum  album. 

—  with  vomiting :   Veratrum  album. 

Tooth-pick  (accession,  or  aggravation  of  pain  on  using  the)  :  Puis. 


Vinegar  (mitigation  of  pain  from) :  Tongo. 


Walking  (mitigation  from) :  Mags.  arc. 

—  in  the  open  air  (mitigation  from) :  Mags,  arc,  Nix  v. 

—  —  after,  (mitigation) :  Magn.  s. 
Warmth  (aggravation,  or  accession  of  pain  from):  Mags,  arc,  Puis., 

Nux  mosch. ;  Hep.,  Graph.,  Hell. 
Warmth  of  the  bed  (aggravation  or  accession  of  the  pain  from)  : 


676  DERANGEMENTS  DURING  PREGNANCY. 

Puis.,  Merc,  Phosph.;  or  Cham.,  Acid,  phosph.,  Sabin.,  Ant.,  Alum., 

Add.  ph.,  Am.  c,  Graph.,  Kali,  Baryta  c,  &c. 
Wind  (aggravation  from) :  Puis. 
Wine  (aggravation  from)  :  Nux  v. 


SWELLED  FACE. 

Tumefaction  of  the  cheek  arises  from  different  causes ;  frequently 
it  is  the  consequence  of  toothache,  and  will  then  be  cured,  or  at  all 
events  much  diminished,  by  the  remedy  given  for  the  removal  of  that 
affection.  Sometimes  it  happens,  nevertheless,  that  whilst  the  tooth- 
ache diminishes  from  the  employment  of  the  proper  remedy,  the 
swelling  of  the  cheek  remains  unaltered.  In  this  case  Arnica  is 
generally  of  great  service,  especially  when  the  swelling  is  hard  and 
stiff.  If  this  treatment  is  of  no  avail  we  may  have  recourse  to 
Pulsatilla,  or  to  Mercurms  vivus,  which  is  of  especial  service  when  the 
swelling  of  the  cheek  is  accompanied  with  a  drawing,  tearing  pain, 
an  increased  flow  of  saliva,  and  considerable  erysipelatous  redness  -, 
followed  by  Belladonna,  and  Hepar  s.,  if  the  inflammation  threatens 
to  extend.  (See  Erysipelas.)  Cham.,  Bryonia,  Sec,  are  also  oc- 
casionally of  service. 

Where  the  employment  of  the  appropriate  remedy  has  been 
neglected  at  the  proper  time,  or  the  swelling  has  been  maltreated 
by  some  external  application,  the  tumour  is  frequently  rendered  of  an 
obstinate  character. 

In  most  cases,  however,  the  dispersion  of  the  tumour,  or,  when 
matter  is  forming,  the  speedy  completion  of  the  suppurative  process 
and  consequent  bursting  of  the  abscess,  will  be  readily, enough  affected 
by  means  of  Hepar  sulphuris,  one  grain,  repeated  if  necessary  in  from 
six  to  twelve  hours. 

In  obstinate  cases,  Lachesis  and  Hepar,  or  Mercurius  and  Hepar,  in 
alternation,  are  sometimes  required;  and  occasionally  Silicea,  par- 
ticularly in  strumous  habits.  The  application  of  a  poultice  to  the 
cheek,  or  a  fig  boiled  in  milk  and  placed  in  the  mouth  between  the 
affected  cheek  and  gums,  is  sometimes  useful.  If  the  tumour  has 
burst,  and  the  opening  is  internal,  no  especial  care  need  be  taken  of 
it,  but  if  it  has  burst  externally,  a  simple  bandage,  smeared  with 
melted  suet  or  fresh  butter,  must  be  applied. 


VARICES,  OR  SWELLED  VEINS.  677 


VARICES,  OR  SWELLED  VEINS, 


Many  females  suffer  much  during  pregnancy  from  distension  of 
veins  in  the  thigh  and  other  parts,  which,  becoming  exacerbated, 
eventually  cause  great  pain  and  inconvenience.  These  varicose  veins 
generally  arise  from  obstructed  circulation  caused  by  the  pressure 
of  the  gravid  uterus  upon  the  blood-vessels,  but  are  also  frequently 
a  sure  indication  of  the  existence  of  constitutional  debility,  particulary 
when  they  occur  in  an  aggravated  form.  They  are  much  increased 
by  partaking  of  stimulating  liquids,  which  should  consequently  be 
avoided.  Considerable  alleviation  is  experienced  by  constant  bathing 
with  water,  or  with  diluted  alcohol ;  also  by  bandaging  from  the  foot 
upwards  with  a  gentle  and  equable  pressure,  and  by  preserving  a 
recumbent  posture,  which  is  requisite  in  severe  forms  of  the  com- 
plaint, accompanied  with  considerable  swelling  of  the  feet,  ankles 
&c.  In  order  to  afford  relief,  we  may  have  recourse  to  the  following 
remedies : — 

Pulsatilla  is  one  of  the  most  useful  medicines,  particularly  when 
there  is  excessive  pain  and  swelling,  with  a  good  deal  of  inflammation, 
or  when  the  veins  are  of  a  livid  colour,  which  is  imparted  to  the 
whole  limb.  Should  Pulsatilla  give  some  relief,  but  the  swelling 
and  livid  discoloration  continue  in  much  the  same  state,  Lachesis 
may  be  substituted.  Arnica  is  of  material  service  when  the  occupa- 
tions of  the  patient  render  it  impossible  for  her  to  lay  herself  up, 
or  avoid  much  standing  and  moving  about  in  discharge  of  her 
domestic  duties.  Arnica  and  Pulsatilla  in  alternation,  every  six  or 
eight  days,  have  been  found  of  great  efficacy  in  such  cases. 

Nux  vomica,  when  the  affection  is  attended  with  constipation, 
hemorrhoids,  and  irritability  of  temper.  Sulphur  is  sometimes  very 
beneficial  after  Nux  v\ 

Arsenicum,  when  the  veins  are  of  a  livid  colour,  and  are  attended 
with  severe  burning  pain. 

Carbo  vegetabilis,  where  Arsenicum  is  not  sufficient  to  subdue 
the  constant  scalding  or  burning. 

Belladonna.  Varices,  with  considerable  erysipelatous  inflam- 
mation. 


678  TREATMENT  OF  FEMALES. 

Ly  co  podium  has  been  employed  with  success  in  some  inveterate 
cases. 

The  simultaneous  external  application  of  the  remedy  employed  is 
occasionally  attended  with  benefit. 

For  a  permanent  eradication  of  the  affection,  a  course  of  treatment 
is  requisite,  in  which — Agaricus  muscarius,  Sulphur,  Graphites,  Carlo 
vegetabilis,  Sepia,  &c.,  are  the  most  effectual  medicaments.  (See 
Ulcers,  Part  I.) 


PAINS  IN  THE  BACK  DURING  PREGNANCY. 

Lumbosacral  pains. 

Some  females  suffer  much  from  pains  in  the  lower  part  of  the  back 
during  pregnancy,  which  occasionally  prove  extremely  distressing, 
particularly  when  they  occur  during  the.  night,  and  tend  to  disturb 
sleep.  They  generally  consist  of  an  almost  indescribable  aching,  or  of 
an  obtuse,  heavy,  dragging,  or  pressure,  as  if  caused  by  a  dead  weight 
resting  on  the  affected  part.  Kali  carbonicum  is  frequently  adequate  to 
remove  them,  especially  when  they  partake  of  the  character  described. 
In  other  cases,  Bryonia,  Rhus,  Sulph.,  Lycopodium,  Pulsatilla,  JSlux  v., 
Sepia,  Platina,  Natrum  m.,  &c,  may  be  given  with  advantage.  If 
hemorrhoidal  sufferings  become  added  to  these  troublesome  pains, 
and  Kali  c.  prove  insufficient  to  relieve  the  complaint  in  this  com- 
plicated form,  Nux  v.,  Sulphur,  or  Sepia,  may  be  prescribed  with  ad- 
vantage. (See  Hemorrhoids;  as  also  the  indications  given  for  the 
remedies  under  the  heading  of  False  Pains.) 


MISCARRIAGE. 

Abortus. 

Women  who  have  once  suffered  from  this  affection  are  exceedingly 
obnoxious  to  its  recurrence,  and  this  liability  is  still  further  increased, 
if  the  event  has  taken  place  a  second  or  third  time.  Miscarriage  may 
occur  at  any  period  between  the  first  and  seventh  month,  but,  in  the 
majority  of  cases,  it  takes  place  about  the  third,  or  the  beginning  of 


MISCARRIAGE.  679 

the  fourth.  When  it  occurs  before  or  about  this  period,  it  is  frequently 
attended  with  but  little  pain  or  danger,  although  repeated  miscar- 
riages, from  the  great  discharge  that  is  generally  present,  break  down 
the  constitution,  and  frequently  develop  severe  chronic  diseases. 
When  miscarriage  takes  place  at  a  more  advanced  period,  it  assumes 
a  very  serious  complexion,  and  is  often  accompanied  with  a  consider- 
able degree  of  peril  to  the  sufferer. 

The  premonitory  and  accompanying  symptoms  of  miscarriage  vary 
much  in  their  nature  ;  sometimes  the  discharge  is  exceedingly  pro- 
fuse, at  others  moderate  or  inconsiderable;  the  pains,  in  many  in- 
stances, extremely  severe  and  protracted,  are  in  others  very  slight  and 
of  short  continuance. 

Sudden  mental  emotions,  or  great  physical  exertion,  mechanical  inju- 
ries, a  luxurious  mode  of  life,  fashionable  habits,  powerful  aperients, 
neglecting  to  take  air  and  exercise,  are  a  few  of  the  exciting  causes  of 
this  affection,  which  is  particularly  apt  to  occur  both  in  highly  ple- 
thoric and  delicate  or  nervous  habits.  An  abnormal  condition  of  the 
constitution  is  undoubtedly  the  predisposing  cause. 

Miscarriage  is,  in  most  cases,  preceded  and  attended  by  the  majority 
of  the  following  symptoms  : — A  sensation  of  chill,  followed  by  fever, 
with  more  or  less  bearing  down,  particularly  when  occurring  late  in 
pregnancy  ;  also,  severe  pains  in  the  abdomen,  draioing  and  cutting  pains 
in  the  loins,  or  pains  frequently  bearing  a  close  resemblance  to  those 
of  labour;  discharge  of  viscid  mucus,  and  blood,  sometimes  of  a  bright 
red,  not  unfrequently  mixed  with  coagula,  at  other  times  dark  and 
clotted,  followed  by  the  emission  of  a  serous  fluid.  The  miscarriage 
generally  takes  place  during  this  discharge,  which  occasionally  conti- 
nues, if  not  properly  checked,  to  flow  for  hours  after,  placing  the 
sufferer  in  considerable  jeopardy.  When  the  pains  increase  in  in- 
tensity, and  the  muscular  contractions  become  generally  established, 
with  their  characteristic  regular  throes  and  efforts  to  dilate  the  mouth 
of  the  womb,  miscarriage  is  almost  inevitable. 

Therapeutics.  As  preventives  of  this  affection  the  principal  reme- 
dies are  Sabina,  Secale  cornutum,  Kali  c,  Lye,  Sep.,  and  Calc. 

When  the  premonitory  symptoms  declare  themselves,  Chamomilla, 
Nux  vomica,  Ferrum  metallicum,  Ipecacuanha,  Sabina,  and  Calcarea.  The 
same  with  the  addition  of  Hyoscyamus,  Crocus,  and  Secale  cornutum,  after 
the  misfortune  has  taken  place.  Cinchona  is  also  valuable  when  the 
indications  which  we  shall  give  for  that  medicine  are  present. 


680  TREATMENT  OF  FEMALES. 

In  cases  where  there  is  an  evident  disposition  to  miscarriage,  or 
where,  from  a  variety  of  reasons,  it  is  apprehended,  the  employment 
of  Sabina,  in  the  early  stage  of  pregnancy,  will  frequently  prevent 
its  occurrence. 

Administration.  We  may  allow  four  or  five  days  to  elapse 
between  the  first  and  second  dose,  and  gradually  lengthen  the  interval 
between  each  successive  administration,  until  the  period  of  danger  be 
past,  being  careful,  however,  to  watch  the  effect  of  each  dose,  to  dis- 
continue the  medicine  whenever  any  indications  of  its  action  on  the 
system  become  apparent,  and  to  abstain  from  repeating  until  the 
symptoms  attributable  to  the  medicine  have  passed  away,  and  then 
only  with  increased  caution  and  at  longer  intervals. 

Hartmann*  strongly  recommends  Sec  ale  cornutum,  two  glo- 
bules, as  useful  in  similar  cases,  but  particularly  when  this  misfortune 
has  already  occurred  more  than  once ;  it  should  be  administered  every 
fourteen  days,  commencing  immediately  after  the  cessation  of  the 
monthly  period,  and  continuing  until  the  period  at  which  miscarriage 
usually  occurs  is  past ;  one  dose  more,  at  the  utmost,  being  allowed 
after  this  period. 

Both  these  remedies  are  also  extremely  valuable  after  miscarriage 
has  taken  place,  the  latter  particularly  in  weak  or  exhausted  persons, 
or  in  those  cases  of  hemorrhage  in  which  the  discharge  consists  of 
dark  liquid  blood,  and  is  followed  by  considerable  debility ;  this  remedy 
is  also  efficacious  in  cases  of  inevitable  miscarriage,  attended  with  feeble 
expulsive  efforts;  the  former  [Sabina)  when  there  are  dragging  and 
forcing  pains,  extending  down  the  back  and  loins ;  profuse,  bright- 
coloured  hemorrhage  ;  sensation  of  sinking  or  faintness  in  the  abdo- 
men ;  frequent  desire  to  relieve  the  bowels ;  diarrhoea ;  nausea  or 
vomiting  ;  chilliness  and  heat,  with  fever. 

Lycopodium  and  Kali  carbonicum  have  also  been  recommended  as 
useful  preventive  remedies  against  habitual  tendency  to  abortion,  the 
latter  especially  when  the  symptoms  are  always  preceded  or  attended 
by  severe  pain  in  the  loins. 

We  shall  now  treat  of  miscarriage  when  the  premonitory  symptoms 
have  set  in,  giving,  under  the  same  head,  the  indications  for  the  use 
of  the  medicaments,  where  the  result  is  unavoidable  or  has  already 
taken  place,  as  even  in  these  cases  their  administration  is  decidedly 
beneficial  in  obviating  further  injurious  consequences,  and  in  alle- 

*  Therapie  akut.  Krank.  Form.,  vol.  ii,  p.  352,  2d  ed. 


MISCARRIAGE.  681 

viating  the  sufferings  of  the  patient.  The  remedies  in  these  cases 
are,  in  addition  to  the  two  above  mentioned,  Arnica,  Chamomilla,  Nux 
vomica,  Ipecacuanha,  Hyoscyamus,  Belladonna,  Crocus,  Fermm  metallicum, 
and  Calcarea. 

Arnica  : — When  the  symptoms  have  been  excited  by  an  accident, 
such  as  a  fall,  blow,  or  concussion,  &c,  this  remedy  should  be  imme- 
diately administered. 

Chamomjlla  :-—  When  there  are  present:  excessive  restlessness, 
convulsions,  twitching  in  the  back  and  limbs :  severe  pains  in  the  loins 
and  back,  worse  at  night,  generally  of  a  sharp  cutting  description,  ex- 
tending downwards,  strongly  resembling  those  of  labour  :  sometimes 
also  abdominal  spasms,  with  a  species  of  sanguineous  discharge ;  or  dis- 
charge of  deep  red  or  dark  coagulated  blood;  frequent  yawning; 
coldness  and  shivering. 

Nux  vomica  : — Obstinate  constipation,  with  a  varicose  condition 
of  the  internal  organs  of  generation  :  also  when  the  patient  has  been 
accustomed  to  a  stimulating  diet,  and  the  use  of  coffee ;  severe  burn- 
ing, or  wrenching  pains  in  the  loins*;  painful  pressure  downwards 
and  mucous  discharge.  {Bryonia  is  sometimes  of  benefit  when 
Nux  v.  fails  to  do  much  good.)     See  also  Calcarea. 

Ipecacuanha.:- — Chilliness  and  with  heat;  violent  pressure  down- 
waxds,  flooding  j  cramp  and  rigidity  of  the  frame;  sometimes  convul- 
sions ;  vomiting,  or  desire  to  vomit ;  disposition  to  faint  whenever  the 
head  is  raised ;  cutting  pains  in  the  umbilical  region.  (Platina  or 
Cina  have  been  recommended  when  Ipec.  fails.) 

Hyoscyamus: — When  the  convulsions  are  very  severe,  with  cries, 
great  anguish,  oppression  of  the  chest,  and  loss  of  consciousness. 

Belladonna  is  perhaps  more  frequently  required  either  at  the 
commencement,  or  subsequently,  than  any  other  remedy.  The  fol- 
lowing are  its  leading  indications:  great  pains  in  the  loins  and  entire 
abdomen ;  severe  bearing  down,  as  if  the  whole  of  the  intestines  would 
be  pressed  out ;  pain  in  the  back,  as  if  it  were  dislocated  or  broken ; 
bruised  pain  in  the  sacral  region ;  sensation  either  of  spasmodic  con- 
striction, or  of  expansion  in  the  abdomen.  It  is  also  particularly  valu- 
able in  cases  of  profuse  hemorrhage,  the  discharge  of  blood  being 
neither  very  bright  nor  dark-coloured  after  miscarriage.  Blatina  is 
sometimes  to  be  preferred  to  Belladonna,  when,  along  with  bearing- 
down  pains,  there  is  a  thick  and  dark-coloured  discharge,  attended 
with  venereal  orgasm. 

Ferrum  metallicum  is  a  useful  medicine  in  cases  of  miscar- 


682  TREATMENT  OF  FEMALES. 

riage  attended  with  fever,  labour-like  pains,  and  considerable  san- 
guineous discharge. 

Crocus  is  especially  indicated  in  cases  which  are  attended  or 
followed  by  discharge  of  dark,  coagulated  or  viscid  blood,  with  a  sen- 
sation as  of  something  moving  or  fluttering  about  in  the  umbilical 
region,  and  increased  sanguineous  discharge  on  the  slightest  move- 
ment. This  medicine  is  frequently  useful  in  obstinate  cases,  after 
the  employment  of  one  or  more  of  the  above-mentioned  remedies. 

Cinchona  is  valuable  in  restoring  the  exhausted  energies,  after  the 
hemorrhage,  and  materially  assists  in  checking  the  discharge  if  there 
be  spasmodic  pain  in  the  womb,  or  a  bearing-down  sensation,  with 
considerable  discharge  of  blood  at  intervals. 

Caloarea  is  a  remedy  of  considerable  importance  in  the  treat- 
ment of  cases,  where  the  affection  has  apparently  been  induced  by  a 
varicose  state  of  the  veins  of  the  parts.  It  is  also  of  value  as  a  pre- 
ventive, and  especially  where  the  patient  is  of  a  plethoric  habit,  with 
a  tender  or  irritable  skin,  and  other  strumous  appearances. 

Sepia  : — In  threatening  attacks  of  abortus  from  general  plethora, 
or  from  local  congestions  and  obstructed  circulation,  with  sensation 
of  weight  in  the  abdomen,  determination  to  the  head  and  chest,  and 
excessive  nervous  excitability,  this  remedy  has  been  employed  with 
success. 

When  Mental  Emotions  have  given  rise  to  the  symptoms  of 
miscarriage,  see  the  remedies  given  under  that  heading,  Part  I. 

Administration.  A  few  globules,  or  where  necessary,  one 
minim  in  an  ounce  of  water,  a  teaspoonful  every  few  minutes  to  half 
an  hour,  or  only  three  or  four  hours,  according  to  the  nature  of 
the  case,  lengthening  the  intervals  or  discontinuing  the  medicine 
when  decided  benefit,  or  a  stoppage  of  the  hemorrhage  is  effected. 
When  a  favorable  effect  does  not  follow  after  the  second  or  third  dose 
in  serious  cases,  another  remedy  must  be  had  recourse  to.  When 
violent  hemorrhage  is  present,  and  does  not  cease  under  the  employ- 
ment of  any  of  the  before-mentioned  medicines,  Acidum  nitricum  may 
be  administered.     Cold  water  is  also  useful.     (See  Menorrhagia.) 

In  concluding  the  subject,  I  shall  briefly  notify  a  few  precautionary 
measures^  which  the  patient  ought  to  observe  while  threatened  with, 
or  after  having  suffered  from  the  affliction. 

When  miscarriage  is  threatened,  the  individual  must  assume  the 
recumbent  posture,  and  in  some  cases  indeed,  should  be  strictly  con- 


MISCARRIAGE.  683 

fined  to  bed,  sleeping  with  few  bed-clothes ;  the  apartment  should  be 
kept  cool,  and  every  means  must  be  employed  to  ensure  perfect  tran- 
quility of  mind.  The  diet  prescribed  in  cases  under  homoeopathic 
treatment  should  be  closely  followed,  and  warm  fluids  generally 
avoided.  When  the  misfortune  has  proved  unavoidable,  or  has 
actually  taken  place,  before  assistance  has  been  sought,  the  patient 
ought  still  to  be  confined  to  bed  for  a  few  days,  lest  a  fresh  discharge 
should  be  brought  about  by  too  early  a  change  from  a  horizontal  to 
an  upright  posture ;  and  on  future  occasions,  when  a  similar  period 
comes  round,  great  care  should  be  taken  that  the  mishap  may  not 
again  occur :  in  the  attainment  of  this  desirable  object  we  feel  confi- 
dent, that  nothing  will  tend  so  fully  to  ensure  success  as  a  timely 
exhibition  of  one  or  other  of  the  preventive  remedies  already  com- 
mented on  in  this  article. 


TREATMENT  BEFORE  PARTURITION. 


PREPARATION  OF  THE  BREASTS. 

Young  mothers  frequently  find  great  difficulty  in  suckling  their 
children,  in  consequence  of  some  organic  defect  or  incapacity  of  the 
nipple.  In  almost  every  case,  a  preparation  of  the  breasts  is  neces- 
sary some  weeks  before  delivery,  in  order  to  prepare  them  for  their 
future  office.  In  many  instances  the  structure  of  the  breasts  is  dis- 
organised from  an  ignorant  nurse  having  compressed  them  in  child- 
hood, under  the  idea  of  such  a  process  being  needful  for  the  expulsion 
of  some  matter  in  the  breasts  of  a  child — a  vulgar  error,  against 
the  practice  of  which  mothers  ought  to  be  particularly  watchful. 
Inability  of  function  is  also  likely  to  occur  from  the  pressure  of  stays 
in  after  life,  by  which  the  cuticle  is  rendered  so  tender,  as  to  preclude 
suckling. 

The  first  two  cases  are  beyond  the  power  of  art.  If  suckling  be 
attempted,  induration  of  the  nipple  and  mamma  ensues,  attended 
with  severe  suffering :  when,  however,  a  simple  tenderness  of  the 
epidermis  exists,  this  evil  is  much  alleviated  by  bathing  the  nipples 
with  brandy  twice  a  day,  for  several  weeks  anterior  to  delivery. 
Another  difficulty,  frequently  accompanying  this  state,  is  a  shortness 
or  retraction  of  the  nipple,  so  that  the  infant  cannot  take  hold  of  it ; 
this  defect  is  frequently  the  cause  of  the  first,  from  the  ineffectual 
efforts  of  the  child  to  suck  injuring  the  part ;  in  this  case  appropriate 
shields  of  soft  wood  may  be  applied  to  accustom  the  nipple  to  elon- 
gate and  protrude,  so  as  to  present  sufficient  hold  for  the  infant, 
when  the  period  for  suckling  arrives,  and  when  the  efforts  of  the 
child  will  still  further  contribute  to  effect  this  object.  In  this  case 
also,  bathing  with  brandy  will  naturally  tend  to  correct  any  tender- 


FALSE  PAINS.  685 

ness  of  the  skin,  and  prevent  subsequent  excoriation.  It  may  also 
be  here  remarked, -that  when  any  tenderness  exists  during  the  period 
of  lactation,  between  the  intervals  of  the  infant  being  applied  to  the 
breast,  the  shield  should  be  resumed,  and  the  bathing  continued,  due 
care  being  always  taken  to  lave  the  nipple  carefully  with  tepid  water, 
before  it  is  again  offered  to  the  child.* 


REMEDIES  BEFORE  LABOUR. 

Many  things  are  recommended  by  the  old  school  previous  to  labour, 
such  as  frequent  bloodlettings  and  aperients ;  but  these,  instead  of 
promoting  the  object  desired,  have  a  contrary  effect,  by  lowering  the 
energies  requisite  at  such  an  eventful  period,  and  by  placing  the 
nervous  system  in  an  abnormal  state  of  irritation  and  excitement ; 
when  this  loss  of  humour  is  brought  about  in  the  first  period  of  preg- 
nancy, it  defeats  its  own  object,  by  developing  what  are  commonly 
called  plethoric  symptoms,  induced  by  the  reaction  in  the  organism, 
necessary  to  supply  this  uncalled-for  waste,  and  which  always  takes 
place  with  a  correspondent  expenditure  of  vital  power.  Where  an 
evident  plethoric  state  exists,  the  desired  result  may  be  safely  and 
effectually  attained  by  a  dose  or  two  of  Aconite,  which  may  be  fol- 
lowed by  Belladonna,  should  there  be  symptoms  of  active  conges- 
tion, with  fiery  redness  of  the  face,  accelerated  action  of  the  carotids, 
&c. 

An  action  on  bowrels  previous  to  delivery,  may  be  obtained  by  a 
lavement  of  lukewrarm  water,  repeated  with  a  small  quantity  of  linseed* 
oil,  when  necessary  from  a  failure  in  the  first  attempt  to  obtain  the 
desired  effect. 


FALSE  PAINS. 

Before  proceeding  to  notice  parturition,  a  few  words  may  be  said 
upon  the  (so-called)  false,  spurious,  or  intestinal  pains,  brought  about 

*  When  severe  pains  are  experienced  in  the  breast  after  each  application  of  the  infant,  the 
employment  of  Phellandrium  aquaticum  has  been  found  advantageous. 


686  TREATMENT  BEFORE  PARTURITION. 

by  congestion  of  blood  to  the  uterus,  errors  in  regimen,  emotions  of 
the  mind,  effects  of  chill  in  the  abdomen,  and  a  variety  of  other 
causes  :  they  sometimes  precede  labour  but  a  few  hours,  but  in  many 
cases  come  on  some  days,  and  even  weeks,  before  delivery ;  they  chiefly 
differ  from  labour-pains  in  the  irregularity  of  their  recurrence,  in  being 
unconnected  with  uterine  contraction,  and  chiefly  confined  to  the  abdomen, 
with  sensibility  to  touch  and  movement,  and  in  not  increasing  in  intensity  as 
they  return :  sometimes,  from  their  close  resemblance,  it  is  extremely 
difficult  to  discriminate  between  them  and  the  real  labour-pains,  but 
in  such  cases  we  must  be  chiefly  guided  by  the  period  of  gestation  ;* 
and  our  safest  mode  of  procedure  is  to  endeavour  to  mitigate  the 
patient's  sufferings,  if  they  be  considerable,  or  come  on  a  week  or  two 
before  labour  is  expected,  by  the  administration  of  a  proper  remedy, 
as,  if  we  allow  them  to  proceed  unchecked,  they  not  unfrequently 
continue  till  the  moment  of  delivery,  rendering  the  labour  much  more 
painful,  exhausting,  and  difficult. 

Therapeutics.  The  following  medicaments  may  generally  be 
had  recourse  to  with  effect :  Bryonia,  Nux  v.,  Pulsatilla,  Dulcamara,  and 
Aconitum, — the  one  most  suitable  for  the  affection  being  selected, 
according  to  the  causes  and  symptoms. 

Bryonia,  when  there  are  pains  in  the  loins  resembling  a  dragging  weight, 
attended  with  constipation  and  irritability,  much  increased  by  motion, 
with  abdominal  pains  preceding  those  in  the  back,  (This  remedy  is  more 
particularly  indicated,  when  the  above  symptoms  have  been  excited 
by  a  fit  of  passion.) 

Nux  vomica.  Similar  pains  in  the  abdomen  and  back;  also 
*when  there  is  pain  in  the  region  of  the  pubis,  as  if  from  the  effects  of 
a  bruise ;  the  symptoms  arise  chiefly  at  night.  When  the  exciting 
cause  appears  to  be  constipation,  or  mental  irritation,  or  a  too  luxu- 
rious mode  of  living,  stimulants,  coffee,  or  spirituous  liquors,  there  is 
additional  reason  for  selecting  Nux  v. 

Pulsatilla  :  Similar  abdominal  pains ;  pains  in  the  loins 
resembling  those  from  continued  stooping,  or  the  pressure  of  a 
tight  bandage,  attended  with  a  sensation  of  rigidity,  and  painful 
dragging  and  aching  in  the  thighs;  constipation  or  relaxation;  mild- 

*  If  the  os  uteri  be  found  unaltered,  and  consequently  not  enlarged  or  elongated,  it 
way  with  certainty  be  concluded  that  the  pains  are  spurious. 


PARTURITION.       TEDIOUS  LABOURS.  687 

ness  of  temper  or  great  sensibility.  This  remedy  is  particularly 
valuable,  when  these  pains  appear  to  have  arisen  from  indigestion 
brought  on  by  rich,  indigestible  food. 

Dulcamara  :  is  chiefly  useful  when  the  origin  may  be  traced 
to  cold,  and  the  pains  are  of  a  violent,  shooting,  and  drawing 
nature,  situated  in  the  small  of  the  back,  generally  coming  on  at 
night.  When  spurious  pains  arise  from  emotions  of  the  mind,  we 
may  consult  Mental  Emotions. 

Aconitum  : — When  these  pains  occur  in  young  plethoric  subjects, 
attended  with  accelerated  and  strong  pulse,  flushing  of  the  face,  and 
increased  temperature  of  the  skin. 

The  employment  of  this  remedy  completely  obviates  the  necessity 
for  venesection. 


parturition. 

Natural  labour  takes  place  at  the  end  of  the  ninth  month  of  preg- 
nancy ;  the  uterine  contractions  are  regular  and  effective,  and  the 
whole  process  does  not  continue  beyond  twenty-four  hours,  rarely  above 
twelve,  and  very  frequently  not  longer  than  six.  Were  it  not  for  the 
acquired  hahits  of  civilized  life — improper  diet — the  distortion  of  the 
proportions  of  the  female  frame  by  tight-lacing,*  and  the  conse- 
quent displacements  and  disturbances  of  the  regular  functions  of  the 
abdominal  viscera — diseases  generated  by  the  want  of  proper  air  or 
exercise,  or  both — hereditary  maladies,  &c,  parturition  would  be 
comparatively  free  from  pain  and  remote  from  danger,  as  in  fact  it  so 
generally  is,  even  at  the  present  day,  among  savages. 


TEDIOUS  OR  COMPLICATED  LABOURS. 

When  labour  is  protracted  beyond  the  normal  period  stated,  or  is 
attended  with  an  excessive  degree  of  suffering,  which  is  more  prone 
to  happen  when  the  female  is  of  a  slender  form,  and  of  a  highly  ner- 

*  It  is  to  be  regretted  that  the  attention  of  mothers  is  not  more  particularly  directed  to 
the  development  of  the  female  frame  by  means  of  calisthenic  exercises,  instead  of  distorting 
its  symmetry  by  means  of  stays  and  tight-lacing ;  health  being  destroyed  for  the  sake  of  that 
fashionable  and  unnatural  absurdity — a  thin  waist. 


688  TREATMENT  BEFORE  PARTURITION. 

vous  and  sensitive  habit,  it  becomes  incumbent  on  us  to  avail  our- 
selves of  all  the  means  which  art  affords,  in  order  to  endeavour  to 
alleviate  the  sufferings  of  the  patient  as  much  as  possible. 

Amongst  the  medicines  best  suited  to  attain  this  desirable  result,  we 
shall  frequently  find  Coffea  cruda  of  considerable  service  in  miti- 
gating the  pains,  when  they  are  extremely  violent  and  occur  in  rapid 
succession,  scarcely  allowing  the  female  an  interval  of  ease,  and  are 
attended  with  excessive  agitation,  bordering  on  despair.  When  Coffea 
affords  but  little  relief,  which  is  generally  the  case  when  the  patient  has 
constantly  or  frequently  been  in  the  habit  of  using  coffee  as  a  beverage, 
Aconitum  should  be  resorted  to,  followed  by  Chamomitta  if  required. 

If  little  or  no  benefit  ensue  after  several  doses,  another  medicine 
may  be  prescribed.  When  we  find  that  the  throes  are  insufficient  to 
accomplish  their  object,  and  the  female  becomes  exhausted  by  the 
protracted  nature  of  the  labour, — 

Belladonna  is  a  medicine  of  the  greatest  value,  and  will  generally 
prove  serviceable  in  almost  every  case  of  tedious  labour,  which  arises 
from  the  rigidity  and  unyielding  state  of  the  parts,  (as  is  so  frequently 
the  case  with  elderly  females  giving  birth  to  their  first  child ;)  but  it 
is  more  particularly  where  labour  is  protracted  by  a  spasmodic  con- 
traction of  the  inferior  portion  of  the  uterus,  owing  to  which  circum- 
stance, notwithstanding  the  existence  of  powerful  throes,  the  os  uteri 
does  not  become  correspondingly  dilated,  that  Belladonna  is  indicated.  On 
the  other  hand,  this  valuable  remedy  is  further  of  equal  efficacy  when, 
on  the  escape  of  the  waters,  an  almost  complete  cessation  of  labour- 
pains  ensues,  or  the  uterine  contractions  are  rendered  so  feeble  as 
scarcely  to  be  perceptible,  and  are  only  made  known  to  the  patient  by 
a  periodic  sensation  of  pressure  and  aching  at  the  sacral  region — 
while  the  dilatation  of  the  os  uteri  is  found,  as  in  the  above  instance, 
to  make  no  further  progress?* 

The  following  remedies  will  also  occasionally  claim  attention  : — 
Nux  v.,  Pulsatilla,  Secale  cornutum,  and  Opium. 

Nux  v.,  when  the  labour  is  somewhat  protracted,  from  the  irregu- 
larity and  insufficiency  of  the  pains,  and  the  female  complains  of  a 
continual  urgency  to  relieve  nature. 

Pulsatilla,  where  the  labour-throes  are  imperfect,  and  frequently 
extend  upwards  from  the  sacral  to  the  epigastric  region,  attended 
with  spasm  of  the  stomach  and  vomiting ;  or  when  they  are  almost 

*  Kallenbach. 


TEDIOUS  LABOURS.  689 

unfelt,  and  occur  only  at  long  intervals,  attended  with  acute  pains  in 
the  loins,  and  painful  drawing  sensations  in  the  thighs,  which  tend  much 
to  weaken  the  woman,  without  furthering  the  labour. 

When  Pulsatilla  has  not  had  the  desired  effect,  and  there  is  a  con- 
tinual deficiency  of  uterine  contractile  power ;  or  when  the  labour- 
pains  return  every  quarter  of  an  hour,  not  increasing  in  intensity, 
Secale  cornutum  ought  to  be  administered.  Again,  when  we  find 
the  pains,  although  powerful  at  first,  suddenly  cease,  followed  by  a 
tremor  of  the  whole  body,  and  occasionally  interrupted  by  violent 
jerkings,  and  when  the  patient  falls  into  a  sort  of  lethargic  slumber, 
with  open  mouth,  stertorous  breathing,  eyes  half  closed,* — and  there  is  great 
difficulty  in  arousing  the  sufferer,  even  by  violent  means,  Opium  is 
indicated. 


Dose.  A  few  globules  of  the  remedy  may  be  dissolved  in  about  an 
ounce  of  water,  and  a  dessert-spoonful  given  between  each  pain,  until 
benefit  results,  or  a  marked  action  of  the  remedy  calls  for  a  pause.  When 
the  pains  suddenly  disappear  without  other  indications,  one  or  two  drops 
of  the  Mother  Tincture  of  Cinnamon  may  prove  of  service,  especially 
where  the  labour  is  far  advanced. 


We  have  now,  in  a  great  measure,  treated  of  the  course  to  be 
pursued  when  Nature  seems  to  call  for  our  assistance  to  further  her 
exertions ;  but  we  must,  at  the  same  time,  reprobate  a  rash  and  ill- 
advised  interference  with  her  operations ;  and  we  cannot,  in  common 
with  most  men  of  eminence  of  the  other  school,  too  strongly  repre- 
hend the  practice  of  administering  spirituous  beverages,  or  stimulants, 
such  as  chamomile  tea,  and  other  ptisans,  coffee,  etc.,  under  the 
absurd  idea  of  thereby  facilitating  delivery. 

Spirituous  liquors  are  objectionable,  from  their  accelerating  circu- 
lation, and  consequently  producing  difficult  labour,  and  too  great  a 
loss  of  blood ;  Coffee,  from  its  causing  high  nervous  excitability : 
Chamomile,  from  its  pathogenetic  property  of  producing,  or  creating 
a  tendency  to  metrorrhagia ;  ptisans,  whose  peculiar  properties  wre 
need  not  enter  upon  here,  are  all  more  or  less  of  a  stimulative  or  irri- 
tative nature. 

As  a  general  rule,  every  substance,  possessing  a  medicinal  property, 
administered  upon  the  false  premises  above  noticed,  tends  to  injury, 
and  must  therefore  be  carefully  avoided. 

With  regard  to  the  after-birth,  when  common,  gentle^  and  rational 

44 


690  TREATMENT  BEFORE  PARTURITION. 

mechanical  means*  for  its  expulsion  fail,  we  may  have  recourse  to 
Belladonna,  Pulsatilla,  Secale  cornutnm,  or  Opium,  selecting  by  the 
symptoms  already  mentioned,  and  shall  rarely  be  disappointed  in  our 
expectations  of  their  beneficial  effects. 

When  the  parturition  is  complete,  the  administration  of  a  few 
globules  of  Arnica,  in  a  little  water,  is  always  followed  by  the 
happiest  results,  frequently  preventing  much  severe  after- suffering : 
and  we  are  convinced  that  many  critical  cases  of  inflammation,  etc., 
might  thereby  be  warded  off.  In  instances  where  the  labour  has  been 
very  protracted,  the  Arnica  in  lotion,  one  teaspoonful  of  the  Tincture 
to  two  ounces  of  tepid  water,  applied  externally,  will  be  found  to 
afford  great  relief. 


SPASMODIC  PAINS,  CRAMPS,  AND  CONVULSIONS. 

In  complicated  labours  we  sometimes  find  spasmodic  pains  set 
in,  which  occasion  considerable  suffering,  without  advancing  the 
birth. 

Therapeutics.  The  principal  remedies  against  these  affections 
are  Chamomilla,  Belladonna,  Hyoscyamus,  Stramonium,  Ignatia,  Cicuta 
virosa,  Ipecacuanha,  and  Cocculus.  With  regard  to  their  administration, 
a  globule  or  two  may  be  given  in  a  teaspoonful  of  water,  and  repeated 
after  a  shorter  or  longer  interval,  if  necessary,  according  to  the  effects 
produced,  the  selection  of  the  several  Remedies  being  guided  by  the 
following  symptoms : 

Chamomilla  : — Where  there  is  extremely  acute  pain,  chiefly  of 

*  We  do  not  understand  or  mean  to  express  by  the  said  term,  the  exercise  of  brute  force : 
it  is  truly  melancholy,  and  almost  impossible  to  conceive,  that  men,  who  have  received  a 
medical,  education,  and  have  had  opportunities  both  of  reading  and  hearing  the  warnings  of 
enlightened  and  experienced  obstetric  practitioners,  against  the  distressing  and  serious  con- 
sequences which  almost  inevitably  result  from  the  employment  of  harsh  and  inconsiderate 
measures,  whenever  the  expulsion  of  the  placenta  happens  to  be  somewhat  tardy,  could  be 
guilty  of  such  culpable  and  infamous  conduct.  Some  of  these  reckless  individuals  do  not 
appear  to  wait  for  any  signs  of  tardiness,  but  as  if  in  anticipation  of  an  obstinate  and  pro- 
longed retention,  they  set  to  work  with  their  ruthless  proceedings  immediately,  and  are, 
consequently,  but  too  often  the  authors  of  all  the  mischief  and  danger,  and  even  the  fatal 
termination  which  sometimes  result  after  the  natural  process  of  labour. 


SPASMODIC  PAINS.  691 

a  cutting  description,  extending  from  the  lumbar  to  the  hypogastric 
region,  attended  by  spasmodic  convulsions ;  redness  of  the  face, 
especially  of  one  cheek ;  excessive  sensibility  of  the  nervous  system,  •  and 
excitement. 

Belladonna: — When  the  bearing-down  is  excessive,  as  if  the  entire 
contents  of  the  abdomen  were  about  to  be  protruded :  convulsive  movements 
in  the  limbs  ;  great  agitation  with  continual  tossing  ;  occasional  throb- 
bing and  distension  of  the  vessels  of  the  head;  bloated  redness  of  the  face 
with  profuse  sweat.  (See  also  the  indications  for  this  invaluable 
remedy  at  page  505.) 

Hyoscyamus: — When  the  convulsions  are  still  more  severe, 
accompanied  with  great  anguish  and  cries;  oppression  of  the  chest  and 
loss  of  consciousness. 

Stramonium:  —  Convulsions,  without  loss  of  consciousness,  and 
trembling  of  the  limbs. 

Ignatia  : — Spasmodic  and  compressive  pains,  wTith  sensation  of  suffo- 
cation; confused  feeling  in  the  head. 

Cicuta  virosa  : — General  convulsions,  or  cramp-like  contortions 
of  the  limbs  ;  pallor  or  sallow  hue  of  the  face. 

Ipecacuanha  : — Spasmodic  convulsions  ;  paleness  or  bloatedness 
of  the  face,  occasionally  with  desire  to  vomit. 

Cocculus: — Cramps  or  convulsions  of  the  limbs  and  whole  body, 
more  especially  in  the  lower  part  of  the  abdomen,  with  heat,  redness,  and 
puffiness  of  the  face.  Acidum  hydrocyanicum,  Platina,  and  Cina  have  also 
been  recommended  against  convulsions  during  labour. 


TREATMENT  AFTER  DELIVERY. 


After  the  termination  of  delivery,  both  body  and  mind  must  be 
kept  in  a  state  of  perfect  repose ;  everything  which  may  tend  to  arouse 
the  excitability  of  the  patient,  such  as  noise,  strong  light,  and  odours, 
must  be  carefully  avoided,  and  the  room  kept  at  a  moderate  tempera- 
ture. After  the  birth,  the  female  should  be  allowed  to  enjoy  that 
slumber,  which  in  natural  cases  generally  follows,  without  interrup- 
tion ;  but  it  is  commendable  to  feel  the  pulse  from  time  to  time,  to 
ascertain  if  a  healthy  action  is  going  on.  Sometimes  this  desirable 
state  of  rest  is  kept  off  by  great  nervous  excitement  on  the  part  of 
the  female,  with  incessant  tossing  in  bed  and  restlessness.  A  few 
globules  of  Coffea  cruda  will  often  suffice  to  dissipate  these  symp- 
toms, and  procure  a  refreshing  slumber ;  should  it  be  insufficient  and 
any  febrile  symptoms  be  present,  Aconite  will  generally  produce 
the  desired  effect.  When  these  remedies,  which  answer  in  the  ma- 
jority of  cases,  fail  of  their  accustomed  success,  we  must  endeavour 
to  trace  the  cause  of  the  derangement,  and  shall  generally  discover 
symptoms,  pointing  out  a  different  remedy,  which,  if  judiciously 
chosen,  will,  with  almost  absolute  certainty,  afford  a  satisfactory  result. 
(See  the  article  Sleeplessness,  Part  I.) 

Here  again  we  must  severely  reprobate  the  practice  of  administer- 
ing stimulating,  and  even  spirituous,  beverages  to  females  after  delivery, 
which,  far  from  possessing  a  strengthening  property,  tend  only  to  excite 
and  irritate  the  whole  nervous  system.  For  some  time  after  parturi- 
tion, Nature  calls  for  but  little  nourishment ;  it  should  be  given  only 
when  the  female  herself  expressly  feels  the  want  of  it,  and  then  be  of 
the  lightest  and  most  digestible  kind,  and  in  very  small  quantities. 
It  is  highly  reprehensible  to  endeavour  to  induce  a  female  to  partake 
of  food,  under  the  absurd  idea  of  strengthening  her.  We  must  allow 
Nature  to  pursue  her  own  course,  which  prescribes  but  little  nourish- 


AFTER-PAINS.  693 

ment  for  the  first  five  or  six  days  after  delivery,  and  thereby  avoids 
the  necessity  of  calling  the  bowels  into  action,  which  state  of  Consti- 
pation (if  it  may  be  so  called),  is  ordained  for  the  wisest  purposes,  and 
attended  with  the  most  beneficial  results ;  while  the  temporary  in- 
activity of  the  alimentary  canal  is  compensated  by  the  vicarious  action 
of  the  skin  (demonstrating  itself  by  increased  perspiration),  and  the 
balance  of  the  system  thus  kept  up.  We  cannot,  therefore,  suffi- 
ciently condemn  the  use  of  aperients,  which  only  tend  to  promote 
irritation,  and  bring  on  puerperal  fever,  and  other  evil  consequences ; 
in  many  cases,  also,  this  artificial  relaxation  interferes  with  the  proper 
secretion  of  milk.  After  the  fourth  or  sixth  day,  Nature  generally 
acts  spontaneously,  and  when  it  appears  necessary  to  afford  mecha- 
nical assistance,  we  may  do  so  by  the  application  of  warm  friction  to 
the  abdomen,  or  the  employment  of  a  simple  lavement,  consisting  of 
tepid  water,  with  a  little  linseed  oil  or  thin  gruel.  When  this  state, 
which  seldom  happens,  continues  so  long  as  to  cause  inconvenience, 
Bryonia,  or  Nux  vomica,  Pulsatilla,  and  Opium,  may  be  resorted  to. 
(See  article  Constipation.) 


AFTER-PAINS. 

These  pains  are  considered  salutary,  and  perhaps  justly  so  to  some 
extent ;  at  the  same  time,  when  they  occur  in  an  aggravated  form^ 
and  are  unduly  protracted,  as  frequently  occurs  in  females  of  exalted 
nervous  sensibility,  they  tend  to  deprive  the  patient  of  her  rest, 
and  ought,  under  such  circumstances,  to  be  subdued  as  speedily  as 
possible ;  their  early  mitigation,  in  all  cases,  by  means  of  homoeopathic 
remedies,  is,  moreover,  always  attended  with  the  most  satisfactory 
results. 

In  many  instances  the  employment  of  Arnica  internally,  and  like- 
wise externally  as  a  lotion,  (a  few  drops  of  the  tincture  to  an  ounce 
or  so  of  tepid  water,)  when  the  labour  has  been  somewhat  severe,  is 
sufficient  to  prevent  the  excessive  development  of  these  pains,  as  also 
in  most  cases  to  ward  off  fever  and  inflammation.*     But  when  the 

*  The  soothing  effects  of  Arnica  are  properly  appreciated  by  those  females  who  have  had 
opportunity  and  occasion  for  its  employment ;  and  we  believe  there  are  few  who,  having 
once  experienced  the  beneficial  effects  of  the  homoeopathic  treatment  generally,  during  the 
entire  period  of  confinement,  would  willingly  return  to  the  old  method  of  treatment. 


694  TREATMENT  AFTER  DELIVERY. 

pain  still  continues,  and  the  patient  is  highly  excitable  and  sensitive, 
we  should  give  Chamomilla,  followed  in  about  an  hour  by  Nux  v., 
if  no  change  is  effected  by  it.  If  the  pain  is  of  an  insupportably 
intense  description,  or  followed  by  convulsions,  coldness,  and  rigidity 
of  body,  Coffea  cruda  ought  to  be  selected.  We  may  give 
Pulsatilla,  when  the  convulsions  do  not  supervene,  but  the  pains 
are  protracted,  and  the  patient  is  of  a  mild  and  gentle  disposition, 
but  sensitive  and  easily  alarmed  about  herself.  Again,  when  the 
after-pains  are  very  severe,  and  there  is  a  continual  inclination  to  re- 
lieve the  bowels  when  in  a  recumbent  posture,  but  passing  away  when 
rising,  followed  by  spasmodic  pains  in  the  lower  parts  of  the  abdomen, 
they  are  usually  readily  relieved  by  Nux  vomica. 

Secale  cornutum  and  Cuprum  metallicum  have  been 
strongly  recommended  in  preference  to  any  of  the  foregoing  remedies, 
in  severe  and  protracted  after-pains  occurring  in  females  who  have 
already  borne  many  children. 

With  regard  to  the  dose,  we  may  dissolve  a  few  globules  in  a  wine- 
glassful  of  water,  and  give  a  teaspoonful  every  hour,  or  only  every 
three  or  four  hours,  according  to  circumstances  ;  carefully  watching 
the  effect  produced,  and  discontinuing  the  medicine  as  soon  as  relief 
is  afforded ;  in  many  cases  a  single  dose  will  suffice.  When,  on  the 
other  hand,  no  improvement  follows  after  a  dose  or  two  of  the  same 
remedy,  another  must  be  selected. 

In  the  event  of  flooding,  the  following  remedies  must  be  had  recourse 
to :  Ipecacuanha — or  Crocus,  Flatina,  or  Sabina ;  also  Belladonna,  Cha- 
momilla, or  Cinchona,  in  particular  cases,  according  to  the  symptoms. 
(For  indications  see  Miscarriage.) 


duration  of  confinement. 

Even  a  strong  and  healthy  female,  during  the  first  five  days,  should 
remain  in  bed;  in  the  four  following,  if  she  feel  herself  perfectly 
strong,  and  desirous  to  rise,  she  may  gradually  accustom  herself  to 
longer  periods  of  sitting  up ;  the  great  risk  is  from  the  extreme  sus- 
ceptibility of  the  system  to  cold.  After  this  period  a  female  who  still 
finds  herself  weak  and  languid,  should  prefer  the  horizontal  to  the 
half-recumbent  posture ;  and  if  this  prove  wearisome  she  may  sit  up 
for  an  hour  or  two,  but  not  so  as  to  fatigue  herself.     The  diet  should 


DURATION  OF  CONFINEMENT,  695 

be  regulated  according  to  the  habit  of  body  and  the  state  of  the  di- 
gestive functions ;  in  all  cases  it  should  be  light,  and,  at  first,  ex- 
tremely light,  and  not  of  a  very  nutritious  quality ;  the  patient  ought 
only  gradually  to  partake  of  food  of  a  more  nourishing  nature,  never 
having  recourse  to  anything  in  the  least  degree  stimulating,  and  all 
strong  odours,  from  flowers  or  other  aromatic  substances,  must  be 
carefully  avoided,  the  mind  being  also  kept  in  as  perfect  a  state  of 
tranquillity  as  possible^  and  the  room  dark. 


DISEASES  FOLLOWING  PARTURITION. 


SUPPRESSED  SECRETION  OF  MILK. 

It  is  of  paramount  importance  that  the  normal  operations  of  the 
organism  peculiar  to  this  state,  proceed  with  due  regularity.  Among 
these  the  secretion  of  milk  takes  a  prominent  position,  and  its  sudden 
suppression  is  apt  to  be  followed  by  internal  and  local  inflammation, 
determination  of  blood  to  the  head,  and  the  usual  array  of  symptoms, 
which  form  the  disease,  commonly  denominated  puerperal  fever, 
wThich,  however,  also  results  from  internal  injuries,  consequent  upon 
difficult  or  protracted  labour ;  but  if  the  precaution  of  administering 
Arnica,  already  enjoined,  has  been  taken,  that  source  of  danger  will 
almost  always  have  been  effectually  guarded  against. 

When,  however,  puerperal  fever  arises  or  threatens  to  set  in,  from  a 
sudden  suppression  of  the  lacteal  secretion,  the  immediate  administra- 
tion of  Pulsatilla,  three  globules  in  a  teaspoonful  of  water, 
repeated  in  six,  twelve,  or  twenty-four  hours,  according  to  necessity, 
will  frequently  be  found  sufficient  to  check  it  at  the  outset,  restore 
the  flow  of  milk,  and  re-establish  the  equilibrium  of  the  organism ; 
if  any  unpleasant  symptoms  still  remain,  they  will,  in  most  cases, 
yield  to  the  administration  of  Calcarea,  followed  by  Zincum,  if  it 
appear  called  for.  In  other  cases,  particularly  where  serious  metas- 
tases result,  Belladonna,  Bryonia,  Rhus,  or  Sulphur  may  be  required. 

If  the  suppression  of  the  secretion  arise  from  any  sudden  mental 
emotion,  we  may  select  one  of  the  remedies  mentioned  in  that  article, 
which  see — giving  perhaps  a  preference  to  Bryonia,  CJiamomilla,  Pul- 
satilla, or  Coffea. 

Should  active  feverish  symptoms,  such  as  hot,  dry  skin,  &c.  set  in, 
Aconite  should  be  given  at  short  intervals,  until  a  favorable  impres- 


EXCESSIVE  SECRETION  OF  MILK.  697 

sion  is  made : — when  there  is  excessive  restlessness  along  with  the 
above,  considerable  advantage  will  accrue  from  the  alternate  use  of 
Aconitum  and  Coffea. 

We  may  here  refer  back  to  our  remarks  upon  the  evil  effects  of 
aperients,  which,  by  their  action  upon  the  intestines,  frequently  cause 
a  suppression  of  the  lacteal  fluid,  and  the  consequent  fever. 


EXCESSIVE  SECRETION  OF  MILK. 


Sometimes,  on  the  other  hand,  it  happens  that  too  abundant  a  secre- 
tion takes  place,  causing  distension  of  the  breasts,  and  involuntary 
emission  of  milk,  and  productive  of  extreme  emaciation,  and  some- 
times development  of  phthisis.  Calcarea  will  be  found  useful  in 
this  affection  ;  or,  should  it  fail  to  relieve,  Phosphorus. 

When  febrile  symptoms  arise  from  distension  of  the  breasts, 
induced  by  an  excessive  secretion,  and  indications  of  what  is  gene- 
rally denominated  milk-fever,  (which,  however,  frequently  arises  from 
other  causes,)  we  may  have  recourse  to  Rhus  toxicodendron. 

Aconite  may  be  exhibited,  as  a  precautionary  measure,  when 
there  is  high  febrile  action  of  the  whole  system,  and  we  are  ignorant 
of  the  exciting  cause.  The  dose  to  be  repeated  every  six  hours,  or 
oftener,  if  necessary,  until  the  rapidity  of  the  circulation  is  dimin- 
ished, and  the  skin  rendered  moist. 


PERSPIRATION  AFTER  DELIVERY,  SUPPRESSION  OR  EXCESS  OF- 


The  increased  perspiration,  which  takes  place  after  childbirth  is, 
as  we  have  before  observed,  a  substitute  for  the  suspended  action  of 
the  alimentary  canal ;  consequently  its  sudden  suppression  is  unavoid- 
ably followed  by  an  injurious  result,  and,  not  unfrequently,  puerperal 
fever. 

Exposure  to  cold,  or  a  sudden  chill,  is  the  most  frequent  cause  of 
this  affection ;  wre  consequently  find  that  the  immediate  administra- 
tion of  Dulcamara,  will  often  suffice  to  restore  the  action  of  the 


698  DISEASES  FOLLOWING  PARTURITION. 

skin,  and  prevent  further  injurious  consequences.  Should  it  fail, 
Nux  vomica  will  frequently  be  found  efficacious,  or  Chamomilla  : 
this  latter  remedy  particularly,  when  there  is  excessive  restlessness 
and  excitability,  with  colic  and  relaxation  of  the  bowels.  When 
severe  one-sided  headache  arises,  combined  or  not  with  distressing 
pain  in  the  neck,  Belladonna  may  be  prescribed.  In  other  cases, 
Bryonia  or  Sulphur  may  be  called  for. 

On  the  other  hand,  an  excessive  perspiration  is  almost  equally  pre- 
judicial ;  it  is  generally  brought  about  by  keeping  the  room  of  the 
female  at  too  high  a  temperature,  the  use  of  too  great  a  quantity  of 
bedclothes,  or  stimulating  beverages ;  it  is  chiefly  injurious  from  the 
extreme  debility  and  high  susceptibility  of  taking  cold,  which  it 
occasions.  Our  first  care  must  be  a  removal  of  the  exciting  causes  ; 
and  should  the  malady  still  continue,  we  may  administer  Sambucus 
niger,  which  will  generally  be  found  effectual  in  its  removal.  In 
other  cases,  China,  Cocc,  Sulph.,  Calc,  or  Acid,  sulph.  The  latter 
especially  when  the  sweating  is  most  profuse  when  lying  still,  and 
diminished  by  movement. 


MILK  FEVER. 

The  secretion  of  milk  must  be  looked  upon  rather  as  an  operation 
of  Nature,  than  one  requiring  medical  aid  for  its  regulation.  Never- 
theless, many  females  suffer  some  slight  uneasiness  for  a  few  days 
following  confinement,  during  the  first  period  of  that  process ;  but 
when  any  of  the  undermentioned  group  of  symptoms  present  them- 
selves, the  affection  is  known  by  the  name  of  milk-fever : — 

Thirst,  shivering,  and  heat,  terminating  in  perspiration ;  the  pulse, 
at  first  weak,  changing  to  various  phases,  sometimes  quick  and 
frequent,  at  others  soft  and  regular ;  in  some  instances,  these  symp- 
toms are  attended  with  a  drawing  pain  in  the  back,  extending  to  the 
breast,  a  disagreeable  taste  in  the  mouth,  thirst,  oppressed  breathing, 
anxiety,  headache,  and  diminution  or  suppression  of  the  secretion  of 
milk,  etc.;  the  exacerbation  declares  itself  regularly  about  evening, 
and  towards  morning  perspiration  comes  on,  with  alleviation  of 
suffering,  or  temporary  termination  of  the  attack,  which  not  unfre- 
quently  recurs  on  the  following  day,  but  rarely  rises  to  such  a  height 
as  to  threaten  danger ;  Nature  herself,  if  not  disturbed  by  improper 


MILK  FEVER.       LOCHIAL  DISCHARGE.  699 

treatment,  will,  in  most  cases,  suffice  to  restore  the  equilibrium  of  the 
system.  When  the  secretion  is  re-established,  and  the  lochial  dis- 
charge resumes  its  normal  course,  the  derangement  generally  ceas*es  ; 
should,  however,  the  affection  become  aggravated,  we  may  dread  the 
setting  in  of  puerperal  fever. 

When  the  symptoms  are  as  above  described,  and  medical  assist- 
ance is  required  for  their  alleviation,  we  must,  if  possible,  in  the  first 
place,  endeavour  to  discover  the  exciting  cause  ;*  when  the  affection 
is  traceable  to  mental  emotions,  we  may  consult  that  article  for 
the  remedy. 

Aconite  may  be  employed  in  all  instances,  where  considerable 
fever  is  present,  or  administered  alternately  every  six  hours,  with 
Coffea,  when  there  is  extreme  restlessness,  anxiety,  and  dread. 

Bryonia  may  with  great  advantage  follow  Aconite,  when  the  active 
febrile  symptoms  are  in  a  great  measure  subdued;  and  is  further 
particularly  indicated,  when  there  are  oppressed  and  laborious  breath- 
ing, intense  headache,  and  obstinate  constipation. 

Pulsatilla  will  be  found  particularly  useful  in  severe  cases, 
especially  when  caused  by  taking  cold,  and  bearing  a  closer  approxi- 
mation to  a  rheumatie  affection  than  to  the  general  symptoms  of 
milk  fever;  this  medicament  is  very  efficacious  in  restoring  the  lacteal 
secretion,  and  may  be  regarded  as  a  prophylactic  against  puerperal 
fever,  especially  when  the  precautionary  measure  of  the  administra- 
tion of  Arnica  has  been  neglected. 

Belladonna  is  very  useful  in  particular  cases :  a  reference  to 
Inflammation  of  the  Breasts,  and  other  parts  of  the  work 
where  that  medicament  is  mentioned,  will  serve  to  point  out  in  what 
instances  it  is  most  likely  to  prove  efficacious. 

Rhus  is  also  of  considerable  service  in  some  cases  of  milk  fever. 
(See  the  indications  given  for  this  remedy  under  the  heading  of 
Excessive  Secretion  of  Milk.) 


IRREGULARITIES  OF  THE  LOCHIAL  DISCHARGE. 

This  discharge  varies  considerably  in  different  females ;  with  some 
it  continues  for  several  weeks,  in  others  only  a  few  days ;  sometimes 

*  Neglecting  to  put  the  infant  sufficiently  early  to  the  breast,  with  consequent  absorption 
of  the  milk  into  the  circulation,  is  a  frequent  source  of  the  derangement. 


700  DISEASES  FOLLOWING  PARTURITION. 

it  is  thin  and  scanty,  at  others  so  profuse  and  long  continued,  as 
imperatively  to  call  for  medical  assistance,  which  may  be  frequently 
traced  to  sitting  up  too  soon  after  confinement,  to  errors  in  regimen, 
keeping  the  chamber  of  the  female  at  too  high  a  temperature,  or 
mental  emotions.  If,  after  nine  days,  the  discharge  continues  pro- 
fuse, containing  pure  blood,  whereby  an  abnormal  state  is  indicated, 
Crocus,  Bryonia,  and  Calcarea  are  the  principal  remedies. 

Crocus  : — In  most  cases  where  the  discharge  is  of  too  long  dura- 
tion, and  particularly  when  the  blood  is  of  a  black  or  dark  colour, 
and  viscid  consistency. 

Bryonia  : — When  of  a  deep  red,  with  internal  burning  pains  in 
the  region  of  the  uterus. 

Calcarea  is  more  particularly  indicated,  when  there  is  an  itching 
kind  of  sensation  in  the  uterus. 

When  the  lochia  are  suddenly  suppressed,  which  they  sometimes 
are,  from  a  variety  of  external  causes,  such  as  mental  emotions,  &c. 
and  from  this  source  puerperal  fever  threatens,  the  danger  may  fre- 
quently be  warded  off  by  the  employment  of  Pulsatilla. 

When  the  sudden  suppression  arises  from  fright,  and  is  attended 
with  febrile  symptoms,  Aconite  will  generally  be  found  sufficient, 
or  Opium,  when  the  indications  given  under  Mental  Emotions 
are  present.  (See  also  the  other  remedies  mentioned  under  that 
heading.) 

When  the  suppression  is  caused  by  exposure  to  cold  or  damp, 
Dulcamara  will  be  found  efficacious,  and  may  be  advantageously 
followed  by  Pulsatilla. 

On  the  other  hand,  wThen  the  discharge  continues,  but  becomes 
sanious,  fetid,  and  offensive,  Belladonna  will  generally  suffice  to 
restore  it  to  its  normal  state ;  if  this  remedy  prove  inefficient,  we 
may  administer  Carbo  animalis  in  the  same  manner;  and,  if  the 
occasion  still  seem  to  require  it,  Sec  ale  cornutum,  until  benefit 
results. 

Silicea,  when  pure  blood  is  discharged  with  the  lochia,  each  time 
that  the  infant  is  applied  to  the  breast. 

The  following  remedies  may  also  prove  useful :  Nux  v.,  Hyoscyamus, 
Zincum,  Colocynth,  Veratrum,  and  Secale  cornutum,  chiefly  in  the  event 
of  a  suppression ;  and  Platina,  Secale  cornutum,  Hepar  s.,  Rhus,  against 
too  copious  or  protracted  lochia. 


ABDOMINAL  DEFORMITY.  701 


DIARRHCEA  IN  LYING-IN  WOMEN. 


Diarrhoea,  during  this  period,  is  a  state  to  be  looked  upon  as 
highly  injurious,  and  immediate  means  should  be  taken  for  its 
suppression,  by  the  administration  of  Dulcamara,  Hyoscyamus,  Rheum, 
Antimonium  cmdum,  Phosphorus,  and  Acidum  phosphoricum,  &c. 

The  first  remedy  is  generally  indicated  by  the  cause  being  a  check 
of  the  naturally  increased  perspiration  in  lying-in  women,  from  a 
chill:  and,  when  timely  administered,  it  will  generally  be  found 
sufficient  to  answer  the  purpose  required. 

In  painless  and  almost  involuntary  evacuations,  Hyoscyamus  is 
most  effectual. 

Rheum  and  Antimonium  crudum,  in  watery  or  very  offensive 
evacuations ;  the  former  when  they  emit  a  sour  smell. 

In  very  obstinate  cases,  when  the  discharge  is  watery,  almost  in- 
voluntary, and  painless,  Phosphorus  followed,  if  necessary,  by 
Acidum  phosphoricum.  (Vide  also  Diarrhoea,  in  the  First 
Part  of  this  work,  and  administer  or  repeat  the  remedies  as  there 
directed.) 


ABDOMINAL  DEFORMITY. 


Although,  in  natural  cases  and  healthy  constitutions,  no  abnormal 
derangement  should  follow  parturition,  still  we  frequently  find  that 
a  number  of  unpleasant  symptoms,  generally  arising  from  maltreat- 
ment, supervene.  Among  these  we  may  mention  the  thickening  of 
the  abdominal  coats,  occasionally  ending  in  a  permanent  malforma- 
tion and  pendulous  appearance.  Abdominal  deformity  is  more  com- 
monly incident  to  females  who  have  borne  many  children,  or  who 
present  a  predisposition  to  corpulency ;  and  is  found  especially 
difficult  of  treatment,  when  tight  stays  which  we  have  already  re- 
marked upon  as  one  of  the  principal  exciting  causes,  have  relaxed 
the  abdominal  muscles,  and  by  so  doing,  increased  the  existing  bias 


702  DISEASES  FOLLOWING  PARTURITION. 

to  the  affection.  When,  however,  it  is  caused  by  the  natural  strain 
upon  these  muscles  during  pregnancy,  the  inconvenience  may  be 
considerably  alleviated  by  the  internal  and  external  use  of  Rhus 

TOXICODENDRON. 

The  internal  administration  of  Sepia  is  recommended  by  Dr. 
Gross*  as  still  more  effectual ;  he,  at  the  same  time,  advises  the 
adoption  of  an  elastic  bandage,  laced  at  the  back,  and  exerting  an 
equable  pressure  over  the  whole  of  the  abdominal  region.  In  some 
cases  where  there  is  a  tendency  to  this  affection,  particularly  in  cor- 
pulent habits,f  we  may,  soon  after  delivery,  have  recourse  to  mechanical 
aid,  by  transferring  the  weight  from  the  abdominal  muscles  to  the 
shoulders,  by  the  aid  of  a  properly  constructed  apparatus ;  but  we 
must,  in  the  strongest  manner,  object  to  this  or  any  other  pressure 
being  exercised  upon  the  abdominal  region  during  pregnancy,  as  such 
a  measure  is  obviously  calculated  to  entail  malformation,  as,  for 
instance,  club-feet,  &c,  upon  the  offspring. 


FALLING  OFF  OF  THE  HAIR. 

Another  evil  that  some  females,  particularly  those  who  nurse  their 
infants  themselves,  suffer  after  confinement,  is  a  falling  off  of  the 
hair. 

This  frequently  arises  from  an  innate  delicacy  of  constitution 
against  which  the  following  medicaments  have  proved  efficacious, 
and  may  be  repeated  every  eight  days. 

Tinctura  sulphuris  six  globules,  Natrum  muriaticum  six 
globules,  Carbo  vegetabilis  six  globules,  Sepia  six  globules* 
Lycopodium  six  globules,  and  Calcarea  six  globules.  The  last, 
particularly  in  those  cases  in  which  the  lochial  discharge  has  proved 
very  profuse,  or  in  which  the  catamenia  are  generally  too  abundant. 

*  Das  Verhalten  der  Mutter  und  des  Sauglings,  p.  95. 

f  Against  Polysarcia  (occurring  in  either  sex),  Calcarea  is  one  of  the  most  useful  reme- 
dies, especially  in  lymphatic  persons.  In  other  cases,  Sulphur,  Arsenicum,  Baryta,  Anti- 
monium  are  very  useful.  When  the  abnormal  secretion  of  fat  takes  place  exclusively,  or 
chiefly,  in  the  abdomen  (omentum),  and  forms  the  pot-  or  Falstaff -belly,  Colocynth  has 
been  recommended  as  a  medicine  of  considerable  utility.  One  or  more  of  the  remedies 
mentioned  as  applicable  to  general  corpulency  may,  however,  be  called  for  after  the  previous 
employment  of  Colocynth.  Spare  diet  and  regular  exercise  must,  in  both  varieties  of  corpu- 
lency, be  inculcated. 


LEUCORRHCEA.       PROLAPSUS.  703 

China,  followed  by  Ferrum,  is  useful  in  debilitated  females  particularly 
if  there  has  been  flooding  after  labour.  Mercurius  is  serviceable 
when  there  is  excessive  perspiration  at  the  head.  In  females  who 
have  suffered  much  from  hysterical  affections,  Hepar  is  often  of  con- 
siderable efficacy.  If  the  hair  falls  off  after  metritis  or  other  inflam- 
matory attacks.  Hep.,  Lye.,  and  SiL, — Sulph.,  Calc.,  Ac.  phosph.,  Natr.  m., 
or  Carlo  v.  may  be  employed  with  advantage. 

With  regard  to  the  other  medicines  we  would,  in  most  instances, 
recommend  a  commencement  with  Tinctura  sulphuris. 


LEUCORRHGEA  AFTER  PARTURITION. 

A  third  evil  is  Leucorrhcea,  which,  although  at  the  commencement 
merely  a  consequence  of  the  relaxation  of  the  internal  uterine  economy, 
after  the  completion  of  the  lochial  discharge,  and  at  first  of  an  innocu- 
ous character,  frequently  proves  exceedingly  troublesome,  and  finally 
puts  on  a  morbid  appearance, becoming  acrid,  and  productive  of  excoria- 
tion. We  generally  find  a  predisposition  to  the  disease  in  scrofulous, 
torpid,  and  leuco-phlegmatic  temperaments ;  in  some  families  this 
malady  is  hereditary,  and  only  to  be  removed  by  a  careful  course  of 
anti-dyscratic  treatment.  It  is  frequently  of  a  very  obstinate  cha- 
racter, requiring  the  exercise  of  considerable  study  and  attention  on 
the  part  of  the  medical  attendant,  on  the  one  hand,  with  much 
patience  and  strict  attention  to  dietetic  rules  on  that  of  the  patient, 
on  the  other,  ere  a  successful  result  can  be  attained. 

The  remedies  which  have  been  found  the  most  efficacious  against 
the  affection,  either  occurring  after  parturition,  or  at  other  times, 
are  Pulsatilla,  Sulphur,  Sepia,  Bovista,  Calcarea,  Lycqpodium,  and  Carlo  v., 
Causticum,  Conium,  Mezereon,  Natrum,  Magnesia  c.  et  m.,  Ammonium  c, 
Cannabis,  Iodium,  Petroleum,  Stannum,  &c. 


INTERNAL,  OR  UTERINE  SWELLING  AND  PROLAPSUS. 

A  swelling  of  the  interior  economy  is  frequently  the  result  of  a 
difficult  labour,  and  in  some  cases  of  mismanaged  parturition:  we 
sometimes  find  it  complicated  with  uterine  or  vaginal  prolapsus ; 


704  DISEASES  FOLLOWING  PARTURITION. 

if  the  precaution  of  exhibiting  Arnica,  which  we  have  before 
noted  (page  690),  have  been  taken,  this  will  frequently  be  pre- 
vented; but  should  symptoms  of  prolapsus  set  in,  attended  with 
a  painful  burning  sensation,  and  bearing  down,  a  dose  or  two  of 
Nux  vomica  will  generally  remove  the  evil.  Sepia,  Belladonna, 
Aurum,  Mercurius,  Lycopodium,  Stannum,  Cannabis,  China,  Platina,  and 
Calcarea,  &c,  have  been  employed  with  material  benefit  in  cases  of 
this  description  of  long  standing,  as  also  in  other  uterine  affections, 
such  as  Metritis,  Retroversio  uteri,  &c. 


INFLAMMATION  OF  THE  WOMB. 

Inflammatio  uteri.     Metritis. 

Diagnosis.  Continuous,  burning,  pricking,  or  shooting  pain,  in 
the  hypogastric  region,  sometimes  of  a  very  acute  description,  accom- 
panied by  a  sensation  of  weight.  At  the  commencement  of  the 
attack,  the  pain  occupies  only  a  small  extent  of  surface,  but  it  soon 
afterwards  extends  to  the  perineum,  rectum,  and  even  the  entire  ab- 
domen. On  examination,  the  vagina  and  os  uteri  generally  feel  hot, 
and  are  tender  to  the  touch.  The  abdomen  becomes  subsequently 
tumefied,  sensible  to  the  touch,  and  considerably  increased  in  tem- 
perature. The  utero-vaginal  secretions  are  suppressed,  sometimes 
also  the  evacuation  of  faeces  and  urine ;  and,  in  lying-in  women,  the 
secretion  of  milk  is  likewise  arrested.  These  form,  in  general,  the 
more  constant  symptoms  of  uterine  inflammation  ;  but  as  the  entire 
womb  is  very  rarely  affected,  the  symptoms  are  liable  to  vary  some- 
what according  to  the  precise  seat  of  the  inflammation. 

Causes.  Severe,  unnatural  labours,  maltreatment,  such  as  harsh 
manual  interference,  the  administration  of  powerful  stimulants,  &c, 
during  protracted  labours,  or  labours  with  deficient  contraction,  re- 
tention of  the  placenta,  coagula,  mental  emotions,  &c,  are  the  most 
frequent  exciting  causes  of  the  disease ;  but  it  is  likewise  prone  to 
occur,  though,  for  the  most  part,  in  a  less  active  form  in  married 
women  who  have  never  borne  children,  or  during  the  period  of  utero- 
gestation,  in  consequence  of  cold  in  the  feet  or  abdomen,  inflammation 


INFLAMMATION  OF  THE  WOMB.  705 

in  neighbouring  organs,  external  injury,  &c.      Organic  defects  and 
menstrual  ataxia  are  frequent  predisposing  causes. 

Therapeutics.  The  remedies  which  have  hitherto  been  chiefly 
employed  in  homoeopathic  practice  against  metritis  are :  Aconitum, 
Belladonna,  Arnica,  Nux,  Mercurius,  Ckamomilla,  and  Cqffea. 

When  the  accompanying  fever  partakes  of  a  synochal  type,  a  few 
doses  of  Aconitum  are  requisite,  particularly  at  the  commencement  of 
the  treatment.  As  soon  as  the  violence  of  the  fever  has  been  miti- 
gated some  other  remedy  must  be  prescribed,  according  to  the  ex- 
citing cause  of  the  attack,  when  known,  and  the  characters  of  the 
symptoms.  Belladonna  will  thus  claim  a  preference  in  cases  which 
have  resulted  from  adherence  to  the  placenta ;  or  if  the  inflammation 
has  taken  place  after  confinement,  without  any  assignable  cause,  and 
is  attended  with  the  following  symptoms :  suppression  of  the  lochia ; 
distressing  sensation  of  weight,  dragging,  or  bearing  down  in  the 
hypogastric  region ;  burning,  shooting  pains  in  the  lower  part  of  the 
abdomen ;  shooting  pains  in  the  hip-joint ;  severe  pain  in  the  back,  as 
if  it  would  break ;  tenderness  of  the  abdomen  to  the  touch.  When 
metritis  has  arisen  in  consequence  of  severe  and  protracted  labour,  with 
laceration  of  the  parts,  Arnica  should  first  be  prescribed,  or  it  should 
be  given  in  alternation  with  Aconitum,  or  with  any  other  remedy  which 
may  seem  called  for  by  the  symptoms.  The  early  employment  of  this 
remedy,  both  externally  and  internally,  after  delivery,  is  always 
attended  with  more  or  less  benefit,  and  is  undoubtedly  frequently  the 
means  of  warding  off  mischief  in  cases  of  unnatural  labour. 

Nux  vomica  is  a  most  useful  remedy  in  various  uterine  derange- 
ments. In  this  inflammation  it  may  be  employed  with  advantage 
when  the  pains  in  the  region  of  the  uterus  are  very  severe,  partaking 
chiefly  of  a  shooting  or  cutting  description ;  and  are  accompanied  by 
ischuria  or  dysuria,  constipation  or  costiveness,  and  tenesmus ;  when 
a  feeling  of  soreness  or  pain,  as  from  a  bruise,  is  constantly  expe- 
rienced in  the  epigastrium ;  when  there  is  severe  aching  in  the  lumbo- 
sacral region ;  and  when  all  the  symptoms  become  exacerbated  towards 
morning. 

Mercurius  is  useful  when  frequent  fits  of  perspiration  or  shivering 
take  place,  and  when  shooting,  pressive,  boring,  or  piercing  pains  are 
complained  of  in  the  region  of  the  uterus. 

Chamomilla,  Ignatia,  Coffea,  or  Bryonia  may  be  of  much  service  in 
some  cases,  particularly  when  mental  emotions  hav%  preceded  the 

45 


706  DISEASES  FOLLOWING  PARTURITION. 

attacks.  (See  the  different  indications  which  call  for  the  one  or  the 
other  of  these  remedies  in  the  article  Mental  Emotions.) 

Cinchona  is  indicated  in  metritis,  by  most  of  the  symptoms  which 
have  been  mentioned  under  Belladonna,  The  latter  is  better  adapted 
to  plethoric  habits^  whereas  the  former  is  more  appropriate  in  feeble 
or  exhausted  constitutions,,  who  have  suffered  from  excessive  hemor- 
rhage, or  other  debilitating  causes. 

'  In  other  cases  recourse  may  be  had  to  Lachesis,  Platina,  Pulsatilla, 
Rhus,  Sec,  Thuja,  &c. 

In  irritable  litems,  so-called,  the. most  important  remedies  are:  Nux  v., 
Plat,,  Bella.,  Stan.,  Cham.,  China,  Ipec. ;  and  also  :  Sepia,  Sulph.,  Calc, 
Coc.,  Con.,  Graph.,  Natr.  m.,  Kali,  Kreos.,  Croc.,  Ac.  muriat.,  Magn.,  &c. 

Against  uterine  spasms:  Cocculus,  Ignatia,  Conium,  Magn.,  Magn., 
m.  j — Bella.,  Cham.,  Nux,  Hyoscy.,  Natr.  m.,  China,  are  the  principal 
homoeopathic  remedial  agents. 

Against  uterine  polypus :  Staphysagria,  Thuja,  Calc,  Ac.  nitr.,  Carl,  v., 
have  been  chiefly  recommended. 

Against  ulcerations  at  the  os  uteri,  &c. :  Carlo  v.,  Graph.,  Sulph., 
Silic,  Sep.,  Ars.,  Merc,  or  Thuja,  may  be  successfully  employed. 

In  indurations  of  the  uterus :  Aurum,  Bellad.,  Sep.,  Staph.,  Tad.,  Ca- 
lendula, have  hitherto  claimed  the  principal  attention. 

And  in  carcinoma :  Bellad.,  Ars.,  Staph.,  Thuja,  Carlo  v.  et  a.,  Clem., 
Con.,  Sil. 


WEAKNESS  AFTER  DELIVERY. 

We  frequently  find  a  high  degree  of  weakness  or  exhaustion  re- 
maining after  delivery ;  when  it  has  been  caused  by  very  considerable 
hemorrhage,  during  or  after  that  period,  Cinchona  is  particularly 
indicated,  and  will  generally  be  found  efficient  in  restoring  the  vital 
energies. 

When,  however,  the  derangement  is  attributable  to  nervous  weak- 
ness, and  is  attended  with  restlessness  and  want  of  sleep,  we  may 
administer  Aconite,  followed,  if  necessary,  by  Coffea,  or  substi- 
tute Veratrum  for  the  latter  medicine,  when  the  prostration  of 
strength  is  excessive. 

In  some  instances  we  must  have  recourse  to  Kali  carbonicum, 
or  to  Sulphur,  Calcarea,  or  Acid,  phosphoricum. 


OBSTACLES  TO  SUCKLING. 


DISINCLINATION  OF  THE  INFANT. 

Where  there  is  a  tendency  to  consumption  in  the  mother,  or  she 
is  of  a  strumous  habit,  the  infant  ought,  for  its  own  sake,  to  be 
reared  with  the  spoon,  or  a  nurse  provided.  But  even  some  healthy 
mothers  find  a  difficulty,  before  they  become  accustomed  to  it,  in 
nursing  their  children,  which,  however^  a  little  perseverance  will 
soon  effectually  overcome ;  but  when  the  child  itself  refuses  to  take 
the  breast,  (a  rare  instance,  if  it  be  applied  soon  after  delivery,)  the 
administration  of  Cina,  followed,  if  not  speedily  efficacious,  by 
Mercurius  solubilis,  is  often  found  to  remove  this  repugnance 
in  the  course  of  a  few  hours.  Silicea  is  also  an  excellent  remedy 
in  some  cases,  particularly  when  the  child  takes  the  breast  readily 
enough,  but  returns  the  milk  almost  immediately  after ;  the  remedy 
selected  ought  to  be  given  to  the  mother  as  well  as  the  child. 


EXCORIATION  OF  THE  NIPPLES. 

In  the  majority  of  those  cases  in  which  no  malformation  of  the 
parts  is  present,  the  main  difficulty  arises  from  the  nipples  having 
become  sore  and  cracked,  which  the  efforts  of  the  infant  tear  open 
afresh,  and  cause  to  bleed. 

This  excoriation  of  the  nipples  is  frequently  prevented  by  following 
up  the  treatment,  of  which  we  have  already  spoken,  under  the  head 
of  Preparation  of  the  Breasts,  of  course  taking  the  precaution 
of  laving  the  nipples  with  a  little  warm  milk  and  water,  before  the 


708 


OBSTACLES  TO  SUCKLING. 


child  is  applied  to  the  breast ;  the  shield  before  mentioned  ought 
always  to  be  worn  during  the  intervals  of  suckling. 

When  there  is  a  tendency,  however  slight,  to  rawmess  or  excoria- 
tion, great  care  must  be  taken  lest  the  shield  adhere  to  the  skin ;  it 
ought  to  be  frequently  removed,  and  together  with  the  nipple,  kept 
perfectly  dry ;  attention  to  these  particulars  will  generally  remove 
this  difficulty.  The  mother  ought,  however,  gradually  to  accustom 
herself  to  nourish  the  infant,  using  a  sucking-glass,  which  should  be 
carefully  washed  every  day.  Should,  however,  the  nipples  have 
already  become  very  sore  and  irritable,  from  the  neglect  of  these 
precautionary  measures,  it  will  be  necessary  to  have  recourse  to 
specific  remedies,  without  which,  if  suckling  be  persisted  in,  sup- 
puration frequently  ensues. 

In  the  first  stage  of  the  affection,  Arnica,  should  be  employed 
internally,  and  the  breast  laved  with  a  weak  lotion,*  say  about 
a  teaspoonful  of  the  Mother  Tincture,  a  few  globules  to  one  ounce 
of  water.  If  this  fail,  we  must  have  recourse  to  anti-dyscratic 
remedies,  as  this  disease  almost  always  arises  from  a  constitutional 
cause,  females  of  healthy  temperament  being  generally  exempt  from 
it.  Among  these  Tinctura  sulphuris  seems  particularly  indi- 
cated for  most  cases  of  this  affection,  and  a  dose  of  one  or  two 
globules  may  be  administered  every  five  or  six  days  until  improve- 
ment sets  in,  wThich  w7ill  generally  be  the  case  in  the  space  of  a  few 
days ;  and  if  this  fail,  Calcarea  administered  in  the  same  manner, 
will  in  most  instances  suffice.  We  may  also  mention  Graphites, 
Sepia,  Lyco  podium,  Merc,  and  Silic,  as  remedies  of  much 
value  in  some  obstinate  cases.  In  the  choice  of  the  fitting  medica- 
ment in  complicated  cases  (as  indeed  in  all  others),  the  physician 
must  be  guided  by  the  aggregate  of  the  symptoms.  (Nux  v.  has 
been  found  of  considerable  service  in  soreness  of  the  nipple,  with 
painful  excoriation  of  the  adjacent  surface. 


inflammation  of  the  breasts. 

Another,  and  one  of  the  greatest  obstacles  to  a  mother  nourishing 
her  infant,  is   an  erysipelatous  inflammation   and   swelling  of  the 

*  This  lotion  may  also  be  applied  with  advantage  in  the  preparation  of  the  breasts r 
when  irritation  or  inflammation  appears  to  arise  from  the  pressure  of  the  shield. 


INFLAMMATION  OF  THE  BREASTS.  709 

breasts,  of  which  anything  tending  to  disturb  the  lacteal  secretion, 
such  as  fright,  passion,  cold,  &c,  serves  for  an  exciting  cause, 
although  we  frequently  find  it  present,  without  being  able  to  trace 
its  origin;  it  not  unfrequently  arises  from  a  too  tardy  application 
of  the  breast  to  the  infant,  or  from  a  sudden  cessation  of  suckling, — 
occasioned  by  the  death  of  the  child,  or  other  reasons, — causing  a 
distension  of  the  lactiferous  tubes.  When  a  sudden  suppression  of 
the  secretion  occurs,  the  breasts  become  red,  inflamed,  and  indurated, 
occasionally  suppurating  in  some  parts,  which  open  and  discharge, 
while  others  remain  still  hard  and  inflammatory,  and  ultimately  either 
ending  in  suppuration,  or  in  the  formation  of  obstinate  nodosities. 

This  disease,  if  not  checked,  as  but  too  frequently  happens  under 
allopathic  treatment,  exhibits  a  variety  of  phases ;  and  the  suppura- 
tion that  takes  place  leaves  behind  it  disfiguring  cicatrices ;  frequently 
the  breasts  are  so  far  destroyed  as  to  be  rendered  ever  after  incapable 
of  performing  their  functions,  and  in  some  instances  the  foundation 
of  cancer  is  laid. 

The  principal  remedy  in  this  affection,  before  the  inflammation 
becomes  fully  developed,  is  Bryonia,  especially  when  the  breasts  are 
hard  and  tumefied,  and  the  secretion  of  milk  is  suppressed.  Bella- 
donna, when  the  inflammation  is  more  intense,  and  the  erysipelatous 
appearance  of  the  skin  clearly  defined;  after  which  remedy,  the 
disease  is  generally  vanquished. 

When,  however,  a  degree  of  induration  still  remains,  Mercurius 
solubilis,  three  globules,  should  be  given,  and  repeated  in  from 
two  to  three  days;  in  more  severe  cases,  Acid um  phosphoricum 
should  be  resorted  to,  or  Hepar  sulphuris,  when  suppuration  has 
already  commenced. 

In  instances  in  which  wTe  find  a  fetid  and  serous  discharge,  wrhich 
is  frequently  brought  about  by  neglect  or  by  improper  treatment, 
such  as  the  application  of  deleterious  unguents,  &c,  Silicea  will 
generally  have  the  effect  to  restore  the  breast  to  its  former  condi- 
tion ;  in  some  extreme  cases,  however,  it  will  be  found  necessary  to 
follow  up  the  treatment  with  Phosphorus,  Calcarea,  or  one  or  more 
of  the  remedies  above  mentioned,  such  as  Mercurius  and  Hepar  sul- 


If  this  disease  has  evidently  arisen  from  the  effect  of  a  sudden  chill, 
Dulcamara  ought  to  be  given  immediately,  and  will  frequently 
obviate  all  injurious  consequences. 

In  cases  where  the  disease  has  arisen  from  external  injury,  Arnica 


710  OBSTACLES  TO  SUCKLING. 

should  be  employed,  and  a  lotion,  one  part  of  the  tincture  to  seven 
of  pure  water,  locally  applied.  When  the  consecutive  inflammation 
is  of  an  intense  description,  Aconitum  is  preferable  to  Arnica.  When 
induration  has  taken  place,  Conium  is  required.  And  when  suppura- 
tion has  ensued,  Phosjohoms  is,  in  general,  the  most  effective  remedy ; 
when  given  sufficiently  early,  it  will  rarely  fail  to  promote  rapid 
absorption  of  the  collected  matter. 

In  strumous  habits,  Tinctura  sulphuris,  Calcarea,  Gra- 
phites, and  Iodium,  will  occasionally  be  found  necessary  to  com- 
plete the  cure  after  Belladonna  has  removed  the  active  inflammatory 
symptoms. 


MENTAL  EMOTIONS  AFFECTING  THE  MILK. 

It  is  a  well-known  fact,  confirmed  by  numerous  examples,  that 
Mental  Emotions  have  a  most  powerful  effect  upon  milk,  in  a  moment 
changing  it  from  a  source  of  nutriment  into  a  substance  most  inju- 
rious to  the  infant.  Mothers  ought  to  bear  this  in  mind,  and  after 
having  suffered  from  fright,  passion,  &c,  should  desist  from  suckling 
until  they  are  perfectly  composed ;  and  ere  the  infant  be  again  applied 
to  the  breast,  a  portion  of  the  milk  should  be  drawn  off.  Fortunately 
for  evils  arising  from  these  causes,  Homoeopathy  presents  prompt  and 
efficacious  remedies,  (for  which  see  Mental  Emotions,)  which,  if 
at  hand,  should  be  administered  immediately,  according  to  the  cause 
and  symptoms. 


DEFICIENCY  IN  THE  SECRETION  OF  MILK.     SUPPRESSED  SECRETION 

OF  MILK. 

Sometimes  a  deficiency  of  milk  is  found  to  arise  from  a  want  of 
energy,  either  functional  or  general.  For  disturbance  of  the  secretion 
arising  from  an  inflammatory  action,  vide  Inflammation  of  the 
Breasts. 

When  the  deficiency  or  suppression  arises  from  the  first  cause, 
the  chief  medicines  useful  in  restoring  a  proper  and  healthy  flow  of 
milk,  are  Pulsatilla  and  Calcarea.      In   simple  cases  Vitex 


MOTHERS  NOT  SUCKLING  THEIR  CHILDREN.  711 

agnus  castus,  and  Pulsatilla  will  frequently  be  found  efficacious ; 
in  others,  but  particularly  where  there  is  simply  a  scanty  secretion 
without  any  apparent  abnormal  state  of  the  system  which  might  give 
rise  to  the  deficiency,  Calcarea  c.  rarely  fails  to  increase  the  secretion.* 
It  is,  however,  more  generally  requisite  for  the  female  to  undergo  a 
complete  course  of  treatment,  if  she  is  anxious  to  persevere  in 
nursing,  in  which  the  two  latter  remedies,  together  with  Aconitum, 
Bryonia,  Chamomilla,  Belladonna,  Sulphur,  Sepia,  lodium,  will  be  found 
of  very  great  value,  where  the  case  is  one  that  is  capable  of  being 
remedied. 


DETERIORATION  AND  DISCOLORATION  OF  MILK. 

If  the  milk  becomes  too  clear  and  watery  (or  otherwise  deteriorated 
in  quality,  or  is  distasteful  to  the  child,)  Cina,  three  globules,  and 
Mercurius  solubiliSj  three  globules,  ought  to  be  administered 
alternately  every  twenty-four  hours,  for  three  or  four  days;  or 
Silicea,  three  globules,  in  obstinate  cases,  (particularly  if  the  infant 
vomits  immediately  after  suckling,)  will  frequently  bring  .about  an 
amelioration. 

Rheum  will  frequently  be  found  of  efficacy,  when  the  milk  becomes 
thick  and  yellow,  and  disagrees  with  the  child,  rendering  it  restless 
and  fretful. 


MOTHERS  NOT  SUCKLING  THEIR  CHILDREN. 

In  the  present  state  of  society  there  are  many  mothers  who,  from 
a  variety  of  circumstances,  find  themselves  necessitated  to  engage 
the  services  of  a  nurse  for  their  offspring ;  in  such  cases,,  a  female, 
who  has  the  slightest  regard  for  her  health,  should  be  particularly 
careful  in  her  diet,  and  until  the  secreting  process  has  completely 
ceased,  she  should  live  as  low  as  possible.  The  employment  of  dry 
cupping  at  the  outer  surface  of  the  arm,  a  little  below  the  shoulder, 
or  at  the  inferior  extremities,  will  materially  hasten  the  suppression 
of  the  lacteal  secretion.     At  the  same   time,  material  aid  will  be 

*  Journ,  de  la  Med.  Horn.,  tome  i,  cap.  1. 


712  OBSTACLES  TO  SUCKLING. 

derived  from  the  internal  administration  of  Pulsatilla  ;  indeed, 
the  employment  of  that  remedy  alone  will  often  be  found  sufficient 
to  stop  the  secretion.  When  suffering  from  inflammation  ensues, 
we  may  have  recourse  to  Phosphorus,  Belladonna,  and  Bryonia, 
for  which  indications  are  given  under  Inflammation  of  the 
Breasts  ;  Calcarea  is  serviceable,  when  the  breasts  are  consider- 
ably distended  with  milk.  These  directions  will  also  serve  as  a  guide 
during  the  period  of  weaning. 


END  OF  PART  II. 


PART  III. 


TREATMENT  OF  INFANTS  AND  CHILDREN. 


PART  III. 


TREATMENT  OF  INFANTS  AND  CHILDREN. 


INTRODUCTORY  REMARKS. 

Homoeopathy  possesses  many  peculiar  advantages  in  the  Treat- 
ment of  the  Diseases  of  Infancy  and  Childhood.  In  the  first  place, 
when  any  constitutional  taint  exists,  this  system,  by  the  selection  of 
specific  remedies,  meets  disease  upon  the  very  threshold  of  life,  and 
destroys  it  in  the  germ  ;  it  substitutes  a  rational  mode  of  treatment 
for  the  nostrums  of  the  nursery,  since  the  application  of  the  reme- 
dies, even  in  the  most  trifling  cases,  requires  a  certain  degree  of 
education,  and  a  careful  study  of  medicinal  action.  There  can, 
indeed,  be  no  doubt  that  many  lives,  which  have  unfortunately  been 
sacrificed  by  the  overweening  self-confidence  and  prejudices  of 
those  intrusted  with  the  life  of  man,  at  the  most  precarious  period  of 
his  existence,  might  have  b,een  preserved,  had  this  system  been  more 
extensively  known  and  acted  upon. 

Again,  the  receptivity  of  the  infant  organism  to  the  influence  of 
homoeopathic  remedies,  is  a  fact  established  by  experience.  Here, 
therefore,  from  the  minuteness,  yet  sufficiency  of  the  dose,  all  risk  is 
obviated  of  producing  hurtful  and  even  fatal  consequences  by  the 
accidental  exhibition  of  one  medicine  in  place  of  another, — an  event 
unfortunately  of  but  too  frequent  occurrence  in  the  old  mode  of 
practice. 

The  tasteless  nature  of  the  medicaments  is  another  point  of  no 


716         TREATMENT  OE  INEANTS  AND  CHILDREN. 

small  importance  in  affections  of  infants  and  children,  and  by  means 
of  which  nausea  and  annoyance  are  completely  avoided. 

In  such  complaints  as  occur  at  all  periods  of  life,  and  which  have 
been  treated  in  the  First  Part  of  this  work,  we  should  be  guided 
in  the  selection  of  the  dose  by  the  age  of  the  patient ;  with  infants 
we  may  use  the  highest  potencies,  and  rarely,  even  in  acute  diseases, 
give  more  than  a  single  globule  ;  children  from  four  to  eight  years  of 
age,  may  take  about  one  fourth  to  one  third  of  the  dose  prescribed 
for  an  adult,  and  above  that  age,  one  half  to  two  thirds.  A  great 
deal,  however,  depends  upon  the  constitution  of  the  patient,  whether 
delicate  or  robust,  and  upon  the  child's  susceptibility  to  medicinal 
influence,  a  point  only  to  be  determined  by  experience ;  in  very  acute 
diseases  we  may  sometimes  be  called  upon  to  administer  as  low  as 
the  sixth  potency,  and  even  lower,  particularly  when  employing  such 
remedies  as  Sambums,  Tartarus  emetims,  &c.  ;  from  the  great  recep- 
tivity, however,  of  the  system  in  early  life,  as  above  remarked,  we 
should  be  particularly  careful  in  repeating  the  medicines. 


TREATMENT  AFTER  BIRTH. 

As  soon  as  the  child  is  born,  it  should  be  wrapped  in  fine  flannel, 
with  a  piece  of  soft  linen  rag  inside,  the  flannel  itself  being  too  rough 
for  its  delicate  skin ;  the  wrapper  should  be  heated  to  a  temperature 
of  98  degrees,  as  it  is  only  gradually  that  the  infant  becomes  inured 
to  the  temperature  of  the  surrounding  atmosphere.  The  skin 
should  be  gently  washed  with  a  little  lukewarm  water  and  bran, 
applied  with  a  sponge,  but  care  must  be  taken  not  to  continue  the 
first  washing  too  long,  for  fear  of  irritation;  soap  must  on  no  account 
be  used ;  the  room  should  be  kept  rather  dark,  and  perfectly  quiet, 
and  all  strongly-scented  substances  removed.  After  washing,  the  body 
ought  to  be  dried  immediately,  to  avoid  the  risk  of  taking  cold  ;  the 
child  should  be  bathed  twice  a  day,  to  keep  up  the  action  of  the  skin? 
the  temperature  of  the  water  being  gradually  lowered,  after  weaning. 

The  best  time  for  bathing  the  infant  is  in  the  morning,  when  it  is 
taken  out  of  bed,  and  again  on  returning  to  it  for  the  night;  im- 
mersing the  whole  body,  with  the  exception  of  the  head,  is  preferable 
to  any  other  mode  of  washing,  as  the  practice  of  placing  it  in  a  tub, 


ASPHYXIA.  717 

with  part  of  the  frame  alternately  laved  with  tepid  water,  and  ex- 
posed to  the  action  of  the  atmosphere,  is  apt  to  bring  on  a  chill. 

Nothing  can  be  more  evidently  opposed  to  Nature  and  the  dictates 
of  common  sense — although,  like  many  other  absurdities,  it  bears 
the  impress  of  custom, — than  the  practice  of  swathing  and  bandaging 
the  tender  bodies  of  infants,  and  loading  them  with  a  superfluity  of 
clothing,  which,  by  its  weight  and  length,  presses  upon  their  lower 
extremities,  and  is  the  frequent  cause  of  deformity  and  weakness  in 
after  life  ;  in  this  opinion  we  are  fully  borne  out  by  the  corroborative 
testimony  of  the  most  eminent  practitioners  of  the  old  school. 


ASPHYXIA. 

The  first  danger  that  the  infant  incurs  on  its  entrance  into  life  is 
Asphyxia. 

Symptoms.  Suspension  of  the  functions  of  vitality,  respiration, 
circulation,  and  motion. 

Causes.  Natural  debility ;  difficult  parturition  ;  injury  from  the 
forceps ;  pressure  of  the  umbilical  cord  round  the  neck ;  tying  the 
navel-string  too  tightly  ;  accumulation  of  mucus  in  the  throat ;  too 
sudden  an  alteration  of  temperature,  the  respiratory  action  of  the 
lungs  not  having  commenced.  The  usual  mechanical  means,  under 
the  direction  of  a  competent  person,  must,  of  course,  be  instantly 
had  recourse  to;  I  shall,  therefore,  content  myself  with  simply 
pointing  out  the  homoeopathic  remedies  most  useful  in  such  cases. 

They  are  Tartarus  emeticus,  Opium,,  Cinchona,  and  Aconitum. 

Tartarus  emeticus. 

Dose.  A  grain  in  eight  ounces  of  water,  a  few  drops  into  the  month 
of  the  child  every  quarter  of  an  hour. 

Opium  : — If  after  half  an  hour  no  change  for  the  better  takes 
place,  and  the  face  is  livid  and  bluish. 

Dose.  A  few  globules  in  a  wine-glassful  of  water,  a  few  drops  into 
the  mouth  of  the  child  every  ten  or  fifteen  minutes,  until  some  effect  is 
produced. 

Cinchona: — If  the  face  be  pale  during  the  affection;  and  also 


718  TREATMENT  OF  INFANTS  AND  CHILDREN. 

when  the  infant  is  reviving  and  respiration  commencing — if  the  same 
indication  present  itself. 

Dose.     Same  as  Opium. 

Aconitum  :  When  the  child  is  reviving  and  beginning  to  breathe, 
if  the  face  has  been  previously  flushed,  or  of  a  bluish  tint. 

Dose.    One  globule   on  the  tongue,  repeated  if  necessary,  after  a 
shorter  or  longer  interval,  according  to  the  effects  produced. 


SWELLING  OF  THE  HEAD. 

Immediately  after  birth,  the  head  of  the  infant  appears  more  or 
less  swollen  ;  this  is  in  most  cases  but  a  trifling  affection,  and  gene- 
rally goes  off  of  itself.  The  administration  of  Arnica,  one  globule, 
will  materially  hasten  its  disappearance ;  should,  however,  the  swell- 
ing be  at  all  excessive,  bathe  the  part  affected  in  a  weak  lotion, 
consisting  of  three  drops  of  the  tincture  of  Arnica  to  a  wine-glassful 
of  water. 

Occasionally  a  considerable  swelling  in  the  larger  mould  (fontanel,) 
consisting  of  fluid  is  observable  ;  this  affection  is  of  greater  import 
than  the  other,  though  seldom  dangerous ;  if  it  does  not  disappear  in 
a  day  or  two,  we  may  administer  Rhus  toxicodendron,  one  glo- 
bule, to  the  infant ;  or  Calcarea  carhonica,  one  globule,  in  six  days,  in 
cases  where  the  fontanel  is  long  in  closing.  In  some  instances 
Silicea  or  Sulphur  is  also  requisite  in  addition,  if  not  in  preference  to 
Calcarea. 


NAVEL  RUPTURE  IN  INFANTS. 

In  cases  where  there  is  an  evident  tendency  to  navel  rupture,  a 
properly  made  bandage*  should  be  applied,  and  will  usually  prove 

*  The  following  is  a  simple,  and  commonly  efficacious  mode  of  applying  a  compress :  take 
a  piece  of  lint,  just  sufficiently  large,  when  folded  five  or"  six  times,  to  cover  the  rupture 


MECONIUM,  EXPULSION  OF.  719 

sufficient  to  effect  a  cure;  but  if  not,  we  must  prescribe  Nux 
vomica  ;  if,  however,  we  discover  no  amelioration  from  the  employ- 
ment of  Nux  vomica,  we  may  have  recourse  to  Veratrum.  Obsti- 
nate cases  are  frequently  found  to  yield  to  the  application  of  the 
North  Pole  of  the  Magnet.*  These  medicines  are  equally  useful 
in  cases  of  inguinal  hernia.  In  scrotal  hernia,  Magn.  m.,  Nux  v.,  and 
Lycopod.  have,  more  especially,  been  recommended.  (See  Hernia, 
Part  L) 

This  disease  being  frequently  brought  on  by  the  violent  fits  of 
crying,  to  which  delicate  children  are  subject,  the  bandage  may  be 
worn,  and  retained  for  some  time  after  the  cure,  as  a  precautionary 
measure  against  its  return.  In  cases  of  soreness  of  the  umbilicus  or 
navel,  remaining  after  the  falling  off  of  the  ligature,  or  even  before, 
we  may  give  Sulphur,  one  globule,  a  single  dose,  and  repeat  in  six 
days.  If,  however,  during  that  time,  no  amelioration  has  been  observ- 
able, we  should  exhibit  Silicea,  one  globule,  which,  if  marked 
benefit  result,  may  be  at  the  same  interval  repeated  with  advantage. 


MECONIUM,  EXPULSION  OF. 

After  having  been  permitted  to  sleep  for  five  or  six  hours  undis- 
turbed, the  infant  should  be  applied  to  the  breast  as  soon  as  the 
mother  feels  herself  sufficiently  recovered  to  permit  it,  which  is  gene- 
rally from  six  to  eight  hours  after  delivery,  and  this  should  never  be 
deferred,  as  we  elsewhere  observed,  longer  than  twelve  hours ;  the 
milk  of  the  mother  exciting  a  mechanical  action  of  the  alimentary 
canal,  and  assisting  in  the  expulsion  of  the  meconium.  Here  again 
we  cannot  too  strongly  reprobate  the  too  general  practice  of  adminis- 
tering laxative  medicines  for  this  purpose,  possessing,  as  they  do,  a 
most  deleterious  effect  upon  the  tender  organism  of  the  infant,  and, 
if  not  productive  of  jaundice — a  too  frequent  consequence  of  their 

effectually ;  then  press  in  the  protrusion,  and  keep  it  reduced  with  the  hand,  until  the  com- 
press is  rightly  adjusted  and  secured  in  its  position  by  means  of  two  strips  of  adhesive 
plaster  (which  have  been  previously  warmed  by  being  held  at  the  fire,  so  as  to  make  them 
adhere)  placed  over  the  compress  in  the  form  of  a  cross.  It  is  still  better,  however,  to  get 
an  efficient  bandage  made  to  measure  by  an  intelligent  and  experienced  maker. 

*  Chamomilla,  Aurum,  and  Sulphur  are  occasionally  found  necessary,  particularly  the  last- 
named,  in  order  to  effect  a  permanent  cure. 


720  TREATMENT  OF  INFANTS  AND  CHILDREN. 

repeated  administration— at  least  laying  the  foundation  of  bowel 
complaints,  debility  of  the  stomach,  and  a  host  of  diseases  in  after- 
life. 

Mothers  need  not  be  under  apprehension,  should  a  temporary 
delay  occur  in  the  passing  of  the  meconium ;  far  greater  evil  results 
from  the  violent  methods  taken  for  its  expulsion,  than  could  possibly 
occur  from  its  continuance  in  the  alimentary  canal  for  a  few  hours 
later  than  ordinary. 

Should,  however,  an  unusually  long  period  elapse,  and  the  child 
appear  costive,  which  in  many  instances  arises  from  the  mother  hav- 
ing indulged  in  the  use  of  ptisans,  such  as  chamomile  tea,  &c.  or 
coffee,  the  administration  of  a  few  teaspoonfuls  of  warm  sugar  and 
water  will  generally  answer  every  purpose ;  if  it  should  fail  to  pro- 
duce immediate  relief,  we  may  then  make  use  of  a  lavement  of  equal 
parts  of  sweet  oil  (or  pure  honey)  and  water ;  and  if  these  simple 
means  do  not  effect  the  desired  object,  and  the  infant  appear  to  suffer 
from  inconvenience,  more  particularly  when  the  origin  of  the  consti- 
pation seems  to  be  from  the  mother  or  nurse,  we  may  administer 
Nux  vomica,  Bryonia,  Tinctura  sulphuris,  one  globule,  or  Opium,  one 
globule,  to  the  female  herself — for  the  indications  of  which  medicines 
see  Constipation. 


SUCKLING  OF  THE  INFANT. 


While  upon  this  subject  we  shall  quote  the  expression  of  a  well- 
known  writer,  in  whose  opinion,  in  this  respect,  we  perfectly  coincide. 

"  Unless  very  peculiar  urgent  reasons  prohibit,  a  mother  should 
support  her  infant  upon  the  milk  she  herself  secretes.  It  is  the 
dictate  of  Nature,  of  common  sense,  and  of  reason.  Were  it  other- 
wise, it  is  not  probable  that  so  abundant  a  supply  of  suitable  food 
would  be  provided  to  meet  the  wants  of  an  infant,  when  it  enters 
upon  a  new  course  of  existence. 

"  It  is  difficult  to  estimate  the  mischief  resulting  from  infants 
being  deprived  of  their  natural  nourishment ;  for,  however  near  the 
resemblance  may  be  between  food  artificially  prepared  and  breast 
milk,  still  reason  and  observation  demonstrate  the  superiority  of  the 
latter  to  the  former."     [Conquests  Outlines  of  Midwifery,  p.  193.) 


SUCKLING  OF  THE  INFANT.  721 


And  again : — 


"As  a  further  inducement  it  should  be  remembered  that  medical 
men  concur  in  their  opinion,  that  very  rarely  does  a  constitution 
suffer  from  secreting  milk ;  whilst  the  health  of  many  women  is  most 
materially  improved  by  the  performance  of  the  duties  of  a  nurse/" 
(Ibid.  p.  194.) 

Upon  this  subject  the  same  author  also  remarks  in  another  place : 

(C  But  few  mothers,  comparatively,  are  to  be  found  who,  if  willing^ 
would  not  be  able  to  support  their  infants,  at  least  for  a  few  months ; 
and  parental  affection  and  occasional  self-denial  would  be  abundantly 
recompensed  by  blooming  and  vigorous  children. 

"  Presuming  that  the  laudable  determination  is  formed  to  indulge 
the  child  with  that  nutriment  which  is  designed  for  its  support,  it 
becomes  necessary  to  state,  that  unless  very  strong  objections  should 
exist,  twelve  hours  should  never  elapse  before  the  infant  has  been  put 
to  the  breast.  Instinct  directs  it  what  to  do,  and  .the  advantages  of 
allowing  it  to  suck  soon  after  birth  are  many  and  important,  both  to 
the  mother  and  child. 

"  By  this  commendable  practice,  the  patient  is  generally  preserved 
from  fever,  from  inflamed  and  broken  breasts,  and  from  the  distress- 
ing and  alarming  consequences  resulting  from  those  complaints. 

66  If  the  breasts  should  not  have  secreted  milk  previous  to  delivery, 
the  act  of  sucking  will  encourage  and  expedite  the  secretion.  Thus 
the  mother  will  be  saved  from  much  of  the  pain  connected  with 
distended  breasts.  Besides  which,  if  the  infant  be  not  put  to  the 
nipple  till  the  breasts  become  full  and  tense,  the  nipple  itself  will 
sometimes  almost  disappear  on  account  of  its  being  stretched ;  and 
without  much,  and  often  ineffectual,  labour  on  the  part  of  the  child 
it  cannot  be  laid  hold  of,  and  even  then  the  pain  endured  by  the 
mother  is  exquisitely  severe,  and  not  unfrequently  the  cause  of  sore 
nipples." '(Ibid.  p.  195.) 

Having  premised  thus  much  upon  the  advantages  resulting  to  both 
mother  and  child  from  following  the  law  of  Nature,  which  enjoins  the 
female  to  nourish  her  own  offspring,  and  having,  moreover,  elsewhere 
noted  some  of  the  causes  which  may  prevent  its  being  fully  carried 
into  effect,  we  shall  now  proceed  to  that  important  point— for  those 
who  do  not  intend  nursing  their  own  children — the  choice  of  a  nurse, 
and  also  the  regimen  to  be  observed,  which  is  equally  applicable  to 
both  parties. 

46 


72.3  TREATMENT  OF  INFANTS. 


THE  CHOICE  OF  A  NURSE. 

In  the  selection  of  a  nurse,  the  medical  attendant  ought  generally  to 
be  consulted ;  and  the  following  points  merit  particular  attention : 

She  should  be  apparently  of  sound  health,  full  and  moderate  plump- 
ness, with  a  fresh  complexion,  and  clear  eyelids,  free  from  any  ap- 
pearance of  redness,  scurfiness,  or  thichening.  She  should  be  thoroughly 
exempt  from  glandular  enlargements ;  possess  deep-red  lips  without 
cracks,  sound  white  teeth  ;  and  well-formed,  moderately  firm  breasts, 
with  nipples  free  from  excoriation  or  appearance  of  eruptions ;  the 
child  of  the  nurse  is  one  of  the  best  criterions  to  judge  by — its  being 
plump  and  healthy  is  a  great  point  in  her  favour.  We  should  also 
endeavour  to  discover  if  she  is  free  from  any  hereditary  taint ;  she 
should,  moreover,  be  of  a  mild,  patient,  and  equable  temper,  not 
irritable  or  disposed  to  fits  of  passion,  nor  nervous ;  of  regular  and 
temperate  habits,  neat  in  person,  and  fond  of  children.  She  ought 
also  to  be  about  the  same  age,  and  delivered  about  the  same,  time, 
or,  at  least,  within  three  months  of  the  same  period  as  the  mother; 
with  respect  to  the  age  we  must,  of  course,  avoid  extremes.  A  woman, 
having  given  birth  to  a  child  very  late  in  life,  should  choose  a  nurse 
several  years  her  junior,  and  fully  qualified  for  her  duties ;  the  reverse 
of  the  rule  applies  to  extremely  young  mothers. 


DIET  DURING  NURSING. 


As  regards  the  nurse's  diet,  it  should  be  simple  and  easily  digested, 
and  she  ought  to  live  upon  a  proper  proportion  of  animal  and  vegetable 
food.  Nature  generally  provides  for  the  increased  call  upon  her 
powers,  by  the  suppression  of  the  menstrual  discharge,  and  a  moderate 
increase  of  appetite,  which  may  be  safely  indulged ;  but  all  food  of 
a  highly  concentrated,  nourishing  nature,  is  injurious,  causing  the 
milk  to  become  too  rich,  and  unsuited  to  the  delicate  digestion  of  the 


SUPPLEMENTARY  DIET  OF  INFANTS.  723 

infant ;  the  best  guide  is  the  regular  homoeopathic  regimen,  which 
may  be  consulted  with  advantage. 

We  cannot  too  strongly  repudiate  the  too  prevalent,  but  deeply 
erroneous  idea,  that  women,  during  the  period  of  suckling,  require 
stimulants  to  keep  up  their  strength ;  under  this  impression,  both 
wine  and  malt  liquors — and,  among  the  latter,  more  particularly 
porter — are  frequently  resorted  to.  Porter  is  not  only  injurious  from 
its  stimulating  properties,  but  the  deleterious  effect,  which  the  different 
ingredients  composing  it  produce  upon  the  milk,  forms  one  of  the 
most  prolific  causes  of  the  many  evils  that  attack  infancy.  Our  own 
opinions  in  this  respect  are  corroborated  by  the  physicians  of  the  old 
school,  though,  we  regret  to  say,  not  to  the  same  extent.  We  shall 
conclude  this  part  of  the  subject  with  a  single  quotation  from  a  well- 
known  medical  writer : 

"  There  is  an  evil  too  generally  prevalent,  and  most  pernicious  in 
its  consequences  on  individuals  and  society,  and  by  no  means  con- 
fined to  mothers  in  the  lowest  classes  of  the  community,  which  cannot 
be  too  severely  reprobated;  it  is  the  wretched  habit  of  taking  wine 
or  spirits  to  remove  the  languor  present  during  pregnancy  and 
suckling.  It  is  a  practice  fraught  with  double  mischief,  being 
detrimental  both  to  mother  and  child.  The  relief  afforded  is  tempo- 
rary, and  is  invariably  followed  by  a  greater  degree  of  languor,  wThich 
demands  a  more  powerful  stimulus,  which  at  length  weakens,  and 
eventually  destroys  the  tone  of  the  stomach,  deteriorates  the  milk 
and  renders  it  altogether  unfit  to  supply  that  nutriment,  which  is 
essential  to  the  existence  and  welfare  of  the  child." 


SUPPLEMENTARY  DIET  OF  INFANTS. 

Unfortunately,  some  mothers  do  not  possess  sufficient  milk  for  the 
proper  nourishment  of  their  offspring ;  if  this  arise  merely  from  a 
deficiency  in  the  secretion,  and  the  female  is  in  other  respects  healthy, 
we  must  have  recourse  to  supplementary  diet,  to  make  up  for  the 
diminished  quantity  of  the  natural  nutriment.  Goats5,  asses',  and 
cows5  milk  are  excellent  substitutes,  especially  the  latter,  diluted 
with  one  third  of  water;  goats'  milk  being  apparently  objectionable 
from  its  peculiar  aroma.     The  milk,  therefore,  of  the  cow  ought, 


724  TREATMENT  OE  INEANTS. 

when  possible  to  be  obtained,  and,  if  given  undiluted,  to  be  boiled ; — 
cow's  milk  being  generally  considered  too  heavy,  which  boiling,  in  a 
great  measure,  obviates  ;  it  ought  also  to  be  slightly  sweetened,  so  as 
to  resemble  as  closely  as  possible  that  of  the  nurse  ;  it  should,  more- 
over, be  about  the  same  temperature,  say  from  ninety-six  to  ninety- 
eight  degrees,  a  point  less  regarded  than  it  should  be,  and  easily 
determinable  by  the  thermometer.  If  any  constitutional  taint  exist 
in  the  mother,  the  sooner  the  child  is  transferred  to  another  breast 
the  better  for  both  parties  ;  if  a  nurse  be  not  procurable,  the  above 
will  generally  prove  sufficient  nourishment  until  the  front  teeth  ap- 
pear, which  is  a  clear  indication  that  the  digestive  organs  are  pre- 
pared for  more  solid  food;  if,  however,  the  milk  diet  appears  to 
disagree  with1  the  infant,  we  may  mix  a  little  thin  arrow-root,  rusk, 
or  well- toasted  bread  in  water,  to  which  the  milk  may  be  afterwards 
added ;  such  alterations  in  diet  are,  however,  but  rarely  required. 

We  may  here  observe,  that  no  portion  of  the  milk  ought  to  be 
retained  for  a  subsequent  meal,  from  the  quickness  with  which  it 
becomes  sour ;  the  same  remark  applies  to  any  of  the  above  prepara- 
tions, in  which  milk  forms  the  principal  ingredient. 

In  the  cow's  milk,  at  first  diluted  as  above  described,  we  may, 
after  two  or  three  weeks,  gradually  diminish  the  quantity  of  water, 
as  the  digestive  organs  become  stronger,  but  wre  cannot  too  strin- 
gently press  the  point  that,  where  it  is  at  all  practicable,  the  child  ought 
to  derive  as  great  a  portion  of  its  nutriment  as  possible  from  the 
breast,  no  food  being  able  efficiently  to  supply  the  place  of  that  which 
Nature  intended  for  it  at  its  birth. 

When  it  is  necessary  to  give  supplementary  nourishment,  a  suck- 
ling-bottle ought  to  be  used,  as  the  best  imitation  of  nature  in  giving 
the  food  slowly ;  particular  care  being  taken  to  observe  the  utmost 
cleanliness.  The  child  ought,  in  feeding,  to  be  kept  in  a  reclining,  not 
supine,  position,  as  the  latter  frequently  causes  it  to  incur  the  risk  of 
suffocation ;  and  when  it  evinces  disinclination  to  its  food,  no  more 
should  be  offered.  When  the  front  teeth  appear,  which  is  about  the 
fifth  or  sixth  month  in  healthy  children,  an  alteration  may  take  place 
in  the  diet ;  and  a  well-made  panado,  diluted  milk  sweetened,  and 
thickened  with  a  small  quantity  of  arrow-root,  sago,  semolino,  or 
rusk,  may  be  given  twice  a  day.  When  milk,  even  when  prepared 
with  farinaceous  substances,  disagrees,  we  may  substitute  barley- 
water,  fine  well-boiled  gruel,  or  weak  chicken-broth,  and  beef- tea, 
adhering  to  that  which  seems  best  to  agree  with  the  infant,  and  taking 


DURATION  OF  SUCKLING.       WEANJNG.  725 

care  to  vary  according  to  circumstances,  as  too  long  an  adherence  to 
barley-water  may  occasion  looseness  in  the  bowels,  while  the  animal 
diet  is  liable  to  lead,  if  too  long  continued,  to  a  contrary  result ;  the 
best  precaution  in  these  cases,  when  the  predisposition  becomes 
evident,  is  an  immediate  change  of  aliment. 

The  child  should  be  accustomed  to  take  its  nourishment  from  each 
breast  alternately;  as,  if  this  precaution  be  not  adopted,  inflammation 
is  likely  to  arise  in  the  breast  not  used,  and  the  child  is  apt  to  become 
crooked,  from  being  always  retained  in  the  same  position. 

The  physician  is  frequently  asked  how  often  the  child  ought  to  be 
applied  to  the  breast ;  the  best  rule  on  this  point  is,  to  give  the 
breast  when  the  infant  appears  to  desire  it,  and  to  withdraw  it  when 
the  child  appears  satisfied.  As  the  infant  increases  in  strength,  it 
may  easily  be  accustomed  to  regular  hours,  the  breast  being  given 
late  at  night,  and  again  early  in  the  morning ;  but  during  the  first 
six  weeks  or  two  months,  three  times  during  the  hours  of  rest,  late 
in  the  evening,  the  middle  of  the  night,  and  early  in  the  morning, 
will  generally  be  found  sufficient. 


DURATION  OF  SUCKLING.    WEANING. 

The  period  of  suckling  ought  seldom  to  last  longer  than  forty 
weeks ;  but  in  this  we  must  be  guided,  in  a  great  measure,  by  the 
constitution  of  the  infant ;  weak,  ill-conditioned  children,  in  whom 
the  teeth  are  long  in  making  their  appearance,  it  has  been  recom- 
mended to  continue  at  the  breast  for  eighteen  months,  or  even  a 
longer  period.  Weaning  ought,  in  fact,  to  be  regulated  both  by  the 
constitution  and  mother  of  the  child;  in  full  development  of  the  front 
teeth,  which  in  healthy  children  is  from  nine  to  ten  months,  but  in 
delicate  or  scrofulous  constitutions  is  delayed  for  several  months 
later,  is  the  best  indication  for  weaning.  If,  however,  the  strength  of 
the  mother  appear  unequal  to  the  task,  and  the  supply  of  milk  begin 
to  fall  off,  the  child  may  be  gradually  weaned,  even  before  the  teeth 
appear ;  but  if  the  infant  is  healthy,  a  continuance  of  suckling  beyond 
the  tenth  month  is  injurious  to  both  parent  and  child.  Weaning 
should  not  take  place  suddenly,  but  the  infant  should  be  gradually 
accustomed  to  other  food,  and  a  less  frequent  administration  of  the 


726  TREATMENT  OE  INEANTS. 

breast,  till  entirely  weaned ;  the  time  to  commence  this  gradual  course 
is  upon  the  first  appearance  of  the  front  teeth,  so  that  the  weaning 
may  terminate  with  their  full  development ;  thereby  the  secretion 
lessens  by  degrees,  preventing  all  evil  consequences  of  swollen  or  in- 
flamed breasts,  and  the  child  becomes  quietly  reconciled  to  the  de- 
privation. Weaning  ought  not,  however,  to  take  place,  if  the  child 
suffers  considerably  from  the  irritation  of  teeth,  or  any  acute  infantile 
disease.  When,  however,  it  is  absolutely  necessary  to  wean,  Bella- 
donna, one  globule,  should  be  given,  as  a  precautionary  measure  against 
the  inconveniences  and  not  unfrequent  dangers  which  sudden  wean- 
ing entails.  Among  these  may  be  mentioned,  restlessness,  sleepless- 
ness, fretfulness,  and  excitability,  nay,  even  a  degree  of  irritability 
sometimes  amounting  to  inflammation  of  the  brain.  The  value  of 
this  remedy  in  affections  of  that  organ  has  already  been  commented 
upon  in  several  parts  of  this  work.  Although,  perhaps,  slightly  out 
of  place,  it  may  be  here  remarked  that  Phosphorus  is  the  remedy 
best  calculated  to  prevent  inflammation  of  the  breasts  consequent 
upon  a  sudden  cessation  of  suckling.*  See  the  articles  relative  to 
this  subject  in  Part  II,  Treatment  of  Females  and  their  peculiar 
Affections. 

After  the  child  has  been  weaned,  his  nourishment  should  generally 
consist  of  the  same  simple  food  as  before  mentioned,  with  an  occa- 
sional light  pudding,  without  spice  or  eggs,  made  from  semolino, 
tapioca,  or  other  farinaceous  substance.  The  transition  to  a  more 
substantial  diet  ought  to  be  extremely  gradual  and  guarded,  and 
no  material  alteration  made,  till  after  the  appearance  of  the  eye- 
teeth. 


SLEEP.     SLEEPLESSNESS. 

The  sleep  of  the  child  is  the  next  consideration ;  from  the  inability 
of  the  infant  itself  to  maintain  a  proper  degree  of  warmth,  it  should 
sleep  by  its  mothers  or  nurse's  side,  for  at  least  the  first  six  weeks, 
particularly  during  winter  or  early  spring.  Care  must  be  taken  not 
to  overburden  it  with  bedclothes,  and  to  place  it  in  such  a  position 
as  to  prevent  it  slipping  under  them,  and  thereby  becoming  exposed 

*  A.  H.  Z.,  p.  8,  No.  23. 


SLEEP.  727 

to  the  risk  of  breathing  a  vitiated  atmosphere,  or  even  of  suffocation ; 
after  six  or  eight  weeks,  when  the  organism  becomes  stronger,  and 
able  to  preserve  a  proper  degree  of  natural  warmth,  a  separate  bed  or 
cradle  will  be  more  conducive  to  the  health  of  the  infant ;  this  change 
of  arrangement  will  be  found  beneficial  to  both  parties — to  the  child, 
from  its  breathing  a  purer  air,  and  the  continual  appetite  for  the  breast 
diminished ;  and  the  mother,  being  freed  from  the  necessary  watch- 
fulness and  restlessness  consequent  upon  the  child  sleeping  with  her, 
will  enjoy  better  health,  and  be  more  likely  to  secrete  good  and  nutri- 
tious milk.  Moreover,  it  is  generally  known,  that  sleeping  in  the 
same  bed  with  an  adult  is  detrimental  to  the  health  and  proper  deve- 
lopment, not  only  of  infants,  but  even  of  children ;  a  child  sleeping 
in  the  same  bed  with  a  very  old  person,  will  very  soon  begin  to  exhibit 
signs  of  a  falling  off  in  its  general  appearance. 

With  regard  to  the  kind  of  bed  best  suited  to  the  infant,  the  sus- 
pended cradle  seems  the  most  eligible ;  we  must,  however,  be  careful 
not  to  allow  the  nurse  to  abuse  its  use  by  continual  rocking,  which 
frequently  causes  irritation  of  the  brain:  it  should  not  be  closed 
up  with  curtains,  but  the  room  may  be  a  little  darkened ;  and  in 
cases  where  there  is  danger  of  draughts,  a  screen  will  answer  every 
purpose. 

As  to  the  length  of  sleep  allowed  to  the  infant,  the  chief  business 
of  the  first  months  of  its  existence  being  sleep  and  nourishment,  we 
may  safely  leave  the  point  to  Nature,  and  not  attempt  to  coerce  the 
inclinations  of  the  child ;  if  the  infant  is  lively  on  waking,  we  may 
conclude  it  has  not  slept  too  much ;  and  as  it  increases  in  vigour,  and 
is  able  to  endure  longer  intervals  of  wakefulness,  we  may  proceed 
(recollecting  that  night  is  the  proper  period  for  sleep),  so  to  regulate 
its  habits  of  taking  its  food  and  rest,  as  to  accustom  it  to  a  uniform 
system,  and  particular  hours.  Children,  up  to  two  years  of  age, 
require  rest  during  the  day,  and  the  nurse  ought  to  endeavour  to 
get  them  into  the  habit  of  taking  it  in  the  forenoon,  for  if  it  be  taken 
in  the  afternoon,  it  generally  interferes  with  the  night's  sleep. 
Whether  by  night  or  day,  we  must  carefully  exclude  both  light  and 
noise  from  the  nursery,  for  although  they  may  be  insufficient  to 
arouse  the  infant,  still  they  cause  its  sleep  to  be  disturbed  and  unre- 
freshing,  and,  by  acting  upon  the  nervous  sensibility,  predispose  the 
child  to  convulsions  or  spasmodic  attacks  from  slight  accidental 
causes. 

It  is  true,  that  during  the  first  month,  the  child  sleeps  immediately 


728  TREATMENT  OE  INEANTS. 

on  leaving  the  breast,  and  no  evil  consequences  ensue ;  but  it  must 
be  borne  in  mind,  that  it  takes  but  little  at  a  time,  and  the  tenuity  of 
the  milk  is  at  that  time  wisely  adapted  to  its  delicate  digestion,  but 
as  the  secretion  becomes  richer,  and  suited  to  the  increasing  power 
of  those  organs,  it  is  injurious  to  put  the  child  asleep  immediately 
after  a  full  meal ;  his  rest  is  then  unquiet  and  disturbed,  from  the 
process  of  digestion  being  interfered  with,  more  particularly  when 
nurses  foolishly  endeavour  to  force  nature,  by  resorting  to  the  baneful 
practice  of  rocking. 

Nothing  causes  greater  annoyance,  and  even  anxiety  to  the  mother 
than  a  disposition  to  wakefulness  on  the  part  of  the  infant.  A 
healthy  child  should  always  be  prepared  for  its  rest  at  the  usual 
hours ;  if,  instead  of  going  to  sleep,  it  appear  restless,  fretful,  and 
disinclined  for  its  accustomed  rest,  it  is  an  evident  indication  of  some 
derangement  of  the  child's  general  health  ;  frequently,  through  igno- 
rance, nurses,  instead  of  attending  to  this  warning  voice  of  Nature, — 
which  by  the  sleeplessness  of  the  infant  demands  appropriate  relief, — 
endeavour  to  stifle  it,  and  sometimes  to  free  themselves  from  a  little 
temporary  annoyance,  administer  opiates,  which  induce  an  unrefresh-* 
ing  slumber,  and  not  unfrequently  a  deep  stupor,  mistaken  for  sleep, 
while  the  original  evil  still  continues  to  make  head  against  the  vital 
power.  This  baneful  practice  has  not  only  been  the  ruin  of  many 
constitutions  in  after-life,  but  to  it,  conjoined  with  improper  diet, 
stimulating  or  unwholesome  drinks,  carminatives,  and  other  quack 
medicines,  together  with  the  highly  erroneous  practice — sanctioned 
though  it  be  by  names  of  medical  repute — of  a  frequent  administra- 
tion of  that  active  mineral  preparation,  calomel,  in  infant  maladies,  to 
say  nothing  of  laxatives,  an  infinite  number  of  diseases  and  deaths 
are  annually  attributable.  Every  mother  should  not  only  caution 
her  nurse  against  the  use  of  opiates,  but  use  her  utmost  vigilance  to 
detect  any  breach  of  her  injunctions,  which  should  be  visited  with  the 
immediate  discharge  of  the  person  so  offending ;  for  she  must  be  truly 
unfitted  for  such  an  important  trust,  who,  after  being  wrarned  of  its 
injurious  tendency,  will  persevere  in  a  practice  placing  in  jeopardy 
the  .life  of  her  infant  charge. 

Amongst  the  homoeopathic  remedies  which  have  been  found  the 
most  generally  useful  in  removing  restlessness  and  sleeplessness  in  chil- 
dren, Cqffea,  Opium,  Chamomilla,  and  Belladonna,  deserve  notice. 
Coffea  is  very  efficacious  when  the  child  seems  unusually  lively, 


EXERCISE.  729 

restless,  and  wakeful;  but  will  commonly  fail  to  answer  its  purpose 
when  the  nurse  is  in  the  daily  habit  of  taking  coffee  as  a  beverage. 
In  such  circumstances^  Opium  may  be  substituted,  particularly  if 
the  face  of  the  child  is  flushed.  Chamomilla  will  generally  answer 
our  purpose  when  the  child  is  tormented  with  flatulence,  and  dis- 
tension of  the  bowels,  and  appears  to  suffer  from  colic,  indicated  by 
drawing  up  the  legs,  screaming,  &c.  Against  sleeplessness  after 
weaning,  Belladonna  is  the  most  efficacious  remedy.  When 
these  remedies  do  not  seem  indicated,  or  fail  to  relieve,  an  experienced 
homceopathist  ought  to  be  consulted.  (See  also  Crying  and, 
Wakefulness.) 


EXERCISE. 

For  the  first  six  or  seven  months  the  great  business  of  Nature 
seems  to  be  the  proper  development  of  the  infant  organism,  and  par- 
ticularly of  the  respiratory  and  digestive  functions.  During  this  period, 
the  cartilage  is  gradually  forming  into  bone,  and  the  infantas  delicate 
muscles  are  acquiring  power  and  strength.  We  find  also  that  con- 
sciousness is  yet  indistinct,  and  the  infant  evinces  no  anxiety  to  in- 
dulge in  voluntary  motion,  the  muscles  of  the  neck  and  back  not 
possessing  sufficient  power  to  support  the  head,  or  to  keep  the  body 
in  an  erect  position;  for  this  reason,  children  during  this  period 
should,  when  carried  in  the  arms,  be  kept  in  a  reclining  position,  so 
as  to  avoid  an  undue  pressure  upon  the  vertebral  column ;  a  neglect 
of  this  precaution,  and  a  premature  carrying  of  the  infant  in  an  up- 
right position,  are  a  too  frequent  cause  of  deformities  of  the  spine,  and 
derangement  of  the  internal  functions  in  after  life. 

As  its  powers  gradually  develop,  the  infant  seems  inclined  to  exer- 
cise them,  and  evinces  a  desire  to  sit  upright,  which  we  may  safely 
indulge,  taking  care  not  to  overtask  its  strength  by  keeping  it  sitting 
up  during  the  greater  part  of  the  time  it  is  awake.  A  careful  atten- 
tion to  Nature  in  this,  as  in  all  other  cases,  is  the  best  guide. 

The  practice  of  dandling  the  child  in  an  upright  position,  seems 
rather  to  proceed  from  the  pleasure  of  indulging  the  feeling  of  pa- 
rental affection,  than  from  any  benefit  the  child  can,  by  any  possibility, 
be  expected  to  derive  from  it ;  in  fact,  it  is  highly  injurious,  even  at 


730  TREATMENT  OF  INFANTS. 

a  rather  more  advanced  period,  as  exciting  a  premature  involuntary 
exercise  of  the  muscles,  and  consequent  deformity.  The  act  of  respi- 
ration bringing  into  play  a  great  variety  of  muscles,  occasional  crying 
seems  sufficiently  active  exercise  during  this  period. 

In  mild  spring  and  summer  weather  the  child  may,  after  the  first 
fortnight  has  elapsed,  be  carried  out  into  the  air  for  a  quarter  of  an 
hour  at  a  time,  and  the  period  of  exercise  gradually  increased ;  in 
fact,  if  the  weather  be  fine,  it  can  scarcely  be  too  much  in  the  open 
air.  Should  its  birth  occur  in  winter,  advantage  may  be  taken  of  a 
fine  day,  after  it  is  a  month  or  five  weeks  old,  as  the  frame  is  gra- 
dually acquiring  the  power  of  generating  heat ;  but,  at  the  same 
time,  great  care  must  be  taken  to  prevent  its  catching  cold ;  and 
should  the  child  exhibit  the  slightest  sign  of  being  affected  by  the 
atmosphere,  the  practice  of  carrying  it  out  of  doors  should  be  imme- 
diately discontinued,  and  it  should  be  carried  up  and  down  in  a  well 
ventilated  room,  the  nurse  moving  it  quietly  in  her  arms  from  side 
to  side.  Many  children  are  lost  through  a  foolish  idea  of  making 
them  hardy,  by  accustoming  them  to  endure  cold  ;  this  can  occur  only 
through  ignorance,  for  Nature,  in  very  early  infancy,  does  not  possess 
sufficient  energy  of  reaction  to  overcome  the  power  of  a  sudden  or 
long-protracted  chill.  We  may  recommend  an  occasional  gentle 
friction  of  the  hand  over  the  body  and  limbs,  which  materially  assists 
in  the  promotion  of  the  circulation  of  the  blood,  and  will,  in  unfa- 
vorable weather,  serve  in  some  measure  as  a  substitute  for  exercising 
the  infant  out  of  doors. 

In  carrying  the  child,  it  should  be  from  time  to  time  transferred  to 
different  arms,  as  a  continuance  on  one  side  is  a  frequent  cause  of 
deformity,  and  in  some  cases  of  squinting. 

The  child,  as  the  organization  develops  itself,  seems  to  evince  a 
desire  for  independent  movements,  in  which  the  nurse  may  very 
properly  indulge  it,  by  removing  every  impediment  in  its  dress,  and 
allowing  it  to  roll  about,  or  crawl  upon  a  soft  carpet.  The  practice 
of  assisting  children  to  walk,  or  of  exciting  them  to  a  premature 
exercise  of  their  powers,  is  highly  reprehensible,  causing  curvature 
of  the  limbs,  the  bones  not  being  yet  sufficiently  formed  to  bear 
the  burden  imposed  upon  them.  By  allowing  Nature  to  act,  the 
infant's  powers  will  become  more  gradually,  but  at  the  same  time, 
more  fully  developed,  its  carriage  will  be  more  firm  and  erect,  and  its 
limbs  straight  and  well-formed  ;  moreover,  it  will  walk  with  greater 
confidence  and  independence  by  the  expiration  of  the  first  year,  than 


EXERCISE.  731 

those  who  have  been  taught  to  walk  by  the  assistance  of  the  nurse, 
leading-strings,  or  mechanical  inventions.  When  the  period  at 
which  a  child  should  make  attempts  to  walk  is  retarded  by  evident 
debility  of  constitution,  this  evil  is  to  be  overcome  by  many  of  such 
remedies  as  Calcarea,  Silicea,  Sulphur,  Belladonna,  Mercurius,  or  Staphy- 
sagria,  &c. 


DISEASES  OP  INFANCY, 


INFLAMMATION  OP  THE  EYES  IN  NEW-BORN  INFANTS. 

A  sudden  exposure  to  the  strong  light  of  day,  or  the  glare  of  a 
fire,  is  the  general  cause  of  this  affection ;  and  no  doubt  many  chil- 
dren who  are  what  is  vulgarly  denominated  born  blind,  owe  their 
misfortune  to  the  neglect  of  those  precautions  which  we  have  so 
strongly  enforced  under  the  head  of  Treatment  of  Infants,  in 
many  cases  the  external  indications  of  this  affection  being  so  very 
slight  as  to  escape  observation. 

As  soon,  however,  as,  on  a  careful  examination,  we  become  aware 
of  the  existence  of  this  evil,  we  should  administer  Aconite,  which 
will  generally  be  found  promptly  efficacious  in  its  removal. 

When,  from  the  constitution  of  one  or  both  of  the  parents,  we 
have  reason  to  suppose  that  the  exposure  to  light  has  been  merely 
the  exciting  cause,  but  that  the  real  origin  of  the  evil  is  more  deeply 
seated,  or  if  the  Aconite,  seems  to  produce  no  effect,  and  the  disease 
continues  to  increase,  we  may  have  recourse  to  Tinctura  sulphu- 
ris,  and  in  some  cases  Calqarea,  alternating  these  remedies  every 
eight  or  ten  days,  if  we  find  it  necessary  to  resort  to  the  Calcarea.—*- 
Tincttira  sulp/mris  having  been  found  in  many  cases  to  act  as  a 
specific. 

Chamomilla  is  useful  some  weeks  after  birth,  when  the  percep- 
tive faculties  are  more  developed,  and  the  child  exhibits  great  into- 
lerance of  light ;  also  when  redness,  swelling,  and  agglutinations  of 
the  eyelids,  with  other  indications,  given  under  Acute  Inflamma- 
tion of  the  Eye,  (Part  I,  which  see,)  are  present.      Lycopodium 


COLD  IN  THE  HEAD.  733 

clavatum,  and  Rhus  toxicodendron  may  also  be  named  as 
useful  remedies  in  this  inflammation,  the  former  especially  in  invete- 
rate cases. 

The  eyes  may  be  gently  but  repeatedly  bathed  with  tepid  water. 


COLD  IN  THE  HEAD. 

This  affection  frequently  becomes  exceedingly  distressing  to  the 
infant,  when  it  appears  in  the  form  of  an  obstruction  of  the  nose, 
impeding  the  action  of  sucking,  by  not  allowing  the  breath  to  pass 
through  the  nostril,  obliging  the  infant  to  release  the  nipple  fre- 
quently in  order  to  breathe,  and  causing  it  to  become  fretful  and 
irritable ;  sometimes  also  leading  to  irritation  and  excoriation  of  the 
nipple,  and  thus,  in  its  repeated  efforts  to  suck,  the  child  causes 
suffering  both  to  itself  and  the  nurse. 

Whilst  this  state  continues,  it  operates  considerably  against  the 
infant's  thriving,  both  by  hindering  it  from  taking  a  sufficient  quan- 
tity of  nutriment,  and,  by  the  impediment  it  causes  to  respiration, 
preventing  the  child  sleeping  at  night.  When  the  nose  is  dry,  and 
the  secretion  of  mucus  suspended,  we  may,  whilst  administering  a 
remedy  calculated  permanently  to  relieve  the  evil,  afford  relief,  by 
imitating  the  natural  secretion  by  the  application  of  &  little  almond 
oil  or  cream  to  the  interior  of  the  nostrils  with  a  feather. 

This  malady  is  often  excessively  obstinate,  and  presents  itself  under 
many  different  phases,  which  of  course  demand  remedies  suited  to 
the  entire  group  of  the  symptoms.  Among  these,  Nux  vomica  is 
most  frequently  successful,  particularly  when  the  following  symptoms 
are  present : — 

Obstruction  of  the  nose,  with  dryness  or  nocturnal  obstruction,  slight 
discharge  during  the  day ;  irritability  and  peevishness. 

Sambucus  niger  is  frequently  efficacious  when  Nux  v.  fails  to 
relieve ;  but  is  also  of  service  in  cases  when  there  is  an  accumulation 
of  thick  and  viscid  .mucus  in  the  nostril;  when,  in  addition  to  the 
cold  in  the  head,  there  is  a  suffocating  cough,  with  wheezing  in  the 
chest,  and  quick  laborious  breathing,  Tartarus  should  be  had  recourse 
to  if  Sambucus  does  not  soon  relieve  the  latter  symptoms. 

Chamomilla  is  very  useful  when  there  is  cold  in  the  head,  with  a 


734  DISEASES  OF  INFANCY. 

watery  discharge  from  the  nose,  more  particularly  when  there  are  febrile 
symptoms,  soreness  of  the  nostrils,  and  redness  of  one  cheek. 

Carbo  v.  is  chiefly  useful  in  obstinate  cases,  and  particularly 
when  the  cold  in  the  head  becomes  aggravated  towards  evening. 
Calcarea,  when  the  nose  is  stuffed  with  mucus,  and  the  affection 
occurs  in  stout,  lymphatic  children.  Pulsatilla,  thick  green  or 
yellow,  or  purulent-looking  discharge  from  the  nose,  attended  with 
frequent  sneezing. 

Dose.  A  globule  of  the  remedy  selected,  may  be  dissolved  in  half  a 
wineglassful  of  water  and  one  teaspoonful  given  at  bedtime  and  another 
in  the  morning.  Sulphur  may  follow  Pulsatilla,  after  an  interval  of  a 
few  days,  if  the  latter  fails  to  act  beneficially.  Mercurius,  Aurum,  or 
Lycopodium  may  be  required  after  Sulphur,  if  the  discharge  continues  to 
present  a  purulent  appearance.     (See  also  Cgryza,  Part  I.) 


CRYING  AND  WAKEFULNESS  OF  NEW-BORN  CHILDREN. 

As  we  have  already  remarked,  the  occasional  crying  of  new-born 
children  is  a  wise  provision  to  bring  the  respiratory  organs  into  play, 
and  to  expand  t\\e  chest.  When,  however,  the  crying  becomes 
excessive,  and  threatens  to  prove  injurious,  we  must,  in  the  first 
place,  endeavour  to  discover  its  origin,  which  frequently  will  be  found 
to  be  some  mechanical  cause,  such  as  derangement  in  the  infant's 
dress,  or  a  pin  sticking  into  its  flesh,  &c. 

Therapeutics.  When,  however,  no  exciting  cause  or  guiding 
symptoms  of  disease  present  themselves  and  the  infant  is  peevish 
and  irritable,  affected  with  incessant  whimpering  and  wakefulness,  or 
prolonged  fits  of  crying,  Belladonna  will  'frequently  be  found 
sufficient  to  remove  the  evil. 

When  a  fit  of  crying  arises  from  the  child  having  been  irritated  or 
excited  by  any  cause,  such  as  suddenly  rousing  it  from  its  rest,  and 
when  it  seems  willing  to  sleep,  but  finds  a  difficulty  in  composing 
itself  to  slumber,  Coffea  cruda,  will  prove  efficacious.  (Aconitum 
may  follow  Coffea,  when  there  are  considerable  heat  of  skin,  and 
extreme  restlessness.) 


CRYING.  735 

Chamomilla  is  often  more  efficacious  than  Belladonna  when  the 
infant  is  of  a  very  spare  and  delicate  habit ;  or  when  we  can  trace 
the  fits  of  screaming  and  wakefulness  to  a  derangement  of  the  diges- 
tive functions,  and  the  child  appears  to  suffer  from  griping  pains 
indicated  by  contortions  of  the  body,  drawing  up  of  the  little  limbs 
upon  the  abdomen ;  and  when  a  whitish,  yellowish,  or  greenish,  or 
watery  excoriating  diarrhoea  is  present. 

Jalapa,  in  similar  cases,  but  without  diarrhoea,  or  with  motions 
tinged  with  blood. 

In  other  cases,  when  the  screaming  and  vigilance  are  attended  with 
colic  and  flatulence,  Senna  will  answer  best. 

Rheum  is  more  appropriate  when,  in  addition  to  screaming  and 
wakefulness,  combined  with  griping,  there  are  ineffectual  efforts  to 
relieve  the  bowels  by  frequent  straining,  or  when,  at  the  utmost,  only 
scanty,  sour-smelling  motions  are  passed,  of  grayish  appearance,  and 
which  seem  to  afford  no  relief. 

When  flatulent  colic,  accompanied  by  sudden  fits  of  crying,  draw- 
ing up  of  the  legs  or  of  the  scrotum,  and  a  costive  state  of  the 
bowels,  appears  to  be  the  source  of  the  disturbance,  Nux  v.  will  com- 
monly succeed  in  restoring  ease  to  the  little  sufferer. 

Pulsatilla  is  very  efficacious  when  the  derangement  arises  from 
overloading  the  stomach,  or  improper  food,  and  the  crying  or  wake- 
fulness is  accompanied  with  flatulence  and  diarrhoea,  or  with  con- 
stipation. 

Remarks.  The  milk  of  a  nurse  who  has  suckled  for  some  months 
previously  is  much  too  heavy  for  a  new-born  infant ;  here  the  only 
alternative  is  a  change  of  nutriment.  When,  however,  the  above- 
named  or  any  other  infantile  derangement  arises  from  congenital 
weakness  of  the  stomach,  the  most  useful  remedies,  in  addition  to 
Nux  v.  and  Puis.,  are  Sulphur,  Calcarea  carhonica,  and  Baryta  c. 


736  DISEASES  IN  INFANCY. 


REGURGITATION  OF  MILK.    ACIDITY,  FLATULENCE,  ETC. 

Children,  in  sucking,  sometimes  overload  their  stomachs,  and 
regurgitate  a  portion  of  the  milk  ;  so  far,  mothers  have  no  cause  for 
uneasiness,  nor  is  medical  assistance  requisite ;  but  when  this  changes 
into  vomiting,  and  the  whole  of  the  nutriment  is  returned  from  the 
stomach,  or  w7hen  sickness  and  regurgitation  of  food  occur  in  chil- 
dren who  have  been  weaned,  at  times  followed  by  mucus  and  watery 
fluid  and  even  bile,  it  must  be  looked  upon  as  a  disease,  and  treated 
accordingly. 

Therapeutics.  Ipecacuanha  will  generally  afford  relief,  and 
may  be  repeated,  if  not  soon  followed  by  some  amendment.  In  the 
case  of  spoon-fed  infants,  or  in  children  at  a  more  advanced  age,  this 
remedy  is  equally  efficacious,  when  the  derangement  is  evidently 
owing  to  their  having  been  over-fed,  (a  most  culpable  error,  which 
most  nurses  are  prone  to  fall  into  by  cramming  the  stomach  of  their 
little  charges,  and  but  too  often  with  food  of  an  indigestible  nature, 
whenever  they  are  seized  with  a  fit  of  crying.)  Should  the  vomiting 
or  flatulence,  and  also  the  diarrhoea  when  present,  not  decrease  after 
some  doses  of  Ipecacuanha,  Pulsatilla  may  be  given,  and  succeeded  in 
turn  by  Antimonium  crudum,  if  the  symptoms  continue,  though  in  a 
mitigated  form. 

■Nux  vomica,  and  that  failing,  Bryonia  may  be  prescribed  when 
the  disease  is  attended  with  flatulence,  constipation,  uneasiness,  or 
irritability  of  temper. 

Gentle  friction  with  the  extended  hand,  which  has  previously  been 
warmed,  is  a  simple  and  frequently  efficacious  mode  of  affording  tem- 
porary relief  in  cases  of  flatulent  distension  of  the  stomach  and 
bowels.  But  permanent  relief  is  only  to  be  attained  from  Pulsatilla, 
Nux  v.,  Chamomilla ;  or  Carlo  v.  and  Sulphur,  when  the  former  are 
insufficient.  The  diet  must  at  the  same  time  be  attended  to,  and 
altered  if  of  an  indigestible  nature  and  the  undoubted  cause  of  the 
mischief.  When  there  are  diarrhoea  and  excessive  flatulency,  China  is 
very  useful. 

Chamomilla  : — When  the  disease  is  attended  with  convulsions,  or 


SPASMODIC  ASTHMA.  737 

diarrhoea,  as  described    elsewhere   under  this   medicine    (see   those 
Articles). 

A  single  dose  of  Sulphur,  followed  by  Calcarea  carhonica,  in  from 
five  to  ten  days,  and  then  again  one  or  more  of  the  preceding  reme- 
dies, according  to  indications,  will  often  be  the  means  of  effecting  a 
cure  in  inveterate  cases, 


SPASMODIC  ASTHMA.     SPASMS  IN  THE  CHEST. 


Children  are  sometimes  seized  during  the  night  with  sudden  attacks 
of  suffocating  spasm  in  the  chest.  The  little  patient  suddenly 
awakes  from  sleep,  and  utters  a  shrill  cry,  in  consequence  of  the 
feeling  of  suffocation  which  is  experienced.  The  countenance  soon 
assumes  a  livid  hue,  and  is  expressive  of  extreme  anxiety.  A  dull, 
hollow-sounding,  dry  cough  usually  accompanies  the  attack,  and  the 
breathing  is  rapid,  very  laborious,  and  painfully  distressing  to  wit- 
ness. In  such  cases  a  globule  or  two  of  Ipecacttanha  ought  imme- 
diately to  be  dissolved  in  about  a  wine-glassful  of  w'ater,  and  a  few 
drops  of  the  liquid  put  into  the  mouth  of  the  patient.  If  relief 
follows,  the  medicine  must  be  allowred  to  act,  and  only  repeated  when 
the  symptoms  threaten  to  become  worse  again.  But  in  the  event  of 
no  favorable  signs  resulting  in  from  an  hour  to  half  an  hour  or  so, 
according  to  the  severity  of  the  symptoms,  Samhucus  may  be  given  in 
the  same  manner. 

In  other  cases  Arsenicum  will  be  found  more  efficacious  than  either 
of  these  remedies ;  or  Ipecacuanha  and  Arsenicum  may  be  administered 
alternately  until  improvement  takes  place.  Whenever  a  sudden 
aggravation  ensues  after  the  administration  of  any  of  these  remedies, 
nothing  further  should  be  done,  as  on  waiting  patiently  for  a  short 
time,  if  the  change  arise  from  the  effects  of  the  medicine,  the  symp- 
toms will  subside,  and  gradually  give  way  to  unequivocal  signs  of 
improvement.     (See  Asthma  of  Millar.) 

Some  children  are  liable  to  be  seized  with  obstructed  respiration  or 
asthma,  although  otherwise  in  good  health,  whenever  they  are  exposed 
to  sudden  changes  of  temperature,  or  to  a  cold  and  high  w7ind.  This 
form  of  asthma  is  always  attended  with  considerable,  hard  distension 

47 


738  DISEASES  OF  INFANCY. 

of  the  pit  of  the  stomach  and  region  of  the  lower  ribs ;  the  child 
affected  is  at  the  same  time  thrown  into  a  state  of  great  anxiety  and 
uncontrollable  restlessness,  attended  with  crying  or  screaming,  tossing 
about,  &c.  Against  this  indisposition  Chamomilla  has  repeatedly  proved 
to  be  an  effectual  remedy.  A  dose  ought  therefore  to  be  given  as 
soon  as  possible  after  the  attack  declares  itself* 


MILK-CRUST.     MILK-SCAB.     MILK-BLOTCHES. 

Crusta  lactea.     Porrigo  larvalis.     Eczema  faciei.     Tinea  faciei. 

This  affection,  as  it  occurs  in  infants  at  the  breast,  usually  consists 
of  an  eruption  of  numerous  small,  whitish  vesicles,  which  appear  in 
clusters  upon  a  red  ground.  These  generally  show  themselves,  in 
the  first  instance,  on  the  face,  particularly  the  cheeks  and  forehead, 
but  sometimes  spread  over  the  whole  body.  The  lymph  contained 
in  them  soon  becomes  yellow,  dark,  or  even  sanguineous,  and  on  their 
bursting  forms  into  thin,  yellowish  crusts. 

Frequently  there  is  considerable  surrounding  redness  and  swelling, 
with  distressing  itching,  which  renders  the  little  patient  excessively 
restless  and  fretful,  and  causes  it  to  keep  continually  rubbing  the 
affected  parts,  by  which  the  discharge  and  crusts  are  repeatedly 
renewed,  and  increased  in  thickness,  often  to  such  extent  that  the 
whole  face  becomes  covered ;  the  eyes  and  nose  alone  remaining  free. 
The  eyes  and  eyelids,  as  also  the  parotid  and  mesenteric  glands, 
occasionally  become  inflamed,  and  sometimes  marasmus  supervenes. 

Therapeutics.  The  following  medicines  have  been  found  ser- 
viceable in  this  affection :  Aconitum,  Rhus  toxicodendron,  Viola  tricolor, 
Rhus,  Sulphur,  Sarsaparilla,  Mezereum,  Belladonna,  Hepar  mVphuris, 
Euphrasia,  Staphysagria,  &c. 

Aconite  should  commence  our  treatment,  when  we  find  excessive 
restlessness  and  excitability  produced  by  this  affection,  and  when  the 
skin  around  the  parts  is  red,  inflamed,  and  itching. 

As  soon  as  beneficial  effects  have  resulted  from  the  employment  of 
the  above  remedy,  we  may  follow  it  up  with  Viola  tricolor,  wThich 
is  often  sufficient  to  effect  a  cure  in  the  simple  uncomplicated  form 
of  the  disease. 

Rhus  toxicodendron  may  sometimes  succeed  or  supersede  Viola 


THRUSH,  OR  APHTHA.  789 

tricolor,  when  the  scalp  is  considerably  affected  and  thickly  studded 
with  incrustations.  When  Rhus  is  insufficient  to  complete  the  cure^ 
Calcarea  or  Lycopod/tum  are  generally  to  be  selected  in  preference  to 
other  remedies ;  the  former  more  particularly  when  there  is  little  or 
no  discharge,  the  latter  when  there  is  considerable  oozing  (suppura- 
tion), and  the  temperament  of  the  patient  lymphatic. 

If,  after  the  employment  of  Rhus,  the  affection  is  found  to  have 
made  but  little  favorable  progress,  Sulphur  may  be  given  and  repeated, 
in  four  days. 

The  alternate  use  of  Rhus  and  Sulphur  every  four  or  five  days,  has 
been  found  very  efficacious  in  cases  of  the  aforesaid  description,  and 
when  the  eyes  are  a  good  deal  affected. 

Sarsaparilla  and  Mezereum  have  also  been  strongly  recommended 
in  Crusta  lactea.  The  former  in  the  earlier  stage  of  the  malady, 
when  small,  burning,  itching  pustules  appear  on  the  face.  Mezereum, 
when  from  the  bursting  and  discharge  of  the  contents  of  the  pustules^ 
incrustations  have  formed,  from  which  an  acrid  exudation  flows,  and 
gives  rise  to  a  fresh  eruption  of  vesicles  wherever  it  comes  in  con- 
tact with  the  skin.  Graphites,  as  also  Sepia,  Bella.,  Hepar,  Baryta  c, 
Bulc.)  dc,  Iod.,  Merc.,  Natr.  m.,  Acid.fluor.,  have  been  recommended 
as  likely  to  prove  of  service  in  complicated  cases.  (See  also  Scald 
Head.) 


THRUSH,  OR  APHTHA. 


This  disease  commences  by  the  formation  of  small,  isolated,  round, 
white  vesicles,  which,  if  not  checked,  become  confluent,  and  some- 
times present  an  ulcerated  appearance,  or  form  a  thin  white  crust, 
which  lines  generally  the  whole  of  the  cavity  of  the  mouth,  and  in 
severe  cases  extending  to  the  throat,  and  even  throughout  the 
alimentary  canal.  Although  the  affection  is  of  itself  neither  malignant 
nor  dangerous,  it  frequently  causes  not  only  considerable  suffering 
to  the  child  by  preventing  it  from  sucking,  but  great  pain  and  in- 
convenience to  the  mother,  by  being  communicated  to  the  nipples, 
and  causing  excoriation,  &c. 

The  complaint  is  most  commonly  produced  by  the  want  of  proper 
attention  to  appropriate  ventilation  and  temperature,  and  to  cleanli- 


740  DISEASES  OF  INFANCY. 

ness,  as  regards  the  constant  personal  laving  of  the  infant,  but  more 
especially  from  the  suckling-glass,  when  employed,  not  having  been 
carefully  washed  after  use.  Improper  aliment  is  another  of  the 
principal  causes ;  thus  we  find  that  children  who  are  what  is  com- 
monly called  reared  by  the  hand,  either  partially  or  wholly,  are  more 
liable  to  this  affection  than  those  whose  sole  nourishment  has  been 
from  the  breast. 

One  of  the  remedies  in  this  affection,  although  perfectly  homoeo- 
pathic in  its  action,  has  long  been  in  use,  in  its  external  application, 
by  practitioners  of  the  old  school,  namely,  Borax ;  and  a  weak  solution 
applied  to  the  mouth  with  a  brush  has  not  unfrequently  been  found 
efficacious.  Mercurius  is,  however,  still  more  frequently  useful  than 
Borax,  and  especially  when  there  is  much  salivation,  or  the  thrush 
indicates  a  disposition  to  ulceration,  we  may  administer  Mercurius 
solubilis,  one  globule  twice  in  forty-eight  hours,  followed  in  a  few 
days,  if  the  symptoms  do  not  improve,  by  Sulphur,  and  then  Acid* 
sulphuricum,  one  globule  after  a  similar  interval,  if  necessary. 
Natr.  m.  and  Sulph.  are  sometimes  required  after  Merc,  Borax,  or 
Sulph.,  in  protracted  cases.  In  very  bad  cases,  when  the  aphthae 
assume  a  livid,  blue,  or  violet  appearance,  attended  with  excessive 
weakness  and  diarrhoea,  Arsenicum,  one  globule,  is  highly  useful, 
Acidum  nitr.  may  follow  Arsen.  if  the  mouth  and  fauces  become  covered 
wTith  aphthous  ulcerations.  Nux  v.  and  Pulsatilla  are  useful  in  some 
cases  where  there  is  much  acidity  and  excessive  regurgitation  or 
vomiting  of  milk.  (See  Regurgitation  of  Milk,  Acidity, 
Flatulence,  &c.) 

Great  cleanliness  ought  to  be  observed  in  all  cases. 

When  the  disease,  notwithstanding  every  precaution,  frequently 
reappears  in  infants  at  the  breast,  we  may  safely  infer  that  it  arises 
from  some  virus  in  the  constitution  of  the  mother,  or  nurse,  who 
ought  to  be  changed,  or  immediately  put  through  a  proper  course 
of  treatment,  under  the  direction  of  an  experienced  homoeopathic 
practitioner. 


BOWEL  COMPLAINTS.  741 


CONSTIPATION. 

Obstructio  Alvi  Neonatorum, 

This  derangement  generally  appears  in  children  who  are  either 
wholly  or  partially  reared  by  the  hand,  and  also  in  those  whose 
mothers  or  nurses  are  similarly  disposed ;  if  it  arises  from  a  peculiar 
diet  or  want  of  exercise,  such  as  too  much  animal  food,  &c,  on  the 
part  of  the  last  mentioned,  it  may  be  removed  by  a  proper  attention 
to  these  points  ;  but  in  many  instances  it  is  necessary  for  them  also 
to  have  recourse  to  proper  remedial  agents  at  the  same  time  with  the 
infant. 

Therapeutics.  Nux  vomica,  Bryonia  alba,  and  Opium  are  the 
principal  remedies,  and  in  more  obstinate  cases,  Sulphur,  Veratrum 
album,  Lycopodium,  and  Alumina. 

Most  of  the  medicaments  have  been  already  mentioned  under 
Constipation,  (Part  I,)  which  see. 

Dose.  One  globule  of  the  three  first-mentioned  remedies,  every  three 
to  four  days,  until  relief  is  obtained,  or  another  remedy  called  for ;  and 
of  the  last,  the  dose  at  intervals  of  a  week. 

An  enema  of  tepid  water  may  occasionally  be  resorted  to,  if  re- 
quired, or  a  suppository  consisting  of  a  small  slip  of  paper,  or  linen, 
spirally  twisted,  and  lubricated  with  oil,  may  be  introduced  by  a 
gentle  rotatory  movement,  until  the  medicine  has  remedied  the  irre- 
gularity. Rubbing  the  stomach  and  bowels,  frequently  in  the  course 
of  the  day,  with  a  warm  hand,  sometimes  assists  the  other  means 
employed. 


BOWEL  COMPLAINTS  OF  INFANTS. 
Diarrhoea  Neonatorum. 

Diarrhoea,  like  constipation,  is  to  be  regarded  merely  as  a  symptom, 
not  as  a  disease  ;  the  real  disease  here  consists  in  irritation  or  inflam- 


742  DISEASES  OE  INFANCY, 

mation  of  the  mucous  membrane  of  the  intestines,  arising  from  the 
effects  of  aperients,  indigestible  food,  cold,  fright,  &c. 

It  has  already  been  mentioned  (article  Meconium)  that  much 
mischief  is  too  often  occasioned  by  the  deleterious  practice  of  admi- 
nistering laxative  medicines,  and  even  drastic  purgatives,  to  the  tender 
new-born  infant,  for  the  purpose  of  hurriedly  expelling  the  blackish 
green-looking  matter,  technically  known  by  the  name  of  Meconium, 
that  collects  in  the  large  intestine  of  the  foetus  during  the  last  month 
or  two  of  its  uterine  existence.  This  unwarrantable  and  extremely 
reprehensible  conduct  is  frequently  persevered  in,  even  for  some  time 
after  the  expulsion  of  the  first  discharge  has  taken  place,  and  is  in 
many  cases  the  too  evident  cause  of  bowel  complaints  and  other  suffer- 
ings in  infants. 

The  introduction  of  inappropriate,  indigestible  food,  such  as  thick 
gruel,  &c,  into  the  delicate  stomach  of  a  new-born  infant  is  another 
very  frequent  source  of  intestinal  derangement ;  this  unpardonable 
error  is  not  unfrequently  committed  by  ignorant  nurses,  in  order,  as 
they  say,  to  keep  it  from  starving  during  the  few  hours  of  necessary 
repose  to  which  the  mother  is  left  after  delivery. 

This  disturbance  is  moreover  likely  to  be  excited  in  those  cases 
in  which,  either  from  a  deficiency  in  the  secretion  of  milk  or  other 
causes,  it  becomes  requisite  to  administer  supplementary  diet  to 
make  up  for  the  diminished  supply,  and  again  at  the  period  of 
weaning,  when  serious  disturbances  are  occasionally  produced  in  the 
stomach  and  bowels,  from  want  of  proper  attention  and  caution  in  the 
selection  and  administration  of  the  food.  (See  art.  Supplementary 
Diet  of  Infants.) 

Fright  and  exposure  to  cold  are,  as  already  noted,  two  other  most 
frequent  exciting  causes  of  the  disorder. 

Therapeutics.  A  healthy  child  at  the  breast  passes,  on  an 
average,,  from  three  to  six  motions  in  the  twenty-four  hours,  but  in 
some  instances  the  evacuations  are  more  frequent,  while  in  others 
they  are  much  less  so,  yet  without  in  any  degree  affecting  the  health 
of  the  child ;  in  such  cases  then,  little  or  no  interference  ought  to  be 
made,  so  long  as  the  stools  remain  free  from  fcetor,  possessing  merely 
the  slightly  acid  smell  peculiar  to  the  infantile  state,  and  are  evidently 
unattended  with  pain,  or  any  other  abnormal  indication.  When, 
however,  the  stools  become  green  and  watery,  or  yellow  and  watery, 
brown  and  frothy,  or  white  and  frothy,  as  if  fermented,  mixed  with 


BOWEL  COMPLAINTS.  743 

mucus  or  consisting  entirely  of  mucus,  and  emit  an  offensive  odour, 
and  are  generally  preceded  or  accompanied  by  signs  of  suffering,  it 
becomes  imperative  to  have  recourse  to  remedial  aid. 

The  following  are  the  principal  remedies  employed  in  homoeopathic 
practice  against  this  derangement :  Aconitum,  Belladonna,  Chamomilla, 
Rheum,  Pulsatilla,  Ipecacuanha,  and  also  Mercurius,  Nux  vomica,  Arseni- 
cum album,  Sulphur,  Sepi$$  Opium,  and  Veratrum  album. 

When  there  is  inflammation,  the  constitutional  symptoms  are  pretty 
clearly  indicated  by  heat  of  the  surface  of  the  body,  quickness  of  pulse, 
and  rigors ;  in  this  case,  we  must  have  immediate  recourse  to  Aconi- 
tum,  one  globule,  and  follow  it,  if  necessary,  with 

Belladonna,— when  the  more  acute  symptoms  have  been  re- 
moved, but  the  infant  continues  to  suffer  much  and  scream  constantly. 
Lachesis  may  be  preferred  to  Belladonna,  when  constipation  suddenly 
supervenes,  attended  with  swelling  and  apparent  tenderness  to  the 
touch  over  the  entire  abdomen,  but  especially  at  one  particular  spot. 
Mercurius  may  follow  Lachesis,  if  the  symptoms  do  not  yield  to  the 
latter  remedy. 

Chamomilla  is  one  of  the  most  invaluable  remedies  in  the  treat- 
ment of  the  diseases  of  children,  and  particularly  in  bowel-complaints, 
whether  arising  from  acidity,  irritation  caused  by  indigestible  food, 
excited  by  a  chill,  or  occurring  during  teething ;  when  the  following 
symptoms  are  apparent :  redness  of  the  face,  or  of  one  cheek,  hard- 
ness and  tension,  and  fulness  of  the  abdomen,  attended  by  severe 
colic,  which  is  indicated  by  a  state  of  peevishness,  restlessness,  constant 
crying,  and  drawing  up  of  the  legs  towards  the  abdomen,  sickness,  fre- 
quent evacuations,  of  a  bilious,  watery,  slimy,  or  frothy  description,  of 
a  whitish,  yellowish,  or  greenish  colour,  sometimes  bearing  a  resem- 
blance to  beat-up  eggs,  and  of  an  offensive  odour,  similar  to  that  of 
rotten  eggs.  Chamomilla  may  be  preferred  to  Belladonna  after  Aconite 
in  cases  of  inflammation,  when  any  of  the  above  symptoms  present 
themselves.     (See  also  Infantile  Remittent  Fever.) 

Rheum  is  another  remedy  of  great  utility  in  the  treatment  of  this 
affection,  provided  the  disorder  has  not  been  actually  excited  by  fre- 
quent use  of  this  medicine  itself  in  allopathic  doses,  in  which  case  it 
will  be  necessary  to  have  recourse  to  Pulsatilla,  Chamomilla,  or  Mer- 
curius, as  antidotes,  according  to  the  nature  of  the  symptoms.  Bheum 
is  particularly  appropriate  when  acidity  or  bilious  derangement  has 
been  generated  by  indigestion,  or  has  arisen  from  the  prolonged  use 


744  DISEASES  OF  INFANCY. 

of  antacids,  such  as  magnesia,  &c,  and  when  there  are  flatulent  dis- 
tension of  the  abdomen,  colic,  crying,  restlessness,  tenesmus  before 
and  after  the  evacuations,  which  are  either  of  the  consistence  of  pap, 
or  watery  and  somewhat  slimy,  occasionally  of  a  grayish,  or  of  a  brown 
colour,  and  when  a  sour  smell  is  emitted  from  the  body  of  the  infant. 
It  is  sometimes  necessary  to  give  Chamomilla  after  Rheum,  to  com- 
plete the  cure ;  in  other  cases,  and  particularly  those  of  an  obstinate 
character,  Magnesia  c.  is  more  efficacious, 

Pulsatilla  : — Diarrhcea  arising  from  "indigestion"  or  from  a  chill, 
with  watery,  slimy,  whitish,  or  bilious,  greenish-looking  evacuations,  oc- 
curring chiefly  at  night;  want  of  appetite,  fretfulness.  Pulsatilla,  as 
before  stated,  is  also  very  serviceable  in  obstinate  cases,  where  the 
affection  has  been  brought  on  by  the  abuse  of  Rhubarb,  or  by  Rhubarb 
and  Magnesia,  when  the  symptoms  are  as  above  described ;  it  is  further 
often  efficacious  under  similar  conditions,  when  fright  has  been  the 
exciting  cause,  and  Opium  has  not  sufficed,  or  has  been  administered 
too  late  to  procure  relief.     (See  Veratrum.) 

Ipecacuanha  is  particularly  valuable  when  the  diarrhcea  is  ex- 
cited at  the  period  of.  weaning  (weaning-brash),  from  the  sudden  change 
of  food,  which  the  stomach  is  unable  to  digest;  and  when  the  follow- 
ing symptoms  result  in  consequence:  bilious  derangement,  with 
repeated  attacks  of  vomiting,  paleness  of  the  face,  frequent  crying, 
diarrhoea  with  stools  of  a  bilious,  slimy,  or  greenish  yellow,  sometimes 
blackish,  or  streaked  with  blood,  and  of  a  putrid  odour ;  on  other 
occasions,  evacuations  resembling  matter  in  a  state  of fermentation,  or 
containing  substances  like  white  flocks  or  flakes,  followed  by  strain- 
ing. When  this  remedy  is  insufficient  to  effect  a  complete  cure,  we 
should  have  recourse  to  Ptclsatilla,  or  to  Antimonium  crudum,  should 
the  vomiting  not  speedily  subside. 

Mercurius: — This  medicine  will  be  found  very  serviceable  in 
some  cases  where  the  irritation  owes  its  origin  to  the  abuse  of 
aperients,  such  as  Rheum,  &c. ;  or  wrhen  it  has  arisen  from  a  chill. 
The  following  are  the  principal  indications  :  watery,  slimy,  or  bilious 
stools  (sometimes  streaked,  or  mixed  with  blood),  of  a  blackish,  green- 
ish, or  whitish-yellow  colour :  frothy,  or  having  the  appearance  of 
beat-up  eggs ;  attended  with  symptoms  of  severe  colic,  and  fre- 
quently also  severe  tenesmus  and  protrusion  of  the  intestine  ;  diarrhcea, 
with  redness  of  the  whole  body,  as  from  general  excoriation. 

Dulcamara .:—  This  is  an  admirable  remedy  in  derangements  of 
every  description  arising  from  exposure  to  a  cold,  damp  atmosphere ; 


BOWEL  COMPLAINTS.  745 

and  is  Indicated  in  cases  of  diarrhoea  from  this  cause  with  the  follow- 
ing symptoms :  watery,  bilious,  or  slimy  evacuations,  of  a  greenish 
yellow  colour,  and  occurring  chiefly  at  night.  {Merc,  or  Cham,  may 
be  required  to  complete  the  cure  in  some  instances.) 

Nux  vomica  is  very  useful  in  cases  arising  from  a  chill,  or  from 
indigestible  food  at  the  period  of  weaning,  or  earlier;  it  is  also  use- 
ful in  some  cases,  in  which  the  disorder  has  been  created  by  the 
frequent  employment  of  laxative  medicines. 

Its  indications  are :  very  frequent  but  scanty  evacuations  of  watery, 
slimy,  whitish  or  greenish stools,  attended  with  colic  and  tenesmus, 
sometimes  followed  by  protrusion  of  the  intestine ;  extreme  fretful- 
ness.  This  medicine  is  also  of  great  service  in  many  cases  when  the 
diarrhoea  alternates  with  constipation. 

Bryonia  is  a  useful  remedy  in  cases  of  diarrhoea,  which  recur 
whenever  the  weather  becomes  very  wrarm.  {Carlo  v.  has  been  found 
efficacious,  when  only  temporary  benefit  had  resulted  from  Bryonia, 
in  diarrhoea  during  the  heat  of  summer.) 

Arsenicum  : — This  medicine  becomes  indispensable  in  neglected 
cases,  or  in  those  at  an  advanced  stage  of  the  disorder,  when  there  is 
reason  to  fear  that  it  will  terminate  in  marasmus. 

The  following  are  its  characteristic  indications :  watery  or  slimy 
stools,  mostly  profuse,  of  a  greenish,  whitish,  dark,  or  brownish 
colour,  or  of  a  putrid  or  gangrenous  odour,  taking  place  chiefly 
during  the  night,  or  after  drinking  or  partaking  of  any  kind  of  food, 
often  preceded  by  crying  and  restlessness,  and  followed  by  exhaus- 
tion or  tendency  to  faint  in  children  of  a  more  advanced  age;  great 
thirst,  sleeplessness,  paleness  of  the  face,  sunken  cheeks,  and  blue 
circles  round  the  eyes,  enlargement  of  the  abdomen,  with  extreme  weak- 
ness and  excessive  emaciation.  In  diarrhoea  attended  with  vomiting, 
Arsenicum  is  one  of  the  most  valuable  remedies. 

Sulphur  is  an  invaluable  remedy  in  protracted  cases,  or  in  those 
occurring  in  children  who  are  the  offspring  of  delicate  parents, — 
when  there  are  great  weakness,  emaciation,  distension  of  the  abdomen, 
redness  or  soreness  of  the  anus,  and  excoriations  between  the  thighs 
and  adjacent  parts,  or  a  sort  of  miliary  eruption  over  the  whole 
body.  (CalcareaAs  sometimes  required  to  complete  the  cure  after 
Sulphur.)  In  other  cases,  Sepia,  Hepar  s.,  Acid,  sulph.,  Magnesia, 
Graphites,  or  Feratrum  may  be  required.     (See  Diarrhoea,  Part   I.) 

Opium,  as  has  been  stated  in  another  part  of  the  work,*  is  a  most 

*  Vide  Mental  Emotions. 


746  DISEASES  OF  INEANCY. 

valuable  remedy,  when  immediately  employed,  for  averting  the  bad 
results  which  sometimes  arise  in  consequence  of  a  sudden  fright. 
When  convulsions,  with  derangement  in  the  stomach  and  bowels  are 
excited  in  children  by  such  a  cause,  we  ought  to  administer  Opium, 
followed  by  Veratrum,  should  Opium  prove  insufficient,  and  the  vomit- 
ing and  diarrhoea  become  excessive ;  or  we  may  select  a  remedy  from 
amongst  those  above  mentioned,  in  preference,  such  as  Pulsatilla,  &c, 
if  the  symptoms  correspond. 

Against  Diarrhcea  unattended  with  pain  (painless  diarrhoea)  the 
most  useful  remedies  are :  Ferrum,  Ars.,  Lye,  Hyos,,  Phosph.,  Phosph. 
ac,  Stram.- — China,  Sulph.,  Baryta  m.,  Clem.,  Cina,  Nitr.,  Mgs.,  Cham., 
Bella.,  Chel.,  Puis.,  Ban.  lull.,  Bhod.,  Rhus,  Merc.,  Ign.,  Graph.,  Con., 
Calc,  Acid  nitr.,  Op.,  &c. 
Diarrhoea,  stercoral :    Cm.,  Rep.,  Gran.,  Led.,  Ac.  mur.,  Plmmb., 

Mosch.,  Prun.,  Spig.,  &c. 
Diarrhoea  arising  from  acids  (acid  food,  fruit,  lemon-juice,  &c.) : 

Lachesis* — Arsenicum,  Pulsatilla. 
Diarrhoea  after  exposure  to  cold  :  Merc,  Cham.,  Bulc,  Bry.,  Bella., 

Nux  moschata. — Puis.,  Nux  v*,  Sulph.,  Veratr.,  &c. 
Diarrhcea  which  manifests  itself  on  exposure  to  the  cool,  fresh  air 

of  the  evening :  Mercurius. 
Diarrhcea  which    manifests    itself   in   damp  weather :    Lachesis 

Rhododendron. 
Diarrhcea  which  manifests  itself  day  and  night :  Sulphur. 

—  — -  after  drinking :  Ars.,  Cina. 

—  -—in  the  evening  :  Lachesis,  Kali  c 

—  — -  after  eating   (after  a  meal)   Ars., 
Col.,  Bry.,  China,  Lach.,  Am.  m..  Rheum,  Bor.,  Per.  mg.,  Veratr. 

Diarrhcea  which  occurs  after  eating  and  drinking:  Bry.,  Ars.,  Bhus. 

—  — -        eating  fruit :  Lach,  China,  Bhod.,  Cist. 
Ars.,  Puis, 

Diarrhcea   which  occurs  after  drinking  milk:    Bry.,  Lye,  Sepia, 

Sulph.,  Natrum. 
Diarrhcea  which  takes  place  in  the  morning :  Bry.,  Caps.,  &c, 

—  —         at  night :   Ars.,    Puis.,  Merc,   China, 
Cham.,  Mosehus,  Sulph.,  &c. 

Diarrhcea  which  takes  place  (during  sleep)  :    Puis.,  Am.,  Rhus, 

Mosch.,  &c. 
Diarrhcea  which  occurs  during  warm  weather :  Bry.,  Lach. 


BOWEL  COMPLAINTS.  747 


Concomitant  Symptoms. 

Diarrhcea  attended  with  distension   of  the  abdomen  (flatulent)  : 

Veratr.,  Colch.,  Sulph.,  Graph.,  &e. 
Diarrhcea  attended  with  distension  of  the  anus,  pain  (burning)  in 

the :  Merc,  Puis. — Lack.,  Veratr.,  &c. 
Diarrhoea  attended  with  excoriation  of  the  anus  :    Cham.,  Merc, 

Sulph.,  Ferr.,  Sass. 
Diarrhcea  attended  with  loss  of  appetite  :  Niece  mosch, — Antim.  c, 

Puis.,  &c. 
Diarrhcea,  attended  with  pains  in  the  back :  Ferrum. 

—  —  cephalalgia:  Rhus  to®. 

—  —  coldness :  Spig.,  &c. 

—  _  Colic :  Ars.,  Merc,  Fids.,  Cham,,  Nm  v., 
Veratr.,  Ipec,  Bry.,  Bheum,  Jalap,  Bhus,  Bat.,  Sulph.,  CantL,Baryt.  c9 
Ant.,  Agar.,  Fetr.,  &c. 

Diarrhcea,  attended  with  crying  or  screaming  (in  the  case  of  chil- 
dren) :  Cham.,  Ipec. — Bheum,  Jalap,  Sen.,  Carb.  v.,  Sulph. 
Diarrhcea  attended  with  dyspncea :  Sulphur. 

—  —  eructations  :  Merc,  Con.,  Bulc,  &c. 

—  —  flatulency  :  Ferrum  mg.,  &c. 

—  —  pains  in  the  limbs  ;  Bhus,  Ammon.  m. 

—  —  lassitude,  debility  :  Ipec,  Ays.,  Veratr. % 
Kali,  Ferr*  mg. 

Diarrhcea  attended  with  nausea  :  Merc,  Ipecac,  Ars.,  Bach,,  Bella., 

Gran.,  Hell. 
Diarrhcea  attended  with  cold  perspiration  on  the  face  :    Merc, 

Veratr. 
Diarrhcea  attended  with  pains  in  the  rectum  :  Alum. 

—  —  shivering:  Merc,  Puis.,  Sulph,,  Veratr., 
Cast.,  Cop.,  Big. 

Diarrhcea  attended  with  shuddering  :  Merc,  Puis.,  Veratr.,  Shewn,. 

—  —  inclination  to  sleep :  Nux  mosch. 

—  —  tenesmus:  Merc,  Bach.,  Ars.,  Nux  v.,  Ahm. 
— •                 —               thirst :  Ars.,  Magn.  s.,  Bulc 

—  —  tremor:  Merc 

—  —  vomiting :  Ipec,  Ars.,  V#ratr.~r-Cup.,  Tart., 
Bheum,  Lach.,  Ant.,  Phosph.,  &c. 


748  DISEASES  OF -INFANCY. 


Colour  of  the  Faces. 

Ash-coloured:  Digitalis  purpurea,  Asarum  europcmm. 

Black,  or  very  dark :  Ars.,  Ipec,  China,  Veratr.,  Camph.,  Ac.  sulph. 

Brownish :  Ars.,  Rheum,  Veratr.,  Camph.,  Merc,  c,  Dulc,  Sulph.,  Magn. 

m.,  Tart.,  Sec. 
Clay-coloured :  Calcarea  carlonica,  Hepar  sulphuris,  Petroselinum,  Dig., 

Puis.,  Sulph.,  &c. 
Frothy:  Lach.,  Rhus,  Calc,  Coloc,  Merc. — Iod.  mag.,  Natr.  s.,  Sulph* 

ac,  Op. 
Grayish  :  Digitalis,  Merc,  Phosph.,  Rheum,  Ac.  phosph.,  Asar. 
Greenish :  Chamomilla,  Puis.,  Arsenicum,  Mercurius,  Sulphur,  Phosph., 

Veratrum. — Bella.,  Ipecac,  Hep.,  Nux  v.,  Magn.  m.,  Sep.,  &c. 
Pale :  Lycopodium,  Carbo  vegetabilis. 
Whitish :  Pulsatilla,  Sulphur,  China,  Digitalis,  Chamomilla,  Hepar,  Colch., 

Ign.,  Aeon. — Nux  v.,  Merc,  Rhus,  Ars.,  Calc,  &c. 
Yellowish  :  Chamomilla,  Mercurius,  Puis.,  Ipecac,  Ars.,  Phosph.,  Tart., 

Calc,  Magn.  m.,  Coloc,  China,  Sec. 

Nature  of  the  Ahine  Discharge. 

Acrid  (producing  excoriation  of  the  anus)  :  Merc,  Ars.,  Lach.,  Cham., 
Puis.,  China,  Ign.,  Veratr. — Ferr.,  Sass.,  Lach.,  Staph.,  Sulph.)  Kali, 
Phosph.,  Graph.,  Nux  v.,  &c. 

Bilious :  Pulsatilla,  Chamomilla,  Ipecac,  Veratr. — Merc,  Nux  v.,  Dulc, 
Ars.,  Oleand.,  China — Bism.,  Coloc,  Sulph. 

Ingesta  containing  (lienteria) :  China,  Ferrum,  Oleander. — Ars.,  Bry., 
Men.,  Phosph.,  Phosph,  ac. — Ant.  c,  Am.,  Asar.,  Bar.,  Calc,  Can., 
Nitri.  ac,  Rheum,  Rhus,  Sil.,  Sulph.  ac. 

Gelatinous:  Colch.,  Hell.,  Rhus,  Sep. 

Membranes^  (containing  portions  of  false) :  Cantharis,  Colchicum, 
Sepia. 

Mucous :  Pulsatilla,  Capsicum,  Chamomilla,  Borax,  Nux  vomica,  Phos- 
phorus, Sulphur  asarum,  Am.,  Ars.,  Carl,  v.,  Coloc,  Graph.,  Hell.,  Ipec, 
Kali,  Magn.  m.,Merc,  Petr.,  Rheum,  Rhus,  Sep. — Ant.  c,  Canth.,  China, 
Colch.,  Hep.,  Hyos.,  Ign.,  Iod.,  Led.,  Natr.,  Nitr.  ac,  Phosph.  ac,  Salad., 
Salin.,  Stann.,  Veratr.,  Viol,  tr.,  Sec. 

Pitch,  or  tar,  resembling :  Lachesis,  Ipecacuanha,  Mercurius,  Nux 
vomica. 


BOWEL  COMPLAINT.  749 

Purulent :  Mercurius,  Silicea.—Puls.,  Sulph.,  Canth.,  Am.,  Lye— Col., 
Kali,  China,  Bella.,  Cocc,  Sep.,  &c. 

Sanguineous  :  Mercurius,  Cantharis,  Nux  vomica,  Pulsatilla,  Ipecacuanha, 
Sepia,  Sulphur. — Am.,  Ars.,  Asar.,  Bry.,  Cole,  Caps.,  Carlo  v.,  China, 
Bros.,  Ferr.,  Led.,  Lye,  Nitr.  ac,  Phosph.,  Rhus,  Sahin.,  Sil. — Alum., 
Amm.,  Ant.  c,  Bella.,  Cham.,  Coloc,  Con.,  Croc,  Cupr.,  Bute,  Graph., 
Hep.,  Hyos.,  Magn.  m.,  Mur.  ac,  Natr.,  Natr.  m.,  Sabad.,  Sec  com., 
Selen.,  Stram.,  Sulph.  ac,  Zincum,  &c. 

Viscous,  glutinous :  Mercurius,  Asar.,  Sassap.,  Hell.,  Nux  v.,  Plumb., 
Ars.,  Cole,  Carb.  v.,  Hep.,  Kali,  Mezer.,  Natr.,  Veratr. 

Watery :  Ars.,  Puis.,  China,  Lach.,  Cham.,  Rhus,  Ferr.,  Hyos.,  Sec,  Nux  v.* 
Ant.,  Ipecac,  Phosph.,  &c. 

Smell  of  the  Alvine  Evacuations. 
Acid  :1  Rheum,  Mercurius,  Sulph.,   Cale,    Graph.,  Natr. — Cham.,  Am., 

Hep.,  Sep.,  Magn.,  Phosph.,  &c. 
Cadaverous:  Bismuthum. 
Mouldy:  Colocynthis. 
Eggs,  rotten,  resembling :  Chamomilla. 
Fetid,    putrid :    Ars.,  Carb.  v.,  Ass.,  Puis.,  Sil.,  Sulph. — Am.,  Bry., 

Aur.,  Bor.,  Cale,  Cham.,  China,  Graph.,  Nitr.  ac,  Nux  v.,  01.,  Plumb., 

Scill.,  Stram.,  Phosph.  ac,  Carb.  a.,  Bule,  Mgs.,  Lach.,  Mar.,  Asar., 

Ant.  tart.,  Iod.,  Sep.,  &c. 
Involuntary  discharge  of  faeces:  Phosph.  ac,  Phosph.,  Veratr. — Ars., 

Bella.,  Muriat.  ac,  Natr.  m.,  Sulph. — Rhus,  Bry.,  Lach.,  China,  Nux  v., 

Am.,  Op.,  Sec  com.,  Staph.,  Hyos.,  Colch.,  Big.,  Hell.,  Merc,  Laur., 

Puis.,  Sep.,  Zincum,  &c. 
When  urinating :  Ac  mur. 
When  expelling  flatus :  Ferr.  mag. 
When  sleeping :  Rhus.,  Puis.,  Am.,  Moschus,  &c. 

In  Coma  occurring  in  children  from  the  depleting  effects  of  neg- 
lected or  protracted  diarrhoea,  China  and  Arsenicum  in  alternation  are 
of  considerable  efficacy.  Supplementary  nourishment  ought  at  the 
same  time  to  be  given  in  the  case  of  infants  at  the  breast ;  and  diet 
of  a  nutritive  quality  to  children  of  more  advanced  age. 

Diet.  When  the  derangement  can  be  traced  to  any  particular 
kind  of  food,  an  alteration  in  the  diet  becomes  imperative ;  at  the 
same  time  the  quantity  of  food  or  drinks  must  be  diminished,  until 
improvement  sets  in. 


750  DISEASES  OF  INFANCY. 


EXCORIATIONS. 

Excoriationes  Neonatorum.    Intertrigo. 

Against  this  affection  cleanliness  is  the  best  preventive ;  however, 
we  frequently  find  it  proceed  to  such  an  extent  as  to  require  the  aid 
of  medicine  for  its  removal. 

Chamomilla  will  be  found,  in  most  instances,  speedily  effective, 
when  we  are  certain  the  disease  is  not  the  medicinal  result  of  cha- 
momile-tea  taken  by  the  nurse  or  child,  in  which  case  Ignatia, 
Pulsatilla,  Borax,  or  Carbo  vegetabilis,  have  been  recom- 
mended to  be  given. 

Mercurius: — When  a  yellow  colour  of  the  skin  is  present, 
which  Chamomilla  has  not  removed,  and  when  the  excoriation  is 
extensive  and  severe.  In  very  obstinate  cases  we  may  have  recourse 
to  Carbo  v.,  followed  in  four  to  six  days  by  Tinctura  sulpkuris; 
Graphites,  lycqpodium,  Acidum  suVphurieum,  Silicea,  and  Sepia,  are  also 
useful  in  this  malady. 


JAUNDICE. 

Icterus  Neonatorum. 

This  disease,  as  we  have  before  observed,  frequently  takes  its  rise  from 
the  mischievous  practice  of  administering  aperients  immediately  after 
birth ;  exposure  to  cold  is  also  one  of  its  exciting  causes. 

When  it  has  arisen  from  the  latter  cause,  and  when  there  is,  toge- 
ther with  the  distinguishing  characteristic  of  the  disease — a  yellow 
hue  of  the  skin — considerable  distension  of  the  stomach,  the  admi- 
nistration of  Chamomilla  will  be  found  prompt  in  affording  relief. 
Mermrius  may,  in  many  cases,  follow  this  remedy,  if  it  has  only  par- 
tially relieved ;  after  which,  if  any  symptoms  still  remain,  we  may 
exhibit  Cinchona. 

N'ux  vomica,  when  the  complaint  is  combined  with  costiveness, 
and  the  little  patient  appears  generally  of  an  irritable  temper. 

For  more  particular'  indications  for  the  medicines  above  given,  and 
further  information,  see  article  Jaundice,  in  Part  I  of  this  work. 


INDURATION  OF  THE  CELLULAR  TISSUE.  751 


INDURATION  OF  THE  CELLULAR  TISSUE.    INFANTILE  ERYSIPELAS. 

Erysipelas  Infantum. 

Symptoms.  Fever  with  red  spots,  generally  appearing  first  upon 
the  nates,  but  sometimes  on  the  extremities,  afterwards  upon  the 
abdomen  and  genital  organs,  accompanied  with  induration  of  the 
skin  and  even  of  the  maxillary  muscles,  which  prevents  the  child 
from  uttering  other  than  a  dull  sound ;  the  skin  at  last  becomes  as 
dry  and  hard  as  parchment.  Sometimes,  instead  of  fever,  the  indu- 
ration is  accompanied  with  cold. 

This  affection  generally  presents  itself  in  the  first  two  months  of 
infancy;  its  duration  is  from  four  to  fourteen  days,  and  if  not 
promptly  treated,  it  is  generally  fatal. 

Therapeutics.  The  remedies  principally  required  in  this  affec- 
tion are  Aconitum,  Belladonna ,  Uhus  toxicodendron,  Arsenicum  album, 
LacJiesis  and  Sulphur. 

Aconitum  : — At  the  commencement,  when  fever  is  present. 

Belladonna  may  follow  the  exhibition  of  Aconitum,  particularly 
when  the  spots  present  an  erysipelatous  appearance. 

Rhus  toxicodendron,  if  the  appearance  of  the  skin  exhibits  a 
vesicular  character.  (In  some  cases  Belladonna  and  Rhus  alternately 
may  be  found  necessary.) 

Arsenicum,  should  the  dryness  and  hardness  of  the  skin  remain 
undiminished,  or  become  increased;  should  we  also  find  rejection  of 
food  from  the  stomach,  evacuations  green,  watery,  acrid,  and  very 
offensive;  moreover,  when  there  is  a  tendency  to  gangrene,  with 
livid  spots  and  vesications,  and  when  the  scrotum  is  especially 
affected. 

Lachesis  may,  in  some  cases,  be  called  for  after  Belladonna,  when 
that  remedy  does  not  appear  sufficient  to  combat  the  malady ;  or  it 
may   sometimes  be  advantageously  exhibited  in  alternation  with 


When  the  joints,  particularly  the  knee  of  ankle,  are  the  principal 
seat  of  the  disease,  and  the  bowels  are  in  a  very  costive  state,  Nux  v. 
is  useful. 

Sulphur  may  be  usefully  employed  against  the  sequelae  of  this 
affection,  such  as  torpidity  of  the  intestines^  and  is  also  indicated 


752  DISEASES  OF  INFANCY. 

where  we  have  reason  to  suspect  some  constitutional  taint.     Silicea, 
Graphites,  Hepar  s.,  or  Clematis,  may  also  prove  useful. 

The  body,  during  this  disease,  must  be  kept  as  dry  as  possible,  and 
lint  applied  to  the  parts  affected;  when  practicable,  the  infant's  only 
nourishment  should  be  from  the  breast,  to  which  it  should  be  fre- 
quently applied,  but  only  allowed  to  suck  little  at  a  time. 


LOCK-JAW  OF  INFANTS. 

Trismus  Nascentium. 

This  serious  and,  under  the  old  mode  of  treatment,  so  generally 
fatal  disease,  usually  occurs  in  the  first  few  days  of  infant  life ;  at 
first  the  child  vainly  attempts  to  suck,  and  even  if  it  succeed,  the 
milk  is  returned.  On  examination,  from  stiffness  of  the  masticator 
muscle,  the  lowTer  jaw  cannot  be  depressed — the  jaws  gradually  close, 
the  whole  frame  becomes  rigid,  and  death  ensues. 

The  duration  of  the  malady  is  from  two  to  four  days. 

Causes.  Foul  air ;  vitiated  milk  ;  taking  cold ;  and  local  irrita- 
tion, for  example,  the  umbilical  cord  being  too  tightly  tied. 

Therapeutics.  We  must  in  the  first  place  remove  the  causes 
where  known.  When  local  irritation  has  given  rise  to  the  attack, 
Arnica  ought  to  be  immediately  given  internally ;  at  the  same  time 
the  seat  of  the  injury  may  be  bathed  once  or  twice  with  a  weak  ami- 
cated  lotion,  a  few  drops  of  the  tincture  to  a  wineglassful  of  water. 
When  we  can  trace  the  originating  cause  to  a  bad  state  of  the  milk, 
Lachesis  may  be  first  prescribed,  followed  by  Belladonna  (which, 
it  may  be  observed,  is  to  be  held  as  a  most  important  remedy  in  all 
cases  where  the  affection  cannot  be  assigned  to  any  particular  cause), 
if  no  signs  of  improvement  transpire  after  the  first  or  second  dose. 
Mercurius  may  also  prove  useful  in  similar  cases.  If  cold  or 
sudden  chill  has  evidently  given  rise  to  the  disorder,  Chamomilla  may 
first  be  administered,  and  then  Belladonna,  if  required ;  or  Nux  v.  may 
be  given,  in  preference  to  Ghamomilla,  when  catarrhal  symptoms  are 
present  and  indicate  that  remedy  especially.  (See  Cold  in  the 
Head,  Parts  I  and  II.)  Hyoscyamus, — or  Belladonna,  Lachesis  and 
Hyoscyamus  in  alternation,  may  be  found  useful  in  some  cases.  (See 
also  Trismus  and  Tetanus,  Part  I.) 


DERANGEMENTS  DURING  TEETHING.  753 


HEAT  SPOTS. 


New-born  infants  and  young  children  are  often  affected  with  an 
eruption  consisting  of  small  vesicles  filled  with  a  pellucid  or  slightly- 
tinged  fluid,  surrounded  by  an  inflamed  base.  When  the  vesicles 
break,  they  generally  form  into  thin  incrustations,  but  sometimes 
the  parts  are  inclined  to  ulcerate.  The  eruption  is  commonly  at- 
tended, especially  at  the  outset,  by  more  or  less  fever,  and  is  occa- 
sionally ushered  in  by  sickness  and  languor.  .  The  duration  of  the 
affection  is  uncertain;  and  it  is  prone  to  return  again  soon  after 
receding.  A  hot  state  of  the  atmosphere,  or  confinement  to  a  close, 
warm  apartment,  and  an  excess  of  clothing,  appear  to  favour  the 
development  of  the  eruption. 

The  daily  use  of  the  bath,  with  proper  attention  to  ventilation  and 
clothing,  are  sufficient  to  remove  the  disorder  in  a  few  days  in  trivial 
cases ;  but  when  there  is  considerable  fever,  restlessness  and  sleep- 
lessness, a  globule  of  Aconite  may  be  dissolved  in  three  teaspoonfuls 
of  water,  and  a  teaspoonful  given  every  twelve  hours.  Rhus,  one 
globule,  may  follow  Aconite  after  an  interval  of  twelve  to  twenty-four 
hours,  when  the  eruption  is  extensive.  Should  the  affection  continue 
to  spread,  and  the  vesicles  increase  in  size,  notwithstanding  the 
employment  of  these  remedies,  Sulph,,  one  globule,  may  be  adminis- 
tered, and  then  again  Aconitnm  if  renewed  irritation  succeed  the 
exhibition  of  the  former. 

Chamomilla  and  Bryonia  are  also  useful  in  some  instances ;  the  first 
named  especially  when  the  restlessness  does  not  yield  to  Aconite,  and 
the  child  is  fretful  and  much  excited;  the  latter  when  it  is  peevish 
and  sleepless,  yet  seems  languid,  and  cannot  bear  to  be  moved. 


DERANGEMENTS  DURING  TEETHING. 

About  the  fifth  or  sixth  month,  as  already  stated,  the  teeth  gene- 
rally begin  to  protrude.  Under  a  proper  system  of  treatment,  if  due 
attention  has  been  paid  to  the  rules  for  exercise  and  diet  which  we 

48 


754  DISEASES  OE  INFANCY. 

have  already  laid  down,  and  the  child  is  free  from  any  constitutional 
infirmity,  we  may  safely  calculate  upon  the  period  of  dentition  being 
exempt  from  much  suffering. 

Broths  and  jellies  should,  during  the  acute  stages,  be  wholly  pro- 
hibited, and  if  the  infant  take  other  nourishment  than  the  breast,  its 
food  should  be  of  the  lightest  and  simplest  description.  The  mother 
or  nurse  should  also  pay  particular  regard  to  her  regimen,  and  avoid 
all  substances  of  a  stimulating  and  indigestible  nature.  Here,  again, 
we  may  remark,  that  the  indulgence  in  vinous  or  fermented  liquors  is,, 
from  their  irritating  properties,  one  of  the  most  frequent  causes  of 
the  suffering  of  children  during  this  period. 

During  dentition  there  is  always  a  tendency  of  blood  to  the  head, 
which  from  simple  irritation  may,  if  not  quickly  checked,  terminate 
in  inflammation  of  the  brain ;  the  best  preventive  against  this  affec- 
tion is  keeping  the  head  perfectly  cool. 

In  order,  as  much  as  possible,  to  allay  the  anxiety  of  parents,  who 
may  be  led  to  mistake  the  natural  symptoms  attendant  upon  dentition 
for  those  of  disease,  we  shall  in  the  first  instance  briefly  enumerate 
those  which  frequently  take  place  in  healthy  children,  and  may  be  safely 
left  to  Nature ;  and  afterwards  proceed  to  point  out  in  what  cases, 
from  any  of  the  symptoms  diverging  from  the  usual  track,  it  may  be 
necessary  to  have  recourse  to  medicines,  or  to  call  in  the  assistance  of 
the  physician. 

During  the  teething,  the  child  is  more  restless  than  usual,  espe- 
cially at  night ;  has  flushes  of  heat,  alternating  with  paleness ;  the 
gums  gradually  swell  and  become  hot;  it  evinces  a  difficulty  in 
sucking,  sometimes  Forcibly  bites,  and  frequently  lets  go  the  nipple; 
it  drivels  at  the  mouth,  and  its  bowels  become  relaxed ;  the  two  latter 
symptoms  may,  in  some  measure,  be  looked  upon  as  a  wise  precau- 
tionary measure  of  Nature,  to  prevent  a  congestion  to  the  head  and 
lungs,  to  which  all  children  are  at  this  time  more  or  less  disposed  ; 
and  the  sudden  cessation  of  either,  after  having  once  set  in,  is  a  sign 
of  a  derangement  of  functions,  demanding  prompt  attention. 

Therapeutics.      The  medicines  most  generally  required  are, 

Coffea,  Ckamomilla,  Nux  vomica,  Belladonna,  Cuprum  aceticum,  Kali  nitri- 
cum,  and  Calcarea  carhonica. 

When  the  child  is  in  an  excited  state,  and  unable  to  sleep,  irritable, 
liable  to  start,  and  difficult  to  soothe,  Coffea  may  be  administered;  if 
the   symptoms   remain   without  alteration,  we  may  have  recourse 


DERANGEMENTS  DURING  TEETHING.  755 

to  Aconitmn.  When  benefit  results  from  either  one  or  the  other  re- 
medy, the  dose  must  only  be  repeated  in  the  event  of  a  threatening 
relapse. 

Chamomilla  may  be  given  after  the  foregoing  remedies,  when 
they  are  merely  productive  of  partial  relief;  or  it  may  be  given  in 
preference  thereto,  if  the  following  symptoms  are  encountered  : 
extreme  excitability ;  the  infant  starts  at  the  slightest  noise ;  evinces 
great  thirst;  spasmodic  twitches  or  convulsions  in  the  limbs,  during 
sleep :  short,  quick,  and  loud  respirations,  sometimes  with  a  hacking 
cough ;  excessive  diarrhoea,  with  green,  whitish,  or  watery  evacuations ; 
and  especially  when  the  mother  has  been  in  the  habit  of  taking  coffee, 
which  we  have  already  so  strongly  reprobated  as  an  article  of  diet  to 
women  nursing.  Mercurius  and  Sulphur  are  sometimes  requisite  after 
Cliamomilla  against  the  diarrhoea.     (See  Diarrhcea.) 

When  in  the  assemblage  of  these  symptoms,  constipation  takes  the 
place  of  diarrhoea,  wre  may  prescribe  Nux  vomica. 

When  strong  symptoms  of  cerebral  irritation  set  in,  we  should 
have  instant  recourse  to  Belladonna,  or 

Cuprum  [aceticum  :  when  marked  cerebral  sensibility  declares 
itself,  and  the  child  almost  spasmodically  clenches  the  spoon  or  cup 
with  its  gums  when  drinking. 

Zincum  is  strongly  recommended  by  Dr.  Elb,  of  Dresden,  in 
apparently  hopeless  cases,  with  symptoms  of  incipient  paralysis  of  the 
brain,  such  as  sopor,  half-closed  eyes,  or  motionless  eyes  with  insen- 
sible pupil ;  loss  of  consciousness ;  moaning ;  icy  coldness  of  the 
whole  body,  and  bluish  colour  of  the  skin;  pulse  nearly  imper- 
ceptible; respiration  interrupted. 

Dose.  Gr.  ss.  every  two  hours,  until  the  temperature  of  the  skin  in- 
creases, and  consciousness  returns,  upon  which  the  intervals  between  the 
doses  may  be  lengthened  ;  but  if  some  other  remedy,  as  Belladonna  for 
instance,  should  be  called  for  by  the  nature  of  some  of  the  remaining 
symptoms,  it  ought  to  be  given  in  alternation  with  Zincum,  until  all 
signs  of  danger  are  removed. 

When  the  irritation  seems  to  arise  from  difficulty  of  teething,  we  may 
administer  Calcarea,  and  repeat  it  every  eight  days  for  about  a 
month,  which  will  materially  assist  the  protrusion  of  the  teeth. 
Kali  nitrieum  is  a  useful  remedy  when  inflammatory  symptoms  set  in 
during  dentition. 

When  obstinate  constipation  is  present,  see  that  article  in  this  part 


756  DISEASES  OF  INFANCY. 

of  the  work.  (See  also  Convulsions  in  Children  where  ad- 
ditional indications  will  be  found  for  the  selection  of  Belladonna, 
Chamomilla,  and  other  remedies  which  are  frequently  required  in  fever 
and  other  derangements  during  teething.) 


CONVULSIONS  IN  CHILDREN. 

Early  childhood  is,  from  various  causes,  peculiarly  predisposed 
to  this  distressing  malady.  Convulsions  generally  arise  from  the 
anatomical  and  physical  peculiarities  of  infancy,  in  the  preponderance 
of  the  nervous  and  cerebral  systems  over  the  other  parts  of  the  frame ; 
hereditary  predisposition  called  into  activity  by  dentition — repelled 
eruptions,  irritating  substances  in  the  stomach,  intestinal  worms, 
mechanical  injuries,  fright,  and  lastly,  from  some  occult  cause,  fre- 
quently a  derangement  of  the  organic  structure,  in  many  instances 
bidding  defiance  to  the  powers  of  medicine.  When  no  physician  or 
medicines  are  at  hand,  and  the  danger  is  imminent,  we  may,  in  the 
first  place,  recommend  immersing  the  lower  extremities  up  to  the 
knees  in  water,  as  hot  as  can  be  borne  with  safety  to  the  infant, 
for  the  space  of  eight  or  ten  minutes,  until  the  paroxysms  seem  in 
a  measure  subdued;  after  which  the  child  should  be  wiped  perfectly 
dry,  and  placed  in  a  warm  wrapper;  if  the  first  immersion  be  followed 
by  no  relief,  it  should  be  repeated,  at  the  same  time  we  may  pour 
a  small  stream  of  cold  water  upon  the  crown  of  the  head,  until 
reanimation  becomes  apparent ;  when  the  child  ought  again  to  be 
warmly  covered  up ;  this  course,  frequently  repeated,  has  been  found 
to  restore  children,  although  the  prior  attempts  have  proved  inefficient 
— when  improper  food  or  foreign  substances  in  the  stomach  or 
intestines  are  the  causes,  lavements  of  equal  parts  of  sweet  oil  and 
warm  milk  should  precede  the  foot-bath  ;*  if  homoeopathic  medicines 
be  not  immediately  at  hand,  the  careful  administration  of  Camphor 
by  olfaction,  or  a  drop  or  two  of  the  tincture,  considerably  diluted, 
placed  on  the  tongue,  will  frequently  be  found  efficacious  in  giving 
relief,  awaiting  the  arrival  of  a  physician. 

*  Some  useful  remarks  upon  this  subject  may  be  found  in  the  '  Homceopathic  Exa- 
miner' (published  in  New  York,  vol.  i,  No.  2). 


CONVULSIONS  IN  CHILDREN.  757 

Therapeutics.  Chamomilla,  Belladonna,  Ignatia  amaras,  Cina, 
Mercurius,  Cicuta  virosa,  Arsenicum,  Bryonia,  Sulphur,  Nux  vomica,  Bui- 
satilla,  Arnica,  Opium,  Stramonium,  Secale  cornutum,  and  Hyoscyamus, 
form  the  most  important  remedies  in  the  majority  of  cases.* 

Among  these  Chamomilla  stands  in  the  first  rank,  particularly  in 
very  young  children,  when  the  convulsions  have  been  excited  by 
dentition,  as  well  as  for  children  who  have  passed  that  period,  who 
are  of  a  nervo-sanguine  temperament,  extremely  sensitive  and  peevish,  or 
when  the  attacks  have  been  excited  by  fever,  colic,  or  chill,  or  a  fit 
of  passion  or  vexation.  The  characteristic  indications  for  its  employ- 
ment are,  restlessness,  fretfulness,  and  disposition  to  drowsiness  when 
awake ;  one  cheek  red,  the  other  pale,  diarrhoea ;  (if  this  remedy  be 
exhibited  at  this  stage  of  the  disorder,  it  will  frequently  prevent  the 
fit  from  becoming  fully  developed ;)  eyes  half  closed ;  great  thirst ; 
quick  and  loud  breathing ;  rattling  in  the  throat ;  moaning ;  cessation 
of  consciousness ;  twitches  of  the  eyelids  and  muscles  of  the  face ; 
contortion  of  the  eyeballs,  jerks  and  convulsions  of  the  limbs,  with 
clenched  thumbs ;  constant  rolling  of  the  head  from  side  to  side ;  loss 
of  .consciousness.  (Belladonna  may  be  exhibited  after  Chamomilla, 
should  this  fail  to  do  much  good.) 

Dose.  We  may,  for  very  young  children,  prescribe  one  globule  in 
four  teaspoonfuls  of  water,  one  teaspoonful  to  be  given  at  the  commence- 
ment of  the  attack ;  if  fresh  paroxysms  come  on  some  hours  after,  but 
decreased  in  intensity,  we  ought  not  to  repeat  the  remedy,  but  allow  it 
to  exhaust  its  action ;  if  the  convulsions  increase,  on  a  second  or  third 
attack,  we  may  give  another  spoonful ;  unless  other  symptoms  declaring 
themselves,  intimate  that  we  ought  to  have  recourse  to  any  other  of  the 
under-mentioned  medicaments. 

Belladonna  : — Besides  being  useful  in  cases  of  suppressed  erup- 
tions, is  more  particularly  indicated  when  the  child  starts  suddenly, 
when  asleep,  or  stares  about  wildly;  the  pupils  are  much  dilated;  the 
body  or  individual  members  become  rigid ;  the  forehead  and  hands 
dry  and  burning ;  occasionally  followed  by  clenching  of  the  hands ; 
involuntary  micturition  after  returning  to  consciousness  ;  the  slightest 
touch  will  sometimes  provoke  a  renewal  of  the  attack.  This  medicine 
is  also  indicated  when  the  paroxysms  are  preceded  by  smiles  or  laughter*. 

*  It  may  be  remarked,  that  in  plethoric,  well-nourished  children,  great  advantage  will 
frequently  be  derived  from  administering  a  dose  of  Aconite  prior  to  any  of  the  other 
remedies. 


758  DISEASES  OF  INFANCY. 

It  is  frequently  found  that  Chamomitta  and  Belladonna  answer  in 
alternation,  and  that  when  one  has  alleviated  the  evil,  the  other,  some- 
times followed  by  the  one  first  administered,  will  dissipate  the  remain- 
ing symptoms. 

In  cases  that  withstand  the  exhibition  of  these  two  remedies,  par- 
ticularly during  dentition,  we  frequently  find  Ignatia  successful^ 
more  especially  in  children  that  appear  of  a  melancholy  temperament, 
or  in  pale,  delicate  infants,  of  peevish  dispositions,  with  alternations 
of  vivacity  and  sadness,  and  laughing  and  crying  almost  in  the  same 
breath. 

The  characteristic  symptoms  are :  the  infant,  while  reposing  in  a 
moaning,  light  slumber,  becomes  suddenly  flushed  with  burning  heat, 
awakes,  and  springs  with  a  convulsive  start,  and  the  utmost  soothing 
scarcely  quiets  the  excitement ;  a  tremor  of  the  entire  body,  attended  by 
violent  crying  and  agonising  shrieks ;  and  the  muscles  of  single  limbs 
seem  convulsed.  Ignatia  is  further  indicated  when  the  fit  returns 
every  day  at  a  regular  hour,  followed  by  fever  and  perspiration,  or  every 
other  day  at  variable  hours.  (In  other  instances  Belladonna  will  be 
found  requisite  after  Ignatia!) 

Ipecacuanha  is  useful  when  great  difficulty  of  breathing,  nausea, 
aversion  to  food,  and  vomiting,  either  precede,  accompany,  or  follow 
the  attacks ;  and  when  the  child  has  a  constant  inclination  to  remain 
in  the  recumbent  posture. 

Cina  is  useful,  particularly  during  the  second  teething,  for  children 
of  a  melancholy  temperament,  scrofulous  constitution,  and  who  are 
troubled  with  worms,  or  habitually  wet  the  bed ;  the  characteristic 
symptoms  are  :  spasms,  commencing  with  constriction  of  the  breast, 
followed  by  stiffness  of  limbs,  pallor,  and  rigidity  of  the  whole  frame. 

Mercurius  is  useful  in  spasms  which  are  caused  by  the  presence 
of  worms :  the  stomach  is  swollen  and  hard  before,  during,  and  after  the 
fit;  the  child  is  attacked  with  painful  eructation,  and  a  species  of 
salivation ;  the  limbs  tossed  and  convulsed,  attended  by  fever  and 
moist  skin;  after  the  paroxysms,  the  child  lies  for  a  long  time 
exhausted  and  apparently  dying. 

The  foregoing  are  the  more  generally  useful  remedies  in  ordinary 
cases ;  but  the  subjoined  are  sometimes  called  for  in  the  particular 
instances  specified. 

Cicuta  virosa  is  exceedingly  serviceable  wThen  there  is  a  clear 
indication  of  the  presence  of  worms ;  when  the  child  is  first  attacked 
with  severe  griping  and  colic,  terminating  in  convulsions ;  the  charac- 


CONVULSIONS  IN  CHILDREN.  759 

teristic  features  of  the  fit  are :  tremor  of  the  limbs  ;  jerks  like  electric 
shocks,  terminated  by  insensibility. 

Arsenicum  has  proved  very  valuable  in  severe  cases  of  convulsions, 
during  dentition,  with  the  following  symptoms  :  a  burning  heat  diffuses 
itself  over  the  whole  body  of  the  child ;  it  stretches  its  feet  out,  and 
the  hands  convulsively  backwards,  then  throws  its  hands  about,  and 
rolls  over  with  violent  shrieks ;  changes  its  position,  and  bends  for- 
ward with  clenched  fingers  and  extended  thumbs;  it  is  irritable,  restless, 
and  perverse  ;  evinces  insatiable  thirst,  but  drinks  little  at  a  time  ;  is 
affected  with  diarrhoea,  sometimes  of 'undigested  food  ;  frequently  vomits 
immediately  after  taking  food,  the  paroxysms  recur  frequently,  and  all 
attempts  at  soothing  seem  only  to  irritate  the  child. 

Bryonia  is  valuable  in  convulsions  arising  from  suppressed 
measles.     (See  Measles.) 

Sulphur  is  particularly  indicated  in  spasms  arising  from  repelled 
chronic  eruptions. 

When  the  disease  arises  from  indigestible  substances  being  taken 
into  the  stomach,  Nux  vomica  or  Pulsatilla  may  be  given, 
according  to  the  symptoms  and  disposition ;  for  these  remedies  the 
indications  have  been  already  given  in  different  parts  of  the  work,  to 
which  the  reader  is  referred.     (See  Tabular  Index.) 

In  cases  arising  from  mechanical  lesion,  Arnica,  externally  in 
lotion,  where  any  wound  or  contusion  exists. 

In  cases  of  convulsions  from  fright,  we  may  have  recourse  to 
Opium,  when  the  following  appearances  are  present ;  general  tremb- 
ling ;  throwing  about  of  the  limbs ;  vacant  stare ;  cries,  seemingly 
unconscious ;  stertorous  breathing,  and  final  insensibility. 

Stramonium,  when  the  child  becomes  suddenly  convulsed  and 
senseless  from  fright. 

Secale  cornutum,  in  alternation  with  Stramonium,  in  cases  where 
the  latter  does  not  afford  relief. 

Hyoscyamus,  when  sudden  fright  causes  very  violent  convulsions. 
(See  Mental  Emotions,  Part  I.) 


760  DISEASES  OF  INFANCY. 


WATER  IN  THE  HEAD.    DROPSY  OF  THE  BRAIN.    DROPSY  OF  THE  HEAD. 
Hydrocephalus  membranarum  et  ventricularum. 

General  pathognomonic  signs :  headache,  particularly  frontal,  nausea, 
vomiting,  dilatation  of  the  pupils,  stupor,  abnormal  slowness  of  pulse, 
and  convulsions. 

This  fatal  and  frequent  disease  is  liable  to  be  excited  by  a  variety  of 
causes,  and  is  particularly  prone  to  take  place  in  scrofulous  children, 
who  are  born  with  unusually  large  heads,  and  in  whom  the  fontanels 
remain  long  unclosed.  The  symptoms  of  acute  hydrocephalus  are 
sometimes  so  mild  and  insidious,  that  parents  are  thrown  off  their 
guard,  and  attribute  the  apparently  slight  indisposition  of  the  little 
patient  to  some  comparatively  trivial  circumstance ■;  such  as  teething, 
or  gastric  derangement.  In  other  instances,  the  symptoms  are  much 
more  striking,  and  in  many  respects  strongly  resemble  those  described 
under  Inflammation  of  the  Brain.  In  general,  the  skin  is  hot; 
pulse  rather  quick,  chiefly  at  night — but  often  very  variable.  The  child 
becomes  peevish  whenever  it  is  raised  from  the  horizontal  position;  at 
other  times  it  is  affected  with  fits  of  screaming ;  grinding  of  the  teeth; 
redness  of  the  face  and  eyes;  peculiar  expression  of  countenance; 
strabismus ;  convulsions  and  stupor. 

Dropsy  of  the  brain  is  liable  to  be  confounded  with  other  diseases, 
as  invermination,  inflammation  and  ulceration  of  the  mucous  membrane  of 
the  small  intestines  (ileum  particularly),  coma  from  exhaustion,  occurring 
after  protracted  debilitating  diseases,  &c.  The  history  of  the  case, 
together  with  a  close  scrutiny  of  the  whole  of  the  symptoms,  will  rarely 
fail  in  establishing  the  diagnosis. 

Therapeutics.  The  most  appropriate  remedies  are :  Aconite, 
Belladonna,  Bryonia,  Helleborus,  Mercurius,  and  Sulphur,  or  Sulphuris 
tinctura.  The  indications  for  the  first  two  have  already  been  given 
under  Inflammation  of  the  Brain,  Part  I. 

Bryonia  may  be  administered  after  Aconite,  or  Belladonna,  if 
necessary,  or  may  be  given  at  the  commencement,  when  there  are 
heat  in  the  head,  with  dark  redness  of  the  face,  and  great  thirst ; 


WATER  IN  THE  HEAD.  761 

eyes  convulsed,  or  at  one  time  closed,  and  at  another  time  wide  open 
or  fixed ;  delirium ;  sudden  starts,  with  cries,  or  constant  inclination 
to  sleep;  continual  movement  of  the  jaws  as  if  engaged  in  chewing ; 
tongue  coated  yellow ;  abdomen  distended ;  urine  suppressed  or  the 
passing  of  urine  appears  to  cause  pain ;  great  thirst,  especially  at 
night ;  skin  hot  and  dry ;  respiration  hurried,  laborious,  and  anxious, 
constipation. 

Helleborus  niger: — This  remedy,  as  stated  by  Dr.  Wahle,* 
will  generally  prevent  a  fatal  termination,  when  Bryonia  merely 
produces  only  temporary  benefit.  The  same  authority  quotes  it  as 
being  the  most  important  medicine  in  all  serious  cases,  and  recom- 
mends it  to  be  given  in  these  at  the  very  commencement,  in  prefer- 
ence to  all  other  remedies ;  followed  by  Sulphuris  tinctura  when 
danger  is  not  removed  within  a  few  hours,  and  when  spasms  are 
present. 

Mercurius  will  sometimes  be  found  useful  after  Belladonna,  or 
previous  to  that  remedy,  when  the  bowels  are  much  relaxed.  Hyo- 
scyamus,  Opium,  Cina,  and  Stramonium  may  likewise  prove  valuable  in 
cases  wherein  the  indications  correspond  with  those  described  in 
Part  I,  and  in  some  cases,  Lachesis,  particularly  when  the  disease 
has  reached  an  advanced  stage. 

Zincum,  (gr.  ss,  every  two  hours)  has  been  successfully  employed 
by  Dr.  Elbf  in  the  last  stage  of  hydrocephalus  with  symptoms  of 
incipient  paralysis  of  the  hrain.  As  soon  as  the  signs  of  immediate 
danger  have  been  removed,  some  other  remedy,  appropriate  to  the 
remaining  symptoms  should  be  prescribed ;  but  it  is  recommended 
by  Dr.  Elb  to  give  Zinc,  at  first  in  alternation  with  the  new  remedy, 
otherwise  a  relapse  is  liable  to  happen.  Kali  hydriod.,  Digitalis, 
Arnica,  and  Conium  have  also  been  named  as  likely  to  prove  service- 
able in  this  malady.  In  chronic  hydrocephalus,  Dr.  Wahle  recommends 
Helleborus,  Arsenicum,  and  &ulphur%  in  particular.  (See  also  the  reme- 
dies enumerated  under.  Scrofula  and  Rachitis,  with  which 
diseases,  chronic  hydrocephalus  is  generally  connected.) 

*  British  Journal  of  Homoeopathy,  No.  vii,  p.  286. 

f  Allg.  Horn.  Zeit.  No.  15,  31ter  Bd. 

%  According  to  my  experience  Sulphur  (30)  is  the  most  important  remedy  in  the  treat- 
ment of  inflammatory  and  exudatory  affections  of  the  brain.  It  is  more  effective  in  the 
erethic  than  in  the  torpid  stadium.  The  previous  or  intercurrent  employment  of  Aconitum 
and  Belladonna  is  often  necessary.  In  the  torpid  stage  I  consider  Helleborus,  and,  in  some 
cases,  Acid,  phosphoricum,  fully  equal  to  Sulphur. — (Rummel,  Allg.  Horn.  Zeit.  No.  22, 
32ster  Bd.) 


762  DISEASES  OF  INFANCY. 

ASTHMA  OF  MILLAR. 

La 


This  affection  is  by  some  denominated  the  Spasmodic  Croup,  or 
Acute  Asthma  of  infants  ;  it  bears  a  considerable  resemblance  to 
croup,  yet  differs  from  it  in  many  respects,  as,  for  instance,  by  the 
extreme  suddenness  of  the  attack,  while  that  of  croup  is  generally 
preceded  one  or  two  days  by  hoarseness  and  a  slight  cough,  and  by 
the  cessation  from  suffering  the  patient  enjoys  between  the  attacks, 
whereas  when  croup  has  once  set  in,  the  excitement  is  permanent ; 
moreover,  this  disease  generally  attacks  in  the  evening  or  at  night, 
whereas  croup  in  most  cases  makes  its  first  appearance  during  the  day. 

Croup,  as  we  mentioned  in  the  article  upon  that  subject,  is  an 
inflammation  of  the  membrane  of  the  windpipe,  exciting  the  forma- 
tion of  a  peculiar  secretion,  which,  if  not  checked,  concretes  into  an 
abnormal  membranous  tissue,  constituting  wrhat  is  technically  called 
the  false  membrane  of  croup ;  whereas,  in  the  Asthma  of  Millar,  the 
suffering  appears  to  arise  from  a  spasmodic  contraction  of  the  top  of  the 
windpipe,  impeding  the  progress  of  respiration. 

The  attack  commences  with  a  sudden  spasmodic  inspiration, 
accompanied  by  a  species  of  stridulous  or  crowing  noise ;  if  the  fit 
continues,  the  face  becomes  purple,  and  the  extremities  partake  of 
the  same  hue,  frequently  attended,  as  in  convulsions,  with  a  clenching 
of  the  thumbs  inside  the  palm,  and  spasmodic  constriction  of  the 
toes,  giving  an  appearance  of  distortion  to  the  foot ;  if  proper  means 
are  not  promptly  taken,  these  attacks  recur  frequently,  and  at  short 
intervals,  and  occasionally  the  little  patient  perishes  during  one  of 
the  paroxysms. 

The  disease  rarely  occurs  except  in  infants  of  delicate  constitution, 
when  due  means  should  be  taken  to  endeavour  to  eradicate  it  by  a 
proper  course  of  treatment ;  it  frequently  accompanies  the  period  of 
dentition,  and  is  excited  by  similar  causes  to  those  bringing  on  con- 
vulsions. 

Therapeutics.  Aconite,  Ipecacuanha,  Arsenicum,  Sambucus,  Mos- 
chus,  or  Pulsatilla,  are  the  medicines  which  have  hitherto  been  em- 
ployed by  homoeopathists  with  the  most  successful  results. 

The  dose  to  be  repeated  every  one  or  two  hours,  according  to  the 
symptoms. 


REMITTENT  FEVER.  763 

Aconite,  when  a  suffocating  cough  comes  on  at  night,  with 
shrillness  and  hoarseness  of  voice ;  respiration  short,  anxious,  and 
difficult,  more  particularly  if  any  marked  febrile  symptoms  be  pre- 
sent, or  we  have  reason  to  dread  determination  of  blood  to  the 
head. 

Ipecacuanha,  when  there  is  rattling  in  the  chest,  from  an  accumu- 
lation of  mucus,  with  spasmodic  constriction,  and  symptoms  as  from 
suffocation ;  anxious  and  short,  or  sighing  respiration,  with  purple 
colour  of  the  face,  and  cramps,  or  rigidity  of  the  frame;  it  may  be 
advantageously  followed  by 

Arsenicum,  when  many  of  the  above  symptoms  are  still  present, 
or  in  a  measure  subdued :  also  if  we  find  great  anguish,  cold  perspira- 
lion, .  and  considerable  prostration  of  strength,  during  and  after  the 
paroxysms ;  when  these  last  indications  are  particularly  prominent, 
Arsenicum  may  supersede  Ipecacuanha  at  the  commencement. 

Sambucus  : — Lethargy,  or  ineffectual  inclination  to  sleep,  with 
oppressed  respiration  and  wheezing ;  livid  hue  of  the  face,  agonizing 
jactitions,  dry  heat  of  the  trunk;  no  thirst;  pulse  small,  irregular, 
and  intermittent. 

Moschus  is  frequently  of  value  in  cases  that  occur  at  a  more 
advanced  period  of  life,  when  a  constriction  in  the  larynx,  as  if  caused  by 
the  vapour  of  sulphur,  is  complained  of;  difficult  respiration  and  short 
breathing  ;  severe  spasms  in  the  chest,  with  inclination  to  cough,  after 
which  (especially  in  children)  the  paroxysms  become  much  exacerbated, 

Pulsatilla  will  often  be  found  successful  in  cases  in  which  the 
foregoing  remedy  fails  in  producing  the  desired  effect. 


INFANTILE  REMITTENT  FEVER. 


By  infantile  remittent  is  here  chiefly  meant  that  form  of  fever 
which  occurs  in  infants  and  children,  arising  from  morbid  irritability, 
inflammation  or  even  ulceration  in  the  mucous  membrane  of  the 
stomach  and  bowels. 

The  affection  is  usually  preceded  by  languor,  irritability  of  temper, 
want  of  appetite,  nausea,  thirst,  slight  heat  of  skin,  and  very  restless 
nights.     Ere  long  these  symptoms  present  themselves  in  a  more 


764  DISEASES  OF  INFANCY. 

aggravated  form,  together  with  a  further  development  of  abnormal 
phenomena,  such  as  hurried  and  oppressive  breathing,  quickness  of 
pulse,  with  occasional  flushes  in  the  face,  vomiting  of  food  or  bile, 
distension  and  tenderness  of  the  abdomen ;  obstinate  constipation ; 
sometimes  diarrhoea,  or  frequent  desire  to  go  to  stool  with  but  little 
effect ;  motions  discoloured,  fetid,  frequently  mixed  with  mucus,  and 
occasionally  with  blood.  The  hands  and  feet  are  often  cold,  while 
the  rest  of  the  body  is  parched  ;  the  head  hot  and  heavy,  or  attended 
with  other  symptoms  resembling  hydrocephalus,  such  as  coma,  &c. 
The  tongue,  at  first  moist,  loaded,  and  occasionally  very  red  along 
the  margins,  often  becomes  dry  over  a  triangular  spot  at  the  point. 
When  the  febrile  exacerbation  takes  place  at  night,  it  is  accompa- 
nied by  violence  and  jactition ;  when  during  the  day  there  is,  on  the 
other  hand,  drowsiness  and  stupor.  An  annoying  cough  with  bron- 
chitic  indications,  succeeded  by  wheezing  and  expectoration,  some- 
times appears.  Although,  as  is  characteristic  of  remittent  fever,  the 
febrile  symptoms  never  entirely  subside,  still  the  patient  will  fre- 
quently appear  to  be  steadily  recovering  for  a  time,  and  the  unwary 
or  inexperienced  may  consequently  be  led  to  pronounce  an  unduly 
favorable  prognosis,  which  will  too  often  be  contradicted  by  the 
occurrence  of  a  relapse,  followed  perhaps  again  by  another  encou- 
raging but  deceptive  remission  and  so  on,  unless  the  progress  of 
the  disease  be  checked,  until  either  the  mesenteric  glands  become 
affected,  or  dropsical  effusion  into  the  cavity  of  the  abdomen,  or 
unequivocal  signs  of  cephalic  disease  supervene,  or  the  little  sufferer 
is  so  emaciated  and  reduced  by  protracted  disease,  that  the  vital 
powers  give  way,  and  he  sinks  exhausted. 

Therapeutics.  In  mild  attacks  occurring  in  tolerably  healthy 
children,  the  disease  is  generally  readily  subdued  in  a  few  days,  by 
means  of  one  or  more  of  the  following  remedies :  Ipecacuanha,  Pulsa- 
tilla;, China,  Nux  v.,  Aconitum,  Belladonna,  Mercurius,  Bryonia,  Lachesis, 
Chamomilla,  and  Sulphur,  combined  with  light  farinaceous  diet.  Solid 
food  must  be  strictly  prohibited,  even  though  the  appetite  should  be 
good,  which  it  occasionally  is,  and  even  ravenous  at  times. 

With  regard  to  the  indications  for  the  remedies  quoted,  Ipeca- 
cuanha may  be  given,  if,  as  is  commonly  the  case,  the  attack  has 
been  excited  by  over-feeding,  or  by  indigestible  food,  and  particularly 
when  the  patient  has  contracted  a  habit  of  bolting  the  food  without 
having  previously  masticated  it  properly,  and  the  symptoms  encoun- 


REMITTENT  EEVER,  765 

tered  are  as  follows : — General  dry  heat,  or  harsh  and  parched  skin, 
especially  towards  evening;  thirst,  extreme  restlessness,  burning 
heat  in  the  palms  of  the  hands;  perspiration  at  night,  quick 
oppressed  breathing,  foul  tongue,  nausea,  vomiting,  or  fastidious 
appetite,  with  sickness  after  eating ;  great  languor,  apathy,  and  indif- 
ference. Should  these  symptoms  remain  unaltered  after  several 
doses  of  Ipecac,  or  should  the  bowels  become  very  relaxed,  the  mo- 
tions fetid,  whitish,  bilious,  or  of  variable  colour  at  different  times, 
and  accompanied  with  griping  and  distension  of  the  abdomen,  fever 
during  the  night — Pulsatilla  may  be  prescribed,  followed,  if 
required,  by  Cinchona,  especially  if  the  nausea  or  vomiting  has 
subsided,  but  the  bowels  remain  relaxed,  and  are  considerably  dis- 
tended, or  tense  and  tympanitic. 

Nux  vomica  is  also  a  most  efficient  remedy  in  mild  cases,  or  in 
the  early  stage  of  any  variety  of  the  disorder,  when  the  bowels  are 
confined,  or  very  costive,  with  frequent  inclination  to  go  to  stool ; 
or  when  there  is  tenesmus,  followed  by  scanty  watery  motions,  gene- 
rally mixed  with  mucus,  or  occasionally  with  a  little  blood  ;  abdomen 
tumid  and  rather  painful ;  further — when  the  child  is  excessively 
peevish  and  ungovernable ;  the  tongue  foul ;  appetite  impaired,  or 
there  is  nausea  with  disgust  at  food ;  restlessness ;  fever  towards 
morning,  but  also  in  some  degree  during  the  night. 

Chamomilla  is  sometimes  useful  after  Nux  v.  when  bilious  diar- 
rhoea or  vomiting  supervenes.  It  is  further  indicated  if  the  tongue 
is  red  and  cracked,  or  coated  yellow ;  sleep  lethargic,  or  restless  and 
agitated,  attended  with  frequent  starts  and  jerkings  of  the  limbs ; 
flushes  of  heat  in  various  parts  of  the  body.  Also  when  the  little 
patient  is  of  a  plethoric  habit,  and  in  all  cases  in  which  the  head  is 
hot  and  heavy,  the  skin  hot  or  parched,  the  face  flushed,  the  pulse 
quick ;  and  when  there  is  thirst,  foul  tongue,,  nausea,  bilious  vomiting, 
no  motions,  or  frequent  and  scanty  evacuations,  with  tenesmus. 

Belladonna  may  succeed  Chamomilla,  if  the  head  continue  hot, 
the  pulse  excessively  quick  and  full,  the  tongue  loaded,  or  coated 
white  or  yellow  in  the  centre,  and  very  red  at  the  edges;  thirst; 
nausea  or  vomiting ;  great  heat  of  the  abdomen  with  tenderness  on 
the  slightest  pressure;  oppressive  breathing.  If  the  more  active 
inflammatory  symptoms  yield  to  the  action  of  Belladonna, — Mercu- 
rius  will  often  serve  to  complete  the  cure ;  but  more  particularly 
when  the  following  symptoms  remain;  loaded  tongue,  nausea  or 
vomiting,  with  continued  tenderness  of  the  abdomen ;  thirst,  some- 


766  DISEASES  OF  INFANCY. 

times  with  aversion  to  drinks  when  offered  ;  no  motions,  or  diarrhoea 
with  excessive  tenesmus.  If,  on  the  other  hand,  the  head  continue 
hot  and  heavy,  the  pulse  quick,  the  tongue  foul,  and  other  symptoms 
of  gastric  derangement  are  prominent,  together  with  a  tumid  and 
painful  state  of  the  abdomen,  constipation,  excessive  restlessness, 
and  quick,  laborious  respiration,  particularly  at  night,  with  drowsi- 
ness during  the  day,  Bryonia  is  to  be  preferred. 

Lachesis  may  follow  Belladonna  or  Mercurius,  when  the  signs  of 
intestinal  irritation  or  inflammation  continue  with  but  little  abate-? 
ment.  Or  it  may  precede  these  remedies,  when  the  tenderness 
and  distension  are  more  marked  at  one  particular  spot  (the  most 
trivial  pressure  there  being  intolerable,)  than  over  the  entire  abdomen ; 
and  when  the  fever  is  highest  at  night. 

Sulphur  : — May  be  given  with  advantage  to  complete  the  cure  in 
many  cases,  after  the  previous  employment  of  any  of  the  foregoing 
medicines.  It  is,  however,  when  the  attack  is  characterized  by  the 
following  features,  that  this  remedy  is  more  directly  called  for: 
feverish  heat,  especially  towards  evening,  but  also  in  the  morning,  or 
during  the  day ;  flushes,  alternately  with  paleness  of  the  face  ;  dryness 
of  the  skin ;  hurried  and  laborious  breathing ;  palpitation  of  the 
heart ;  nocturnal  perspiration ;  languor  and  great  weakness,  particu- 
larly in  the  inferior  extremities ;  tense,  tumid  and  painful  abdomen ; 
dry,  hard,  or  loose  and  slimy  motions. 

These,  then,  are  the  most  generally  useful  remedies  in  cases  of 
the  above  description,  and  will  materially  tend  to  facilitate  recovery, 
and  prevent  the  disease  from  assuming  an  obstinate  character.  When, 
however,  the  malady  occurs  in  children  of  relaxed  and  feeble  habits, 
or  of  a  decided  strumous  diathesis,  it  becomes,  especially  if  neglected, 
and  not  checked  at  the  commencement  of  its  course,  a  most  intract- 
able and  frequently  fatal  disease,  from  the  proneness  which  it  then 
has  to  become  complicated,  and  terminate  in  one  or  other  of  the 
serious  forms  alluded  to  in  the  diagnosis. 

The  remedies  from  which  the  most  benefit  is  to  be  anticipated  under 
such  unfavorable  circumstances  are,  in  addition  to  those  previously 
mentioned,  Silicea,  Sulphur,  Calcarea,  Baryta  c,  Arsenicum,  Cocculus, 
Cina,  Sabadilla,  &c. 

Silicea  : —When  there  is  great  emaciation,  languor  and  debility, 
paleness  of  the  face,  want  of  appetite,  or  craving  for  dainties ;  short- 
ness of  breath  on  movement ;'  feverish  heat  in  the  morning  or  towards 
evening.    This  remedy  is  also  a  most  important  one  when  the  patient 


REMITTENT  FEVER.  767 

is  afflicted  with  worms,  and  when  the  disease  is  in  a  great  measure 
attributable  to  invermination.  Cina  and  Sahadilla,  may  likewise  be 
found  useful  along  with  Silicea  in  the  latter  instance.  (See  Inver- 
mination.)    The  indications  for  Sulphur  have  already  been  given. 

Calcarea  : — Great  debility,  with  flabbiness  of  the  muscles,  dry- 
ness of  the  skin,  and  excessive  emaciation;  frequent  flushes,  or 
general  heat,  followed  by  shivering  towards  evening ;  exhaustion,  or 
dejection  after  speaking;  impaired,  fastidious  appetite,  with  weak 
and  slow  digestion,  or,  on  the  contrary,  extreme  voracity ;  perspira- 
tion towards  morning,  hard,  tense,  and  tumid  abdomen.  [Baryta  c. 
is  sometimes  useful  after  Calcarea.) 

Arsenicum  : — Extreme  prostration  of  strength  and  emaciation, 
with  desire  to  remain  constantly  in  the  recumbent  posture;  dry, 
burning  heat  of  the  skin,  wdth  great  thirst,  but  desire  to  drink  little 
at  a  time,  or  merely  to  moisten  the  lips,  which  are  frequently  parched ; 
impaired  appetite,  and  sometimes  excessive  irritability  of  the  stomach, 
so  that  very  little  food  can  be  retained ;  hard  and  tense  abdomen ; 
restless,  unrefreshing  sleep,  and  frequent  starts,  or  subsultus  ten- 
dinum ;  fretful  and  capricious  disposition. 

Cocculus  : — Great  weakness,  with  excessive  fatigue,  depression, 
and  tremor  after  the  slightest  exertion ;  heavy  expressionless  eyes ; 
flushes  of  heat  in  the  face ;  nausea,  or  aversion  to  food,  distension  of 
the  abdomen,  constipation ;  oppressed  respiration ;  perspiration  on 
attempting  any  trivial  exertion;  lowness  of  spirits;  mildness  of 
temper. 

Belladonna,  Lachesis,  or  Baryta  c,  will  be  required  when  the  head 
becomes  much  affected.  Belladonna,  especially  when  there  are 
heat,  heaviness,  flushing  and  delirium ;  or  deep  and  protracted  sleep, 
with  subsultus  tendinum,  coldness  of  the  hands,  pale  cold  face,  small 
quick  pulse,  hot,  tumid,  and  tense  abdomen. 

Lachesis  : — Either  before  or  after  Belladonna,  when  we  encounter 
deep,  prolonged  sleep ;  grinding  of  the  teeth  ;  or  somnolency  alter- 
nately with  sleeplessness ;  tremulous,  intermittent,  or  scarcely  per- 
ceptible pulse. 

Baryta: — Lethargy,  jactitation,  or  agitation,  moaning  and 
muttering,  feeble  and  accelerated  pulse.     (See  Hydrocephalus.) 

Other  remedies,  such  as  Antimonium,  Acid,  phosphoricum,  Phosphorus, 
Ilepar  s.,  Kali,  Acidum  nitr.,  Lycopodium,  Rhus,  &c,  may  be  required 
according  as  the  symptoms  happen  to  vary :  we  have  merely  given 
some  of  the  medicines  which  have  been  found  of  valuable  service, 


768  DISEASES  OF  INFANCY. 

when  the  indications  of  the  disease  have  corresponded  with  those 
above  given.  It  may  be  added,  that  when  the  skin  is  hot  and  parched, 
the  sleeplessness  and  restlessness  are  often  temporarily  removed  by 
sponging  the  body  with  tepid  water;  this  expedient  is,  however,  only 
to  be  had  recourse  to  when  the  remedies  fail  to  afford  this  relief,  and 
that  in  a  more  permanent  degree.     (See  also  Atrophy.) 


ATROPHY. 
Atrophia. 

The  medicines  from  which  the  most  appreciable  benefit  has  hitherto 
been  obtained  in  this  serious  malady  are :  Sulph.,  followed  by  Calcarea; 
also  Ars.,  Bar.  c,  Bell.,  Chin.,  Nux  vom.,  Phosph.,  and  Bhus. 

Sulphur  in  almost  all  cases  at  the  commencement  of  the  treat- 
ment ;  craving  appetite ;  enlargement  of  the  inguinal  or  axillary 
glands ;  slimy  diarrhoea,  or  obstinate  constipation ;  pale  complexion, 
sunken  eyes,  &c 

Calcarea  : — Great  emaciation,  with  craving  appetite ;  enlarge- 
ment and  induration  of  the  mesenteric  glands;  great  weakness^, 
clayey  evacuation,  a  dry  and  flabby  skin;  too  great  a  susceptibility  of 
the  nervous  system.* 

Arsenicum  : — Dryness  of  skin,  which  resembles  parchment ; 
hollow  eyes ;  desire  to  drink  often,  but  little  at  a  time;  excessive  agitation 
and  tossing,  especially  at  night;  short  sleep  interrupted  by  jerks ;  faeces 
of  greenish  or  brownish  colour,  with  evacuations  of  ingesta ;  extreme 
prostration. 

Baryta  : — Enlargement  of  the  glands  of  the  nape  of  the  neck ; 
continual  desire  to  sleep ;  great  indolence,  and  aversion  to  exertion 
and  amusement. 

Bell.  : — Capriciousness  and  obstinacy  ;  nocturnal  cough,  with 
rattling  of  mucus;  enlargement  of  the  glands  of  the  neck;  unquiet 
sleep  ;  precocity  of  intellect,  blue  eyes  and  fair  hair. 

*  Calc.  <?.,  3 — 4,  gtt.  j,  once  or  twice  a  day  for  the  space  of  six  or  eight  weeks,  is  (toge- 
ther with  embrocations  of  oil  (?)  and,  perhaps  also,  single  intermediate  doses  of  Sulphur) 
one  of  the  most  efficacious  remedies  in  Tabes  mesent.  infant.;  and,  in  general,  a  much 
superior  remedy  to  Iod.,  Cicuta,  Baryta,  &c.  In  most  instances  the  abdomen  becomes 
smaller,  the  stools  more  regular,  in  from  eight  to  fourteen  days  after  its  employment. 
Furuncles  and  a  sort  of  miliary  eruption  then  frequently  break  out. — Hygea. 


VACCINATION.  769 

China: — Excessive  emaciation;  voraciousness;  diarrhoea  at  night, 
with  frequent  white  motions  or  evacuations  of  ingesta;  frequent  per- 
spirations^ especially  at  night ;  unrefreshing  sleep. 

Cina  : — Vermiculous  symptoms ;  wetting  the  bed.  (See  Worms.) 

Rhus  : — Slimy  or  sanguineous  diarrhoea ;  debility ;  voracity. 

In  children  past  the  age  of  infancy,  great  attention  should  be  paid 
to  the  diet ;  pure  air  and  exercise  are  also  of  great  importance. 


VACCINATION. 

This  is  an  operation  purely  homoeopathic,  and  one  which,  from  its 
efficacy  in  the  prevention  of  a  disease  exhibiting  analogous  symptoms, 
has  been  frequently  quoted  by  our  Great  Founder  and  his  disciples, 
as  one  of  the  best  illustrations  of  the  immutable  law  of  similia 

SIMILIBUS    CURANTUR. 

Vaccination,  when  the  child  is  strong  and  healthy,  may  be  safely 
performed  during  the  fourth  or  fifth  month ;  but  when  the  smallpox 
is  rife  as  an  epidemic,  we  may  have  recourse  to  this  prophylax  with 
infants  of  a  still  more  tender  age.  If,  however,  we  are  allowed  a  choice 
of  time,  summer  is  the  best  period  for  performing  the  operation,  as 
then  the  infant,  after  having  taken  the  infection,  incurs  least  risk  of 
catching  cold. 

It  is  of  the  utmost  importance  to  obtain  the  lymph  from  a  per- 
fectly pure  source,  as  experience  has  too  truly  proved,  that  other 
diseases  have,  from  a  neglect  of  this  precaution,  been  frequently  trans- 
mitted to  healthy  children.  For  this  reason,  a  child  that  has  suffered 
from  eruptions  of  the  skin,  affections  of  the  glands,  or  soreness  of  the 
eyes,  or  one  born  of  scrofulous  parents,  is  an  unfit  subject  for  taking 
the  vaccine  matter  from,  although  at  the  time  apparently  in  health. 


49 


INDEX. 


PAGE 

Abdomen,  determination  of  blood  to 

the      .  .  .     163,533 


Abdominal  deformity 

Abortus 

Abscess 

acute 

chronic    . 
Abscessus  nucleatus 
Abscesses  in  ano 
Acidity  in  children 
Acute  inflammation  of  the  eyes 

inflammation  of  the  liver 

inflammation  of  the  spinal  cord 

rheumatism  of  the  heart 
Aegylops 
After-pains 
Affections  of  the  knee 
Ague  . 
Agrypnia 
Air  and  exercise 
Aliments  allowed 

prohibited 
Alvine  discharge,  colour  of  the  (see 

Bowel  Complaints  of  Infants). 
Ambustiones 
Amenorrhoea 
Anasarca 

integumentorum  scroti 
Aneurism  of  the  aorta 
Angina  faucium 
.  aphthosa . 

maligna 

pharyngea 

parotidea 

perniciosa 

membranacea 
Anorexia 
Anthrax 

Aorta,  aneurism  of  the 
Apepsia 
Aphthae 

Appetite,  want  of 
Apparent  death  . 

from  hunger 

from  a  fall 


701 
678 
419 
420 
421 
416 
154 
736 
534 
200 
345 
411 
539 
693 
532 
31 
561 
662 
3 
4 


628 
652 
596 
476 
411 
100 

ib. 
107 
110 
112 
258 
258 
125 
417 
411 
125 
739 
125 
633 
634 

ib. 


Apparent  death  from  suffocation  (hang- 
ing, pressure,  choking) 

from  lightning       .  . 

from  drowning 

from  being  frozen    . 

from  noxious  vapours 
Apoplexy 
Apoplexia 

Arteries,  inflammation  of  the 
Arthritis 


PAGE 


Arthritic  nodes   . 
Ascites 
Asphyxia 
Asthma 

humidum 

moist 

of  Millar 
Atrophy 
Atrophia 
Attenuations  in  general 

Balanitis 

Balano  blenorrhcea 

Bilious  fever 

Black  water 

Bladder,  inflammation  of  the 

chronic  inflammation  of 
Blear-eyedness    . 
Bleeding  from  the  nose 
Blenorrhcea        .  . 

ventriculi 
intestinorum     . 
recti 
Blepharitis 

Blindness,  sudden  attack  of 
Blood,  vomiting  of 

spitting  of 
Bloodshot  eye  . 
Boils  . 

Bowels,  hemorrhage  from  the 
Hemorrhoids). 

inflammation  of  the 
looseness  of  the 
Bowel  complaints  of  infants 


634 
635 

ib. 
636 
637 
339 

ib. 
412 
515 
517 

ib. 

593 

633,  717 

324 

330 

ib. 
762 
768 

ib. 

Hi 

472 

ib. 

56 
140 
447 
448 

ib. 
547 
226,  466 
226 
228 
229 

ib. 
540 

ib. 
314 
539 
416 


(see 


212 
164 
741 


772 

INDEX. 

PAGE 

PAGE 

Brain,  inflammation  of  the 

335 

Chronic  abscess  . 

421 

fever 

ib. 

laryngitis 

239 

concussion  of  the 

613 

bronchitis 

274 

dropsy  of  the 

760 

inflammation  of  the  bladder  . 

448 

Breath,  offensive 

557 

rheumatism 

524 

Breasts,  preparation  of  the 

684 

Cingulum 

435 

inflammation  of  the 

708 

Cirsocele              .                . 

475 

Bronchial  tubes,  inflammation  of  the 

Clap    .... 

466 

mucous  membrane  of  the 

268 

Clavi  pedis 

419 

Bronchitis 

ib. 

Clavus  hystericus 

361 

chronica 

274 

Clothing  during  pregnancy . 

663 

Bronchocele        .                .                . 

559 

Cold  on  the  chest 

268 

Bruises 

617 

in  the  head                 .             240 

,733 

Bubo  . 

486 

Colic   .... 

159 

Buboes 

507 

from  hemorrhoids 

160 

venereal 

487 

from  worms 

ib. 

sympathetic 

ib. 

spasmodic  . 

ib. 

scrofulous 

489 

indigestible  food 

ib. 

sycosic     . 

499 

from  passion  or  indignation 

ib. 

Burns 

628 

external  violence 

ib. 

painters'     .                .             160 

,348 

Camp  fever 

29 

of  Poictou  . 

348 

Cancer  nasi 

552 

lead            .                .             160,347 

Cancerum  oris 

ib. 

Devonshire 

160 

Canker  of  the  mouth 

ib. 

from  a  chill 

ib. 

Carbuncle            . 

417 

in  infants    . 

734 

Cardialgia 

134 

hysterical  . 

160 

Carditis 

409 

menstrual  . 

ib. 

Caries 

604 

Colica  pictonum                   .             160,348 

Catarrh 

231 

Common  cold 

231 

pulmonary 

268 

Concussion  of  the  brain 

613 

Catarrhus  bronchiarum 

299 

Condylomata 

509 

Catarrhal  fever    . 

231 

Confluent  smallpox 

85 

Cataract 

538 

Congestio  ad  caput 

331 

Cephalalgia 

361 

Congestio  viscerum  abdominis          163,  533 

arthritica 

ib. 

ad  abdomen         .              >  . 

163 

nervosa 

ib. 

ad  pectus 

265 

Cephalsea 

.      ib. 

Congestive  fever 

13 

Chancre,  Hunterian 

479 

Constipatio 

143 

superficial,  with  raised  edges 

ib. 

Constipation        .                .     143,  669,  741 

phagedenic 

.      ib. 

in  aged  persons 

147 

sloughing 

.      ib. 

When  travelling 

ib. 

Chest,    determination    of  blood   to 

from  exposure  to  the  va- 

the 

.    265 

pour  of  lead 

ib. 

Chicken  pock 

.      90 

from  congestion,  or  ful- 

Chilblains 

.     417 

ness  of  the  vessels  oi 

Children,  diseases  of 

.     732 

the  head     . 

ib. 

Chimney-sweeper's  cancer  . 

.    415 

from  duodenitis 

148 

Chlorosis 

.     649 

Constitutions       . 

lxvii 

Choice  of  a  nurse 

.     722 

Contagious  typhus 

29 

of  the  remedy 

xix 

Consumption,  pulmonary    . 

319 

Chbleia 

.    177 

Convulsions  during  labour  . 

696 

Asiatic    . 

.     180 

in  children 

756 

malignant 

.      ib. 

Convulsio  cerealis 

41 

Asiatica  . 

.      ib. 

Costiveness 

143 

epidemica 

.      ib. 

Corns 

.    419 

spasmodica 

.      ib. 

Cornea,  specks  on  the,  or  opacity 

.     538 

preliminary  symptoms  of 

.     185 

Coryza 

.     240 

first  stage,  of 

.     185 

Cough 

.     242 

fever,  or  hot  stage  of 

.     187 

hooping  .                i 

.     254 

causes  of     '      ■ 

.     192 

Coup  de  soleil  (see  Exposure  to  heat) 

accessory  treatment 

.     199 

Coxalgia 

.     528 

Cholerine            .               . 

.     200 

Coxagra 

.       ib. 

INDEX. 

7/6 

PAGE 

PAGE 

Cramps  in  the  legs 

558 

Dropsy                     ■    .     . 

.     592 

Croup 

258 

of  the  belly  (see  Ascites). 

Crusta  lactea 

738 

of  the  pericardium  (see  Pericarditis, 

Crying  and  wakefulness  of  new-born 

L 

chronic). 

infants 

.     734 

ovarium  . 

.     659 

Cynanche  tonsillaris 

.     100 

of  the  cellular  tissue 

.     596 

maligna 

.     107 

of  the  chest 

.     600 

pharyngea 

.     110 

of  the  brain 

.    760 

laryngea 

.     258 

of  the  head 

.      ib. 

tracheitis 

.      ib. 

Duration  of  confinement     . 

.     694 

Cystitis               .                .             447,471 

suckling 

.     725 

Dysecoia,  or  deafness 

.     546 

Deafness,  congestive 

546 

Dysenteria 

.    170 

nervous 

.      ib. 

alba  . 

.      ib. 

catarrhal,  or  rheumatic 

.      ib. 

rubra 

.      ib. 

from    the    repercussion    o 

f 

rheumatico-catarrhalis      .      ib. 

eruptions 

.      ib. 

inflammatoria 

.     171 

after  scarlatina    . 

ib. 

biliosa 

.      ib. 

from  the  abuse  of  mercury 

ib. 

putrida 

.      ib. 

Death  apparent  . 

633 

Dysentery 

.     170 

Deficiency  in  the  secretion  of  milk 

710 

suppressed 

.     176 

Derangement  of  the  stomach 

129 

rules  of  conduct  and  diet  in    171 

Derangements  during  teething 

753 

Dysmenorrhea    . 

.     655 

Derbyshire  neck 

559 

Dyspepsia 

.     114 

Deterioration    and    discoloration    oi 

Dysuria 

.     451 

milk 

711 

Determination  of  blood  to  the  abdo- 

Ears,  inflammation  of  the    , 

.    543 

men            .               .             16 

3,533 

Earache 

.      ib. 

chest 

.     265 

Eclampsia  typhoides 

.      41 

head 

.     331 

Ectropium 

.     541 

Delirium  tremens  potatorum 

351 

Eczema  faciei 

.    738 

Diabetes 

.     460 

Emansio  mensium 

.     649 

mellitus 

.     461 

Employment  of  the  mind  and  Habits 

insipidus 

ib. 

during  pregnancy 

.     665 

Diarrhoea 

164 

Encysted  hydrocele  of  the 

spermatic 

biliosa 

165 

cord 

.    478 

mucosa,  s.  pituitosa 

ib 

Endocarditis 

.     384 

stercoralis 

ib.. 

Entropium 

.     542 

serosa 

ib. 

Enteritis 

.     212 

lienteria 

ib. 

Encephalitis 

.     335 

torminosa 

166 

Ephialtes 

.    577 

during  pregnancy 

670 

Epilepsy 

.    353 

in  lying-in  women 

.    701 

Epilepsia 

.      ib. 

neonatorum 

741 

Epiphora 

.     539 

Diaphragmitis     . 

312 

Epistaxis 

.     547 

Diet  during  pregnancy 

665 

Evacuations,  abnormal,  colour  of  the 

rules  for     .                . 

3 

(see  Diarrhoea  in  Infants). 

to  be  observed  in  fevers 

5 

Errata 

.    lxxi 

during  nursing 

722 

Eructations 

.     129 

Difficulty  in  discharging  the  urine 

451 

Eruptive  fevers    . 

.       58 

Dilatation  of  the  heart 

410 

Erysipelas 

.     413 

Discharge  of  blood  from  the  urethra 

466 

bullosum 

.      ib. 

Disease  of  the  conglobate  glands 

419 

phlegmonodes 

.     414 

venereal 

479 

cedematodes 

.      ib. 

Diseases  of  the  heart 

373 

erraticum 

.      ib. 

of  the  valves  of  the  heart 

410 

pseudo 

.     415 

Disinclination  of  the  infant  to  suck 

707 

gangrenosum 

.      ib 

Dislocations 

626 

scroti 

.      ib. 

Dispensation,  and  the  preservation  oJ 

F 

infantum 

.     751 

homoeopathic  medicines 

lxiii 

Excessive  secretion  of  milk 

.     697 

Dispositions 

lxvii 

Excoriation  of  the  nipple 

.     707 

Dose  and  its  repetition 

xxvi 

Excoriations 

.     750 

Dreams  (see  Sleeplessness). 

Excoriationes  nee 

matorum 

.     756 

774 


INDEX. 


PAGE 

Exercise              .  .  .     729 

Exostosis             .  .  .    604 

Exposure  to  heat  .  .631 

Eyes,  acute  inflammation  of  the  .     534 

inflammation  of  in  infants  .     732 

Eye,  fungus  nematodes  of  the  .     538 

weeping  or  watery  .  .539 

bloodshot   .  .  ib. 

Eyelids,  inflammation  of  the  margins 

of  the              .  .  .540 

catarrhal  inflammation  of  the     541 

Face,  swelled      .  .  .676 

warts  on  the  .  .    543 

Face-ache            .  .  .    358 

Face-ague            .  .  .      ib. 

Fainting              .  .  .589 

and  hysterical  fits  .    670 

False  pains          .  .  .685 

Falstaff  belly       .  .  .702 

Fatigue                .  .  .630 

Favus  confertus  .  .  .    428 

Febres                 .  .  .5 

intermittentes  .  .31 

Febris  simplex    .  .  .8 

inflammatoria  simplex  .  9 

synochalis  .  .      ib. 

nervosa     .  .  .12 

nervosa  versatilis  .  .15 

nervosa  stupida  .  .      ib. 

lenta  nervosa  .  .30 

hectica     .  .  .48 

gastrica  biliosa  .  .56 

pituitosa  .  .  .52 

mucosa     .  .  .       ib. 

dysenterica  .  .170 

helminthiaca  .  .219 

bullosa      .  .  .433 

rheumatica  .  .517 

Feet,  sweating     .  .  .560 

Females,  diseases  of  .  .     649 

Fevers                 .  .  .5 

simple  or  ephemeral  .        8 

Fever,  general  treatment  of  .        7 

inflammatory  .  .        9 

synochal   .  .  .9 

nervous     .  .  .12 

slow          .  .  .      ib. 

typhus      .  .  .      ib. 

congestive  .  .13 

putrid       .  .  .27 

pestilential  .  .      ib. 

malignant  .  .      ib. 

jail           .  .  .      29 

camp        .  .  .      ib. 

petechial  .  .  .      ib. 

intermittent  .  .31 

marsh       .  .  .34 

remittent  .  .  .46 

yellow      .  .  .      ib. 

hectic       .  •  .48 

mucous     .  .  .52 

contagious  .  .      29 


Fever,  gastric 
bilious 
eruptive    . 
scarlet 
catarrhal  . 
rheumatic 

Fistula  in  ano 

lachrymalis 

Fistulae  in  perinaeo 

Fractures 

Flatulence  in  infants 

Flatulency 

Flatulentia 

Flatus 

Furunculus 

malignans 

Fungus  haematodes 


Gangrena  oris 

Gastric  fever 

Gastrodynia 

Gastralgia 

Gastritis 

Giddiness 

Glands,  conglobate,  disease  of 

Glandular  swellings 

Gleet 

Glossitis 

Goitre 

Gonorrhoea 

glandis 
Gout 

Gravel  (see  Hematuria). 
Gum-boil 

Gums,  hemorrhage  from    the    (see 
Cancrum  oris  and  Odontalgia). 


PAGE 

56 

ib. 

58 

ib. 

231 

517 

154 

538 

458 

626 

736 

132 

ib. 

ib. 

416 

417 

538 

552 

56 

134 

ib. 

209 

334 

419 

419 

511 

556 

559 

466,  510 

512 

515 


555 


Haematemesis      ,                .  .     140 

Haemorrhage  from  the  bowels  (see  Piles). 

Haemorrhagia  pulmonum     .  .314 

Haemoptysis        .                .  .      ib. 

Hematuria          .                .  .     463 

Haemorrhagia  urethrae        .  .466 

Head,  determination  of  blood  to  the  .    331 

Head,  cold  in  the                .  .240 

water  in  the              .  .760 

dropsy  in  the            .  .       ib. 

Headache            .                .  .361 

Heart,  diseases  of  the         .  .373 

valves  of  the  .    410 

dilatation  of  the       .  .      ib. 

acute  rheumatism  of  the  .    411 

Heartburn           .                .  .     140 

Heat,  exposure  to               .  .631 

spots          .                .  .     753 

Hectic  fever        .                .  .48 

Helminthiasis      .                .  .219 

Hemicrania  (megrim)         .  .     361 

Hemorrhoids        .                .  .     148 

with  mucous  discharge    .     150 

Hemorrhage  from  the  lungs  .    314 

Hepatitis             .                .  .200 

chronica              .  .    204 


INDEX. 


775 


Hernia 

humeralis 
Herniae  incarcerate 
Herpes  circinnatus 
serpigo    . 
zoster 
Herpes  preputialis 
Hip,  pain  in  the 
gout 
rheumatism  in  the 


Hoarseness 

Homoeopathic  attenuations 
Hooping-cough    • 

second,  or  convulsive 
stage 
Hordeolum 
Humid  asthma     . 
Hydrocele 

funiculi  spermatid 


PAGE 

.  578 

,  473 

.  582 

.  427 

.  427 

.  435 

.  496 

.  528 

.  ib. 

.  ib. 

.  530 

.  238 

.  Hi 

.  254 

256 
540 
330 
476 

478 


encysted  of  the  spermatic  cord  478 

cystata  funiculi  spermatici         ib. 

tunica  vaginalis  .     476 

Hydrops              .                .  .592 

pectoris                 .  .     600 

thoracis                 .  .      ib. 

Hydrothorax       .                .  .      ib. 

Hydrophobia       .                .  .637 

Hydrocephalus  membranarum  et  ven- 

triculorum   .                .  .760 

Hypertrophy       .                .  .410 
Hypopium  (see  Ophthalmia  gonorrhoeal). 

Hysterics             .                .  .     655 

Hysteria              .                .  .      ib. 

Ictus  solis  (see  Coup  de  Soleil). 

Icterus               .                .  .205 

neonatorum             .  .750 

Ignis  sacer          .                .  .     435 

Ileo  typhus         .                .  .15 
Ileus           ■         * 

Index-table  of  the    medicines  con- 
tained in  this  work  .    lxix 
Incontinence  of  urine          .  .     459 
Induration  of  the  cellular  tissue  .     751 
Incubus              .                .  .577 
Indigestion         .                .  .114 
Infantile  erysipelas              .  .751 
remittent  fever        .  .763 
Influenza             .                .  .     262 
Inflammatory  fever             .  .9 
Inflammation  of  the  oesophagus  .     Ill 
of  the  spleen            .  .     207 
of  the  stomach        .  .     209 
of  the  bowels           .  .212 
of  the  peritoneum    .  .218 
of  the  arteries          .  .412 
of  the  mucous  membrane  of  the 

bronchial  tubes    .  .268 

of  the  lungs             .  .     276 

of  the  pleura            .  .     302 
of  the  brain  and  its  tissues      .     335 

of  the  larynx            .  .236 


PAGE 

Inflammation  of  the  kidneys  ,     444 

of  the  bladder  .  .447 

of  the  urethra  .  .466 

of  the  glans  penis    .  .472 

of  the  testes  .  .473 

of  the  testicle  .  .512 

of  the  psoas  muscle  .     526 

of  the  margin  of  the  eyelids  or 

meibomian  glands 
of  the  ears,  earache 
of  the  tongue 
of  the  ovaries 

of  the  labia,  majora,  and  vagina 
of  the  womb 
of  the  breasts 
of  the  eyes  in  new-born  infants 

Inflammatio  uteri 

Influence  of  external  objects  on  the 
unborn  infant 

Ingina  pectoris    . 

Intermittent  fever 

Intertrigo  .  .  432,  750 

Internal  or  uterine  swelling  and  pro- 
lapsus 

Invermination     . 

Irritation  or  itching  of  the  skin 

Iritis  arthritica    . 
mercurialis 

Irichiasis 

Irregularities  of  the  lochial  discharge 

Ischuria 

Ischias 

Itch    .... 
watery        .  .  . 


540 
543 
556 
657 
659 
704 
708 
732 
704 

666 

370 

31 


703 
219 
426 
538 
ib. 
542 
699 
449 
528 
422 
424 


Jail  fever            .                .  .29 

Jaundice             .                .  205,  750 

Kidneys,  inflammation  of    .  .    444 

Knee,  affections  of  the        .  .     532 

Labour,  remedies  before     .  .    685 

tedious  or  complicated  .     687 

Laryngitis                           .  .     236 

chronic                 .  .     239 

Larynx,  inflammation  of  the  .     236 

Laryngismus  stridulus         .  .762 

Lead  colic  (see  Colic  and  Palsy).  347 

Legs,  cramps  in  the            .  .     558 

Leucorrhcea  after  parturition  .     703 

Lienteria             .                .  .165 

Liver  complaint                  .  .     200 

acute  inflammation  of  .      ib. 

chronic  inflammation  of  .  •  204 

Lips,  swelling  of  the           .  .     542 

Lippitudo            .                .  .     540 

List  of  medicines  adapted  to  particular 

temperaments              .  *    lxix 

Lockjaw  of  infants              .  .     752 

Loins,  pains  in  the            *  .  .591 

Looseness  of  the  bowels  I  .  .164 

Lues  venerea       .                .  .479 

Lumbago            .                .  .525 


77b 

INDEX. 

PAGE 

PAGE 

Lumbo-sacral  pains 

.     678 

Nipples,  excoriation  of  the 

.     707 

Lungs,  inflammation  of  the 

.    276 

Nodes 

.     512 

hemorrhage  from  th 

e              .    314 

Nose,  swelling  of  the 

.     550 

Luxations 

.    626 

caries  of  the  bones  c 

>fthe        .     551 

Lymphatic  tumours 

.    419 

Notalgia 

.     591 

Mamma,  diseases  of  the 

.708 

Observations  on  pregnancy 

.     660 

Marsh  fever 

.       34 

Obstacles  to  suckling 

.     707 

Malignant  quinsy 

.     107 

Obstructio  alvi  neonatorum 

.     741 

putrid  or  gangrenous 

sore-throat     ib. 

Obstipatio 

.     143 

Measles 

.      81 

Obstipation 

.      ib. 

repercussion  of  the  < 

eruption  in      83 

Obstructio  alvi   . 

.       ib. 

Meconium,  expulsion  of 

.     719 

Occulta 

.     299 

Menorrhagia 

.     653 

Odontalgia 

.      96 

Mental  emotions 

644,  666 

(Esophagitis     .   . 

.     Ill 

affecting  th 

3  milk       .     710 

Opacity 

.     538 

Menstruatio  nimia 

.     653 

Ophthalmia 

.     534 

Menstruation 

.    668 

syphilitic 

.     491 

Meningitis  spinalis 

.    345 

catarrhal 

.     537 

Metritis 

.     704 

rheumatic 

.      ib. 

Mictus  cruentus 

.    463 

sclerotitis 

.      ib. 

Milk,  regurgitation  of  the 

.     736 

scrofulous 

.      ib. 

crust 

.     738 

syphilitic 

.      ib. 

scab 

.      ib. 

sycosic 

.       ib. 

blotches  . 

.      ib. 

gonorrheal 

.       ib. 

fever 

.    698 

Orchitis 

473,  512 

Miliaria 

.      91 

Otalgia 

.     543 

alba 

.      ib. 

Otitis 

.       ib. 

purpurea 

.       64 

Otorrhcea 

,                 .     545 

Miliary  fever 

.       91 

catarrhal  or  mucous 

.      ib. 

Miliaris  Hahnemann! 

.       64 

purulent 

.      ib. 

sudatoria 

.       91 

sanguineous 

.      ib. 

repercussion  of  the 

eruption   .      93 

suppressed 

.      ib. 

Miliformis  papulosa 

.      64 

Ozaena 

.    551 

Miscarriage 

.    678 

Offensive  breath 

.     557 

Moist  asthma 

.    330 

Ostitis 

.     604 

Morbus,  sacer     . 

.     353 

Overheating 

.     631 

caducus    . 

.      ib. 

Ovaritis 

.     657 

divinus     . 

.      ib. 

Ovarian  disease 

.     659 

herculeus 

.      ib. 

comitialis 

.      ib. 

Palsy  . 

,    347 

coxarius 

.  •  530 

Paralysis  of  the  brain  (s 

ee  Scarla- 

cerealis    . 

.      31 

tina,  Water  on  the 

Brain,  and 

Mouth,  canker  in  the 

.     552 

Dentition). 

scurvy  in  the 

.      ib. 

Paralysis    of  the   chest  (s 

see  Scarla- 

Morning  sickness 

.     668 

tina). 

Mothers  not  suckling  their 

children  .    711 

Paralysis 

.      ib. 

Mucous  fever 

.      52 

Painters'  colic     . 

.    348 

Mumps 

.     112 

Panaris 

.    425 

Myelitis 

.    345 

Paronychia 

.      ib. 

Myopia 

.     539 

Parotitis 

.     112 

Paraphymosis 

*    495 

Navel  rupture  in  infants 

.     718 

Pain  in  the  hip   . 

.     528 

soreness  of  the 

.      ib. 

Pains  in  the  loins 

.     591 

Necrosis 

.     604 

in  the  back  during  pi 

•egnancy    .     678 

Nearsightedness 

.     539 

Parulis 

.     555 

Nephritis 

.     444 

Passio  hysterica 

.     655 

Nervous  fever     . 

.       12 

Parturition 

.     687 

Nerve  pain 

.    358 

Pemphigus 

.     433 

Nettle  rash 

.       94 

Pendulous  belly 

.     702 

Neuralgia 

.     358 

Penis,  inflammation  of  the 

.    472 

facialis  . 

.      ib. 

Pericarditis 

.    373 

Nightmare 

.     577 

Peritonitis 

.     218 

INDEX. 

777 

. 

PAGE 

PAGE 

Peritoneum,  inflammation  of  the 

218 

Psoitis 

526 

Periostitis 

608 

Psoas  muscle,  inflammation  of  the 

526 

Peripneumonia   . 

276 

Pulmonary  catarrh 

268 

notha                   . 

299 

consumption 

319 

Perniones 

417 

Pulmonitis                           . 

276 

Perspiration  after  delivery 

697 

Purpurea  rubra  . 

64 

Pertussis 

254 

Pustula  nigra 

417 

Pestis                 .                       ■         . 

44 

Pustular  ringworm 

428 

Pestilential  fever 

27 

Putrid  fever 

27 

Petechial  fever   . 

29 

Pyrosis 

140 

bubonica 

ib. 

Pharyngitis         .                                . 

110 

Quinsy 

100 

Phenomena  of  Asiatic  cholera  as  it 

sphacelated  (see  Quinsy). 

appeared  in  this  country 

188 

Phthisis  laryngea 

239 

Rachitis 

612 

pulmonalis 

319 

Raucitas              .                . 

238 

Phrenitis            .                . 

535 

Ranula 

557 

Phimosis 

494 

Raphania 

41 

Pharmaceutical  signs 

xxxi 

Rash,  scarlet 

64 

Piles   . 

148 

nettle 

94 

Plague 

44 

Rectum,  stricture  of  the 

151 

Pleura,  inflammation  of  the 

302 

Regurgitation  of  milk 

736 

Pleurisy 

ib. 

Regimen                   .          . 

xvii 

spurious  or  bastard 

311 

Remedies  before  labour 

685 

chronic  (see  Pleurisy). 

Remarks 

xxxi 

Pleurodynia 

ib. 

Remittent  fever  . 

46 

Pleuritis 

302 

Retention  of  urine 

449 

muscularis 

311 

Rheumatic  fever 

517 

Pneumo-typhus    . 

.     15 

Rheumatism 

ib. 

Pneumonia  vera 

276 

without  fever  . 

523 

chronic  (see  Pneumonia). 

chronic 

524 

typhoid  or  congestive 

301 

in  the  hip 

528 

Pneumonitis       .                . 

276 

in  the  head  (see   Head- 

Podagra (see  Gout). 

ache  and  Rheumatism). 

Poictou,  colic  of                 . 

348 

Rickets 

612 

Porrigo  scutulata 

428 

Ringworm,  herpetic  or  vesicular 

427 

lupinosa 

438 

of  the  scalp 

428 

furfurans 

431 

•   pustular 

ib. 

favosa                      . 

ib. 

Rose    . 

413 

decalvans 

ib. 

Rubeola 

81 

larvalis    . 

738 

Rupture 

578 

Polysarcia 

702 

Pompholyx 

433 

Sarcocele 

474 

Pot-belly 

702 

Scabies 

422 

Potencies  of  the  medicaments 

xvii 

papuliformis 

.    423 

Potency,  attenuation,  or  dilution  of  the 

purulenta 

424 

medicament 

xxi 

lymphatica 

ib, 

Pregnancy,  observations  on  the 

660 

Scald  head 

428 

Preparation  of  the  breasts  . 

684 

Scalds 

628 

of  attenuations 

lix 

Scarlet  fever 

.       58 

of  medicines  in  their  primitive 

rash 

.      64 

state    ♦ 

lxiv 

Scarlatina  anginosa 

59 

Preservatives,  rules  for  the  selection  of 

ib. 

miliaris 

.      64 

Prohibited  aliment 

4 

Sciatica 

.    527 

Proctalgia 

157 

Scirrhus 

542 

Protrusion  of  the  intestine 

158 

Scorbutus 

.    554 

Prolapsus  ani                      . 

ib. 

Scrofula 

.     602 

Prosopalgia 

358 

Scurvy 

.     554 

Prostatitis  (see  Hematuria). 

in  the  mouth 

.     552 

Prurigo 

426 

Sea-sickness 

.    632 

Pseudo-pleuritis  . 

311 

Shingles 

.     435 

Psora                 . 

422 

Short  sight 

.    539 

Psoriasis 

432 

Simple  or  ephemeral  fever  . 

8 

778 


INDEX, 


PAGE 

Skin,  irritation  or  itching  of  .    426 

Sleep  .  .  .726 

agitated  .  .563 

disturbed    or     prevented     by 

anxiety  .  .      ib. 

disturbed  by  acbing  pains  in  the 

body    .  .  .563 

disturbed  by  agitated  anxious 

dreams  .  ,564 

disturbed  or  prevented  by  ex- 
citement .  .568 
abnormal  state  during             .      ib. 
position  during        .                .576 
positions  in  which   it   is  impos- 
sible to  recline  during          .     577 
Sleeplessness       .                .                ,561 
of  infants       .                .     726 
Slow  fever          .                .                .12 
Smallpox             .                .                .84 
confluent            .                .85 
repercussion  of  the  eruption  in  88 


modified 

.                , 

89 

diet  to  be  observed  in 

ib. 

Sore  throat,  or  quinsy 

100 

aphthous 

ib. 

Spasmodic  pains  during  labour 

690 

asthma 

737 

Spasms  in  the  chest 

ib. 

Specks  on  the  cornea 

538 

Sprains 

615 

Spleen,  inflammation  of 

207 

Splenitis              . 

ib. 

Spitting  of  blood 

314 

Spinal  cord,  acute  inflammation  of  the 

345 

Sputum  cruentum 

314 

Spurious  peripneumony 

299 

or  bastard  pleurisy 

311 

St.  Anthony's  Fire 

413 

Stings  of  insects  . 

632 

Stools  of  abnormal  colour  (see  Diar- 

rhoea in  Infants). 

Stomach,  inflammation  of  the 

209 

derangement  of  the 

129 

spasm  of  the 

134 

Stpmacace 

552 

Strabismus 

538 

Strains 

. 

616 

Stranguria 

451 

Stricture  of  the  rectum 

151 

urethra 

. 

456 

Stye    . 

540 

Stymatosis 

466 

Suckling  of  the  infant 

720 

Sudor  miliaris     . 

. 

91 

Suffocating  breast-pang 

367 

Suppressed  dysentery 

. 

176 

secretion  of  mil 

£           696 

710 

perspiration  after  delivery      697 

Suppression  of  urine            .  .     454 

Suppressio  mensium            .  .     652 

Supplementary  diet  of  infants  .     723 

Sweating  feet      .                .  .560 

Swelled  testicle  .               .  .    473 

face       .               .  .676 


PAGE 

Swelled  veins      .                .  ,     677 

Swelling  of  the  lips              .  .     542 

of  the  nose            .  .     550 

of  the  head  in  infants  .     718 

Swooning            .                .  .     589 

Sycosis                .                 .  .497 

Syncope              .                .  .589 

Synopsis  of  the  rules  for  diet  .        3 

Synocha              .                .  .9 

Synochal  fever    .                .  ib. 

Syphilis               .                .  479,  500 

secondary  symptoms  of  .    480 

in  infants                .  .     493 

Syphilitic  ophthalmia          .  ,491 

Syphilides           .                .  .481 

Table  of  medicines  with  abbreviations     lxix 
Tabes  mesenterica  (see  Atrophy). 
Tears,  involuntary  flow  of  .  .     539 
Tedious  or  complicated  labours  .     687 
Teething,  derangements  during  .     753 
Temperaments     .                .  .   lxvii 
Testis,  inflammation  of  the  .     473 
Testicle,  swelled                  .  .      ib. 
inflammation  of  the  .     512 
Tetanus               .                .  .348 
Thrush                .                .  .739 
Tic  douloureux   .                .  .358 
Tinea  capitis       .                .  .     428 
annularis  .                .  ib. 
Tinea  faciei         .                .  .     738 
Toothache           .                .  96,671 
Tongue,  inflammation  of  the  .     556 
Tonsillitis  phlegmonoides    .  .100 
maligna               .  .107 
Tophus,  (see  article  Ostitis). 
Tracheitis  (see  Croup). 
Treatment  after  delivery     .  .    692 
of  infants  and  children  <     716 
after  birth          .  .      ib. 
Trichiasis            .                .  .    542 
Trismus  nascentium            .  .752 
Tumours,  lymphatic            .  .419 
Tussis                  .                .  .242 
convulsiva                  .  .     254 
Tympanitis  intestinalis        .  .132 
Typhoid  or  congestive  pneumonia  .    301 
Typhus  cerebralis               .  .       15 
biliosus                  .  .      ib. 
gastricus                .  .      ib. 
pulmonalis             .  .      ib. 
abdominalis            .  .      ib. 
sequelae  of: — decubitus,  me- 
tastatic abscess,  furunculi, 
diarrhoea,         nightsweats, 
oedema  of  the  feet,  intes- 
tinal ulcerations  .      26 
malignant              .  .27 
putridus                  .  ib. 
abdominalis            .  .      ib. 
contagious              .  .       29 
contagiosus            .  .       ib. 
accessory  treatment,  prophy- 
laxes in              .  ib . 


INDEX. 

77y 

PAGE 

PAGE 

Typhus  pestilentialis 

.         44 

Varicella 

.          90 

icterodes 

.       46 

Varicocele  * 

.     475 

Variola 

.       84 

Ulcera 

.    437 

spuria 

.90 

Ulcerated  sore  throat 

.     107 

Vehicles  which  serve  for  the  prepara- 

Ulcers 

.    437 

tion  of  homoeopathic  medicines   .  xxxvi 

phagedenic 

.     441 

Venereal  disease  . 

.    479 

scrofulous 

.      ib. 

Vomiting  of  blood 

.     140 

putrid     . 

.      ib. 

gangrenous 

,       ib. 

Wakefulness  of  new-born  infants        .     734 

carcinomatous 

.      ib. 

Want  of  appetite 

.     125 

fistulous 

.      ib. 

Warts  on  the  face 

.     543 

mercurial 

.      ib. 

Water  brash 

.     140 

syphilitic 

.     441 

Watery  itch 

.     424 

indolent 

.     441 

Water  in  the  head 

.     760 

Ulcer  of  the  rectum  (see    Stricture 

Weakness  after  delivery 

.     706 

of  the  Rectum). 

Weaning 

.     725 

Urethra,  stricture  of  the 

.     456 

Weeping,  or  watery  eye 

.     539 

discharge  of  blood  from 

the  .     466 

Whitlow 

.     425 

inflammation  of  the 

.      ib. 

Womb,  inflammation  of  the 

.     704 

Urethritis 

.      ib. 

affections  of  the 

>     704 

Urethrorrhagia    . 

.      ib. 

Worms 

.     219 

Urine,  retention  of 

.     449 

Wounds 

.     616 

difficulty  in  discharging 

.     451 

incised  . 

.    617 

suppression  of 

.     454 

lacerated 

.    619 

incontinence  of 

.     459 

contused 

.      ib. 

Urinary  abscess  and  fistula 

.     458 

punctured 

.    621 

Urticaria 

.       94 

gunshot 

.      ib. 

> 

poisoned 

.     622 

Vaccination 

.     769 

Vagina,  inflammation  of  the 

.     659 

Zona   . 

.     435 

Varices 

.     677 

THE  END. 


PRINTED  BY  C.  AND  J.  ADLARD, 

BARTHOLOMEW  CLOSE. 


WORKS  BY  DR.  LAURIE. 


HOMCEOPATHIC   DOMESTIC   MEDICINE. 

FOURTH  EDITION; 

8vo,  bound  in  cloth,  price  12s. 

"  The  very  fact  of  the  publication  of  a  third  edition  of  such  a  large  work  as  Dr.  Laurie's, 
proves  how  widely  the  practice  is  spread  among  the  public  generally." 

Dr.  Forbes1  s  British  and  Foreign  Medical  Review. 


BGENINGHAUSEN'S 
MANUAL 


HOMCEOPATHIC    THERAPEUTICS  ; 

TRANSLATED  FROM 

M.    ROTH'S  IMPROVED  FRENCH  EDITION.